Infection Control Today - 12/2002: We Need a New Approach to Hand Hygiene

December 1, 2002

We Need a New Approach to Hand Hygiene

By Deb Paul Cheadle, RN, CIC

Handwashingis the single most important thing people can do to stop the spread of virusesand bacteria that cause infection. Everybody, especially those in healthcare,knows how to wash his or her hands, right? Wrong! Rarely do I observe someonedoing it correctly.

I have been an infection control practitioner (ICP) for nine years. I havedone multiple quality improvement monitors to evaluate staff compliance withhandwashing and I have learned two things. Less than one-third of personnel washwhen they should and less than one-tenth of that one-third wash correctly. Youwant "official" studies to prove this? I have a better way. Go to apublic 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, watchhealthcare 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 thehandwashing need when there is no available sink. They can be used anywhere,ideally at patients' bedsides. They are broad spectrum and act quickly but donot have a continuous germicidal activity. The healthcare worker does need tovisit the sink periodically to rid their hands of obvious soil. Preparationscontaining CHG have a greater persistence, but there is the risk for skinreactions to or the absorption of the CHG.

Another technological breakthrough is the brushless OR scrub, an alcohol-zincproduct of which ICPs should take note. Its efficacy against all organisms,including resistant strains, is nearly 100 percent. Its persistence lasts forhours. This is the kind of product we need to put in patient rooms and publicrestrooms and everywhere there is a sink. Why? Let's go back to the observationexercise you did in the restroom. People wash by squirting some soap on theirhands, 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 onlyrearranged the bacterial colonies. Maybe they rubbed some off with the water andpaper towel. If they use the alcohol-based waterless de-germer, they rinse itoff in the water and it is no longer effective. If they use the alcohol-zincpreparation, after 15 seconds a 99.9984 percent reduction of all organisms isachieved and maintained for hours. Because there are no absorption or toxicityissues, the Food and Drug Administration (FDA) does not need to approve it. Itis safe.

I see this product as one that fits the way people wash their hands. That iswhat we need. Education has helped increase awareness, but nothing has made muchof a prolonged impact. As an ICP, I am looking at changing the goal. I give upon 100 percent compliance with hand hygiene before and after every patientcontact. I am willing to look at a product that will continuously keep one'shands germ-free for hours after its application.

Deb Paul Cheadle, RN, CIC, works in infection control for Spectrum Healthin Grand Rapids, Mich.