JCAHO may add hand hygiene to surveys
Continuing her high-profile presence in infection control, Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), emphasizes that the CDC’s landmark new hand hygiene guidelines are now the "de facto standard of care" for the nation’s health care settings.
Speaking at a press conference to announce the finalization of the guidelines, Gerberding said that even though the CDC is not a regulatory agency, accreditation groups might become involved in enforcing the new emphasis on alcohol-based waterless hand rubs. The Joint Commission on Accreditation of Healthcare Organizations released a statement urging all accredited facilities to become aware of the hand hygiene guidelines. "We are considering ways in which these guidelines may be incorporated into the accreditation process in the future," the Joint Commission stated.
In addition, the CDC will make its "voice heard" through the growing patient safety movement, Gerberding said. "We recognize, in the broadest sense of the word, that there is a growing need to take actions within the health care setting to promote patient safety and protect patients," she said. "CDC has a strong stake in this mission under the rubric of our overall goal of providing safer healthier people [and] that certainly translates to safer, healthier patients. We know that hand hygiene is a critical component of safe and healthy health care."
Given the poor history of hand-washing compliance with the traditional soap and sink approach, the CDC guidelines recommend the use of waterless alcohol products for most patient care encounters unless hands are visibly soiled.1 (See Hospital Infection Control, November 2002, under archives at www.HIConline.com.)
"Hand hygiene saves lives," Gerberding said. Hand hygiene improvement could not only prevent specific hospital infections, but also help blunt the rise of antibiotic-resistant pathogens. "We’ve learned now that using alcohol-based hand products in the health care setting improves adherence to hand-hygiene practices, and we’ll end up with more people doing the right things to clean their hands more of the time and ultimately [have] a better impact for patient safety," she said.
Gerberding emphasized that alcohol preps are not the sole component of the new approach. "What we’re advocating is a comprehensive approach to hand hygiene. Certainly, if hands of health care workers are soiled with blood or other materials, they need to wash with soap and water, and alcohol preps are not going to deal with that aspect of hand hygiene. Likewise, gloves are still recommended for situations where health care workers have contact with blood or other body fluids or when they’re conducting sterile procedures.
High risk, no wash
In the past there actually has been an inverse correlation between the frequency of adherence to hand hygiene and the level of risk of the procedure, she noted. "In other words, during high-risk procedures or in intensive care units, there was actually less adherence to the guidelines than in lower-risk areas, which clearly has to do with priorities and how busy one is," Gerberding said. "So I think the other thing that’s advantageous about these new guidelines is that it will be possible — in emergency situations or in higher-risk situations — to not have to line up at a sink and make a choice between doing hand hygiene and doing a high-risk emergency kind of a procedure."
The new guideline goes beyond hospitals, recommending the approach for nursing homes, ambulatory care, and other settings across the health care continuum.
"Our hope is that these products will also have a very important role to play in the nonhospital setting where it’s even more difficult to achieve adherence with the old guidelines," Gerberding said. "Clinics and physicians’ offices, dialysis units, any place where you’ve got a lot of patients in a small area and many steps to take to get to the sink, it’s just really difficult to adhere. So having this product on hand, no pun intended, will make a difference in those environments."
The guidelines include performance indicators to assist ICPs in assessing compliance with the recommendations. There has been some debate in health care facilities about the cost-effectiveness of these products because they are often more expensive than soap and water, she conceded. "We have the evidence base to say that the cost is worth it. [Even] if there is an incremental upfront cost, the efficacy of the products, their [improved] adherence, and their impact on patient safety make them appropriate purchases."
1. Centers for Disease Control and Prevention. Guideline for hand hygiene in health care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002; 52(RR16);1-44.