Nosocomial Infections and Hand Hygiene Best Practices

Introduction to Nosocomial Infections and Hand Hygiene

Kampf and colleagues (2009) assert that the regular use of hand sanitizers has a better antimicrobial effect than regular hand washing, and they suggest that this practice — in conjunction with improved availability of sanitizers, regular compliance education, reminders, and monitoring — is best practice for hospital hand hygiene in the prevention of nosocomial infections. This recommendation is based on a review of the literature, which included studies forming the evidence-based foundation for the 2006 World Health Organization (WHO) hand hygiene recommendations, together with more recent recommendations by several authoritative bodies, including: (1) the Commission for Hospital Hygiene and Prevention of Infection, Robert Koch Institute (RKI); (2) the Association of the Scientific Medical Societies in Germany (AWMF); (3) WHO's final recommendation; and (4) the Centers for Disease Control and Prevention (CDC) (Kampf, Loffler, & Gastmeier, 2009, p. 649).

Apart from the reference list for the 2006 WHO hand hygiene recommendations and organizational recommendations, Kampf and colleagues (2009) performed a selective review of relevant articles retrieved from the National Library of Medicine. This was the limit of methodological information provided to readers. The source material cited included a cross-section of recent international studies examining antimicrobial efficacy in the form of hand hygiene measures. The authors also discuss environmental hygiene issues, such as protective clothing, but the main focus of their article was hand hygiene best practice from an evidence-based perspective.

Kampf and colleagues (2009) argue that hand washing simply cannot provide the level of hand hygiene needed for healthcare workers, especially for nurses and physicians who may be involved in invasive procedures. The only viable alternative is therefore the use of alcohol-based hand sanitizers and gloves. These two reasons represent the foundation upon which the authors base their thesis.

Limitations of Traditional Hand Washing

Evidence to support the first reason comes from scientific findings that revealed hand washing with regular or antibacterial soaps can reduce the amount of transient flora by only 2–3 logs, in part because most people tend to minimize the amount of time spent washing hands (Kampf, Loffler, & Gastmeier, 2009). Another study revealed that frequent washing of hands will strip the skin of endogenous fats and proteins essential for maintaining an intact barrier against pathogens. Frequent washing with hand soap will dry the skin, thereby creating cracks in that barrier. Best practice recommendations concerning hand washing therefore limit its use to cleaning soiled hands, visits to the toilet, and when arriving at and departing from the workplace.

Superiority of Alcohol-Based Hand Sanitizers

Evidence to support the second reason comes from a number of studies that have revealed hand disinfection is far superior to hand washing (Kampf, Loffler, & Gastmeier, 2009). Some of the pathogens almost eradicated with 30 seconds of rubbing include Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Candida species, Rhodotorula species, and the viral vectors for hepatitis C, HIV, and influenza. The degree of pathogen elimination is almost 7 logs, which is between 1,000 and 10,000 times greater than that achieved by washing the hands for 3 minutes with soap and water. When confronted by pathogens resistant to the disinfecting capabilities of common hand rubs, the authors refer readers to the RKI list of recommended antiseptics.

Conclusion and Best Practice Recommendations

Within the healthcare environment, Kampf and colleagues (2009) recommend that clinicians rely on alcohol-based hand rubs to minimize the transfer of pathogens from patient to clinician to patient. When combined with gloves and proper environmental hygiene, the incidence of preventable nosocomial infections should thus be almost eliminated.

Reference

Kampf, G., Loffler, H., & Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial infections. Deutsches Arzteblatt International, 106(40), 649–655.