Expert guidance on hand hygiene in healthcare settings

Expert guidance released today offers updated evidence reviews and recommendations for hand hygiene in healthcare facilities. The guidance is featured in the August issue of Infection Control and Hospital Epidemiology and emphasizes best practices for implementing and optimizing hand hygiene programs to prevent the spread of healthcare-associated infections (HAIs). The guidance is part of the Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates produced in a collaborative effort led by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission.

"For more than 150 years, we have known the link between hand hygiene improvement and reducing HAIs," said Janet Haas, PhD, RN, CIC, co-lead author of the guidelines with Katherine Ellingson, PhD. "Yet adherence to recommended practices remains low. While there can be barriers to optimal hand hygiene in healthcare settings, poor hand hygiene undermines care and threatens patient safety."

With varied practices and some mixed messaging surrounding hand hygiene in healthcare settings, the guidelines aim to clarify best practices for hand hygiene and update recommendations, including the following:

• Improve Accessibility and Acceptability of Products: Soap and alcohol-based hand rubs (ABHR) should be convenient for routine hand hygiene in all patient care areas. Consult staff about tolerability of products on hands.
• Stress Hand Hygiene at Critical Moments: Healthcare personnel should clean hands with ABHR or soap and water:
• Before direct patient contact;
• Before preparing or handling medication in anticipation of patient care;
• Before moving from a contaminated body site to a clean body site on the same patient;
• Before and after inserting and handling invasive device;
• After contact with blood or bodily fluids, after direct patient contact, or contact with patient environment.
• Measure Progress: Monitoring hand hygiene adherence is critical to improving practice, but there are many monitoring methods used and promoted in various settings, including advanced technologies. Consider advantages and limitations of each type of monitoring when deciding on a monitoring system.
• Recognize the Importance of Glove Use as a Complement to Hand Hygiene: Gloves protect hands from contamination with micro-organisms and are essential when contact with blood or body fluid is anticipated. Gloves are also critical in instances when hand hygiene may be insufficient to prevent transmission via hands (e.g., during Clostridium difficile or norovirus outbreaks).
• Empower Healthcare Personnel: Develop a multidisciplinary team that includes representatives from administrative and unit-level leadership to create a hand hygiene program that works best for the institution. Provide meaningful feedback on hand hygiene performance with clear targets and an action plan for improving adherence.
• Wash Hands When Soiled: Hand hygiene should be performed using soap and water, not ABHR, when hands are visibly soiled.
• Avoid Triclosan-Containing Soaps: A review of current literature found triclosan to be no more effective in preventing transmission of micro-organisms in healthcare settings than products currently recommended (e.g., ABHR and soap). Further, triclosan kills a narrower spectrum of organisms compared to ABHR and soap, which can lead to contamination and resistance.

"It is our hope these updated evidence-based recommendations will guide healthcare institutions in implementation of hand hygiene programs and clarify the state of the science behind recommended hand hygiene practices," said Ellingson.

The practice recommendations are a part of Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates, a series of articles that share evidence-based strategies to help healthcare professionals effectively control and prevent the spread of healthcare-associated infections (HAIs). The hand hygiene strategies have been added to the series following the initial 2008 Compendium publication.