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Hand hygiene... the key to infection control in the healthcare setting

The Centers for Disease Control (CDC) estimates that each year 722,000 patients in the United States acquire a hospital infection, representing about 1 infection for every 25 patients. These infections are becoming  increasingly  hard to treat, and can be life-threatening. Infections are also a complication of care in other settings including long-term care facilities, clinics and dialysis centers. [i]

Although hand washing has been proven to reduce the spread of microorganisms in healthcare facilities, healthcare workers often do not wash their hands. The Joint Commission notes that baseline hand hygiene compliance was around 48% in a sampling of facilities but dramatically improve when barriers are identified, and quality improvement measures are put into place.[ii]

The Joint Commission identified causes of hand hygiene noncompliance that include[iii]:

  • Worker forgot or was distracted
  • Hand rub dispensers or sinks were poorly located, broken or empty
  • Perception that wearing gloves  negated need for hand hygiene
  • Skin irritation from hand cleaning product
  • Inadequate safety culture and lack of accountability
  • Caregiver’s hands were full with no place to put items down to clean hands

Healthcare workers can get bacteria on their hands by performing simple tasks even some that seem to be a “clean” procedure such as taking vital signs.

Other routine activities can create exposure to infection

  • Assisting patients with personal care
  • Delivering care such as injections or specimen collection
  • Preparing food or medications
  • Touching equipment or surfaces

Examples of microbes, some of which are multidrug-resistant, spread by the hands of healthcare workers include:

  • Staph aureus (MRSA)
  • Enterococcus ( VRE)
  • Pseudomonas
  • Clostridium difficile
  • Hepatitis A virus

Healthcare workers are exposed to a multitude of dangerous microbes. putting them at risk of becoming infected, and also infecting others. Patients or healthcare workers carry organisms on their skin, even when they don’t have any wounds or broken skin areas.                    

Healthcare workers can protect themselves, their patients, visitors, co-workers and family members, by using established standard and transmission-based precautions – guidelines set up by the Centers for Disease Control and Prevention (CDC), World Health Organization and others[iv],[v] According to these experts, good hand hygiene is a critical infection control strategy in preventing the spread of infections

  [i] Mark R. Chassin, MD, FACP, MPP, MPH et al. The Joint Commission Journal on Quality and Patient Safety, Improving Hand Hygiene at Eight Hospitals in the United States by Targeting Specific Causes of Noncompliance.  January 2015 Volume 41 Number 1

[ii] Id

[iii] The Joint Commission

[iv] http://www.cdc.gov/handhygiene/

[v]http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf?ua=1

Prevention of healthcare associated infections (HAIs) in the medical office

According to a prevalence survey, there were an estimated 722,000 HAIs in U.S acute care hospitals in 2011. About 75,000 hospital patients with HAIs died during their hospitalizations.1 Because the infection risk in ambulatory settings is the same as in hospitals, the Centers for Disease Control (CDC) recommends that ambulatory facilities follow similar infection prevention procedures as those required in hospitals. According to the CDC, “All healthcare settings, regardless of the level of care provided, must make infection prevention a priority and must be equipped to observe Standard Precautions.”2

The fundamental elements needed to prevent transmission of infectious agents in the ambulatory care setting are as follows:

  • Dedicated resources for infection prevention
  • Education and training for healthcare personnel
  • Monitoring and reporting of healthcare-associated infections
  • Adherence to standard precautions

Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered.

Standard Precautions include: 1) hand hygiene, 2) use of personal protective equipment (e.g., gloves, gowns, masks), 3) safe injection practices, 4) safe handling of potentially contaminated equipment or surfaces in the patient environment, and 5) respiratory hygiene/cough etiquette.

Good hand hygiene is essential for infection prevention. The CDC’s recommendations for hand hygiene in ambulatory care settings are as follows:

1. Key situations where hand hygiene should be performed include:

  • Before touching a patient, even if gloves will be worn
  • Before exiting the patient’s care area after touching the patient or the patient’s immediate environment
  • After contact with blood, body fluids or excretions, or wound dressings
  • Prior to performing an aseptic task (e.g., placing an IV, preparing an injection)
  • If hands will be moving from a contaminated-body site to a clean-body site during patient care
  • After glove removal

2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus). Otherwise, the preferred method of hand decontamination is with an alcohol-based hand rub.

The Joint Commission has addressed the importance of infection prevention with a National Patient Safety Goal (NPSG) to “reduce the risk of healthcare-associated infections.” To demonstrate compliance the healthcare organization must, “comply with either the Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines.” (See the listed resources at the end of this article.)

MagMutual Risk Management and Patient Safety Consultants invite our policyholders’ questions. If you wish to discuss issues related to this article, or have other questions please call us at 1-800-282-4882, and ask for Risk Management.

Resources: For guidance on development of an infection control program and key recommendations related to standard precautions, refer to the Centers for Disease Control’s, “Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care,” (May, 2011).

As a supplement, the CDC has developed an Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care. These resource documents are available on the CDC website at www.cdc.gov.

The Joint Commission Healthcare-Associated Infections (HAIs) portal offers resources on HAI topics and Infection Prevention and Control.

World Health Organization: Guidelines on Hand Hygiene in Health Care

Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.