Problematic Hand Sanitation Can Lead to Healthcare-Acquired Infection

Problematic Hand Sanitation

As indicated in the Dancer paper,³ pathogens get on bare or gloved hands or clothing of the HCW from contact with a prior patient or from contact with contaminated surfaces, air and instruments. The compromised hands of the HCW then touch the patient while performing care-related tasks. The interaction between the hands of HCWs, whether they are bare or gloved, and their patient invariably transfers infectious pathogens to the patient.⁵ This is shown by Hayden,⁷ who documented gloved hand contamination from multiple tested sites within a patient’s room.

Bare-hand sanitation using alcohol-based sanitizing rubs is somewhat helpful when performed by a HCW between patient visits. However, it is done only 40 percent of the time or less.⁸ Often their use is avoided because busy schedules or the rubs cause significant hand irritation, or because of poor habit or discipline. Moreover, handwashing and alcohol rubs are not effective against all pathogens; in particular, alcohol rubs do not inactivate dangerous spores such as Clostridium difficile. Also, through carelessness, they generally do not cover the entire bare hand surface, with key spots missed frequently. As a result, they do not achieve sanitation, which is defined as inactivating 99.99 percent of all pathogens on the surface being sanitized. Poor bare-hand hygiene in hospitals is widespread.

The problem is much worse than just lack of bare-hand sanitation between patient visits. Even if there was 100 percent compliance, patients would still be a great risk. There is a tenuous relationship at best between increased bare-hand hygiene compliance and significant infection rate drops.^9-10 This is because bare hands and gloved hands quickly lose their marginally sanitary condition during the patient visit. All touched surfaces compromise the conditions of the hands. All sanitation bets are off once the HCW enters and moves around the room, performing his or her tasks.

As a result, to lower the bioburden and counteract the contamination, it is necessary to repeat the sanitation process frequently during the patient visit or pathogens will be continuously transmitted to the patient and to the surroundings following the transmission cycle, and continually raising the risk of infection. The problem, of course, is that if it is so hard to achieve bare-hand sanitation between patient visits more than 40 percent of the time, it may not be feasible to rely on HCWs to perform multiple effective bare-hand sanitation during patient encounters due to limitations of speed, capability, and efficacy of existing technology.