CDC describes hand hygiene as a general term used to explain handwashing, antiseptic hand rub, antiseptic hand wash and surgical hand antiseptics.1 Proper hand hygiene is one of the most important aspects of infection prevention within healthcare, including home health.
Healthcare associated infections (HAIs) are those acquired during the treatment of other conditions in any healthcare setting, including in the home.2 CDC emphasizes the detrimental effects of HAIs by reporting that these infections have been recognized as one of the top-10 leading causes of death in the U.S.
Whether initially acquired in the hospital or home environment, HAIs can increase patient morbidity and mortality and lead to increased healthcare costs that can amount to billions of dollars and close to 100,000 deaths each year.3-5
Compliance with hygiene guidelines should include instructions on proper hand hygiene techniques. This includes length of time washing; correct products (soap and warm water, alcohol-based gels or foams, sanitizer sprays, etc.); the frequency of performing practices in relation to patient contact; and when the episodes occur in relation to certain activities, such as before patient care or after touching inanimate objects.6-9
Several studies have documented reasons given by healthcare professionals as to why proper hand hygiene was not completed and include not having enough time or proper products available; not having knowledge of guidelines or having personal beliefs that go against the practice; being understaffed, overworked, forgetful; or experiencing skin irritation by the products.6,7,9
To improve compliance, there are several methods that will produce positive results. Educational programs such as poster campaigns in the home office, direct demonstration and use of other visual programs, questionnaires and pre- and post-test evaluations can result in improved compliance.7 Other possible methods such as direct observation with follow-up reports and discussions and repeated monitoring have all been effective to a point.6,10
Evidence of Reduced Infection
Maskerine and Loeb noted that 15-30 percent of HAIs can be prevented through improved hand hygiene practices.11
In a study by Gould et al., the amount of bacteria on home healthcare workers' hands were measured at the start of the day and before each patient visit.9 The results of this study found: "nurses' fingers were frequently contaminated with large numbers of transient bacteria of the type that can cause iatrogenic infections."
Maliekal, et al. found there was more than 90 percent bacterial density on hands prior to hand hygiene practices, yet after using soap and water, that number dropped to 50 percent; and with alcohol-based rubs the bacterial density was just 5 percent.
Alcohol-Based vs. Soap & Water
Several studies have proved that alcohol-based products are more effective than traditional soap and water in reducing bacteria on hands.4,12 It is further noted in several studies that use of alcohol-based products produces less skin irritation and dryness than use of soap and water.4,7,13,14 It was also found that use of alcohol-based rubs was more cost efficient for a facility in that less product and less time was used to perform hand hygiene for healthcare personnel.14
All studies reviewed concluded alcohol-based products are most effective for routine disinfection and cleansing but that soap and water should be used when hands are visibly soiled with blood or other body fluids such as fecal material or urine.1
Finally, in studies that evaluated the use of alcohol-based products, participants commented positively on the improved look and feel of their skin after using alcohol-based products. It was noted that participants preferred alcohol-based products over soap and water in relation to the potential damage to skin.7,9,14,15
This would lead to the belief that use of alcohol-based products produces less damage to skin than traditional soap and water does and that staff would be more likely to use it for this reason.
Based on the research evidence, there needs to be more consistent and repetitive instruction given to healthcare professionals in regard to the benefits of proper hand hygiene practices. As well, the benefits of using alcohol-based products seem to outweigh any potential negatives.
In home health care, personal-sized bottles could be provided to staff to promote proper hand hygiene. By providing staff with the alcohol-based hand gels, agencies can encourage healthcare workers to practice hygiene according to CDC guidelines while promoting improved skin conditions.
This simple step can be a sure way to create compliance with this important practice for both staff and patients alike.
References for this article can be accessed here.
Linda Snyder is a wound care nurse at Keystone Home Health Services in Wyndmoor, PA. She is currently completing her MSN through Walden University.