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

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
Appendix 2.
Guide to appropriate hand hygiene in connection
with Clostridium difficile spread
Hand hygiene and infection control
Hand hygiene is a crucial action recommended for preventing
and controlling the transmission of pathogens within healthcare
settings to ensure that patients remain safe and that their
risks of acquiring infection are minimized. Hand hygiene is
an essential practice for all health-care workers (physicians/
doctors, midwives, nurses, pharmacists, dentists, and other
care providers including community health workers and family
members) in order to protect the patients and themselves.
The method employed in ensuring that hand hygiene is effective
falls into one of two categories:
• Handrubbing with an alcohol-based handrub
Handrubbing is the gold standard technique to perform
hand hygiene on all occasions except for those described
for handwashing with soap and water, i.e. handrubbing is
the action recommended for health-care workers for the
routine, day-to-day decontamination of hands.
• Handwashing with soap and water:
Handwashing still occupies a central place in hand hygiene
and should be employed when hands are visibly dirty or
visibly soiled with blood or other body fluids; after using
the toilet; and when exposure to potential spore-forming
pathogens is strongly suspected or proven, including during
outbreaks of diarrhoea.
Correct method at the correct moment
Understanding and employing the correct method and
technique at the correct moment is highly likely to result in
optimum compliance with hand hygiene and maximum safety of
patients and staff.
The advantages and disadvantages of both alcohol-based
handrubs and handwashing with soap and water can be found
throughout the <strong>WHO</strong> <strong>Guidelines</strong> on Hand Hygiene in Health
Care. The following information is intended to support healthcare
workers and others in understanding and explaining the
challenges presented by patients with C. difficile infection,
particularly in relation to hand hygiene.
Specific challenges posed by patients with
diarrhoeal illnesses
Preventing and controlling the spread of all diarrhoea-related
bacteria, viruses, and parasites is always important. One of the
main actions in this regard is to ensure that hands are washed
thoroughly with soap and water when they are:
– visibly dirty or visibly soiled with blood or other body fluids;
– after using the toilet;
– when exposure to potential spore-forming pathogens is
strongly suspected or proven, including during outbreaks of
C. difficile.
What is Clostridium difficile?
Background information on C. difficile is available from a range
of scientific and patient support documents. The following
information is an overview of what C. difficile is and the
problems it can cause.
C. difficile is a bacterium (germ) that is present naturally in the
bowel of some individuals. It can spread by touching faecally
contaminated surfaces and then touching your mouth, e.g.
when eating. It can also spread following contact with the
faeces of people who have the infection, if the bacterium is
ingested through your mouth.
If someone is taking antibiotics to treat an infection, they can
kill the good bacteria living in the bowel as well as the bad;
when this happens C. difficile can grow quickly in the bowel
and produce toxins that lead to disease. C. difficile is passed
out in the faeces of people who are infected, including in the
form of spores (a hardy form of the bacterium), which can
survive for a long time in patient surroundings on any surface,
e.g. toilet areas, clothing, sheets, and furniture, if these items
are not regularly and appropriately cleansed. It is possible
for anyone to spread the infection (to themselves or others)
because they have not performed hand hygiene properly or kept
patient surroundings clean. Elderly people and patients with
comorbidities or who have had certain medical procedures to
the bowel are especially at risk of getting C. difficile infection.
Why have there been increasing numbers of cases in
certain countries recently?
This is not entirely clear, though it is known that a number of
factors may be responsible, including natural changes to the
way in which bacteria act in relation to their circumstances;
for example, C. difficile becoming more resistant to antibiotics
in response to their increased and more widespread use. The
growing numbers of elderly, sick patients receiving care, the
pressures on health-care workers to deliver care, and the way
in which services such as cleaning are provided to health-care
settings may all have had an impact. New strains of C. difficile
have evolved in recent years that appear to spread more readily
and may cause more severe cases of illness. It is also possible
that the recommended practices for preventing and controlling
C. difficile are not always applied for a number of reasons and
may, as a result, be contributing to the current problem. Finally,
in some countries where there has been no surveillance of C.
difficile until now, reports of rising numbers may be explained
because they are now looking for it.
242