JCAHO Update for Infection Control

JCAHO: Adopt strongest hand hygiene measures

CDC IA, IB, IC measures should be followed

The Joint Commission on Accreditation of Healthcare Organizations requires that health care facilities adopt the most strongly recommended hand hygiene measures in the Centers for Disease Control and Prevention (CDC) guidelines.1

These measures are classified by the CDC in the following three categories:

Category IA. Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.

Category IB. Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies, and a strong theoretical rationale.

Category IC. Required for implementation, as mandated by federal or state regulation or standard.

The recommendations include the following key measures:

Hand washing and hand antisepsis

  • When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water (IA).
  • If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations (IA).
  • Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter (IB).
  • Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure (IB).
  • Decontaminate hands after contact with a patient’s intact skin (e.g., when taking pulse or blood pressure, and lifting a patient) (IB).
  • Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled (IA).
  • Before eating and after using the restroom, wash hands with a nonantimicrobial soap and water or with an antimicrobial soap and water (IB).
  • Antimicrobial-impregnated wipes (i.e., towelettes) may be considered an alternative to washing hands with nonantimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of health care workers (HCWs), they are not a substitute for using an alcohol-based hand rub or antimicrobial soap (IB).

Selection of hand hygiene agents

  • Provide personnel with efficacious hand hygiene products that have low irritancy potential — particularly when these products are used multiple times per shift (IB). This recommendation applies to products used for hand antisepsis before and after patient care in clinical areas and to products used for surgical hand antisepsis by surgical personnel.
  • To maximize acceptance of hand hygiene products by HCWs, solicit input from these employees regarding the feel, fragrance, and skin tolerance of any products under consideration. The cost of hand hygiene products should not be the primary factor influencing product selection (IB).
  • Do not add soap to a partially empty soap dispenser. This practice of "topping off" dispensers can lead to bacterial contamination of soap (IA).

Administrative measures

  • Make improved hand hygiene adherence an institutional priority, and provide appropriate administrative support and financial resources (IB).
  • Implement a multidisciplinary program designed to improve adherence of health personnel to recommend hand hygiene practices (IB).
  • As part of a multidisciplinary program to improve hand hygiene adherence, provide HCWs with a readily accessible alcohol-based hand-rub product (IA).
  • To improve hand hygiene adherence among personnel who work in areas in which high workloads and high intensity of patient care are anticipated, make an alcohol-based hand rub available at the entrance to the patient’s room or at the bedside, in other convenient locations, and in individual pocket-sized containers to be carried by HCWs (IA).

Reference

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; 51(RR16):1-44.