Hand hygiene clearly impacts the wellness of any community. Keeping hands clean at home, in schools and elsewhere makes a significant difference in keeping folks healthy. The impact of poor hand hygiene habits is linked to increased occurrences of illness, absences, and their associated costs. A renewed commitment to “shared responsibility” in our homes and classrooms may be one of our most important infection prevention strategies.
Hand Hygiene at Home and School, written by Patrick Boshell at Infection Control Tips, says “studies demonstrate that poor hand hygiene practices can contribute to an increase in community-based infections including gastrointestinal, skin and respiratory infections. Additionally, there has been a steady increase in the global burden of infectious diseases, resulting in an reported 13 million deaths annually. Between 1980 and 1992, deaths attributed to infectious disease increased by 22%, according to reports. This is a cause for concern as we continue to see a decline in hand hygiene promotion and education.”
Hand Sanitizer Alert draws attention to the fact that “efficacy experiments reported here reinforce what has been known for more than 50 years: 40% ethanol is a less effective bacterial antiseptic than 60% ethanol. Consumers should be alerted to check the alcohol concentration in hand sanitizers because substandard products may be marketed to the public.”
Effects of Hand Hygiene Campaigns on Incidence of Laboratory-confirmed Influenza and Absenteeism in Schoolchildren, Cairo, Egypt: Elementary schoolchildren are important vectors for spreading infectious diseases between themselves, their families, and their communities, especially in developing countries where public schools are extremely overcrowded. Aiello et al. noted that infectious agents that children contract in schools can result in infections in up to 50% of household members.
Previously, at our blog:
To first do no harm is a fundamental principle followed by physicians and advanced practice clinicians (APCs). And few would argue that a decided majority believe they adhere to that precept most of the time. But it isn’t always the case when health-care folks are faced with the conundrum of sitting out or going to work while showing symptoms of infection, potentially spreading illness to patients and colleagues.
Reasons Why Physicians and Advanced Practice Clinicians Work While Sick tries to identify a comprehensive understanding of the reasons attending physicians and APCs work while sick. Of the medical professionals surveyed, 95 percent believe working while sick puts patients at risk. But of this same group, 83 percent reported working while sick at least once in the previous year. Nine percent said they worked while sick at least five times the previous year! Among the reasons cited for this disconnect: difficulty in finding someone to cover, a strong cultural norm to come to work unless remarkably ill and ambiguity about what constitutes “too sick to work.”
Effective hand hygiene is another way to help ensure no harm is done, yet hand hygiene remains low in most hospitals. Hand hygiene among physicians: performance, beliefs, and perceptions shows that at a large university hospital adherence averaged 57% and varied markedly across medical specialties. In multivariate analysis, adherence was associated with the awareness of being observed, the belief of being a role model for other colleagues, a positive attitude toward hand hygiene after patient contact, and easy access to hand-rub solution. Conversely, high workload, activities associated with a high risk for cross-transmission, and certain technical medical specialties (surgery, anesthesiology, emergency medicine, and intensive care medicine) were risk factors for non-adherence. Another related piece: Physician ‘defiance’ towards hand hygiene compliance: Is there a theory–practice–ethics gap?
Even when hand hygiene is practiced, potential problems arise. Contamination of Medical Charts: An Important Source of Potential Infection in Hospitals notes that medical charts should be considered a source of infection. The authors say “our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions.” In short, hand hygiene that is practiced at the door upon entry is largely negated when a non-gloved hand then pulls back a contaminated curtain or handles a bacteria-laden medical chart. We must stay ever aware of infection vectors all along the chain of infection.
While hand hygiene is a critical part of infection control programs, hand hygiene alone won’t do the trick. It is only a necessary piece of a broader approach to an effective infection control program. In a study titled Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions, hand hygiene is examined in relation to environmental cleaning to weigh the relative impact of each. The study developed an agent-based model of patient-to-patient – via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms – in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. The study simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for one year using data from the literature and observed data to inform model input parameters.
The results, which you can view at the link above, show that hand hygiene absolutely should remain a priority but also indicate that environmental cleaning also holds an important beneficial position in any hospital infection control program. This includes for hospitals overall or for individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.
Also, here’s a study that indicates even less-than-stellar hand hygiene programs can impact health outcomes.