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Clean
Hands - Procedures and Products to Protect Health
By: Dr.
Stefanie Kelley
Introduction
Thirteen laboratories in ten countries have worked around the clock to identify
the cause of the atypical pneumonia, Severe Acute Respiratory Syndrome (SARS).
The SARS virus, a virus from the coronavirus family never before seen in
humans, has been identified in all SARS cases. Using the latest technology
to decipher this new virus, an old procedure to prevent the spread of disease,
handwashing, has been declared by the World Health Organization (WHO) as
crucial to reducing the spread of SARS (WHO, 2003).
Historically, Ignaz Semmelweis and Oliver Wendell Holmes observed independently
in the 19th century that handwashing with an antiseptic agent reduced the
spread of contagious diseases. It was not until 1961 that the United States
Public Health Service developed training videos and handwashing procedures
for health-care workers. In 1975 and 1985, the Centers for Disease Control
and Prevention (CDC) issued formal handwashing guidelines that recommended
using plain soap for patient contact and anti-microbial soap before and
after invasive procedures. Alcohol-based hand rubs were only recommended
in situations where sinks were unavailable. In 1995 the Association for
Professionals in Infection Control (APIC) included more support but no recommendations
for alcohol-based hand rubs in the clinical setting. Most recently the Guideline
for Hand Hygiene in Health-Care Settings (CDC, 2002) recommends the
use of alcohol-based hand rubs for patient care in the clinical setting.
Clean hands are considered the single most important factor in reducing
the transmission and overall incidence of health-care related infections
(CDC, 2002).
Microorganisms occur
naturally on skin. These organisms are called normal flora or resident flora.
Normal flora are usually aerobic, gram-positive organisms. Normal flora
can grow and multiply on the skin without invading or damaging the skin
tissue. Handwashing does not easily remove these organisms. Staphyloccus
epidermidis is a common resident flora.
On the other hand, transient organisms contaminate skin and live for less
than 24 hours unless invasively introduced into the skin tissue. These organisms
are often anaerobic, gram-negative organisms and readily cause infection.
These organisms are easily removed by handwashing. Escherichia coli is a
common transient organism.
The largest colonization of pathogens exists in the perineum or inguinal
areas, axillae, trunk, upper extremities, and hands. Inanimate objects like
patient gowns, bed linen, and bedside furniture that are exposed by skin
can be exposed to patient flora. Transmission of microorganisms increases
if hands or donor fabrics are wet (CDC, 2002).
Plain or non-antimicrobial soap removes dirt, soil, and some organic substances
from hands by the detergent properties. Plain soap has minimal antimicrobial
activity. Plain soaps come in the form of bar soap, tissues, and liquid
preparations. Bar soaps must be properly drained in order to reduce the
chance of colonization of gram-negative bacilli.
Antimicrobial soap removes dirt, soil, organic substances, and disrupts
cytoplasmic membranes to kill microbes. Antimicrobial soaps also work against
enveloped viruses like human immunodeficiency virus (HIV), herpes simplex
virus (HSV), influenza, and respiratory syncytial virus (RSV). Several different
antimicrobial substances are found in antimicrobial soap and have various
methods of action and affect various pathogens. For a complete list of antimicrobial
agents found in soaps see the CDC's Guideline
for Hand Hygiene in Health -Care Settings. An important feature of antimicrobial
soaps is the persistent residual germicidal activity. This hand hygiene
procedure requires a minimum of 15 seconds. When performed correctly in
a busy clinical setting, handwashing with antimicrobial soap and water can
result in substantial health protection but also lost productivity.
Alcohol-based hand
rubs are antiseptics that contain isopropanol, ethanol, n-propanol or a
combination of these products. Solutions that contain 60%-95% are most effective
to denature microbial proteins (CDC, 2002). Alcohol has germicidal activity
against gram-positive and gram-negative bacteria, multidrug-resistant pathogens,
Mycobacterium tuberculosis, fungi, as well as lipophilic viruses (HIV, HSV,
RSV, influenza, and rotavirus). The CDC has suggested that the short duration
of hand antisepsis with alcohol-based hand rubs could save one hour of nurses'
time in a busy clinical setting. However, alcohol-based hand rubs do not
remove dirt, soil, or organic substances. They also have no persistent residual
germicidal activity. More research needs to be conducted to determine the
concentration of alcohol and quantity of solution per application to best
prevent the spread of pathogens.
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Washing with
plain soap and water is recommended for hand hygiene in non-health
care settings. |
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When
in a health care setting, if hands are visibly soiled, wash hands
with antibacterial or non-antibacterial soap and water. |
|
If
hands are not visibly soiled, use an alcohol-based hand rub for routinely
decontaminating hands or wash hands with an antimicrobial soap and
water. |
|
Wash
hands with non-antimicrobial or antimicrobial soap and water if exposure
to Bacillus anthracis is suspected or proven. |
Procedures for hand hygiene:
|
When washing
hands with soap and water, wet hands first with water, apply an amount
of product recommended by the manufacturer to hands, and rub hands
together vigorously for at least 15 seconds, covering all surfaces
of the hands and fingers. Rinse hands with water and dry thoroughly
with a disposable towel. Use towel to turn off the faucet. Multiple
use towels are not recommended in the health-care setting. |
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When decontaminating
hands with an alcohol-based hand rub, apply product to palm of one
hand and rub hands together, covering all surfaces of hands and fingers,
until hands are dry. Follow the manufacturer's recommendations regarding
the volume of product to use. Insufficient volume of the product has
been applied if hands feel dry after rubbing hands together for 10--15
seconds. |
Other facts related to proper hand antisepsis include:
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Hot water is
not recommended when washing with soap because it can cause hand dermatitis.
This can result in a breakdown in the skin barrier and allow a portal
of entry for pathogens. |
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Antimicrobial-impregnated
wipes (i.e., towelettes), that contain a minimal amount of alcohol,
are as effective as plain soap and water. These towelettes should
not be considered a hand antisepsis substitute for alcohol-based hand
rubs or antimicrobial soap. |
|
Long nails and
artificial nails have been implicated in transmission of pathogens.
Nails should be kept < ¼ inch long. |
|
The
use of gloves does not eliminate the need to wash hands. |
|
Handwashing
does not eliminate the need to wear gloves. |
As the CDC and
WHO embark on further tools to fight the SARS virus, further research on
handwashing products and procedures becomes even more important. The speed
at which the SARS virus was identified was the work of dedicated scientists
and cooperating multinational disease agencies. The time invested at a sink
with plain or anti-microbial soap and water or alcohol-based hand rubs is
an investment that can pay huge health dividends.
References:
Centers for Disease
Control and Prevention. (2002). 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.
MMWR, 51 (No. RR-16).
CDC. (2002). Hand Hygiene Guidelines Fact Sheet. Retrieved April 18, 2003
from http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm.
World Health Organization. Hospital Infection Control Guidance for Severe
Acute Respiratory Syndrome (SARS). Retrieved April 22, 2003 from
http://www.who.int/csr/sars/infectioncontrol/en/.
Stefanie
J. Kelley, ND, RN, CS
has been in the nursing field for over 10 years. She has clinical expertise
in general pediatrics and pediatric hematology, oncology, and bone marrow
transplantation. As a family nurse practitioner she has advanced practice
expertise in internal medicine, urban health care, and general pediatrics.
As a faculty member at Texas A&M University and Case Western Reserve
University, she has taught in the undergraduate and graduate didactic and
clinical portions of nursing. Dr. Kelley's interest in web-based instruction
and health care has been a part of her academic, clinical, and research
practice.
Dr. Kelley welcomes your comments about her article or suggestions for future
topics. She can be emailed at sjkelley6@yahoo.com.
.
Recommended Products related to hand washing:
| SH
Catalog # |
Product
Name |
| Soaps |
| 34007 |
Dial Soap |
| 34079 |
Hibiclens |
| 34240 |
J & J Prevacare
Antimicrobial Handwash |
| 50078 |
Vionex Antimicrobial
Soap |
| 34187 |
Lysol IC Antimicrobial
Soap |
| Hand
Sanitizers |
| 34243 |
Dial Instant Hand
Sanitizer |
| 34235 |
Purell Instant Hand
Sanitizer |
| 49026 |
Clini-derm Hand
Sanitizing Towelette |
| 34218 |
Vionex No-Rinse
Gel Antiseptic Hand Wash |
| Hand
Washing Education |
| 12146 |
Hand Washing Poster
& Tear Pad |
| 24203 |
Glo Germ Kits |
| 90492 |
Hand Washing Kit |
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