Hand Hygiene in Healthcare & Post-Pandemic Era

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The Importance of Hand Hygiene1

Lessons on handwashing start at a very early age, as clean hands are one of our best defenses for mitigating the spread of bacteria and illness. Globally, we’ve worn masks to cover our mouths and noses, and we employed fun tactics like singing the “Happy Birthday” song while handwashing to ensure the public was taking proper precautions against the spread of illness.

Why?

Clean hands are important in our daily lives, and the mitigation of infectious disease and bacteria is even more paramount in the healthcare industry where the cleanliness of hands can literally make the difference between life and death.

The Origins of Hand Hygiene in Healthcare2

Did you know that the birth of infection prevention started because of hand hygiene?

In the mid-1840s in Vienna, Austria, a surgeon named Ignaz Semmelweis noticed a discordant number of postpartum women developing puerperal fever. When a colleague died from similar symptoms after being stabbed by a scalpel utilized in a post-mortem examination, Dr. Ignaz Semmelweis hypothesized “cadaverous particles” on the doctor’s hands contributed to the higher rates of puerperal fever.

As a result, Dr. Semmelweis implemented a chlorinated lime solution to clean the hands of the doctors leaving the morgue before examining patients. The mortality rate instantly dropped from 18% the prior month to 2% and remained low. This discovery led to Dr. Semmelweis being named the “Father of Hand Hygiene,” the “Father of Infection Control,” and “Savior of Mothers.” His findings are the basis for what we know today as the Germ Theory of Disease, which states that pathogens, such as viruses or bacteria, can lead to illness or disease.

Learn more about the origins of infection prevention and control here.

Dr. Ignaz Semmelweis – Father of Hand Hygiene
Source: NCBI

Hand Hygiene in Healthcare Today3

80% Of All Infectious Diseases Are Transmitted by Touch

From its origins, hand hygiene in the healthcare setting has always been viewed as very important in the prevention of infections, and there’s a ton of good research that shows that higher hand hygiene rates result in lower healthcare associated infections4 ; however, historically, it has been hard to ensure that healthcare workers are performing hand hygiene at the correct times and indications.

Direct observation has long been the gold standard for evaluating proper hand hygiene in the healthcare setting; however, when caring for patients with COVID-19, it was not always possible to achieve the same level of evaluation. Infection Prevention has had to rely on alternative methods such as secret shopper observations by other staff members, and/or hand hygiene product usage calculations to monitor compliance. None of these are perfect systems but have allowed for continued performance monitoring despite all the pandemic challenges.

In the future, hand hygiene compliance should be fully automated. Enhanced radio frequency identification (RFID) technology can be employed to track hand hygiene compliance by individual, hand hygiene dispenser, and for what specific indication the hand hygiene was performed. This will allow for robust hand hygiene observations, and IPs will be able to monitor and provide feedback in real time.

Ensuring Hand Hygiene in Healthcare

The importance of hand hygiene and standards of cleanliness are never more stressed than in an operating room; however, there are many opportunities for clean or contaminated care outside of the operating room, and some of them are touch points not automatically considered in sanitation guidelines in healthcare.

These common touch points and interactions between care providers and patients that can either maintain cleanliness or spread infection. Evaluate your hand hygiene5:

5 barriers
        of proper hand hygiene displayed around a patient in a hospital bed.
        They include Before patient contact, before the aseptic task,
        after-body fluid exposure, after-patient contact, and after touching
        the patient’s surroundings.Source: World Health Organization

Barriers of Proper Hand Hygiene in Healthcare5

Did You Know Only 5% of People Wash Their Hands Correctly?

The following is a list of self-reported factors for poor adherence with hand hygiene in the healthcare space, as well as suggested solutions to combat poor adherence:

Barriers Solution
Handwashing agents cause irritation and dryness Use of alcohol-based hand rubs decrease the likelihood of drying or irritating the skin
Sinks are incoveniently located/lack of sinks Use of alcohol-based hand rubs are to be used at the point of care, no need to use a sink for routine hand hygiene, only needed when visibly soiled...
Lack of soap and paper towels Only needed as stated above, use of alcohol-based rubs are more effective in killing pathogens and should be used unless hands are visibly soiled
Too busy/insufficient time The time saved by using hand rubs instead of handwashing can save a nurse up to 1 hour daily.
Patient needs take priority Yes, they do, but proper hand hygiene and good patient care should not be mutually exclusive.
Low risk of acquiring infection from patients The risk is always there. By using proper standard precautions and hand hygiene the risk can be cut substantially. But also remember the risk we may cause to the patient. They are the ones with multiple ports of entry and compromised conditions.

Community Commitment to Hand Hygiene

Hand hygiene will continue to remain a key strategy for staying healthy in the community. The Centers for Disease Control and Prevention (CDC) recommends that community members use an alcohol-based hand rub (ABHR) that contains at least 60% alcohol or use soap and water; and, thanks to the pandemic, there’s now a plethora of ABHR options for people.

Regular hand hygiene by community members has many benefits to the community, including reducing respiratory illnesses by 21% and reducing diarrheal illnesses by 31%6. Community members should continue to perform hand hygiene, preferably using an ABHR, during key moments such as before eating or preparing food, and after coughing or sneezing. Handwashing using soap and water should be performed when hands are visibly dirty or after using the restroom.

Global Hand Hygiene in the Post-Pandemic Era

As the current pandemic shifts to COVID-19 as an endemic pathogen, like Influenza, many people are wondering what habits that they acquired in the pandemic should remain. While there are some habits that we can safely get rid of (looking at you, people wearing latex gloves at the grocery store), there are some that should stay for good. Respiratory etiquette, which is covering your cough and/or sneeze, was an effective strategy for preventing transmission of respiratory illnesses prior to the pandemic and will continue to be for other respiratory illnesses going forward7.

More frequent surface cleaning and disinfection should also hang around, as cleaner surfaces translate to a lesser chance of acting as a reservoir or vehicle for infection transmission 9. Air quality has also been a huge focus and employing technology that can rid the air of viral or bacterial pathogens should definitely be considered. However, the one habit that should remain is regular hand hygiene. I believe the increased focus hand hygiene through the pandemic has allowed for reductions in other infectious diseases that are generally transmitted through direct touch, and this increased focus on hand hygiene applies to both the healthcare and community settings.

Fighting the spread of infection is a job for everyone, and continued commitment to proper and thorough hand hygiene, covering our cough, and keeping surfaces clean, will allow us to perform that job well, ensuring the infection prevention and a healthier world.

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