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Abstract & Commentary
Synopsis: The CDC has published a new set of recommendations aimed at preventing health care-associated infections by optimizing hand hygiene in health care personnel. The following is a summary of some of those recommendations, selected because of their strength and/or novelty.
Source: CDC. Guidelines for hand hygiene in health care settings: Recommendations of the health care infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. MMWR 2002;51(No. RR-16):1-45.
"What separates two people most profoundly is a different sense and degree of cleanliness." — Nietzsche, in "Beyond Good and Evil" 1886, p. 271, translated by Walter Kaufmann.
Although visibly soiled hands should be washed with either a nonantimicrobial soap and water or with an antimicrobial soap, an alcohol-based hand rub should be used for routine hand decontamination. Such hand decontamination is to be performed before direct contact with a patient, as well as after skin or mucous membrane contact, or contact with body fluids, potentially contaminated objects (eg, wound dressings), and after removing gloves. The use of soap is also recommended before eating and after using a restroom, as well as if exposure to Bacillus anthracis is suspected or proven (because of the lack of efficacy of other products against spores and the hope that the spores would be dislodged by hand washing with soap).
When soap is used, vigorous hand rubbing should be performed for at least 15 seconds and a disposable towel used for drying should be used to turn off the faucet. Hot water should be avoided because its use may increase the risk of development of dermatitis. Hand rubbing with an alcohol-based product should continue until the hands are dry.
For surgical hand antisepsis, jewelry should first be removed and debris removed from under the fingernails. Soaps or alcohol products with persistent (residual) activity should be used; washing with a nonantimicrobial soap should precede use of the alcohol product. The duration of the scrub, which should include the forearms, should be that recommended by the manufacturer, usually 2 to 6 minutes; drying must be allowed to occur before gloving.
In selecting hand-hygiene products for use in an institution, great importance should be given to choosing ones with a low potential for provoking irritation with repeated use; feedback from staff is invaluable. "The cost of hand-hygiene products should not be the primary factor influencing product selection." Health care workers should be supplied with lotions or creams to minimize the occurrence of contact dermatitis. Do not add soap to partially empty soap dispensers, a practice that may lead to bacterial contamination.
Artificial fingernails or extenders may not be worn during direct contact with patients at high risk of infection and natural nail tips should be kept at a length of less than ¼ inch. Gloves should be worn whenever contact with blood or other potentially infectious materials, skin that is not intact, or mucous membranes is likely to occur. Gloves should be removed after caring for a patient, should not be washed, and should not be used in care of a second patient.
The adherence of health care workers to recommended hand-hygiene practices should be monitored and feedback on performance provided in the context of a multidisciplinary program to improve adherence. This program should include provision of a readily accessible alcohol-based hand-rub product, including, in high-workload areas, at the entrance to patient rooms or at the bedside and at other convenient locations, as well as in individual pocket-sized containers to be carried by health care workers.
Adherence to the recommended policies should be made an institutional priority and appropriate administrative support and financial recourses provided. A series of performance indicators should be measured. In addition to periodic monitoring with feedback of adherence to hand hygiene practices, including adherence to policies regarding the wearing of artificial nails, there should be monitoring of the volume of hand washing liquids used per 1000 patient-days. Reassessment of adherence should be performed as part of outbreak investigations.
The guideline along with promotional materials and fact sheets is available at: www.cdc.gov/handhygiene.