Read the Hand washing article from the CDC Emerging Infectious Diseases Journal and answer the following questions. This document is posted in the Read and Study section of this module.
When was this article published? (Hint: Check the bottom of the pages) March-April 2001
In the DEFINITIONS Section
What are the two major groups of organisms?
1. Resident Flora – Normally reside on skin
2. Transient Flora – Contaminants
What is hand hygiene?
Hand hygiene “is the simplest most effective measure for preventing nosocomial infections”. It includes actions, such as hand washing and hand disinfection, that will reduce the amount of transient flora and remove dirt from the skin in order to prevent the spread of infection.
Hand washing can be done using non-medicated soap and water or soap that includes antiseptic. The latter is referred to as hygienic hand washing. Hand disinfection refers to use of an antiseptic solution to clean hands, either medicated soap or alcohol.
Hand washing is preferred over hand disinfection in certain situations such as when they are visibly soiled or contaminated by C-Diff. It typically takes 20-30 seconds using certain steps in order to perform it correctly.
What is hand disinfection?
Hand disinfection is a form of hand hygiene that utilizes an antiseptic solution to clean hands. They not only reduce transient flora by mechanically removing them. Their antimicrobial properties also kill remaining microbes or reduce how quickly they can reproduce. Hand disinfectants are useful in situations when “microbiologically clean hands are required for extended periods”.
In the section Hand Hygiene Agents
What agent has excellent activity and the most rapid bactericidal action of all antiseptics? Alcohol based cleansers have more rapid action than products containing other antiseptics such as; chlorhexidine gluconate or providone iodine.
Which alcohol is the most effective?
Which alcohol is the least effective?
After extensive reduction following hand disinfection with an alcohol preparation, how long does it take for the resident skin flora to become completely restored? Several hours
What were the factors associated with increased bacterial contaminations levels on the hands? Activities associated with higher microbe contamination levels are:
Direct patient contact
Handling of body fluids
Disruption in the sequence of patient care
Simple hand washing before patient care without hand disinfection was associated with bigger colony counts
In the section Factors Influencing Noncompliance with Hand Hygiene What factors were found to be causes of non-compliance with hand washing guidelines? Being a physician or a nursing assistant rather than a nurse Being a nursing assistant rather than a nurse
Working in an ICU
Working during weekdays rather than the weekend
wearing gown and gloves
Using an automated sink
Performing activities with high risk for cross-transmission
Having many opportunities for hand hygiene per hour of patient care
In the section Perceived Barriers to Hand Hygiene
What were some of the factors found?
Interference with worker-patient relation
Patient needs perceived as priority
Ignorance of guidelines
Inconveniently located or lack of sinks
Lack of a role model
High workload and understaffing
Lack of scientific information showing positive impact of improved hand hygiene
In the section Risk Factors for Noncompliance
What was the KEY barrier to motivation to comply with hand washing guidelines?
Lack of knowledge and education
Looking at Table 1 in this study, what hospital setting
Had the highest compliance?
Table 1 illustrates that ICU had the highest compliance – 81%. However, the article states that in the largest hospital-wide survey ever conducted Pediatrics had the highest compliance rate – 59%.
Had the lowest compliance?
Table 1 illustrates that Open Ward had the lowest compliance – 16%. The article states that ICU had the lowest compliance – 36%.
What overall recommendations are suggested to obtain higher hand washing
compliance levels? The article states these overall suggestions for improvement:
“Improvement in infection control practices requires questioning basic beliefs, continuous assessment of the stage of behavioral change, interventions with an appropriate process of change, and supporting individual and group creativity… A framework for change should include parameters to be considered for hand hygiene promotion, together with the level at which each change must be applied: education, motivation, or system.”
More specific suggestions are listed in table 3 and include:
-Routine observation and feedback
-Make hand hygiene easy and convenient
-Make available alcohol-based hand rub available in high demand situations
-Reminders in the workplace
-Promote and facilitate care for HCW hands
-Obtain active participation at individual and institutional levels
-Avoid overcrowding, understaffing, excessive workload