Importance of Keeping Your Hands Clean

from health and fitness

The historic studies of Ignaz Semmelweiss conducted in the mid 19th century at the General Hospital of Vienna and numerous other investigations since then have demonstrated the possibility of infectious diseases being transmitted from patient to patient through the hands of healthcare workers.

Equally scientifically well documented proves the fact that good hand hygiene prevents effective transmission of micro-organisms and decreases the frequency of healthcare associated infections.

Do the health sectors follow the WHO's World Alliance for Patient Safety?

Today, hand hygiene is recognized as the most important measure for reducing the transmission of microorganisms and preventing infection. In spite of this, compliance remains poor and the problem of healthcare associated infections transmitted by doctors' and nurses' hands continue to increase globally.

In the last few years, several strategies to improve compliance and to increase patient safety have been initiated to correct this situation, most importantly the World Health Organizations World Alliance for Patient Safety, which particularly emphasizes the importance of hand hygiene.

The challenges faced by the health sectors

The continuing challenge, however, is getting doctors and nurses to follow recommended hand hygiene practices. Worldwide studies on healthcare workers' compliance toward hand hygiene report, that compliance rates ranges from only 10 percent to 60 percent, depending on the clinical setting.

Key reasons given for not disinfecting hands according to recommended guidelines include lack of time, limited access to hand disinfectants, perception that peers and supervisors do not follow hand hygiene as recommended, and the belief that frequent hand disinfection irritates the skin of the hands and may lead to chronic irritation and hand eczema.

Hence, the question is how hospitals can promote hand hygiene, and if they do so, do they promote something that irritates the healthcare workers' hands?

The amount of medical literature on the issue of skin irritation potentially caused by alcohol based hand disinfectants is scant, and mostly anecdotal. Furthermore, most often it remains rather unclear if irritation was caused by the alcohol alone, chemical additives, detergents contained in hand disinfection products, or other toxic compounds used as stabilizers.

Are the detergents causing irritant skin?

Irritant skin changes in healthcare workers are undoubtedly caused by frequent wet work and contact with detergents. The prevalence of eczematous hand lesions in medical staff ranges between 20 percent and 40 percent. Individuals working in the medical professions have up to six times increased risk for occupational dermatitis.

Irritant contact dermatitis is frequently observed in these occupations and is sometimes regarded as unavoidable. Nevertheless, hand hygiene procedures are often quoted as important underlying factors for the development of hand dermatitis and the assumption of poor skin tolerance remains among one of the major reasons for low compliance rates.

Few studies have been conducted on alcohol's ability to cause skin irritation. When the irritant effects of alcohol on the skin were evaluated, most authors found low toxicity. By contrast, many healthcare workers complain about unacceptable skin irritation caused by alcohol-based hand disinfectants. Even today, several international guidelines pertaining to hand hygiene skin tolerability of alcohol-based hand disinfection products are sometimes viewed as potentially "problematic".

The hand hygiene approach in Prince Court Medical Centre

Prince Court Medical Centre in Kuala Lumpur was built and structured right from the beginning for maximum patient safety and highest quality in health care. Therefore, the management of Prince Court together with the owner decided on a different and new approach for compliance to hand hygiene.

As different conditions and modalities are encountered during clinical work, staff must be able to easily either wash their hands if visibly soiled, or disinfect them before and after each patient contact with an alcohol-based hand disinfectant.

Keeping hands clean and uncontaminated, being able to wash hands without contaminating the surrounding, and having the possibility to disinfect hands at all times are important measures in preventing healthcare associated infections. To be able to perform hand hygiene correctly, health care facilities must ensure adequate provision of hand hygiene installations.

Essentially, these include 5 critical items: washing sink, water faucet, liquid soap dispenser using a cartridge system, alcohol-based disinfectant dispenser, and clean single-use paper towels in adequate dispensers. Implementing one without provision of the others will result in undesired outcomes and the hospital's inability to ensure patients' safety.

Prince Court Medical Centre placed particular emphasis on the positioning of sinks and dispensers in all clinical areas, and meticulous emphasis was placed on the correct adjustment, ergonomic positioning towards each other and fitting of all components.

Interesting findings at Prince Court Medical Centre

Various types of alcohol dispensers have been evaluated in a two weeks quasi experimental setting. Two different models of elbow operated dispensers — one foot-operated dispenser and one sensor controlled dispenser were installed at a location frequently passed by all staff.

Dispensers were all filled with 1000ml of the identical alcohol-based hand disinfectant and the consumption was measured daily at 6 pm. No information was given to staff, and there were no posters or brochures reminding them of the importance of hand hygiene.

After two weeks, the lowest usage of disinfectant was found with the foot-operated model, intermediate usage with the two elbow-operated dispensers, and the highest usage with the sensor controlled dispenser. Because staff was not pre-educated on hand hygiene before the intervention and also because the laymen used the sensor controlled dispenser significantly more often, it is tempting to speculate that the modality of providing hand hygiene plays a significant role in staff acceptability and compliance to hand hygiene.

After all, the purpose of a hospital is to provide quality care to its patients. Quality care starts with designing a healthcare facility around patient safety, as well as ethical and professional obligations to improve the safety of the care of the patient, safety and health of its staff, including a healthy condition of its healthcare workers' hands.