Beat germs handily: preventing infection with clean hands.

The Centers for Disease Control and Prevention (CDC) published the Guidelines for Hand Hygiene in 2002, laying out a comprehensive standard for hygiene and infection control. Following is a compilation of its instructions.

Infection control is an ever more serious situation in long-term care facilities nationwide. Washing your hands often is the simplest way to prevent the spread of infection in the facility, but there's a great deal to know about soap, technique, decontamination, and the handling of equipment.

Area 1: When to wash your hands

** Wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water when handling an item that is visibly dirty, contaminated with proteinaceous material, or visibly soiled with blood or other body fluids.

** If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described below.

** If a resident has a condition caused by spores, such as clostridium difficile, or rotavirus, or norovirus, wash hands with soap and running water. Alcohol will not eliminate spores. The friction and running water will remove them from your hands during handwashing.

** Alternatively, wash hands with an antimicrobial soap and water in all clinical situations.

** Decontaminate hands before having direct contact with residents.

** Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure.

** Decontaminate hands after contact with a residents intact skin (e.g., when taking a pulse or blood pressure or repositioning a resident).

** Decontaminate hands after contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled.

** Decontaminate hands if moving from a contaminated body site to a clean body site during resident care.

** Decontaminate hands after contact with inanimate objects, including medical equipment, in the immediate vicinity of the resident.

** Decontaminate hands after removing gloves.

** Wash hands with a nonantimicrobial soap and water or with an antimicrobial soap and water before eating and after using a restroom.

** Do not wear artificial fingernails or extenders when having direct contact with residents at high risk for infection.

Area 2: Use the right soap

** Wash hands with nonantimicrobial soap and water or with antimicrobial soap and water if exposure to bacillus anthracis or any other condition spread by spores is suspected or proven. The physical action of washing and rinsing hands water such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores.

** No recommendation can be made regarding the routine use of nonalcohol-based hand rubs for hand hygiene in healthcare settings. This refers to hand cleansers containing triclosan and other products known to eliminate pathogens.

** Antimicrobial-impregnated wipes (i.e. towelettes) may be considered as an alternative to washing hands with nonantimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of healthcare workers, they are not a substitute for an alcohol-based hand rub or antimicrobial soap.

Area 3: Handwashing technique

** When decontaminating hands with an alcohol-based rub, apply product to the palm of one hand and rub hands together, covering all surfaces of hands and fingers, until the hands are dry. This should take at least 15 seconds.

** Follow the manufacturer's recommendations regarding the volume of product to use.

** When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use the towel to turn off the faucet.

** Avoid using hot water because repeated exposure to hot water may increase the risk of dermatitis.

** Liquid, bar, leaflet, or powdered forms of plain soap are acceptable when washing hands with a nonantimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and small bars of soap should be used.

** Multiple-use cloth towels of the hanging or roll type are not recommended for use in healthcare settings.

Personal protection

Beyond handwashing, you should wear personal protective equipment (PPE) when the nature of the anticipated resident interaction indicates that contact with blood or body fluids may occur. During care delivery, avoid touching surfaces in close proximity to the resident. Prevent contamination of clothing and skin during the process of removing PPE. Before leaving the resident's room or cubicle, remove and discard gowns and gloves.

Regularly educate your staff on the importance of gloves, masks, respiratory protection, eye protection, face shields, gowns, protective garments, sharps, and all other types of PPE.

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Gloves are worn to provide a barrier against pathogens and prevent contamination of the hands when touching blood, body fluids (except sweat), secretions, excretions, mucous membranes, nonintact skin, or potentially colonized intact skin (e.g., of a resident with diarrhea). Observe the following with regard to gloves:

* Gloves reduce the possibility that pathogens on the hands of the healthcare worker will be transmitted to residents and that pathogens from another resident or piece of equipment will be transmitted from the hands of the healthcare worker to the resident

* Gloves should be changed frequently if they contact high concentrations of infective material

* Gloves should be changed immediately before contact with mucous membranes or nonintact skin if gloves are being worn during resident care

* Gloves cannot replace the need for handwashing--they have defects that cannot be seen but allow pathogens to enter, and hands can become accidentally contaminated when gloves are removed

* Changing gloves and washing hands may be necessary several times during the course of caring for one resident to prevent cross-contamination between body sites

* It is not necessary or desirable to wear gloves for all resident contact if you understand and apply the principles of standard precautions

* Wear gloves with fit and durability appropriate to the task

* Wear disposable medical examination gloves for providing direct resident care

* Wear disposable medical gloves or reusable utility gloves for cleaning the environment or medical equipment

* Remove gloves after contact with a resident or the surrounding environment, including medical equipment, using the proper technique to prevent hand contamination

* Do not wear the same pair of gloves for the care of more than one resident

* Do not wash gloves for reuse with different residents

* Change gloves during resident care if the hands will move from a contaminated body site, such as the perineal area, to a clean body site, such as the face

* If rings are worn, smooth, simple bands are best to prevent glove tearing

--Barbara Acello

Barbara Acello is an independent nurse consultant and educator in Denton, Texas. She is a member of the Texas Nurses' Association, and the American College of Healthcare Administrators. Mrs. Acello has worked as a long-term care facility consultant and educator in eight states, and has written many textbooks, journal articles, and other materials related to long-term care and nursing assistant education. She may be contacted at [e-mail].