Despite acknowledgement of the critically important role of hand hygiene in reducing the transmission of pathogenic microorganisms, overall compliance with hand hygiene is less than optimal in healthcare settings. This article addresses hand hygiene best practices, measuring compliance and considerations for improvement strategies. In this context, the term hand hygiene refers to handwashing, antiseptic handwashing, antiseptic hand rub or surgical hand antisepsis.1
Opportunities for Transmission
Although they are a healthcare professional’s most relied-upon tools, the hands are also among the most common conduits for infection. Hand hygiene is recognized as the single most important practice to reduce the transmission of infectious agents in healthcare settings.2
Opportunities for the transfer of microorganisms fall into three primary categories:3-4
1. Animate transmission. The healthcare worker comes into contact with an infected patient, does not perform appropriate hand hygiene and transfers the pathogen through touching another patient.
2. Inanimate transmission: An object, such as a stethoscope, is contaminated through contact with an infected patient, is not properly disinfected and is then used on another patient.
3. Animate and inanimate interaction: The hands of an infected patient touch and contaminate an object, which is then touched by a healthcare worker who does not perform hand hygiene before touching another patient.
Protective garments provide another opportunity for transfer of microbes. One study found that 65 percent of healthcare workers’ gowns or uniforms were contaminated following routine morning care nursing activities. When caring for patients who have methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) patients, 69 percent of lab coats were contaminated. Additionally, 27 percent of these healthcare workers contaminated their hands after touching their coats.5-6
