New hand-washing guidelines emphasize healthy nails, easy access to sanitizers
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New guidelines for hand-washing in medical facilities, aimed at reducing health care- associated infections, focus on healthy skin and nails, as well as easy access to alcohol-based hand sanitizers and improved training.
The new guidance, Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene: 2022 Update, published in the journal Infection Control & Hospital Epidemiology, keeps in place and reiterates many previous recommendations for nails and nail polish, but the updates include where facilities should place sinks and hand sanitizer dispensers and how to maintain them.
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“Health care personnel need to wash their hands dozens of times throughout their workday as they have complex interactions with very sick patients,” Emily E. Sickbert-Bennett, PhD, MS, director of hospital epidemiology at the University of North Carolina Hospitals and an author of the new guidelines, told Healio.
“[These guidelines] provide a roadmap to health care facilities for developing evidence-based policies and implementing practical strategies which promote hand hygiene compliance and healthy skin and nails,” she said.
Sickbert-Bennett and colleagues noted a 2017 study that found just 7% of hand-washing opportunities in a trauma resuscitation center were taken advantage of, about 80% of which were during patient interactions. The authors of the 2017 study, as well as the authors of the updated guidelines, said the lack of hand-washing leaves open myriad opportunities for infections to spread.
The new guidance recommends ongoing training in hand-washing, at least partially because many people do not properly clean their thumbs or fingertips.
“Clearly, there is room for improving adherence and ensuring that hand hygiene programs result in optimal adherence remains a critical element in preventing [health care-associated infections],” Sickbert-Bennet and colleagues wrote in the new guidelines.
The guidelines note that all hand hygiene programs should have in place accessible and functional supplies; senior and unit-based leadership that is responsible and accountable for ensuring engagement and adherence; infection prevention personnel with training and resources to direct these programs; trained observers to evaluate technique and monitor adherence; trained providers who recognize when hand hygiene should be observed during care; and support for data analysis and meaningful communication of findings from such analysis.
Short, natural nails with standard or no polish are easiest to clean, the guidelines say, and the authors left in place other policies about nail polish, gels, shellac and extenders, writing that these policies can be determined by individual facilities. They uncovered no new evidence about chipped nail polish or artificial nails but noted that previous research showed they can harbor germs.
Janet Glowicz, PhD, RN, CIC, FAPIC, an infection preventionist on the CDC’s Hospital Prevention Team, told Healio that health care personnel need “easy access to alcohol-based hand sanitizer in every area that patient care is provided.”
“It should be placed within their workflow so that whenever their hands need to be cleaned, they know exactly where to find it,” Glowicz said.
The authors recommended against providing personnel with individual, pocket-sized hand sanitizers in lieu of wall-mounted dispensers. They said managers should include personnel in the selection of these products to be sure they are compatible with other products used on site.
Sickbert-Bennett said that preventing infections in the health care setting is multifaceted, and noted that many pathogens are becoming harder to treat because of the misuse of antibiotics.
“When we prevent infections through hand hygiene, we also prevent the use of antibiotics, we keep the patient safe and we protect the medications we rely on to treat patients,” Glowicz said.
She said there should be a minimum of one sanitizer dispenser outside of patient rooms, and in rooms with more than two patients, there should be one dispenser per patient. This can make it easier for health care personnel to “do the right thing,” she said.
“Infection preventionists and hospital epidemiologists work together to understand these risk factors for infections and use evidence-based guidelines to implement practical strategies aimed to prevent infections,” Sickbert-Bennett said. “These guidelines are very important to update our current knowledge of hand hygiene that have been shown to be most important.”
References:
Glowicz JB, et al. Infect Control Hosp Epidemiol.2023;doi:10.1017/ice.2022.304.
Haac B, et al. Injury. 2016;doi:10.1016/j.injury.2016.08.004.
SHEA. Hand hygiene is focus of updated advice to prevent healthcare-associated infections. https://shea-online.org/hand-hygiene-is-focus-of-updated-advice-to-prevent-healthcare-associated-infections/. Published Feb. 8, 2023. Accessed Feb. 8, 2023.
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