Hand hygiene.pdf

can be seen during routine work. Data should be incorporated into HCW’s education and
fed back in real time.
The ultimate customer, or course, is the patient. Patients and their families can be given
a “tip sheet” to help them understand their role as partners in patient safety. They should
be encouraged to point out lapses in hand hygiene technique without fear of retribution.
Surveys can help HCWs determine if patient perceptions match their own view of their
performance.
3. COST–EFFECTIVENESS OF HAND HYGIENE
To date, no formal prospective studies have been conducted to establish the cost–effectiveness
of hand hygiene in health-care settings. In general, cost–effectiveness has been
estimated by comparing the costs of hand hygiene promotion programmes versus the
potential cost savings from preventing HCAIs. However, a recent report has reviewed all
economic studies relating to the overall impact of alcohol-based hand hygiene products
in health care 703 and concluded that, while further research is required to measure the
direct impact of improved hand hygiene on infection rates, the potential benefit of providing
alcohol-based handrubs is likely to outweigh costs and their wide-scale promotion
should continue. The report also recommended that those planning local improvements
should note that multimodal interventions are more likely to be effective and sustainable
than single-component interventions, and although these are more resource-intensive, they
have a greater potential to be cost effective.
The costs of hand hygiene promotion programmes include the costs of hand hygiene
products plus the costs associated with HCW time and the educational and promotional
materials required by the programme. The costs of products needed for handwashing
include soap, water and materials used for drying hands (e.g. towels), while the costs of
hand antisepsis using an alcohol-based handrub include the cost of the handrub product
plus dispensers and pocket-sized bottles, if made available. In general, non-antimicrobial
soaps are often less expensive than antimicrobial soaps. In health-care settings, mainly in
resource-poor countries, basic handwashing equipment such as sinks and running water is
often not available or of limited quality. In calculating costs for hand hygiene, these substantial
construction costs need also to be taken into account. In addition, overhead costs for
used water and maintenance need to be added to the calculation.
The cost per litre of commercially prepared alcohol-based handrubs varies considerably,
depending on the formulation, the vendor and the dispensing system. Products purchased in
1.0–1.2 litre bags for use in wall-mounted dispensers are the least expensive; pump bottles
and small pocket-sized bottles are more expensive; and foam products that come in pressurized
cans are the most expensive. Presumably, a locally produced solution composed of
only ethanol or isopropanol plus 1% or 2% glycerol would be less expensive than commercially
produced formulations but may not meet quality control standards achieved by most
manufacturers. Boyce estimated that a 450-bed community teaching hospital spent US$ 22
000 (US$ 0.72 per patient-day) on 2% chlorhexidine-containing preparations, plain soap,
and an alcohol hand rinse 362 . When hand hygiene supplies for clinics and non-patient care
areas were included, the total annual budget for soaps and hand antiseptic agents was US$
30 000 (about US$ 1 per patient-day).