Hand hygiene.pdf

Ideally, narrow-topped containers should be used and dispensing from the container should
be done through a tap/faucet that can be turned on and off.
9.1.4 WATER TEMPERATURE
Does water temperature affect handwashing? A report to determine the impact of different
temperatures ranging from 5°C (40°F) to 50°C (120°F) on removal of different types of
bacteria showed that temperature had no effect in reducing transient or residual flora 180.
Volunteer subjects were tested for resident and transient flora, and washed their hands at
different temperatures levels using a specific amount of liquid plain soap. They lathered
their hands for 15 seconds and rinsed for 10 seconds. Neither the use of medicated soap nor
the water temperature had any significant effect on bacteria removal. Apparently, contact
time and friction are more important aspects than temperature. Even if warm water helps
in dissolving dirt and suspension of oily residues, a quick wash with medicated soap is less
effective than a 30-second wash with cool water and no soap 181 .
Since the reported data are not included in peer-reviewed publications, the consequent
considerations are based on limited evidence. Water temperature does not, however, seem
to be a critical issue for handwashing.
9.1.5 HAND DRYING
Hand drying is an essential step in hand cleansing and should be done in such a way
that hand recontamination does not occur. Wet hands, as a wet environment compared
with a dry environment, provide better conditions for the transmission of microorganisms 31 .
Careful hand drying is a critical factor determining the level of bacterial transfer associated
with touch-contact after hand cleansing. Recognition of this could make a significant contribution
towards improving hand hygiene practices in clinical and public health sectors 31 .
Common hand drying methods include paper towels, cloth towels and hot air dryers. One
report compared four methods of hand drying: cloth towels from a roller; paper towels left
on a sink; hot air dryer; and letting hands dry by evaporation 182 ; no significant difference
in the efficacy of the methods was noted in this study. However, reusing or sharing towels
should be avoided because of the risk of cross-infection 183 . In a comparison of methods to
test efficiency of hand drying for removing bacteria from washed hands, warm air drying
performed worse than drying with paper towels 184 . Furthermore, air dryers may be less
practical because of longer time needed to achieve dry hands 184 , with a possible negative
impact on hand hygiene compliance, and because of the aerosolization of waterborne
pathogens 185 . Ideally, drying of hands should be done by using individual paper towels.
Nevertheless, the bacteria counts on palm and fingers after handwashing may not significantly
differ after drying with a paper towel 184 .
When clean or disposable towels are used, it is important to pat the skin, rather than rub
it, to avoid cracking. Skin excoriation may lead to bacteria colonizing the skin and possible
spread of bloodborne viruses as well as other microorganisms 35 . Sore hands may also lead
to decreased compliance with hand hygiene practices (see also Part I, Section 13).