Hand hygiene is the most important infection-control practice, whether in the hospital, the clinic, or at home. By interrupting the transmission of pathogens, hand hygiene protects not only patients, but also the health care workers (HCWs) who care for them. Monitoring and encouraging compliance with proper hand hygiene is one of the most important goals of every infection control program.
Human skin is naturally colonized with bacteria; our hands have been estimated to have approximately 4 million bacteria/cm2 of skin, mostly coagulase-negative staphylococci and diptheroids.1–3 After admission to hospital, patients become colonized with different, more pathogenic organisms, some acquired in hospital, others brought from the community but increasing in number by stress of illness and antibiotic treatment.4,5 These bacteria can become the source of nosocomial infections. After caring for a hospitalized patient, the hands of a HCW become contaminated with these “transient flora,”6 which can then be passed onto the next patient cared for, to a chart, phone, or computer, unless removed by hand hygiene.7 The deeper resident flora remains mostly intact.8 Viral pathogens such as the respiratory syncytial virus (RSV) and rotavirus are also transmitted to the hands of HCWs during direct patient care,9 and also by contact with fomites in the room. Hence, hand hygiene is crucial not only after touching a patient but also after entering a hospital room and handling objects in the room.
Gloves are used to decrease the risk of transmission of pathogens to hands of HCWs and have an important role in infection-control guidelines. However, gloves do not completely prevent transmission of organisms to our hands.10 It is, therefore, necessary to clean hands after removing gloves and to change gloves when going from an infected site to a “clean” site.
Artificial nails can become colonized with gram-negative bacteria,11,12 and should not be allowed for HCWs involved in direct patient care. In the nursery, rings are removed prior to washing hands on entering the nursery and should remain off until finished with direct patient care.13 While at least one study has suggested that alcohol-based rubs are not adversely affected by the presence of rings,14 other studies raise concern about the ability to remove bacteria adequately when rings are left on during hand hygiene.13
From Semmelweis’ observation that hand hygiene could decrease the risk of puerperal fever and maternal death in an obstetrical ward in 1847, to a recent study showing decreased catheter-related bacteremia with attention to hand hygiene and infection-control guidelines,15 hand hygiene really does save lives.
How Do We Do Hand Hygiene?
Soaps are detergents that remove organic substances and soiling materials from the hands, removing pathogens mechanically. Plain soaps without any antimicrobial additives reduce the burden of bacteria on the skin. A 15-second handwash can reduce the number of pathogenic bacteria ...