If you could prevent a patient’s death with a simple maneuver that takes about half a minute, would you do it? Apparently, only one-third of doctors do. What is this simple, life-saving maneuver? It’s cleaning your hands (ie, washing your hands with soap and water, or using an alcohol-based hand rub for disinfection). Only 32% of hospital physicians comply with accepted hand hygiene guidelines, according to infection control researchers, who conducted a systematic review. Nurses have better hand hygiene, though they still fall short, at a compliance rate of only 48%. Thousands of lives on the line Cleaning your hands may seem like a small thing, but it has huge importance. Lives literally depend on it. “Hand hygiene…is considered the most important measure to prevent nosocomial infections and the spread of antimicrobial-resistant pathogens and subsequent nosocomial infections,” wrote the authors of the systematic review. Indeed, hospital-acquired infections are the most common complication of hospital care and one of the top 10 leading causes of death in the United States, accounting for an estimated 1.7 million infections (about 1 in 20 patients), and nearly 99,000 deaths as of 2002. As you’d expect, the prevalence of hospital-acquired infections decreases as healthcare workers’ adherence to hand hygiene guidelines increases. What the guidelines recommend Hand hygiene guidelines from the World Health Organization (WHO) include these measures: Wash hands with soap and water when visibly dirty or visibly soiled with blood or other body fluids, or after using the toilet. Washing with soap and water is also the preferred means if you strongly suspect or know you’ve encountered spore-forming pathogens, including outbreaks of Clostridium difficile. Use an alcohol-based hand rub for routine hand antisepsis in all other clinical situations. Don’t use soap and alcohol-based hand rub concomitantly. The WHO guidelines also indicate hand hygiene in all of these instances: Before and after touching the patient Before handling an invasive device for patient care, even if you wear gloves After contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings If moving from a contaminated body site to another body site during care of the same patient After contact with surfaces and objects (including medical equipment) in the immediate vicinity of the patient After removing sterile or non-sterile gloves Before handling medication or preparing food Here’s the WHO’s hand hygiene technique for using alcohol hand rub (which takes about 20-30 seconds): Apply a palmful of the product in a cupped hand and cover all surfaces of both hands. Rub hands palm to palm. With fingers interlaced, rub the right palm over the back of the left hand, and vice versa. With fingers interlaced, rub hands palm to palm. Rub the backs of your fingers on the opposing palms. Clasp the right palm around the left thumb and rotate, and vice versa. Rub the tips of the fingers of the right hand in left palm, and vice versa. Once dry, your hands are safe. Here’s the WHO’s hand hygiene technique for washing with soap and water (which takes about 40-60 seconds): Wet hands with water and apply enough soap to cover all hand surfaces. Rub hands palm to palm. With fingers interlaced, rub the right palm over the back of the left hand, and vice versa. With fingers interlaced, rub hands palm to palm. Rub the backs of your fingers on the opposing palms. Clasp the right palm around the left thumb and rotate, and vice versa. Rub the tips of the fingers of the right hand in left palm, and vice versa. Rinse hands with water. Dry hands thoroughly with a single-use towel, then use the towel to turn off the faucet. Your hands are now safe. Although a few studies have suggested that certain pathogens may now be developing resistance to alcohol-based hand rubs, it may actually be the added ingredients, and not the alcohol itself, that’s responsible for potential resistance. The WHO and other experts point out that good hand hygiene, when performed appropriately, is still the best way to reduce hospital-acquired infections. Why don’t doctors do it? Seems easy enough, so why don’t doctors comply with these guidelines? According to authors in the CDC’s Morbidity and Mortality Weekly Report (MMWR), doctors and nurses cite a number of reasons for insufficient hand hygiene: Handwashing agents cause irritation and dryness Sinks are inconveniently located/shortage of sinks Lack of soap and paper towels Often too busy/insufficient time Understaffing/overcrowding Patient needs take priority Hand hygiene interferes with healthcare worker relationships with patients Low risk of acquiring infection from patients Wearing gloves/belief that using gloves avoids the need for hand hygiene Lack of knowledge of guidelines/protocols Not thinking about it/forgetfulness No role model from colleagues or superiors Skepticism regarding the value of hand hygiene Disagreement with the recommendations Lack of scientific information of definitive impact of improved hand hygiene on healthcare-associated infection rates Several of these reasons play into one important factor: Having a heavy caseload. Researchers found that when the intensity of patient care goes up (meaning that the guideline-recommended instances of hand hygiene would also go up), adherence to hand hygiene actually goes down. “The lowest adherence rate (36%) was found in intensive-care units, where indications for hand hygiene were typically more frequent (on average, 20 opportunities per patient-hour),” according to authors in MMWR. No one would argue that cleaning your hands 20 times an hour is a lot. But even when doctors aren’t quite so busy, most still don’t clean their hands nearly enough. To that end, the WHO encourages doctors, facilities, policymakers, and patient advocacy groups to participate in its SAVE LIVES: Clean Your Hands campaign. Source
