DIV19/45: New Approaches to Hand Hygiene (27 February 2020)

Issue Date: 27 February 2020
Ref: DIV19/45

New Approaches to Hand Hygiene

The importance of hand hygiene has been understood and accepted for a long time. The majority of infections – around 80 per cent according to studies – are passed by hand to hand contact or by touching a contaminated surface. This is why hand hygiene and surface disinfection are critical to infection prevention in hospitals, care homes and other settings.

One would imagine that hand hygiene would be the easiest of everyday activities to get right. We all learn at an early age to wash our hands before eating and after going to the toilet. But studies have shown that relatively large numbers of people forget – or refuse – to do this. Even in settings such as hospitals, where poor hand hygiene can have serious consequences, studies suggest that processes can be improved, compliance rates increased and infection rates reduced.

Despite established and robust infection prevention procedures, studies show that infection rates in hospitals run at around 10 per cent – that is one in ten – of all patients. While this is far lower than the past, many facilities have found it difficult to reduce the rate further. This is why current thinking is towards more effective hand hygiene processes and focusing on critical tasks.

The recommended procedure for using hand rubs, for example, proscribes six separate steps. This is a tried and tested technique that is known to be effective at reducing infection rates when followed correctly. However, following all six steps correctly in the real world can sometimes be difficult. Researchers wanted to test if alternative, simpler techniques could be just as effective. 

One study compared the WHO’s current six-step hand rub method with a three-step method that involved covering the entire hand with alcohol rub and then focusing on the fingertips and thumbs. The results were significant and, to many, surprising. The three-step method was more effective at reducing the levels of bacteria on the subjects’ hands. A separate study focused on the fingertips because these are generally accepted to be the most contaminated part of the hand – this intuitively makes sense because it is quite possible to touch and hold all manner of surfaces and objects with the fingers alone. Trials of a fingertip-first method of hand hygiene demonstrated a greater reduction in the number of bacteria than the existing six-step methodology.

Alongside new and improved hand hygiene techniques like these, attention has turned to when health workers should clean their hands. The World Health Organisation’s “Five Moments of Hand Hygiene” initiative has helped reduce infection rates in healthcare settings. These recommend healthcare workers wash their hands: before touching patients; before clean/aseptic procedures; after body fluid exposure; after touching patients; after touching patient surroundings.

But despite progress, studies suggest between 20 and 40% of healthcare associated infections arise when a healthcare worker passes pathogens from one patient to the next. The latest thinking is for a more targeted approach that encompasses hand hygiene and surface disinfection.

All areas in care settings are cleaned and disinfected daily, as before, but additional attention is paid to frequent touch and high-risk surfaces. In practice, this has been distilled into five critical points: before placing food/drink on over-bed tables; after procedures involving faeces or respiratory secretions within the patient bed-space; before/after any aseptic practice; after patient bathing (within bed-space); after any object used by/on a patient touches the floor.

For its part, the cleaning and hygiene industry continues to develop innovations that help to make processes simpler, safer and more sustainable while improving performance and infection rates. Diversey offers a wide range of hand hygiene and surface disinfection products for healthcare and other settings. As a leading supplier with years of experience, the company can advise on the right combination of products for every setting and situation.

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