Overview of Hand Hygiene
The practice of washing hands in healthcare settings began in the early 19th century. Over time, as more proof emerged about its benefits, this practice, together with other cleanliness habits, helped decrease the spread of pathogens, which are harmful germs that can cause diseases. These germs are often responsible for infections that patients get in hospitals, also known as hospital-acquired infections.
Indeed, when healthcare providers don’t properly clean their hands, they can spread these harmful germs, causing further disease spread. By practicing good hand hygiene, healthcare workers can reduce the number of these microorganisms, decreasing the risk of infections, healthcare costs, length of hospital stays, and also affect the reimbursement they receive.
The Centers for Disease Control and Prevention (CDC), a national public health agency in the United States, states that hand hygiene is the single most crucial step in preventing the spread of infections in healthcare settings. However, despite this information, studies have consistently shown that not enough healthcare workers recognize the importance of hygiene, and that not many of them consistently perform the recommended cleanliness procedures.
Anatomy and Physiology of Hand Hygiene
The Center for Disease Control and Prevention (CDC) emphasizes that good hand hygiene can play a vital role in preventing the spread of disease-causing microorganisms. To better understand this, it’s helpful to know a bit about how our skin works. Our skin is like a shield protecting us from losing too much water or heat, keeping out harmful microorganisms and safeguarding us from other hazards in the environment.
Our skin is composed of different parts, starting with the outermost layer known as the stratum corneum. Below this layer, we find the epidermis, followed by the dermis, and finally the hypodermis. A group of microorganisms, called resident flora, live on our skin, particularly under the stratum corneum and on the skin’s surface. These organisms perform two major tasks; they ‘compete’ with harmful bacteria for food, keeping their numbers in check, and engage in ‘microbial antagonism’ – they create a hostile environment for harmful microorganisms to thrive. Usually, these microorganisms are harmless on healthy skin, but they can cause infections if they get into places they should not be, like open wounds, the eyes, or sterile inside parts of our bodies.
Healthcare workers often come in contact with another kind of microorganisms called transient flora through direct interaction with patients or by touching contaminated things. These organisms settle on the superficial skin layers and can be washed off more easily than resident flora by regular handwashing. The number of these bacteria can vary depending on where they are on the body. These transient organisms are often responsible for the infections patients can acquire in healthcare settings.
Why do People Need Hand Hygiene
The Center for Disease Control (CDC) explains that keeping your hands clean is an essential step towards staying healthy. It includes washing your hands with soap and water, using special hand washes that kill germs, using hand sanitizers that contain alcohol, or using antiseptic before surgeries. You should especially wash your hands when they look dirty, after you’ve been in contact with blood or other body fluids, before eating, and after using the restroom. Also, it’s important to wash your hands if you’ve been around bacteria like Clostridium difficile, Norovirus, or Bacillus anthracis.
In 2009, The World Health Organization (WHO) listed five critical times when hand hygiene is particularly important to prevent the spread of diseases:
- Before you touch or come near a patient.
- Before you do a clean or sterile task.
- After you risk exposure to body fluids and take off gloves.
- After you’ve been in contact with a patient’s immediate surroundings.
- After you touch any object in a patient’s immediate surroundings, even if you don’t make direct contact with the patient.
When your hands aren’t visibly dirty, the recommended product for maintaining hand hygiene is an alcohol-based hand sanitizer. When using these, follow the manufacturer’s guidelines on how much to use. Usually, this means applying 3 to 5 mL (about a teaspoon) to your palms and rubbing it all over both hands until they’re fully covered. It should take about 20 seconds for your hands to completely dry.
In healthcare settings, both patients and staff are monitored to ensure that proper hand-washing practices are followed. It’s increasingly common to focus on hand hygiene as one way to make healthcare environments safer.
When a Person Should Avoid Hand Hygiene
Artificial nails and nail extensions can carry germs under them, that can easily be passed on, particularly in health care settings like hospitals. As a result, it’s advised that health care workers should not wear these types of nails. Keeping your nails neat and sticking to the rules about artificial nails in your particular workplace is an important part of keeping your hands clean and reducing the spread of germs. The World Health Organization (WHO) also suggests that nails should be kept shorter than 0.5cm.
If you can see dirt on your hands, using an alcohol-based hand cleanser isn’t enough to get them clean. In those situations, both the Centers for Disease Control and Prevention (CDC) and WHO advise washing your hands thoroughly using soap and water.
Equipment used for Hand Hygiene
Handwashing is the process of cleaning your hands thoroughly with soap and water for about 15 to 20 seconds. You can use any kind of soap, whether it’s antimicrobial (germ-killing) or not. The key here is to rub your hands together vigorously, making sure all parts of your hands and fingers get cleaned.
Doing this properly actually requires certain techniques to make sure it’s effective:
Start by standing in front of the sink without letting your hands or clothes touch the sink. If they do, you’ll have to start over because your hands will be considered dirty. Then, turn on warm water and wet your hands and wrists thoroughly. It’s important to keep your hands and forearms below your elbows to avoid dirty water running back onto your clean skin.
Next, apply about 3 to 5 milliliters of soapy liquid to your hands. Rub this soap all over your hands to make sure it covers completely. Then, you need to rub your hands and wrists for at least 15-20 seconds to get rid of all the germs. Make sure to rub all parts of your hands and wrists, including under your nails and between your fingers. The World Health Organization (WHO) has a six step process for this that includes rubbing your palms together, the back of each hand, your palms with fingers interlaced, the backs of your fingers, your thumbs, and your fingertips. Rinse your hands and wrists thoroughly to make sure all the soap is gone.
When you’re rinsing, remember to keep your hands lower than your elbows and then dry your hands completely with a clean towel. If you’re using a disposable towel, throw it away, or place a reusable towel in the designated place (like a hamper or bin). Make sure you don’t touch anything with your clean hands when you’re done. Most importantly, don’t touch the faucet handles with your clean hands. Use the towel to turn the water off and then put it in the trash (or hamper). In some places like hospital trauma bays, the sinks even have timers that turn off the water automatically to help avoid recontaminating your hands.
Who is needed to perform Hand Hygiene?
For people with weak immune systems, healthcare professionals need to be extra careful about keeping their hands clean. This is because these people are more likely to get infections from germs that don’t usually make people sick. Washing hands with soap and water can get rid of most bad germs within 10 seconds. However, a special soap called chlorhexidine might be better for getting rid of certain germs.
If there’s a chance that healthcare professionals have been exposed to certain harmful bacteria like Clostridium difficile, Norovirus, or Bacillus anthracis, they need to wash their hands thoroughly. This is because these bacteria produce protective spores which aren’t killed by normal hand sanitizing gels. So, washing hands vigorously with soap helps to physically remove these spores from the skin.
The CDC (Centers for Disease Control and Prevention) recommends that for surgical procedures, healthcare professionals should clean their hands with solutions that kill a wide range of germs, aren’t irritating to the skin, work quickly, and provide lasting protection. Research has shown that forms of alcohol, either alone or together with other substances, can reduce the number of germs on the skin right after scrubbing more than other solutions.
How is Hand Hygiene performed
Practices of surgical hand cleaning started back in the late 1800s and continue to be vital in stopping infections today. Properly cleaning hands before surgery requires different skills than everyday handwashing. If germs accidentally move from a surgeon’s hand to where the surgery is taking place, it can cause an infection at the surgical site. This is one of the most common types of infections for surgical patients in a hospital. Proper hand cleaning before surgery can lower the chances of these infections happening.
A guidance document by the CDC, “Hand Hygiene in the Healthcare Settings,” explains how surgeons should clean their hands before a procedure. Certain important steps have to be followed using either a special germ-killing soap or a hand sanitizer that contains alcohol before putting on sterile gloves to begin surgical procedures. The goal is to get rid of any germs that could have been picked from the environment and also reduce the number of permanent germs that live on the skin.
Here is a simple guide to cleaning your hands before a surgery [17] [18]:
- Get rid of any jewelry like rings, watches and bracelets before starting to wash your hands.
- Check your hands for things like cuts, damaged cuticles, open injuries or scratches.
- Put on your surgical shoe covers, hats, caps, masks, and eye protection.
- Turn on the water using foot controls or a knee lever. Adjust it to a comfortable warm temperature.
- Wash your hands and arms with soap, making sure to wash up to two inches above your elbows. Remember that your hands must always be higher than your elbows during this process and while you rinse.
- While the water is running, use a nail cleaner to remove any dirt from under your fingernails.
When using a germ-killing cleaning product, scrub your hands, fingers, and forearms for 2 to 6 minutes. However, make sure to follow the instructions provided by the product manufacturer, as well as any special instructions your workplace may have. Some workplaces might suggest scrubbing in a certain manner when cleaning your nails, palms, hands, and arms. Some might even recommend using a brush. Avoid scrubbing for very long times (like 10 minutes) as it can damage your skin without providing any noticeable benefit. In some places, a two-stage cleaning process with shorter scrubbing times may be the norm. Be sure to rinse off all the soap from your hands, letting the water flow down your arms and off your elbows. Foot controls or a knee lever should be used to turn off the water. Your hands should stay raised and away from your body at all times.
After washing your hands, approach the sterile area you’ll be working in. Take a towel, making sure not to drip water onto the sterile area, and dry one hand. Then get a fresh sterile towel or flip the first one and use it to dry your other hand. After you’re done drying your hands, dispose of the towel. This should be done by dropping it into a nearby linen hamper or handing it carefully to a member of your healthcare team. Once you’ve applied the alcohol-based sanitizer or germ-killing rub as recommended, let your hands and forearms dry completely before putting on sterile gloves.
What Else Should I Know About Hand Hygiene?
Washing our hands properly is very important in stopping the spread of diseases, including infections picked up in the hospital, and decreasing the chance of healthcare workers catching these diseases. If patients in hospital get more infections, this can lead to them becoming sicker and possibly dying, meaning it’s crucial to clean our hands thoroughly. This also helps to provide safe and cost-effective care at the excellent standard our patients deserve.
Educational programs can be used to teach patients and healthcare workers about the importance of hand washing and the best way to do it. Additionally, things such as the design of the hospital and the number of staff can also affect how well hand washing guidelines are followed.
