Standard Precautions for All Patient Care and Hand Hygiene Perform Hand Hygiene

Standard Precautions are used for all patient care. They’re based on a risk assessment and make use of common sense practices and personal protective equipment use that protect healthcare providers from infection and prevent the spread of infection from patient to patient.

Hand hygiene protects you and those receiving the care you provide. The simple act of cleaning your hands can prevent the spread of germs, including those that are resistant to antibiotics. Some healthcare personnel may need to clean their hands as many as 100 times during a work shift. Keeping the skin on your hands healthy and clean is a challenge that requires all healthcare personnel to be knowledgeable about how to care for their hands and when hands should be cleaned.

Show Me the Science

Is there such a thing as too clean? 
- Germs are everywhere. They are within and on our bodies and on every surface you touch. But not all germs are bad. We need some of these germs to keep us healthy and our immune system strong. - Your hands have good germs on them that your body needs to stay healthy. These germs live under the deeper layers of the skin. - Your hands can also have bad germs on them that make you sick. These germs live on the surface and are easily killed/wiped away by the alcohol-based hand sanitizer. - Using an alcohol-based hand sanitizer is the preferred way to keep your hands clean. - Alcohol-based hand sanitizers kill the good and bad germs, but the good germs quickly come back on your hands.

Washing with soap and water: 15 VS 20 seconds
- Wash your hands for at least 15 seconds, not specifically 15 seconds. - The time it takes is less important than making sure you clean all areas of your hands. - Alcohol-based hand sanitizers are the preferred way to clean your hands in healthcare facilities.
Guidelines for Hand Hygiene in Healthcare Settings Published 2002

Which One? Soap and Water VS Alcohol Based Hand Sanitizer
An alcohol-based hand sanitizer is the method for cleaning your hands when they are not visibly dirty because it: - Is more effective at killing potentially deadly germs on hands than soap - Is easier to use during the course of care, especially    when moving from soiled to clean activities with the same patient or resident    when moving between patients or residents in shared rooms or common areas - Improves skin condition with less irritation and dryness than soap and water
CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings
2. Guidelines for Hand Hygiene in Healthcare Settings Published 2002

Areas frequently missed when cleaning your hands These areas are most often missed by healthcare providers when using alcohol-based hand sanitizer: - Thumbs - Fingertips - Between fingers References Widmer, A. F., Dangel, M., & RN. (2004). Alcohol-based hand rub: evaluation of technique and microbiological efficacy with international infection control professionals. Infection Control and Hospital Epidemiology, 25(3), 207-209.

Glove use is not a substitute for cleaning your hands
- Always clean your hands after removing gloves. Dirty gloves can soil hands. - It is important to change your gloves:

IF Gloves are Damaged IF Moving from contaminated body site to clean body site IF Gloves look dirty or have blood or bodily fluids on them after completing a task

Then Gloves look dirty or have blood or bodily fluids on them after completing a task

Guidelines for Hand Hygiene in Healthcare Settings Published 2002

Technique Matters
- Use the right amount of alcohol-based hand sanitizer product to clean your hands - The efficacy of alcohol-based hand sanitizer depends on the volume applied to the hands References Widmer, A. F., Dangel, M., & RN. (2007). Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infection Control and Hospital Epidemiology, 28(1), 50-54.

C.Difficile and Alcohol Based Hand Sanitizer

- C. difficile is a spore-forming bacterium that can lead to a common healthcare-associated infection causing severe diarrhea. Spores are an inactive form of the germ and have a protective coating allowing them to live on surfaces for months.
- The bacteria can be transferred to patients via the hands of healthcare providers who have touched a contaminated surface or item.
- Unless hands are visibly soiled, alcohol-based hand sanitizer (ABHS) is preferred over soap and water for cleaning hands in most clinical situations.1,2 This recommendation does not vary when caring for patients with C. difficile infection (CDI).
Although there is a theoretical advantage to cleaning hands with soap and water when caring for patients with CDI, CDC still indicates a preference for ABHS as studies have not shown a clear prevention benefit for soap and water and removing ABHS risks reducing hand hygiene compliance overall.

- When entering the room of a patient with C. difficile, the priority should be to ensure glove use (in addition to a gown) and proper technique when removing gloves to minimize the risk of self-contamination.3 Current evidence demonstrates that C. difficile spores may not be fully removed from hands, regardless of the method used to clean hands. This further emphasizes the need for appropriate use of gloves for the care of patients with CDI.

One study found that most hand wash products produced less than a 1-log reduction in difficile spores and found the number of spores removed did not vary statistically from the number of spores removed from washing hands with tap water alone.3,4
Several controlled studies have found alcohol-based hand rub to be ineffective at removing or inactivating C. difficile spores from the hands of volunteers contaminated with a known number of spores compared to hand washing.3,5,6
Notably, one study did find a reduction of spores from the palmar surface of the hand with the alcohol-based hand rub.3,5

C.Difficile and Alcohol Based Hand Sanitizer

- Although alcohol-based hand rub is ineffective at removing or disinfecting C. difficile spores in controlled laboratory experiments, clinical studies have not demonstrated an increase in CDI with the use of ABHS products or a decrease in CDI with the use of soap and water.3 For example: Knight et al. found no evidence of an increase in CDI after implementation of an ABHS policy in a 795-bed community teaching hospital, including during the care of patients with CDI (incidence rate of 3.98 per 10,000 patient-days after implementation, compared with 4.96 before; P=.0036).7 Boyce et al. demonstrated no increase in the incidence of CDI over a three-year period despite a significant and progressive increase in the use of ABHS in their 500-bed hospital. In addition, they found an increase in the overall hand hygiene compliance rate from 38% at baseline to 63% after ABHS implementation.8 An observational study compared three years without ABHS use to three years with ABHS as the primary method for cleaning hands and demonstrated a 21% decrease in healthcare-acquired methicillin-resistant Staphylococcus aureus (MRSA), a 41% decrease in vancomycin-resistant Enterococcus (VRE), and no change in the incidence of CDI.9
References - Sources