CDC's advice to doctors: Clean your hands

New guidelines emphasize the role of hand hygiene in reducing the spread of infection.

Editorial. Nov. 25, 2002. Additional information

Each year, about 2 million American patients develop infections while hospitalized. An estimated 90,000 of them die as a result. Additionally, infections are a complication of care in numerous other settings, including long-term-care facilities and clinics.

The problem revealed by these statistics is not new. But reducing its cost, in terms of human suffering as well as actual health care dollars, is literally within reach. Physicians and other health care professionals could make significant inroads by increasing their vigilance in a key area: hand hygiene. And that's why the Centers for Disease Control and Prevention last month issued new guidelines on this very topic.

The agency's directive, which is in sync with current American Medical Association policy, is very clear: Clean 'em up.

"Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance in health care settings," said CDC director Julie Gerberding, MD, MPH.

The American Medical Association has long advanced the importance of hand hygiene in minimizing the spread of infection, both within the practice of medicine and among members of the general population.

Now, the CDC guidelines move into new territory by advising the use of alcohol-based hand rubs by health care professionals in addition to traditional hand washing with soap and water.

First off, recent studies indicate that these hand rubs reduce the number of bacteria on hands more effectively than does soap and water. These products should not be confused with anti-microbial soaps, gels and lotions that have proliferated the consumer market. While the AMA has raised red flags about these anti-microbials and their possible role in antibiotic resistance, alcohol rubs do not pose the same risk.

The CDC offers other practical reasons for its guidance.

Data show that health care personnel may find alcohol-based hand rubs more convenient than traditional hand washing. One study concluded that, during the course of an eight-hour shift, an intensive-care unit nurse could save about an hour by using an alcohol-based hand rub.

The reality is that health care personnel are always on the go, running from room to room, patient to patient. This sometimes makes hand washing with soap and water difficult. But these hand rubs are more accessible -- a tube can be carried in the pocket of a doctor's white coat or clipped on to scrubs.

The CDC also emphasizes some important how-tos. First, when using an alcohol-based hand rub, apply it to the palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. And these rubs do not preclude other infection-control basics. When hands are visibly soiled, wash with soap and water. Additionally, the use of gloves does not eliminate the need for hand hygiene or vice versa.

According to agency data, gloves reduce contamination by 70% to 80%, preventing cross-contamination and protecting patients and health care personnel from infection. But hand rubs should be used before and after each patient, just as gloves should be changed before and after each patient.

The CDC's new recommendations are an important reminder for physicians -- and just one aspect of the continued struggle against the spread of these pernicious germs.

AMA policy encourages doctors to talk to patients, young and old, to remind them to wash hands when they are dirty and prior to eating, to avoid coughing or sneezing into hands and to keep fingers away from the eyes, nose or mouth.

Dec. 8-14 is National Hand Washing Awareness Week. This will provide a perfect opportunity for physicians to drive home these hand-awareness principles -- in the hospital, in their practices, in communicating with patients and in their own lives.

OPINION

CDC's advice to doctors: Clean your hands

New guidelines emphasize the role of hand hygiene in reducing the spread of infection.

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Additional information