The effectiveness of hand hygiene procedures in reducing the risks ...

S58 Vol. 35 No. 10 Supplement 1 Bloomfield et alTable 20. Increased risk situations in the homeRoutine day-to-day situationsNonroutine situationsIncreased risk from source ofinfection in the homePeople who are otherwisehealthy but at increasedrisk of infectionIncreased risk from infectedfamily membersPeople at increasedrisk of infectionHandling of raw meat, poultry,fish, fruit, and vegetablesFamily members or pets that arecolonized or infected with, forexample, Salmonella, C difficile,MRSAYoung babies, elderly adults,pregnant womenPeople in poor living conditionsFamily members infected withcolds, flu, norovirus,Salmonella, Shigella, and othersPatients home from hospital oroutpatients including peoplewith catheters, wounds, orothersPeople undergoing drugtreatment; people withunderlying illness, eg, diabetes,HIVin coming years, rather than decline. One such factor isthe rising proportion of the population in the communitywho are more vulnerable to infection. An importantpart of current European and US health policy is commitmentto shorter hospital stays. A key requirementis to ensure that the increased health provision at homeis not accompanied by an increase in ID risks; otherwise,the cost savings gained by care in the community arelikely to be overridden by costs of rehospitalization.Even for the ‘‘healthy community,’’ ID represents a significanteconomic burden because of absence fromwork and school and added health care costs. Secondaryinfections can produce complications, and some infectionsmay be associated with the development ofdiseases such as cancer or other chronic conditions,which can manifest at a later date. Those responsiblefor ensuring that the public are protected from infectionin health care facilities are now realizing that their abilityto manage the problem is hampered by spread ofpathogens such as MRSA, C difficile, and norovirus inthe community and the home, and the number of infectedpeople or carriers who come into their facilities,and are looking for ways to address this by engaging thepublic to adopt more rigorous standards of hygiene.One of the things that is apparent from newlyemerging data, and that is reflected in this review, isthe extent to which common infections circulating inthe community are hygiene related. This suggests, inturn, that hygiene promotion could have a significantbenefit in terms of improved public health and well-being;in particular, the data highlight the extent to whichviruses (norovirus, rotavirus, rhinovirus, influenza, andother viruses) are responsible for hygiene-related diseasesnow circulating in the community.The main conclusions from this review are asfollows:dID circulating in the home and community is a seriouspublic health problem in the developed as wellas the developing world.dddddGood hygiene practice is key to reducing the burdenof ID in the home and community.Hand hygiene is a key component of good hygienepractice in the home and community and can producesignificant benefits in terms of reducing the incidenceof infection, most particularly for gastrointestinalinfections but also for respiratory tract and skininfections.Decontamination of hands can be carried out eitherby handwashing with soap or by the use of waterlesshand sanitizers, which achieve a log reduction in bacterialand viral contamination on hands by the removalof contamination or by killing the organismsin situ. The health impact of hand hygiene within agiven community can be increased by using productsand procedures, either alone or in sequence, thatmaximize the log reduction of both bacteria and viruseson hands.The impact of hand hygiene in reducing ID riskscould be increased by convincing people to applyhand hygiene procedures correctly (eg, wash theirhands correctly) and at the correct time.To optimize health benefits, promotion of handhygiene must be accompanied by hygiene educationand should also involve promotion of otheraspects of hygiene, for example, surface and clothhygiene.FURTHER RESEARCHThis report highlights a number of areas in whichadditional data are needed:d Further studies are needed to characterize thefrequency of, and factors associated with, ID transmissionin noninstitutional settings such as thehome.d Further studies are needed to assess the relative efficacyof hand hygiene procedures in reducing handcontamination (handwashing with soap and use of