Handwashing: doing it right; adapted from Hand Hygiene Practices, a publication of DebMed, manufacturer of skin care products, with permission. (Cover Features).

Most modern healthcare practitioners have a fundamental appreciation of the traditional role of handwashing in patient care. However, increasing concern about disease transmission by drug-resistant and potent viral microorganisms has led to a re-evaluation of infection-control practices, particularly handwashing measures for healthcare workers and their compliance with them. Recent studies indicate that handwashing practices are less than optimal in some healthcare facilities, and stronger mandates and monitoring of handwashing practices are being recommended.

Hand hygiene decreases colonization with transient flora and can be achieved either through handwashing or hand disinfection. The purpose is to destroy or remove transient microorganisms from the hands. In addition to handwashing with antiseptic products, hand disinfection also includes the use of alcohol-containing waterless hand sanitizers.

Bacterial counts increase when the skin is damaged; therefore, hands should be protected by wetting prior to washing, particularly with antiseptic agents. Thorough rinsing and drying is necessary. Hands can be further protected by applying a good-quality hand cream or lotion. Note Because some hand creams containing an anionic emulsifying agent reduce the residual antibacterial effect, of chlorhexidine, these hand creams should not be used.

Dermatitis in healthcare personnel can place resin dents at risk, because handwashing will not decrease bacterial counts on dermatitic skin, which contains high numbers of microorganisms. Lost integrity of the skin increases risk of exposure to bloodborne pathogens during skin contact with blood or body fluids. Gloves should be worn for any activity where body fluids might contaminate hands compromised by dermatitis.

Which Products to Use

In practice, the effect of handwashing products on the skin of healthcare personnel, patients and residents influences the frequency of handwashing. Choosing suitable nonirrirating cleansing agents improves compliance with hand-hygiene policies. In most situations, routine handwashing with water and plain soaps formulated to be mild and pleasant to use, such as those found in liquid, gel or foam products, is sufficient to physically remove most transient contaminants. Nonreservoir soap dispensers with disposable nonlatex cartridges reduce the risk of soap contamination, compared with refillable containers.

In high-risk areas and when reducing nosocomial (facility-caused) infection is of paramount concern, the use of an antiseptic hand-hygiene product maybe considered.

Alcohol is an effective alternative when water or towels are not readily available, or when there is a need for rapid hand disinfection. Alcohol is more effective than aqueous antiseptic solutions, but a preliminary wash is always needed for soiled hands. Modern alcohol-based formulations contain emollients or skin-conditioning agents to reduce or eliminate drying effects.

When disinfecting with alcohol sanitizers, remember:

1. Soiled hands must be washed prior to hand disinfection with a waterless (alcohol-based) product.

2. Wash or disinfect with waterless products for at least 15 seconds (for routine hand hygiene rather than surgical hand hygiene).

3. Use CHG (chlorhexidine gluconate) and latex-compatible lotions/creams to help protect and maintain healthy, intact skin.

Improving Compliance

There are several steps facility management can take to help promote good hand hygiene, i.e., by providing:

* effective communication about infection control;

* constant creative and innovative in-service education for all staff;

* adequate and conveniently located cleansing facilities and dispensing equipment;

* gentle, pleasant-to-use products specially formulated for healthcare settings;

* visual reminders to promote good hand hygiene;

* demonstration of handwashing or hand-disinfecting techniques;

* auditing of handwashing or hand hygiene on site;

* encouragement of staff initiatives to improve effective hand hygiene;

* high-profile infection-control team members;

* a commitment to improve resources and educational intervention if problems are identified; and

* an understanding of the costs of poor hand hygiene. NH

DebMed is the Healthcare Division of Deb-North America. It is a worldwide manufacturer of skin care products, with a new range of products to be introduced this fall. For further information, phone [phone], fax [phone] or visit www.debmedus.com.