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The draft of new hand hygiene guidelines from the Centers for Disease Control and Prevention (CDC) in Atlanta recommend that health care personnel decontaminate hands without using a brush. (For an excerpt from the guidelines, click here.) As predicted by Same-Day Surgery, the draft also recommends the use of an alcohol-based handrub or an antimicrobial soap before donning sterile gloves when performing a surgical procedure. (For more information on the alcohol agents, see "CDC draft recommends alcohol agents as alternatives for surgical scrubs," SDS, July 2001.) Both recommendations are ranked IB, meaning they are supported by some studies and a strong theoretical rationale.
"Everything in [the draft guidelines] supports having an alcohol-based with an emollients," says Etta Hodge, RN, MBA, director of surgical services, at Christus St. Joseph Hospital in Houston. (For a comparison of agents, click here.) The draft guidelines say no brushes or sponges are necessary. "[The draft] says they’ve been shown to be abrasive to skin, and make things worse," Hodge says. "Others agents aren’t as fast-acting as alcohol, or as sustaining."
When Christus St. Joseph decided to convert from a brush to a brushless agent, the information was presented to the operating room (OR) committee, and the hospital’s infection control coordinator attended. "We presented to them the efficacy of alcohol and other products, and how it was a superior agent to other ones," Hodge says. "We emphasized the lasting effect it had, and that it had emollients so their hands wouldn’t dry out." (For information on companies that carry brush-free scrubs, see "Source and resources" at the end of this article.)
Physicians often believe that the more they scrub, the more effective it is, she says. "They were taught to scrub, scrub, scrub, and you’ll get rid of bugs," Hodge says. "We emphasized that it’s not the friction, but the efficacy of the product that’s important." Physicians usually are open to change if you present new information, she says. "When you present it like that: We have new information, and you don’t want to be a dinosaur,’ they will change," she says.
Also recommended in the draft guidelines is no artificial fingernails or extenders when providing patient care. The recommendation is ranked 1A, which means it is strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiological studies. "Even though they said [within the guidelines that] additional studies are warranted, it’s a no brainer’ that you shouldn’t wear artificial nails" in the OR, Hodge says. They harbor bacteria, she emphasizes. "Even when you do hand washing, no one’s going to do a meticulous hand washing if [she’s] paid $25 to have fake nails put on," Hodge says. "You’re not as rigorous as you are if they are your own nails." Monitoring also is an issue, even with natural nails, she says. "If you tell people they can wear nail polish, who’s going to monitor whether it’s chipped or not?"
The draft is on line at www.cdc.gov/ncidod/hip/hand/hhfedreg.htm. Comments must be received by Dec. 24. Comments must be postmarked by Dec. 26, 2001. Mail written comments (one original and three copies) to the following address: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3047-P, P.O. Box 8018, Baltimore, MD 21244-8010. The final guidelines should be issued in 2002.
For more information on the draft guidelines, contact: Etta Hodge, RN, MBA, Director of Surgical Services, Christus St. Joseph Hospital, 1919 LaBranch, Houston, TX 77002. Telephone: (713) 757-7574. Fax: (713) 657-7153. E-mail: email@example.com.
The following brushless scrubs are available:
• Triseptin. Contact: Healthpoint, Attention: Customer Care, 3909 Hulen St., Fort Worth, TX 76107. Telephone: (800) 441-8227 or (817) 900-4036. E-mail: firstname.lastname@example.org. Web: www.healthpoint.com.