We Need a New Approach to Hand Hygiene
By Deb Paul Cheadle, RN, CIC
Handwashing is the single most important thing people can do to stop the spread of viruses and bacteria that cause infection. Everybody, especially those in healthcare, knows how to wash his or her hands, right? Wrong! Rarely do I observe someone doing it correctly.
I have been an infection control practitioner (ICP) for nine years. I have done multiple quality improvement monitors to evaluate staff compliance with handwashing and I have learned two things. Less than one-third of personnel wash when they should and less than one-tenth of that one-third wash correctly. You want "official" studies to prove this? I have a better way. Go to a public restroom and watch the next 30 people who come in to use the facilities. I guarantee you will leave convinced. If you have the opportunity, watch healthcare workers, including doctors; you will walk away in dismay.
Technology has made wonderful advances in the last few years. The waterless, alcohol-based "de-germers" are one of these advances. They meet the handwashing need when there is no available sink. They can be used anywhere, ideally at patients' bedsides. They are broad spectrum and act quickly but do not have a continuous germicidal activity. The healthcare worker does need to visit the sink periodically to rid their hands of obvious soil. Preparations containing CHG have a greater persistence, but there is the risk for skin reactions to or the absorption of the CHG.
Another technological breakthrough is the brushless OR scrub, an alcohol-zinc product of which ICPs should take note. Its efficacy against all organisms, including resistant strains, is nearly 100 percent. Its persistence lasts for hours. This is the kind of product we need to put in patient rooms and public restrooms and everywhere there is a sink. Why? Let's go back to the observation exercise you did in the restroom. People wash by squirting some soap on their hands, rubbing it around for a couple of seconds and then barely rinsing it off. If they use soap, it is not on their hands long enough, as they have only rearranged the bacterial colonies. Maybe they rubbed some off with the water and paper towel. If they use the alcohol-based waterless de-germer, they rinse it off in the water and it is no longer effective. If they use the alcohol-zinc preparation, after 15 seconds a 99.9984 percent reduction of all organisms is achieved and maintained for hours. Because there are no absorption or toxicity issues, the Food and Drug Administration (FDA) does not need to approve it. It is safe.
I see this product as one that fits the way people wash their hands. That is what we need. Education has helped increase awareness, but nothing has made much of a prolonged impact. As an ICP, I am looking at changing the goal. I give up on 100 percent compliance with hand hygiene before and after every patient contact. I am willing to look at a product that will continuously keep one's hands germ-free for hours after its application.
Deb Paul Cheadle, RN, CIC, works in infection control for Spectrum Health in Grand Rapids, Mich.