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January 2007

Hand Washing and the Prevention of Spreading Infection

How critical is hand washing in the prevention of spreading infection? 

The United States Centers for Disease Control and Prevention (CDC) guidelines clearly recommend the use of Alcohol-Based Hand Rubs (ABHRs). Here are the latest findings and studies reported to the Federal Register/Vol. 71 No 184/ Rules and Regulations.

The CDC states that compared with soap and water hand washing, ABHRs are more effective in reducing bacteria on hands, cause less skin irritation/dermatitis and save on personnel time. The use of ABHRs has been associated with improved adherence to recommended hand hygiene practices, and adherence is directly tied to access. The highest possible adherence to hand hygiene practice is achieved when ABHR dispensers are in readily accessible locations such as the corridor near the patient room entrance and inside patient rooms.

“Improving adherence to hand hygiene practice: A multidisciplinary approach” concludes that, “alcohol-based hand rub, compared with traditional hand washing with un-medicated soap and water or medicated hand antiseptic agents, may be better because it requires less time, acts faster, and irritates hands less often.” (Pittet D. Emerging Infectious Diseases. 2001-March-April; 7 (2):243-40. Review) The same study goes on to state that, “this method was used in the only program that reported a sustained improvement in hand hygiene compliance with decreased infection rates.”

The relationship between ABHRs and improved adherence to recommended hand hygiene practices is also found in other studies. Another study, “Effectiveness of a Hospital-Wide Program to Improve Compliance with Hand Hygiene”, also demonstrated an increase in compliance with hand hygiene practices that was directly related to the use of ABHRs. (Pittet D, Hugonnet S, Harbarth S, et.al. Lancet 356; 2000; 1307-1312)

In this study researchers found that when one ABHR dispenser was available for every four patients’ beds, the adherence rate for hand hygiene was 19 percent before patient contact and 41 percent after patient contact.  When one ABHR dispenser was available for each bed, the rates rise to 23 percent before patient contact and 48 percent after patient contact. Increased availability of ABHR dispensers resulted in increased hand hygiene rates. 

The relationship between increased availability and increased use is likely the result of several factors.  An increase in the number of ABHR dispensers acts as a continuous reminder to workers and others that they need to disinfect
their hands.

Improving hand hygiene has a direct effect on the number of health care acquired infections. In one hospital after they implemented using ABHRs there was a reduction in the MRSA (methicillin-resistant staff aureus infections) for each of the quarters used compared to the year before when they
were not used.

CDC guidelines clearly recommend the use of ABHRs. For more information please click here.

Phyllis Bouley, LPN, AS
Clinical Consultant, Briggs Corporation

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