A new approach to hand hygiene

There is no question that inadequate hand hygiene is a major cause of health care associated infections (HCAI) by which is meant the acquisition of an infection either by those working in health care or those undergoing treatment. The cost to our health care services is enormous, so any action that can reduce the incidence of HCAIs must be welcomed. Unfortunately, all too often action is taken to prevent these that is counter productive. 

For an HCAI to occur there must be a source of infective material and a means of transfer of this to a target person. There are several possible routes of transfer, some of which will involve contact with potentially contaminated surfaces. So not only is there a need to ensure that hands are not contaminated, but that those surfaces which could cause the hands to become contaminated are also free of infective micro-organisms. Thus those engaged in cleaning can play a major role in the prevention of HCAIs. However, this article is concerned with how the maintenance of high standards of personal hand hygiene among those engaged in cleaning activities can be achieved.

Hand protection & infection prevention 

Hand hygiene systems are designed so as not to cause damage to the skin of the hands. Although concerned primarily with health care workers, the following statement is relevant also for those concerned with cleaning tasks:

"For health care workers, protecting the integrity of the skin on their hands is critical. Damaged or non-intact skin places both the patient and the health care worker at risk because it prevents effective hand hygiene. It also provides opportunities for micro-organisms to be transferred between patients and staff, and for skin lesions to become colonised by bacteria, potentially leading to infection.” – Royal College of Nursing, Tools of the Trade, (2012).

Not only is damage to the skin a concern from the infection prevention aspect but action taken by the employer in an attempt to prevent the hands being carriers of infective material that results in such damage may place the employer in contravention of their primary duty to protect the health of their employees. This usually means that those responsible for the health of the employees and those concerned with the prevention of HCAIs need to collaborate to create a policy and associated procedures that achieve high standards of hand hygiene whilst maintaining a high standard of skin care. This is achievable, but may mean that a new approach is required to the subject of hand hygiene.

Minimising skin damage 

For example, traditionally occupational health workers have been required to wash their hands frequently. Frequent hand washing is a common cause of skin damage due to the irritant effect of the water, compounded by the defatting effect of the skin cleanser. This damage can be increased by the use of anti-microbial skin cleansers. Alternative methods, such as the use of alcohol based sanitisers, can eliminate this issue. However, these also have their limitations, specifically that they are ineffective when the hands are soiled with organic matter. So a combination of hand washing and alcohol sanitiser is needed.

The evidence is that alcohol based sanitisers do not damage the skin but can actually improve skin condition. The ‘stinging’ sensation sometimes encountered when these are first used in place of hand washing is due to the sub-clinical skin damage from hand washing and is not the result of the alcohol sanitiser causing skin damage. Alcohol free sanitisers should not be used, as these contain biocides that may actually cause skin irritation and allergy.

Tthe wearing of occlusive (waterproof) gloves should be considered as ‘wet work’ and wearing such gloves for more than two hours in an eight hour shift represents a significant hazard to the skin. Where this is essential due to the need to protect the skin against chemicals used in cleaning then appropriate skin protective measures should be taken.

Hopefully this short article will stimulate the reader to delve into this complex subject in more depth to ensure that not only do they play their role in preventing HCAIs but also in protecting the health of their workforce.