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New guidelines offer advice to optimize hand hygiene in hospitals
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New guidance published in Infection Control and Hospital Epidemiology suggests best practices for implementing and optimizing hand hygiene programs to prevent health care-associated infections.
The guidance is part of the “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates,” which is a collaborative effort of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission.
“For more than 150 years, we have known the link between hand hygiene improvement and reducing HAIs,” Janet Haas, PhD, RN, CIC, director of infection prevention and control at Westchester Medical Center in Valhalla, N.Y., and co-author of the guidelines, said in a press release. “Yet, adherence to recommended practices remains low. While there can be barriers to optimal hand hygiene in health care settings, poor hand hygiene undermines care and threatens patient safety.”
Within the guidelines are recommendations to improve accessibility and acceptability of products by making sure that soap and alcohol-based rubs are available in all patient care areas and seeking staff input on the products’ tolerability on hands. The guidelines also stress hand hygiene at critical moments: before direct patient contact; before preparing or handling medication; before moving from a contaminated body site to a clean body site on one patient; before and after inserting and handling invasive devices; and after contact with blood or bodily fluids, direct patient contact or contact with patient’s environment.
The guidelines also recommend measuring progress by monitoring hand hygiene adherence and stress the importance of glove use to complement hand hygiene when necessary. To empower health care personnel, the guidelines recommend developing a multidisciplinary team to create a hand hygiene program and provide meaningful feedback.
When hands are visibly soiled, hand hygiene should be performed with soap and water instead of alcohol-based rubs, according to the guidelines. In addition, triclosan-containing soaps should be avoided because there are no data suggesting they are more effective than regular soap or alcohol-based rubs.
“It is our hope these updated evidence-based recommendations will guide health care institutions in implementation of hand hygiene programs and clarify the state of the science behind recommended hand hygiene practices,” Katherine Ellingson, PhD, an epidemiologist in the CDC’s Division of Healthcare Quality Promotion, and a co-author of the guidelines, said in a press release.
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Michael Edmond, MD, MPH, MPA
This guidance on hand hygiene offers the infection prevention community a comprehensive summary of the literature. In addition, it describes best practices for performance of hand hygiene and measuring compliance. The document also delineates controversial areas and current gaps in the science. However, at the end of the day, we’re left with a conundrum — hand hygiene remains incredibly simple to perform as an isolated act, yet it remains mysteriously difficult to drive group performance to a high level, which is likely necessary to have a significant impact on infection rates. At some point in the future, most health care workers will have become hard-wired to perform it in a subconscious way, just like seatbelt usage. But until that day comes it remains a struggle for which no guideline can offer a solution.
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