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