Hand washing has been shown to reduce nosocomial infection dating
back to Semmelweis’ historic research on obstetric infections
in the 1800s. Hand washing is now the focus of recommendations and
requirements from the Centers for Disease Control and the Joint
Commission for Accreditation of Healthcare Organizations. It is
also widely felt to be the best measure to prevent the emergence
and transmission of drug-resistant nosocomial infections, such as
Methicillin Resistant Staphylococcus Aureus (MRSA).
- ▪ Plain (detergent) soaps: Used for cleansing but lack
intrinsic antimicrobial properties.
- ▪ Antimicrobial soaps Detergent plus an antimicrobial such
as alcohol, chlorhexidine, or povidone-iodine.
- ▪ Alcohol-based hand rub: Contain ethanol or isopropanol
and denature proteins when used in water-containing solutions; rapidly
active against bacteria, mycobacteria, fungi, and viruses; typically
combined with moisturizer to prevent hand chapping.
- ▪ Chlorhexidine and iodophors: Alternative antiseptic agents
with intermediate speed of action and variable activity against
infectious agents, chlorhexidine has good persistence (see below).
- ▪ Visibly soiled hands: Show visible dirt or proteinaceous
material, blood, or body fluids.
- ▪ Persistent (antimicrobial) activity: The property of certain
hand-cleansing agents having extended antimicrobial action.
- ▪ Visibly soiled hands: Wash with soap and water.
- ▪ Before eating or after using the restroom: Wash with soap
- ▪ Not visibly soiled hands: Use an alcohol-based hand rub
under the following circumstances:
- —Before direct patient contact
- —Before donning sterile gloves for a procedure
- —Before insertion of urinary catheters, intravascular
devices, or other invasive devices
- —After contact with a patient’s skin
- —After contact with bodily fluids, excretions, or
- —After contact with inanimate objects in the immediate
vicinity of a patient (ie, ventilator, bed rail)
- —After removing gloves
- ▪ Remove visible debris from beneath fingernails.
- ▪ Routine hand washing: Wet hands with water, apply recommended
amount of soap, and rub hands together vigorously for at least 15
seconds covering all surfaces of hands and fingers. Dry with disposable
paper towel and turn water off with towel.
- ▪ Decontamination with alcohol-based hand rub: Apply product
to palm of one hand and rub hands together covering all surfaces
of hands and fingers until hands are dry (Figure 4-1).
- ▪ Additional recommendations for healthcare workers
- —Remove rings, watches, and bracelets before
- —Do not wear artificial fingernails.
- —Keep natural fingernail length less than 1/4 in
- —Wear gloves when in contact with blood or other
- —Remove gloves after patient care.
- —Change gloves when moving from one patient to another.
- ▪ Recommendations for healthcare institutions
- —Make improved hand hygiene adherence an institutional
priority (Figure 4-2).
- —Solicit multidisciplinary input in the development
of policies pertaining to hand hygiene and product selection.
- —Ensure ready access to alcohol-based hand rub (Figure
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