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By Ron Cagle
Since the October 2002 update of theCenters for Disease Control and Prevention (CDC)s hand hygiene guidelines forhealthcare settings, wall-mounted alcohol handrub dispensers have been going upin hospitals across the country. These programs will surely have a dramaticimpact on lowering infection rates; however, the questions remain: Is this thebest we can do? Are wall mounts as accessible as they need to be to meet thecritical objectives? And what about body-worn hand sanitizers that have morerecently become available? Body-worn hand sanitizers promise to redefineaccessibility and move hand hygiene practices much closer to the hand-hygienegoals of the CDC as well as Patient Safety Goal No. 7, reducinghealthcare-acquired infections (HAIs), mandated by the Joint Commission on theAccreditation of Healthcare Organizations (JCAHO).
The Critical Scope of the Problem
Weve all read the statistics, but the need for ways toprevent HAIs cannot be overemphasized. According to the CDC, HAIs are the fourthleading cause of death in the U.S. There are 2.2 million nosocomial infectionsannually resulting in more than 80,000 fatalities. The annual economic burden ofnosocomial infections to the U.S. healthcare system is $5.2 billion. Multi-drugresistant pathogens are an emerging contributor and threaten to perpetuallyraise the stakes even further.
Focus on Hands
Weve known about the role hands play in infection controlfor 150 years, yet the problem persists. Hand hygiene is considered to be theNo.1 preventive measure against the spread of infection. At least20,000 of the annual nosocomial infection fatalities are attributed directly toinadequate hand hygiene. The old handwashing model did not account for thereality of todays conditions. For example, studies show that healthcareworkers (HCWs) can wash their hands every time they should, or do their jobs,but not both! Another factor is that constant handwashing is far too damaging tohands. Clearly, HCWs need realistic answers.
CDC Recommends Accessibility
Given the magnitude of the problem and the practical realitiesfacing todays HCWs, the CDC updated its hand-hygiene guidelines. The mostnotable recommendation is to use an alcohol-based handrub when hands are notvisibly soiled.1 This allows hand sanitation to no longer be restricted to asink and makes possible a variety of more accessible options. Going farther toemphasize accessibility, the guidelines recommend that HCWs carry individualpocket-sized containers in areas of anticipated high-intensity patient care.
Much of the groundwork of the updated guidelines point toaccessibility as the key to compliance. CDC guideline co-author Didier Pittet,MD, concludes, Strategies to improve compliance with hand hygiene practicesshould be multi-modal and multi-disciplinary, and easy access to fast-actinghand hygiene agents should be viewed as the main tool of the strategy. 2Bischoff and associates, in their April 2000 study, offered a supporting view:Accessibility may eventually be shown to be the most reliable variable predicting handwashing rates. 3
The question of compliance remains. Will wall-mounted systemsend hand-transmitted infection in healthcare settings and therefore eliminatethe need for additional innovations, tools, and programs? The factorscontributing to non-compliance point to the answer:
Body-Worn Critical Requirements
Since the release of the CDC updated guidelines, a new breedof bodyworn hand sanitizers has been introduced. Although they dispense similaralcohol hand-sanitizing agents, the critical requirements are significantlydifferent from wall-mounted and other delivery systems:
Lessons of Semmelweis
Semmelweis taught us that it shouldnt require 50 years totake the next logical step in hand sanitation compliance. Body-worn handsanitizers warrant a closer look by virtually every healthcare setting. Theintent of the CDC guidelines call for opening the review process to newinnovations.
The process should include:
The change in culture called for in the updated guidelineswill benefit from tools worthy of the paradigm shift. The accessibility ofwall-mounted and body-worn alcohol hand sanitizers together will lend strengthto administrative and educational program components. Higher expectations can beset and achieved given realistic accessibility to hand hygiene agents.
Ron Cagle is the business development manager for HarborMedical, Inc. of Santa Barbara, Calif.