HealthMarch 13, 2023

Two new recommendations for preventing healthcare-associated infections with hand hygiene

By: Collette Bishop Hendler, RN, MS, MA, CIC
Infection preventionists commonly refer to hand hygiene as the single most effective way to prevent infection from spreading. It’s a simple task that protects patients from life-threatening organisms, yet adherence to hand hygiene practices remains a challenge. Patients receiving healthcare continue to be threatened by antibiotic-resistant organisms and infections potentially spread by contact with the hands of healthcare personnel (HCP).

Basic work activities, such as touching a bed’s side rails have been associated with hand contamination. (Thom, K.A., et al., 2017) Failure to perform hand hygiene after this basic task, places patients at risk. As healthcare leaders, it’s in our hands to reduce the infection risk by ensuring that HCP have the knowledge and resources needed to follow evidence-based hand hygiene practices.

High-quality evidence shows the importance of promoting healthy skin and fingernails. In most clinical situations, alcohol-based hand sanitizers, have been shown superior over handwashing when it comes to maintaining hand skin health in HCP. (van der Meer, 2015, CDC, 2022) The COVID-19 pandemic disrupted infection prevention programs as resources, including alcohol-based hand sanitizer, were in short supply. HCP were under constant stress working in a strained healthcare system. Now as we return to the new normal, we need refocus and engage HCP. We need to ensure that they have access to alcohol-based hand sanitizers within their workflow to support adherence to hand hygiene practices, promote hand skin health, and ultimately reduce the spread of organisms.

Latest recommendations

The Society for Healthcare Epidemiology of America (SHEA), Infectious Diseases Society of America (IDSA), and Association for Professionals in Infection Control and Epidemiology (APIC), in collaboration with the American Hospital Association, and The Joint Commission published the SHEA/IDSA/APIC Practice recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 update as a supplement to the February 2023 edition of Infection Control & Hospital Epidemiology. This document recommends seven essential practices for acute care facilities to prevent healthcare-associated infections through hand hygiene, two of which are new. The two new recommendations speak to proper glove use and reduction of environmental contamination associated with sinks and their drains.

1. Proper glove use

The first new recommendation addresses appropriate glove use to reduce the risk for hand and environmental contamination. To comply with the recommendation, we need to teach staff about the risk for self and environmental contamination with glove use, teach proper glove removal, and validate that HCP can remove gloves in a way that prevents contamination. Glove removal seems like such an basic task, but how many times have we seen HCP contaminate themselves or the environment during glove removal, especially when they’re rushed in a high-paced care environment.

We need to encourage HCP to wear gloves according to standard and contact precautions for any contact with patients with organisms that are less susceptible to biocides (e.g., Clostridioides difficile, Bacillus cereus, Cryptosporidium, norovirus). Instruct HCP to immediately perform hand hygiene after glove removal. If their hands become visibly soiled, and a sink isn’t immediately available for handwashing, teach HCP to use an alcohol-based hand sanitizer, and then wash their hands as soon as possible.

2. Reduction of environmental contamination associated with sinks

The second new recommendation provides guidance related to reduction of environmental contamination associated with sinks and their drains. Yes sinks, one of the tools provided for handwashing, can cause contamination. To reduce the risk, make sure that sinks are constructed according to local administrative codes, and that they’re included in your facility’s infection control risk assessment. If possible, dedicate sinks for handwashing, and provide disposable or single-use towels to dry hands. Avoid hot air hand dryers in patient care areas.

Instruct HCP to avoid disposing materials that support biofilm growth, such as food, human waste, IV fluids, and medications, in sinks dedicated to handwashing. Include faucet and sink bowl cleaning using an EPA-approved hospital disinfectant in your facility’s daily cleaning routine. Teach HCP to keep patient care supplies and medications one meter from sink counter tops or mobile surfaces.

Five essential updated practices

Moreover, five of the essential practices have been updated using evidence that wasn’t available for the 2014 recommendations. These essential practice updates charge healthcare leaders to take the following action:

  1. Promote hand skin and fingernail health and prohibit fingernail polish and gel shellac in HCP who scrub for surgical procedures.
  2. Select appropriate hand hygiene products with input from HCP. Consider the manufacturer’s product-specific data when selecting alcohol-based hand sanitizers with ingredients that are more effective against organisms that are less susceptible to biocides.
  3. Ensure accessibility to hand hygiene supplies by making them visible and placing them within HCP workflow. For private rooms, provide one dispenser in the hallway and one in the patient room. For semiprivate rooms, suites, bays, and other multi-patient bed areas, consider at a minimum, one dispenser per two beds.
  4. Monitor hand hygiene adherence using different types of monitoring (direct overt observation, direct covert observation, automated monitoring systems, remote video observation, indirect measures, and supply audits), and evaluate the effectiveness of each chosen type.
  5. Enhance a culture of safety by providing timely and meaningful feedback in multiple formats, on multiple occasions.

Remember hand hygiene really does save lives. By engaging HCP to follow the latest evidence-based practices, you can reduce the risk for healthcare-associated infections in your facility.

Learn how Lippincott Solutions provides the latest evidence-based guidance and procedures for nurse teams, including reducing the risk for healthcare-associated infections.

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Collette Bishop Hendler, RN, MS, MA, CIC
Editor-in-Chief, Lippincott Solutions, Point-of-Care, Wolters Kluwer Health
Collette is certified by the Certification Board of Infection Control and Epidemiology, Inc. as an infection preventionist. She has more than 15 years of experience in critical care nursing and maintains Alumnus Status as a Critical-Care Registered Nurse.
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