Healthy hands save lives
23 March 2021
Chris Wakefield reviews the specific moments that hand hygiene is required in healthcare settings and how it can be implemented most effectively to boost compliance.
THESE DAYS the importance of hand hygiene and its ability to break the chain of infection is widely known and accepted. The pandemic has reinforced this like never before, across all industries. However, having been proven to reduce the spread of coronavirus, healthcare associated infections (HCAIs) by up to 50%, as well as lowering the risk of antimicrobial resistance, it is absolutely critical that workers keep their hands clean in hospitals and other healthcare settings.
In fact, this is something that the World Health Organization (WHO) promotes annually on 5 May. This year its advocacy campaign, ‘Save Lives: Clean Your Hands’ focuses on achieving appropriate hand hygiene action at the point of care. Its slogan reinforces the message that taking a little extra time to practise hand hygiene makes all the difference.
To prevent the spread of infection and ensure patient safety, healthcare workers should practise hand hygiene at five key moments. These include: before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching a patient’s surroundings.
It is important then, that hand hygiene products (for example, alcohol-based hand rubs, if available) are easily accessible and as close as possible – within arm’s reach of where patient care or treatment is taking place. According to guidelines, point-of-care products should be accessible without having to leave the patient zone.
However, opportunities for infections to spread are not limited to the five aforementioned moments, but can be transferred in a variety of other ways by healthcare workers. Hands should also be washed or sanitised before and after eating, using the washroom, and after touching objects that could potentially be harbouring pathogens. For example, grim research has found faecal matter on the handles of kettles, whilst other studies have discovered that smartphones could be covered in up to ten times as much bacteria as a toilet seat – and that people check them every 12 minutes of the waking day!
When you consider that contaminated hands can sequentially transfer some viruses to up to seven surfaces, and that fourteen people can be contaminated by touching the same object one after the other, like the many lift buttons, screening curtains, and door handles found in hospitals, it’s clear to see how infections can spread so easily and why hand hygiene is paramount.
This not only protects vulnerable patients, but also prevents staff from picking up an infection themselves, resulting in them spreading germs at an increased rate.
How to implement hand hygiene effectively
Therefore, when implementing or upgrading a hand hygiene system, healthcare and hospital facilities managers should pay attention to the correct choice and positioning of hand washing and sanitising solutions throughout the entire site. If improvement initiatives are to succeed and effect any lasting behaviour change, it is essential that everyone within the building can access facilities.
The correct choice and positioning is crucial to influencing hygienic practices. Dispensers can be wall-mounted, free-standing, push-activated or touch-free. In fact, contactless technology has become increasingly popular, as these dispensers intuitively release just the right amount of product without the user physically having to touch it. Since a precise amount is delivered, there is less mess and wastage too.
Supplying hand rub in different formats is also a good idea. According to research we undertook with healthcare trusts last year, overburdened and stressed staff felt as if they didn’t have time to clean their hands as often as they should. Issuing staff with small form factors, such as personal bottles of PURELL Advanced Hygienic Hand Rub, means they can sanitise whilst moving between patients, reducing this lost time.
Installing a hand sanitiser dispenser at the washroom exit can also help to improve hygiene levels. If people have not washed their hands properly, germs can be spread onto the door handle and other surfaces that they touch when they leave the washroom. In fact, research has revealed that one single contaminated door handle can infect up to 60% of the occupants of a building within just four hours. Placing a sanitising dispenser at washroom exits provides an extra opportunity for hand hygiene, as well as offering an additional layer of protection. Positioning it between 36" to 46" above the floor, on the handle side, is the optimum height to trigger proper hand hygiene behaviour and prevent the transmission of bacteria to and from door handles.
Appropriate awareness-raising signage in washrooms and at germ hotspots can also help influence compliance. They not only act as a good prompt, but also a reminder of the best techniques.
Product selection is critical, and there is currently more choice than ever before. The pandemic has prompted many companies to begin manufacturing hand hygiene products and as a result, there is a plethora of antimicrobial soaps and sanitising gels on the market. But not all hand gels are equal, either in terms of their impact on skin health or their efficacy. In fact, several products have been pulled from European markets recently, due to compliance and safety issues. It’s therefore essential to choose a brand that you can trust.
Above all, the products selected must be effective. Choose soaps or sanitisers whose efficacy against germs has been proven through independent scientific testing and conform to key hospital norms EN 1500, EN 14476 and EN 12791. This provides assurance that they are safe to use in healthcare settings.
Selecting products that reach their stated efficacy levels quickly can be a key differentiator too. For example, PURELL Advanced Hygienic Hand Rub has proven to be effective against Coronavirus in just 30 seconds, helping to reduce the amount of time required for busy healthcare workers to clean their hands effectively.
Overcoming compliance challenges
As a member of the WHO Private Organizations for Patient Safety group, GOJO is a strong advocate of making hand hygiene second nature to everyone in a healthcare setting and has worked closely with facilities to understand the barriers to hand hygiene performance and the needs of workers. Non-compliance can occur due to a variety of factors, such as insufficient time or patient needs taking precedence. Another common reason cited is skin irritation, often the result of repeated washing and sanitising of hands.
In fact, recent research has shown that 59% of healthcare workers seen in occupational skin disease clinics, set up during the COVID-19 pandemic, were found to be affected by irritant contact dermatitis due to an increased use of personal protective equipment (PPE) and frequent hand washing. The same study also revealed that 18% required time off work as a result of occupational skin problems.
This exposes how serious a subject skin irritation is. It is much more than mild discomfort – skin may itch, become dry, sore and red, and develop small blisters or painful cracks. As well as being painful, damaged skin poses a significant infection risk, as it stops acting as an effective barrier to germs. Not only is the sufferer more at risk of catching infectious diseases such as COVID-19 or influenza, but they are also more likely to transfer these to surfaces and other people, the very opposite of what a hand hygiene programme seeks to achieve!
What’s more, those with irritated skin are much less likely to perform regular hand hygiene, due to concern it will hurt or aggravate their condition further, resulting in them spreading germs around a facility at an increased rate. Therefore, formulations must strike a balance between efficacy and user safety.
As well as proven efficacy against bacteria and viruses, products must also care for hands. Opt for products that are enriched with nourishing agents to help keep skin healthy and feeling soft and refreshed. There is also value in supplying hand cream to rehydrate and replenish oils. This helps to reduce the risk of skin shedding, which can cause additional irritation.
Soap and water vs sanitising gel
Whilst soap and water are perfect for cleaning dirty hands, the WHO recommends using hand sanitiser when they are not visibly soiled. Contrary to what most people think, hygienic hand rubs can actually be a kinder choice for skin than the traditional method of washing with soap and water. Studies have shown that when nurses used an alcohol-based hand rub with moisturising effect for two weeks, like PURELL Advanced Hygienic Hand Rub, skin irritation and dryness decreased.
Giving healthcare workers access to products and systems that they actually enjoy using can only help towards achieving a greater success rate of reducing infections through improved hand hygiene. Additionally, since the WHO has designated 2021 as the ‘International Year of Health and Care Workers’, it is fitting and appropriate that they have access to products that do not harm, but instead, protect their hardworking hands.
The correct systems play a critical role in the promotion of healthy hand hygiene behaviour. To be truly successful, they need to combine good aesthetics, accessibility and ease of use, with effective but skin-friendly formulations. Put simply, they need to provide the right products, in the right place, at the right time.
Chris Wakefield is managing director UK & Ireland, GOJO Industries-Europe.