Hand Hygiene and Glove Issues:


Hand Hygiene and Glove Issues:
Promoting Compliance & Education

By Kris Ellis and Erika Camardella


compliance rates, infection control practitioners (ICPs) and manufacturers of hand-hygiene products have found ways to help healthcare workers (HCWs) better comply with aseptic protocol to reduce or prevent healthcare-acquired infections (HAIs). There are 2 million HAIs per year and more than 100,000 deaths annually due to HAIs, causing four to six billion dollars per year in costs to our healthcare system, says Garry Kelley, president of Garrett Medical Systems.

According to a survey published in the American Journal of Infection Control, 62 percent of patients surveyed are aware of the risks of HAIs, 69 percent stated that the risks were never explained to them during hospitalization, 62 percent were dissatisfied with information about HAIs, and most importantly, 57 percent were willing to pay $7.14 (average) per day extra to enhance the infection control program, if there would be a lower infection risk, notes Sanja Valentic, senior product manager for STERIS Corporation.

How to Increase Compliance

Attention to hand hygiene is constrained by HCWs remembering to wash their hands, the time it takes to wash hands, and the adverse effects on the skin caused by repeated handwashing. Skin irritation and dryness can occur from frequent hand washing and exposure to harsh hand hygiene agents. Involving personnel in choosing the product and placing it in convenient locations are important in maintaining compliance.

The most significant aspects of handhygiene compliance are convenience and the likeability of the product, says Beth Newman, senior product manager for Professional Disposables International (PDI). Education and motivational tools are also needed to increase compliance; however, if the product is not convenient or it is not liked, education and motivational tools may not increase use.

Make hand-hygiene compliance an automatic behavior, urges Rossana Fernandez, marketing manager for Metrex. In order to increase compliance, it is necessary to make the products easily available and convenient. Metrex also advocates touchless technology. Our no-touch dispenser detects hands beneath the spout and dispenses solution in seconds, Fernandez continues. This helps to eliminate cross-contamination and the pre-measured application minimizes waste. Compact bottle sizes also allow patients and HCWs to keep hand hygiene products immediately accessible.

The continuously busy environment of the hospital poses the challenge for HCWs to consistently stop and wash their hands, especially before they enter a room and on the way out. We have found that the hyperactive environment of the hospital is not conducive to elaborate educational programs or learning through written materials, says Lester Sampath, vice president of research and development at Mycrocept Corporation. The high turnover of staff also necessitates continuous on- site training. Our representatives spend as much time as possible on-site, promoting the proper and frequent use of our hand antiseptic products. We have found a definite positive correlation between the amount and frequency of on-site inservicing and use of our products.

HCWs not taking the time, or not knowing when and how to wash are also problems faced by ICPs in enforcing good practices. HCWs do wash their hands when they are visibly soiled, but we do like them to wash their hands after they remove their gloves, says Patricia McBride, RN, MSN, CIC, infection control manager at Bridmar Hospital in Bridmar, Penn. We have the pumps right there in the patients rooms. I talk about it as almost being a public relations component because the patient can see that you are sanitizing your hands. This has really helped in terms of having the cleanliness that everyone should have. Hand hygiene is mentioned at in-services, orientation and monthly classes. And sometimes a floor will just come and ask me to talk to them about a specific infectious disease and then hand hygiene comes up in my informal talks.

Alcohol-based handrubs have certainly been in the forefront of changes in the past five years, says Mary Pontrelli, healthcare marketing manager at Ecolab, Inc. The Centers for Disease Control and Prevention (CDC) hand-hygiene guidelines published in 2002 specifically recommend these products based on scientific evidence that they help to increase hand hygiene compliance.

Joe Kingsley, president of Glo Germ Company worries that proper handwashing habits will suffer due to the increased usage of handrubs. We feel that there is no substitute for proper handwashing, he says. Over the past year, several discussions have been held with members of Congress addressing this issue with three thoughts. First, requiring more detailed national reporting of hospital statistics, with emphasis on nosocomial infections, hospital errors, etc. only four states currently require full reporting. Second, creating a minimum room-fixture requirement; this would include handwashing facilities. Third, to include handwashing compliance data and observations in the overall hospital rating.

Before any organization can ask its employees to comply with a corporate hand hygiene initiative, its management team must live and breathe that same mantra, says Ambereen Renfro, assistant brand manager for Dial Corporation. Thus, one of the most effective ways to encourage compliance is to have the support of senior management from a strategic and monetary standpoint. With support, budgets for such initiatives become active, making it much easier for the bottom-up stage to take place wherein education and marketing can come into play.

Promoting active participation, support from senior management, education, training and multiple soap-dispensing options in restrooms, have all been used to promote hand-hygiene compliance in healthcare settings, Renfro continues. The prevalence and access to germ-reducing products has had a major affect in compliance in healthcare institutions.

One approach to help HCWs be more aware of hand hygiene involves educating the patient to ask the nurse or doctor to wash their hands before any contact. We asked ourselves what is there 24/7 and never goes away? and the answer is the patient, says Maryanne McGuckin, Dr. ScEd., MT (ASCP), senior research investigator at the University of Pennsylvania School of Medicine and the creator of STERISs Partners in Your Care program. In our program, Partners in Your Care, the patient is part of the team and actually becomes the intervention by constantly reminding HCWs, Did you wash your hands? before they have direct contact with them. There are probably three big things that are really important to increase compliance. One is you have to have a good product. Two, there has to be clear education on when gloves need to be used, and the third, and most important, is that you have to have something that is there 24 hours, seven days per week reminding HCWs. Our program has measurement, intervention and an outcome.

Another compliance program, created by 3M Healthcare, is Six for 7, named for the Six Sigma methodology. Based on a simple, five-phase approach with standard templates, the program is designed to allow customization tracking tools at every step. The program also provides support materials to raise and sustain hand-hygiene awareness and compliance among healthcare professionals, says Dennis Graham, sales and marketing manager at 3M.

In pilot programs at five hospitals where Six Sigma methodology was deployed, there was an average 33 percent improvement in handhygiene compliance over the observed baseline and, where there has been sufficient time for data collection, these improvements have been sustained for over one year.

Choosing a Product

With so many choices in products ranging from soaps to foams, gels, wipes and sprays, ICPs face the challenge of finding the right product for their staff. According to McBride, personnel satisfaction comes first as a deciding factor when purchasing products. I always think in terms of the waterless or the antimicrobial soap, and certainly you involve the staff in terms of testing it and in terms of whether it foams well, or lathers well, if they feel like they are getting their hands clean with it and how their hands feel after they have used it, she says. And of course the whole situation needs to be considered whether the company is on our purchasing contract, and the price. But the first thing is certainly the staff satisfaction. The staff has to like the product and that comes before getting the least expensive one.

You have to look at studies that have been done; not only whether they meet the criteria of the FDA monograph, but also what effect they have on the integrity of the skin, says McGuckin of choosing products. I think there are companies out there that are clearly doing these studies now and I think ICPs need to be asking these questions: Have you used this in the real world? and, Do you have studies that show that skin has improved or not improved with your products?

Ways Manufacturers Can Promote Hand Hygiene

PDI introduced antimicrobial alcohol gel hand wipes as an alternative delivery method to the alcohol gels, foams and rinses. The mechanical friction provided by the wipe, combined with the active ingredient ethyl alcohol, provides the ability to remove bacteria and soil while killing 99.9 percent of germs, says Newman. ICPs have placed (wipes) in patient rooms at the bedside, and at the entry to each room for healthcare worker and visitor use, but patient hand hygiene is often overlooked. Many times, a patient cannot wash his or her hands prior to mealtime. Placing a wipe packet on meal trays can make it easier for the patient to disinfect his or her hands. She points out that cleaning fingernails and finger tips can also be overlooked. The alcohol gel wipes enable HCWs to clean fingertips and under finger nails without using a nail brush.

Garrett Medical Systems conducts and promotes research in the field of alcohol-based antiseptics and hand hygiene, and in the areas of aseptic treatments and antiseptics. Every three years we conduct Bode World Hygiene Days where we assemble the worlds leading experts in the field of hand hygiene to come together, present and discuss scientific material relating to this field, says Kelley. Additionally, Bode Chemie sponsors the Ignaz Phillip Semmelweis Research Prize in association with the German Association for Hospital Hygiene (DGKH). This 15,000 Euro prize is awarded for innovative performances in the area of applied infection control, including research activities to improve compliance of hand-hygiene measures.

In one case study presented by PDI, personnel and patients at Northridge Hospital Medical Center in Northridge, Calif., decided to use antimicrobial alcohol gel wipes before and after petting or handling the pet therapy dogs that visit the hospital patients. A physician at the hospital was concerned the dogs could spread diseases to the patients as well as infections from one patient to another, Newman explains. Vicki Keller, RN, infection control manager at Northridge Hospital, found that washing hands before and after touching the animals would be effective in controlling the spread of infections.

We have found that the most powerful methods of reminding staff of hand-hygiene indications are to include the observations of both patients and peers, Pontrelli says. The Circle of Prevention program, created by Ecolab, Inc., is a comprehensive, expanding program supporting our current products, services and educations tools, Pontrelli continues. This program allows us the flexibility to quickly change to meet our customers changing needs. The program features education, training, services and products.

The Future is in our Hands

I feel that compact sinks, touchless paper towel dispensers, touchless faucets, and liquid soap combo units in every room with a bed should be requirements in the future, says Kingsley. He also advocates patient-friendly posters urging patients to remind HCWs to wash their hands.

Metrex is researching new ways to bring the best technology to the marketplace for 2006, according to Fernandez. In the future, we may see combining technology with education, for example, a voice-activated prompt that can reinforce behavior change. Also, monitoring devices utilized to measure hand hygiene compliance.

To McGuckin, the patient is the key to consistency in hand hygiene in the future. The key thing is to have the patient involved every time,

she says. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) isnt telling people what to do, and people dont know what to do, says McGuckin. If the patient asks the HCW to wash their hands, You dont run into a situation where the HCW says to the patient, No Im not going to do it.

We think that national laws requiring detailed reporting on various compliance issues is just a matter of time, Kingsley says. This will result in more awareness and a better focus on areas needing improvement. Several companies are working together on inexpensive handwashing stations, and some are even portable in an effort to make them easily accessible. One thought is to let hospitals that obtain high compliance ratings, low nosocomial infections, and low hospitalacquired illness reports enjoy a significantly lower liability rating from the insurance companies.

The future of hand-hygiene compliance will start to move toward electronic monitoring, says Valentic. We are seeing this trend in other market areas, particularly food service, and as these technologies become more readily available and reliable, we will start to see them move into the healthcare marketplace. The sinks and dispensers will be able to read the badges of the healthcare workers and register handwashing compliance by each individual.

While alcohol gels are popular from a convenient hand hygiene maintenance perspective, they are not a replacement for soap-and-water handwashing in terms of efficacy, Renfro pints out. Thus, moving forward, healthcare facilities will be looking to market leaders and innovators to generate products that provide the convenience of alcohols that have the benefit of the mildness and efficacy of liquid/foam soaps today.

Kelley sums up the effort to promote handhygiene compliance by pointing to education. To win the battle of compliance, we must start with education, he says. We must work to change our healthcare culture and behavior in order to increase compliance. Its a team effort, not a product effort or an individual effort. High rates of compliance must become an ongoing effort focusing on positive efforts to change behavior and create an atmosphere where best practices and best products work together to support safe interaction between HCWs and our healthcare customers.

Gloves Role in Hand Hygiene

Gloves are well established as an effective line of defense against hand contamination in the healthcare setting. Over the years, many studies have demonstrated the effectiveness of gloves in allowing HCWs to provide care for infectious patients while protecting their own health. The use of gloves can also inhibit the spread of dangerous pathogens within the healthcare setting, thus enhancing the safety of everyone therein. The CDCs Guideline for Hand Hygiene in Health-Care Settings recommends that gloves should be worn to:

  • Reduce the risk of personnel acquiring infections from patients

  • Prevent healthcare flora from being transmitted to patients

  • Reduce transient contamination of the hands of personnel by flora that can be transmitted from one patient to another.1

The Occupational Safety and Health Administration (OSHA) dictates that gloves should be worn when HCWs anticipate coming into contact with blood or other potentially infectious materials; mucous membranes; non-intact skin; when performing vascular access procedures; and when handling or touching contaminated items or surfaces.2

While most HCWs understand the importance of glove use, discerning specific nuances such as selection of the proper glove and latex sensitivity can be challenging. For ICPs in particular, keeping abreast of established and emerging information and product options and research regarding gloves is essential.

Generally, the most important function of gloves worn by clinicians or other healthcare personnel is to provide very effective barrier protection for both the users and the patients against viral transmission and other potentially dangerous infectious substances, says Esah S. Yip, DSc, director of the Malaysian Rubber Export Promotion Council. Therefore, the right glove should be one that is capable of doing that. The ability of a glove to provide effective barrier protection is an important criterion, given that it has been estimated that about 2 million people in hospitals are affected by infections due to inadequate barrier, leading to about 80,000 deaths annually.

The integrity and level of protection that a glove can provide is dependent on the material that it is made of. Yip explains that making an educated choice among the many options available is vital. For example, many studies by researchers have shown repeatedly that vinyl gloves tend to leak during use many times that of latex gloves, while other synthetic gloves, such as nitrile and polychloroprene, show better performance than vinyl, but they are more costly, he says. Gloves are also differentiated by other critical characteristics such as comfort, fit, durability, and high resistance to tear. Failure of any glove to possess these qualities could compromise its barrier performance during use.

Manufacturers can do their part in helping HCWs make the right choices, according to John Amat, vice president of sales and global marketing at Kimberly-Clark Health Care. Latex gloves should not be colored to look like synthetic gloves, and vice versa, he says. Healthcare workers need to be able to automatically recognize a synthetic vs. a latex glove. This color differentiation will help lower the risk of accidentally pulling the wrong glove which could result in barrier protection issues as well as latex allergy issues.

Yip points out that glove manufacturers are not currently required to provide this kind of information to consumers. To select the right glove for the job, it is my view that, first, clinicians should have prior knowledge of the differences in in-use barrier protection among the different types of medical gloves, aided by manufacturers who provide such information through Web sites and other channels; and second, manufacturers should clearly indicate what type of materials their products are made from, particularly the specification of the type of synthetic material used, in addition to the product information as required by the regulatory requirements.

Presently, for gloves labeled non-latex, it is often not possible for consumers to identify if the synthetic glove is made of vinyl, nitrile, polypropylene, polyurethane or some other material.

The American Society for Testing and Materials (ASTM) develops and provides many voluntary standards that apply to gloves. Manufacturers may elect to comply with these standards in order to demonstrate their products performance in areas such as:

  • Viral penetration (ASTM F1671-97b) measures the gloves ability to resist penetration by liquid containing a particular virus

  • Strength (ASTM D412) measures the amount of force a glove can withstand before breaking

  • Thickness (ASTM D3767) measures the thickness of a glove at specific locations, which is important for barrier protection and durability

  • Water leak (ASTM D5151) measures the gloves ability to hold a specified amount of water while maintaining acceptable quality levels

ASTM has also very recently published a standard test for medical gloves meant for handling chemotherapy drugs (ASTM D6978- 05), says Yip. Application of this test by manufacturers will assist to provide the information of their chemotherapy gloves that clinicians need to know.

With regard to glove use, proper donning and removal is extremely important. Improper donning could compromise barrier performance, or result in tears that could cause unnecessary wastage of gloves leading to increased healthcare costs, Yip cautions. Traditionally cornstarch has been used to aid donning, but glove manufacturers now also have improved technologies. These include alternative lubricants such as chlorination and polymer coatings, which modify the glove surfaces to facilitate donning without powder.

Proper donning and removal of glove education is ultimately the responsibility of each institution, says Bianca Cenac, marketing manager at Tronex Healthcare Industries. Professionally trained staffs, who work with OSHA and FDA, should be reinforcing these practices.

Poor donning techniques can result in glove rips and tears, Amat explains. Healthcare personnel should take care to don gloves correctly and avoid excessive stretching. Thoroughly dry hands before sliding them into gloves.

Cross-contamination is always a risk as gloves are removed as well. Infectious organisms may contaminate the exterior surface of gloves during use, says Amat. It is important to follow proper glove-removal techniques. The gloves should then be dropped, not tossed, into the appropriate disposal container. A perfect barrier is meaningless if the contamination on the outside of the glove is spread throughout the environment as a result of poor removal techniques.

Cenac points out that manufacturers can work with institutions to provide proper donning/removal guidelines by including informational inserts in glove cases when they are shipped to facilities. As an example, there are certain techniques and important notes about donning that could be included in the information piece, she says. Poor donning techniques can result in glove rips and tears. Healthcare personnel should take care to don gloves properly and avoid excess stretching. Hands should also be thoroughly dried before putting them on.

While powder may help glove users with donning, it may also be the source of adverse consequences such as granulomas, increased skin irritation, increased infection risk, and respiratory complications.3 For years weve been touting the adverse consequences of glove powder for both clinicians and patients, says Amat. In fact, Kimberly-Clark recently announced that they have discontinued the manufacture and sale of powdered gloves in the United States.

Glove compatibility with other hand-hygiene products continues to be another concern that requires constant attention. There has to be clear education on when gloves need to be used, because I think gloves are probably the biggest things that have decreased hand hygiene, says McGuckin. People grab gloves before they go to the sanitizer or soap and water. So I think correct education of staff about glove usage and that you need to still wash your hands before and after you use the gloves.

Pontrelli points out that manufacturers must consider this issue carefully as well. Glove compatibility should be an important consideration in the development and marketing of any skin-care product used in healthcare, she says. It is well-known that latex gloves may be degraded by mineral oil-based lotions. There are standard test methods to evaluate glove integrity and tensile strength after treatment with the skincare product and subjecting the system to exaggerated use conditions with respect to volume, time and temperature.

It may be mentioned here that CDC recommends both handhygiene practices and glove use to prevent outbreaks in healthcare facilities, minimize transmission of antimicrobial resistant organisms, and reduce overall infection rates, Yip explains. They state, gloves reduce hand contamination by 70 percent to 80 percent, prevent cross-contamination, and protect patients and healthcare personnel from infection. CDC recommends that handwashing and handrubs be used before and after treating each patient just as gloves should be changed before and after each patient contact. CDC does not recommend using any lotions or handrubs on gloves.

Cenac contends that manufacturers should facilitate education in this respect. To identify and prevent incompatibilities with hand hygiene products, manufactures must partner with clinicians and fully understand their environments and users, she says. Manufacturers can offer education on how these hand products are used and what their purposes are to help clinicians as well.

Considering the fact that many HCWs must use gloves quite frequently, and some for long periods of time, skin irritation and allergies can become major issues. A latex allergy can produce a range of symptoms, some of which may be serious. Efforts to educate clinicians about this issue and to present suitable alternatives are ongoing.

An initiative currently underway that were particularly proud of is our partnership with the ALAA (American Latex Allergy Association) to promote awareness and education of latex allergy and the alternatives to natural rubber latex products available to healthcare professionals, Amat says. He describes the wealth of information available in Latex Allergy Alert kits, such as information on latex allergy symptoms, identification of individuals who are most susceptible to developing a latex allergy, statistics on the prevalence of latex allergies in HCWs and the general population.

Latex-free products may not be the only option in addressing latex allergies, however. Improved manufacturing technologies have now led to the production of low-protein latex gloves that vastly reduce the risk of latex allergy, Yip says. In fact, several independent hospital studies in the United States, Canada and Europe have shown that the use of such low protein/allergen gloves markedly reduces the incidence of latex sensitization and allergic reactions in workplaces. More importantly, latex allergic individuals donning synthetic gloves can now work alongside their coworkers wearing these low-protein gloves, and suffer no ill effects.

Although the depth and complexity surrounding many of the important hand hygiene and glove issues can become daunting, ICPs must be diligent in their efforts to educate and promote compliance. Association guidelines, manufacturers assistance, and a wealth of ongoing research exist to aid ICPs as they endeavor to protect HCWs and patients.


1. Boyce JM, Pittet D. 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. Infect Control Hosp Epidemiol. 2002 Dec;23(12 Suppl):S3-40.

2. Occupational Safety and Health Administration. 29 CFR Part 1910.1030. Occupational Exposure to Bloodborne Pathogens: final rule. Federal Register 1991;29CFR Part 1910:1030.

3. FirstHAND, Vol. 3. Potential Consequences of Glove Powder. Kimberly-Clark Health Care Education.

Healthcare Facilities and the War on Cross-Contamination

In an industry where exceptional hygiene is critical for operations, the immediate and widely-held perception is that healthcare facilities are among the safest for protection against illness. The reality, however, due to a variety of circumstances, is that this is not always the case. Even in the 21st century, there exists an urgent need for healthcare operators to focus on reducing the risks associated with cross-contamination enemy No. 1 in the battle against the spread of infections.

The urgency can be seen in the numbers. According to the Centers for Disease Control and Prevention (CDC), more than 2.4 million healthcare-acquired infections (HAIs) occur during a stay at a healthcare facility each year in the U.S. These infections account for nearly 10 percent of all healthcare admissions, contributing to more than 70,000 deaths and directly causing 30,000 deaths each year.1 In fact, infectious disease is the third leading cause of death in the United States.4

In addition to the human element, cross-contamination can also deliver a fiscal blow to healthcare operations. HAIs often as a result of cross-contamination cost of more than $4.5 billion annually in extended care and treatment. This reality also has the potential to trigger a domino effect that can lead to costly litigation down the road.1

Cross-contamination is and will remain a critical concern for healthcare operators in the future, says Shannon Jones, senior market development manager for Georgia- Pacific North American Commercial Business. Because of its tremendous physical and fiscal impact on facilities and their patrons, operators simply do not have the option to ignore this issue.

It doesnt take a healthcare professional to realize that the cross-contamination issue is serious and is here to stay. Every day, the news delivers an increasing number of messages on the spread of infectious diseases such as SARS, the Norwalk virus, and more commonly, influenza. The question for healthcare facility operators looking to balance safety with efficiency then becomes, what is the most effective and efficient way to maximize proper hygiene practice and to reduce cross-contamination?

The good news is that for the most part, the solution to reducing cross-contamination in healthcare facilities is both simple and cost-effective.

From education and the promotion of proper hygiene practice, to the investment of touchless dispensing technologies in the washrooms, healthcare operators can greatly reduce the risks associated with cross-contamination, Jones adds.

Alhough common to any facility operations, the issue of cross-contamination is magnified in healthcare facilities where, due to the nature of the business, harmful bacteria are likely to be more prevalent. For this reason, it is critical to reduce the number of touch points (areas and surfaces that come in contact with the skin) in a facility. Every surface in a healthcare facility is a potential hotbed for germs and infection and is a serious risk for cross-contamination.

Installing touchless dispensing technologies, such as automated paper towel dispensers, in washrooms and at handwashing stations near patient rooms, in healthcare foodservice centers and throughout the facility can greatly reduce cross-contamination by reducing the number of touch points associated with washing and drying hands. Touchless towel dispensing products allow users to access paper towels after washing their hands with a simple wave of the hand, without touching other towels or the equipment often a key contributor to the spread of harmful bacteria.

Companies such as Georgia-Pacific North American Commercial Business are offering innovative touchless products, such as automated paper towel dispensers, to help facility operators meet this growing need. In addition to touchless towel dispensers, healthcare operators can also equip their washrooms with touchless soap dispensers to further promote the reduction of touch points in washrooms and the spread of harmful bacteria.

The benefits of touchless products to healthcare facilities extend beyond cross-contamination, as they also help to reduce waste by offering controlled, one-at-a-time towel dispensing and can reduce maintenance time, through less stocking of high-capacity storage cabinets. This advantage, referred to as portion control, reduces material costs and waste over time, creating obvious environmental and financial advantages.

Portion control is the real issue when focusing on source reduction, says Dan Silk, vice president of marketing for Georgia- Pacific North American Commercial Business. It is not only about what we do with the waste we produce, but its also about focusing on how we can reduce the amount of waste created in the first place.

Controlled dispensing of towels through touchless washrooms also works to improve infection control by minimizing the accumulation of contaminated waste in an environment. This benefit alone promotes a healthier environment, key to the functionality and image of a healthcare facility.

A scene familiar to anyone conjuring up images of healthcare facilities might picture a doctor scrubbing up just before or after surgery. While that may be the most common image, the fact is, handwashing and drying affects nearly all aspects of healthcare operation, from the operating rooms and the nursing stations, down to common area restrooms and foodservice operations within the facility.

It is no wonder then that proper handwashing and drying is the first and most effective line of protection against cross-contamination and its harmful effects. A recent study found that nurses, doctors and other caregivers wash only about 40 percent of the recommended times when working with patients.1

With more than 630 million annual cases of infectious disease in the United States alone,2 this is clearly a disturbing trend. Finding the solution for the need to promote better hygiene practices in healthcare comes down to three key areas: education, supplies and reinforcement.

In 2001, the CDC conducted a study1 of handwashing compliance in healthcare facilities and discovered that the top contributors to lack of handwashing compliance in healthcare facilities were:

  • Lack of education and motivation

  • Nursing shortages

  • Primary patient-care concerns (handwashing and drying gets in the way)

  • Hand irritation

  • Inaccessible hand-hygiene products

While on the surface this issue may seem daunting, the solution again is relatively simple. Promoting education about the importance of proper hand washing and drying combined with a convenient supply of hand hygiene products, a healthier environment can be created and greatly reduce the number of HAIs. Although the advice itself simple, the reality is that many of those who do wash their hands often do not do so in the most effective manner. A quick lather and rise will not get the job done. Consider the following:

  • Wet hands can pick up and transfer microbial contaminants more than dry hands3

  • After hands are washed, germs lifted from the skins surface may still live in the moisture existing on the hands.2

  • Transient bacteria has an increased survival time on wet skin3

Companies are increasingly reaching out to healthcare and other facility operators to promote proper handwashing and drying. By practicing the following six steps, 99 percent of transient bacteria can be removed from hands.

1. Wet hands under running warm water from the sink.

2. Dispense liquid soap into palm.

3. Wash and lather. Rub hands together for 10 to 15 seconds. Lather every surface well, especially around the nails.

4. Rinse all soap off hands with warm running water.

5. Dry hands well with a disposable paper towel.

6. Use alcohol-based hand sanitizer for a quick sanitizing of visually clean hands or as an enhancement to handwashing and drying.

One of the most effective actions healthcare operators can take is to post ample signage throughout the facility, encouraging staff and visitors alike to help maintain a healthy environment by practicing the proper steps of handwashing and drying.

Healthcare operators will be wise to approach the cross-contamination challenge with a balanced mix of investing in cost-effective touchless products that reduce the risk of spreading harmful bacteria, while working to educate and reinforce proper handwashing and drying techniques among employees and facility patrons. In the short and long run, the combined effort will yield benefits across the spectrum of healthcare management, from providing a healthier environment to maintenance cost savings through waste reduction and labor savings.


1. CDC / HICPAC (2001). Draft Guideline for Hand Hygiene in Health Care Settings.

2. Georgia-Pacific. Handwashing and Drying: An Effective Tool in the Building Service Managers Arsenal - Part I of II.

3. University of Westminster in London 4. American Society for Microbiology survey

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