Some healthcare professionals began hand washing in the patient-care setting in the early 19th century [Al-Maani & Al-Abri, 2018]. The practice evolved over the years with evidential proof of its vast importance and coupled with other hand-hygienic practices, decreased pathogens responsible for nosocomial or hospital-acquired infections (HAI).
Contaminated hands of healthcare providers are a primary source of pathogenic spread [Allegranzi & Pittet, 2009]. Proper hand hygiene decreases the proliferation of microorganisms, thus reducing infection risk and overall healthcare costs, length of stays, and ultimately, reimbursement.
According to the Centers for Disease Control and Prevention (CDC), hand hygiene is the single most important practice in the reduction of the transmission of infection in the healthcare setting [CDC, 2002].
According to the CDC, understanding the importance of hand hygiene and its impact on the pathogenic spread of microorganisms is best understood when one understands the anatomy of the skin. The skin serves as a protective barrier against water loss, heat loss, microorganisms and other environmental hazards.
Structurally, the skin is made up of an outer, superficial layer known as the stratum corneum, the epidermis, dermis, and the hypodermis. Healthy skin is colonized with bacteria or transient skin flora. These organisms vary in number depending upon body location. Hand washing can remove them. Healthcare workers come in contact with these transient skin flora through direct, close contact with patients or contaminated inanimate objects or environmental surfaces. Healthcare-associated infections are a result of these transient organisms [CDC, 2002].
According to the CDC, hand hygiene encompasses the cleansing of your hands by using hand washing with soap and water, antiseptic hand washes, antiseptic hand rubs such as alcohol-based hand sanitizers, foams or gels, or surgical hand antisepsis. Indications for hand washing include when hands are visibly soiled, contaminated with blood or other bodily fluids, before eating, and after restroom use [CDC, 2002]. Hands should be washed if potential exposure to Clostridium difficile, Norovirus, or Bacillus anthracis.
In 2009, the World Health Organization (WHO) highlighted preset guidelines known as the "Five Moments for Hand Hygiene" [WHO, 2009].
Alcohol-based hand sanitizers are the recommended product for hand hygiene when hands are not visibly soiled. Appy alcohol-based products per manufacturer guidelines on dispensing of the product. Typically, 3 mL to 5 mL in the palm, rubbing vigorously, ensuring all surfaces on both hands get covered, about 20 seconds is required for all surfaces to dry completely.
Patient and facility healthcare professionals are monitored for hand-washing practices, and they are conforming to hand-hygiene practices. This practice is becoming increasingly more popular as healthcare professionals strive for a safety culture [Zottele, Magnago, Dullius, Kolankiewicz & Ongaro, 2017].
Artificial nails and nail extensions contain pathogens in the subungual spaces (as cited in McGinley, Larson & Leyden, 1988)[CDC, 2002]; thus, they pose a threat to microorganism transmission in the healthcare arena. Therefore, it is recommended that healthcare professionals do not use them. Well-manicured nails and adherence to artificial nail policies outlined in facility-specific guidelines are vital to hand hygiene practices.
Handwashing is the act of washing hands with soap, either antimicrobial or nonantimicrobial and water for at least 15 to 20 seconds with a vigorous motion to cause friction making sure to include all surfaces of the hands and fingers [CDC, 2002].
It requires a specific skill set to ensure proper technique.
Healthcare professionals carrying for high-risk patients that are immunocompromised, severely neutropenic, or have infections with pathogens that are multidrug resistant or virulent, must perform hand hygiene with a recommended antiseptic solution such as chlorhexidine, povidone-iodine, hexachlorophene, triclosan or parachlorometaxylenol (PCMX). Institutional policies and manufacturer guidelines will guide you in the care of these individuals.
Remember, handwashing is a requirement if potential exposure to Clostridium difficile, Norovirus, or Bacillus anthracis. Clostridium difficile and Bacillus anthracis contain spores, and none of the agents used in antiseptic handwash or hand-rub preparations are reliably sporicidal. In these cases, vigorous handwashing will assist in the removal of the spores from the skin (as cited in WHO, 2009)[Allegranzi & Pittet, 2009].
Studies have shown that chlorhexidine use in surgical hand antisepsis dramatically reduces pathogens compared to povidone-iodine solutions. Antiseptic hand scrubs intended for use as surgical hand antisepsis agents get evaluated for their performance in the reduction of the number of bacteria released from hands over a specified period and during prolonged use [Jarral, McCormack, Ibrahim & Shipolini, 2011].
According to the CDC's 2002 report, established guidelines recommend that agents used for surgical hand scrubs should reduce microorganisms on intact skin in a substantial manner, contain a nonirritating antimicrobial preparation, have broad-spectrum activity, and be fast-acting and persistent. Studies have demonstrated that formulations containing 60% to 95% alcohol alone or 50% to 95% in combination with other products lower bacterial counts on the skin immediately post-scrub more effectively than other agents [CDC, 2002].
Surgical hand antiseptic practices began in the late 1800s and remain vital to the prevention of infection today. Surgical hand antisepsis or hand hygiene for surgery requires a different set of skills than regular handwashing techniques.
According to the CDC 2002 guideline, "Hand Hygiene in the Healthcare Settings," hand hygiene for surgery follows specific vital steps using either an antimicrobial soap or an alcohol-based hand sanitizer before donning sterile gloves for surgical procedures [CDC, 2002].
Surgical Hand Antisepsis Steps
Hand hygiene practices are paramount in reducing cross-transmission of microorganisms [Souza, Ramos, Becker, Meirelles & Monteiro, 2015], nosocomial or hospital-acquired infections and the risk of occupational exposure to infectious diseases.
Mortality and morbidity increase in the presence of nosocomial infections, thus diligent hand hygiene is essential to providing safe, cost-efficient, quality care to our patients.
Educational programs for patients and healthcare providers [Storr, Engineer & Allan, 2009], ergonomics, and staffing ratios all play a role in hand hygiene compliance.