WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

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<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE use of an alcohol-based handrub compared with the medicated wipe or soap and water. Ring wearing increased the frequency of hand contamination with potential health care-associated pathogens. Wearing artificial acrylic fingernails can also result in hands remaining contaminated with pathogens after use of either soap or alcohol-based hand gel 154 and has been associated with outbreaks of infection 155 (see also Part I, Section 23.4). Sala and colleagues 156 investigated an outbreak of food poisoning attributed to norovirus genogroup 1 and traced the index case to a food handler in the hospital cafeteria. Most of the foodstuffs consumed in the outbreak were handmade, thus suggesting inadequate hand hygiene. Noskin and colleagues 145 showed that a 5-second handwash with water alone produced no change in contamination with VRE, and 20% of the initial inoculum was recovered on unwashed hands. In the same study, a 5-second wash with two soaps did not remove the organisms completely with approximately a 1% recovery; a 30-second wash with either soap was necessary to remove the organisms completely from the hands. investigated an outbreak of multidrug-resistant A. baumannii and documented identical strains from patients, hands of staff, and the environment. The outbreak was terminated when remedial measures were taken. Contaminated HCWs’ hands were clearly related to outbreaks among surgical 148,162 and neonatal 163,165,166 patients. Finally, several studies have shown that pathogens can be transmitted from out-of-hospital sources to patients via the hands of HCWs. For example, an outbreak of postoperative S. marcescens wound infections was traced to a contaminated jar of exfoliant cream in a nurse’s home. 167 An investigation suggested that the organism was transmitted to patients via the hands of the nurse, who wore artificial fingernails. In another outbreak, Malassezia pachydermatis was probably transmitted from a nurse’s pet dogs to infants in an intensive care nursery via the hands of the nurse. 168 Obviously, when HCWs fail to clean their hands between patient contact or during the sequence of patient care – in particular when hands move from a microbiologically contaminated body site to a cleaner site in the same patient – microbial transfer is likely to occur. To avoid prolonged hand contamination, it is not only important to perform hand hygiene when indicated, but also to use the appropriate technique and an adequate quantity of the product to cover all skin surfaces for the recommended length of time. 7.5 Cross-transmission of organisms by contaminated hands Cross-transmission of organisms occurs through contaminated hands. Factors that influence the transfer of microorganisms from surface to surface and affect cross-contamination rates are type of organism, source and destination surfaces, moisture level, and size of inoculum. Harrison and colleagues 157 showed that contaminated hands could contaminate a clean paper towel dispenser and vice versa. The transfer rates ranged from 0.01% to 0.64% and 12.4% to 13.1%, respectively. A study by Barker and colleagues 158 showed that fingers contaminated with norovirus could sequentially transfer virus to up to seven clean surfaces, and from contaminated cleaning cloths to clean hands and surfaces. Contaminated HCWs’ hands have been associated with endemic HCAIs. 159,160 Sartor and colleagues 160 provided evidence that endemic S. marcescens was transmitted from contaminated soap to patients via the hands of HCWs. During an outbreak investigation of S. liquefaciens, BSI, and pyrogenic reactions in a haemodialysis centre, pathogens were isolated from extrinsically contaminated vials of medication resulting from multiple dose usage, antibacterial soap, and hand lotion. 161 Duckro and colleagues 126 showed that VRE could be transferred from a contaminated environment or patients’ intact skin to clean sites via the hands of HCWs in 10.6% of contacts. Several HCAI outbreaks have been associated with contaminated HCWs’ hands. 162-164 El Shafie and colleagues 164 14
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE Figure I.7.1 Organisms present on patient skin or the immediate environment A bedridden patient colonized with Gram-positive cocci, in particular at nasal, perineal, and inguinal areas (not shown), as well as axillae and upper extremities. Some environmental surfaces close to the patient are contaminated with Gram-positive cocci, presumably shed by the patient. Reprinted from Pittet, 2006 885 with permission from Elsevier. 15
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PART V. PATIENT INVOLVEMENT IN HAND
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PART VI. COMPARISON OF NATIONAL AND
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REFERENCES 35. Jroundi I et al. Pre
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