Hand Washing

Aka: Hand Washing, Handwashing, Hand Disinfection, Hand Hygiene, Hand Washing Education, Prevention of Healthcare Associated Infection, Cleaning Tips in Medical Care

1. See Also
   1. Health Care Associated Infection
2. Background
   1. Semmelweis in 1847 Austria identified the importance of Hand Washing in reducing perinatal mortality
      1. https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives
   2. Medical staff (esp. physician) compliance is low
      1. Despite the clear benefits of Hand Washing in Prevention of Healthcare Associated Infection
3. Epidemiology
   1. Healthcare Associated Infection affects 1.7 Million patients per year in U.S. (10% of inpatients)
      1. Kills 90,000 patients per year
4. Approach: Hand Hygiene
   1. See Dry Hand Management
   2. General Measures
      1. Perform Hand Hygiene between every patient (make it a habit)
      2. Include Fingernails, palms, and the back of the hand
      3. Also foam over and around rings, watches as well as stethoscopes
      4. Keep Fingernails trimmed
      5. Avoid wearing shirt sleeves below the elbows
   3. Preparations
      1. Alcohol-based foams (minimum of 60% Ethanol or 70% isopropanol concentration)
         1. Effective and preferred in most instances
      2. Soap and Water
         1. Indicated when visible dirt is present, as well as after caring for patients with Diarrhea (esp. Clostridium difficile)
         2. Wash for 20 seconds (or sing Happy Birthday song twice)
   4. Efficacy
      1. Reduces Diarrheal illness episodes by 30%
         1. Ejemot (2008) Cochrane Database Syst Rev (1):CD004265 +PMID:18254044 [PubMed]
      2. Substantially reduces Healthcare Associated Infections
         1. Pittet (2000) Lancet 356(9238):1307-12 +PMID:11073019 [PubMed]
         2. Stone (2012) BMJ 344: e3005 +PMID:22556101 [PubMed]
5. Approach: Clothing and other Worn Items
   1. See Personal Protection Equipment
   2. See Respiratory Personal Protective Equipment
   3. See Donning and Doffing PPE
   4. White coats
      1. White coats harber Bacteria, especially resistant Bacteria (esp. at the cuffs) and even with frequent washing
      2. Banu (2012) J Clin Diagn Res 6(8): 1381-4 [PubMed]
   5. Neck ties
      1. Neckties frequently culture positive and easily transmit Bacteria to patients
      2. McGovern (2010) J Hosp Infect 75(2): 138-9 [PubMed]
      3. Weber (2012) J Hosp Infect 80(3): 252-4 [PubMed]
   6. Stethoscope
      1. Uniformly culture positive (clean them with foam or Alcohol wipes)
      2. Merlin (2009) Prehosp Emerg Care 13(1): 71-4 [PubMed]
      3. Lecat (2009) Am J Infect Control 37(3): 241-3 [PubMed]
   7. Rings
      1. Smooth rings are not typically a source of infection
      2. Al-Allak (2008) Ann R Coll Surg Engl 90(2): 133-5 [PubMed]
   8. Surgical Scrubs
      1. Easy to clean and typically washed after every use
      2. Patients do not perceive scrubs as unprofessional (preferred by patients over white coat, business clothing)
         1. Petrilli (2018) BMJ Open 8(5): e021239 [PubMed]
      3. Home washing surgical scrubs does not appear to increase infection risk
         1. https://pdfs.semanticscholar.org/5bc6/c4979fceccfe55fa639d69195e39dea405ed.pdf
6. Pearls: Cleaning Tips in Medical Care
   1. Clothing stains from blood
      1. Hydrogen Peroxide removes
   2. Bubble Gum in hair
      1. Peanut butter removes
   3. Corrosion metal contacts (battery compartments, connectors)
      1. Vinegar on cotton swab removes corrosive material
7. Resources
   1. WHO Guidelines on Hand Hygiene in Health Care
      1. https://www.ncbi.nlm.nih.gov/books/NBK144018/
8. References
   1. McCullum in Herbert (2019) EM:Rap 19(10):11-3