Handy advice: CDC asks physicians to come clean with gels
Alcohol-based hand rubs are considered easier to use and more
efficient at killing germs that often cause serious infections.
By
Susan J. Landers, AMNews staff. Nov. 18, 2002.
Additional information
Washington -- Although somewhat surprising, and even a bit
embarrassing, evidence shows that physicians, nurses and other health care
workers don't always adequately wash their hands.
In 34 hand-washing studies, these professionals really cleaned up only
40% of the time, according to the hand hygiene resource center at the
Hospital of Saint Raphael in New Haven, Conn. The shortcoming is
attributed to heavy workloads and hectic schedules. "Health care personnel
are always on the go, which sometimes makes hand washing with soap and
water difficult," said Steve Solomon, MD, acting director of Centers for
Disease Control and Prevention's health care quality promotion division.
But their oversight is linked to the transmission of infection within
the health care system. The CDC estimates that each year nearly 2 million
patients in the United States get an infection in hospitals, and about
90,000 of die as a result.
In an effort to reverse these outcomes, the CDC issued new hand hygiene
guidelines last month that will prove useful in the hospital, the clinic
and even in physicians' offices.
Central to the directive is the regular use of alcohol-based hand rubs,
and the message is clear: Even the busiest physician should be able to
find time to use these products for a between-patient cleanup.
"These hand rubs should help promote hand hygiene because they are much
more accessible than sinks, take less time to use and cause less skin
irritation and dryness than many soaps," Dr. Solomon said.
Specifically, using an alcohol-based hand rub requires about 15 seconds
of time, versus approximately 60 seconds to go to a sink and wash,
according to studies.
Findings also indicate that the alcohol-based hand rubs reduce the
number of bacteria on the hands more effectively than does washing with
soap and water.
But despite their effectiveness, they can't take the place of this
traditional approach if hands are soiled with blood or other material,
said CDC Director Julie L. Gerberding, MD, MPH. "Alcohol preps are not
going to deal with that aspect of hand hygiene."
The use of gloves is also still recommended, especially for situations
in which people are coming into contact with blood or other body fluids or
when they are conducting sterile procedures.
Many physicians also may be surprised by the findings of a recent study
that hand cleaners labeled "antibacterial" are no better at killing germs
than is regular soap and water.
But one piece of information is constant. "Clean hands are the single
most important factor in preventing the spread of dangerous germs and
antibiotic resistance in health care settings," Dr. Gerberding said.
2 million patients a year get hospital-acquired infections; 90,000
die.
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This is not just a concern for hospitals and nursing homes. Physicians'
offices also play a role in the spread of disease, said John Boyce, MD,
co-author of the new guidelines. "When patients who have been in and out
of hospitals come into the office, they continue to carry resistant
bacteria on their skin, such as vancomycin-resistant enterococci or
methicillin-resistant Staphylococcus aureus," he said.
"We are even seeing some people who have acquired the methicillin-resistant
Staphylococcus aureus in the community," Dr. Boyce said.
Many doctors who work with Dr. Boyce have begun using the alcohol
products in their offices. "The alcohol hand rubs are faster, more
convenient and easier on your hands," said Dr. Boyce, section chief of
infectious diseases at the Hospital of Saint Raphael in New Haven, Conn.
Dr. Boyce created the hand hygiene resource center on the hospital's Web
site.
The hand rubs will also prove useful in emergency situations that might
occur during high-risk procedures or in intensive care units, when there
might not be time for everyone to line up at a sink for hand washing, Dr.
Gerberding said.
In fact, many hospitals already use the products. They were introduced
several years ago at Vanderbilt University Hospital, said William Shaffner,
MD, who represented the Infectious Diseases Society at a CDC briefing on
the guidelines. The convenience of the products has increased compliance
with hand hygiene at his hospital, he said.
Benefits outweigh costs
Any additional cost of alcohol hand-cleaning products is easily
outweighed in hospitals by cutting costly patient infections. In offices,
the products' cost, which has yet to be documented, might be offset by
eliminating the need to pay for water and paper towels, Dr. Boyce said.
Many physicians already make hand hygiene an office priority. For
example, Cincinnati family physician William Sawyer, MD, is a champion of
hand washing, and he sees the CDC's new guidelines as a great boon to his
hand hygiene awareness campaign. "To me, what's most important about all
of this is raising everybody's awareness of the role their hands play in
the spread of disease."
Alcohol-based hand rubs take only 15 seconds to use.
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For the past few years, Dr. Sawyer has been aided in his effort by the
large and yellow Henry the Hand, a most noticeable presence at schools and
meetings, including the AMA House of Delegates.
Dr. Sawyer practices what he preaches and always stops at the sink
after exiting an exam room. "It's an ingrained habit," he said. But "if
you can't wash your hands between patients, then sanitize them with an
alcohol-based hand rub."
Melvyn Sterling, MD, a member of the AMA Council on Scientific Affairs,
is also a practitioner of exemplary hand hygiene. "I make it very visible
in my office," he said. "I wash my hands in the sink in the exam room, in
the presence of patients."
Dr. Sawyer also promotes the four basic principles of hand awareness to
all people -- big and little. The principles, which are endorsed by the
AMA, are: Wash your hands when they are dirty and before eating; don't
cough into your hands; don't sneeze into your hands; and do not put your
fingers into your eyes, nose or mouth.
"Coughing or sneezing into your hands is a great way to carry germs
through the hospital," he said.
"You can wash and sanitize your hands all the time and still
contaminate somebody, something or yourself if you aren't aware of what
you're doing with your hands at all times," Dr. Sawyer added.
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ADDITIONAL INFORMATION:
4 rules to keep clean
The AMA also endorses the four principles of hand awareness:
- Wash you hands when they are dirty and before eating.
- Do not cough into your hands.
- Do not sneeze into your hands.
- Above all, do not put your fingers into your eyes, nose or mouth.
The diligent cleaning of hands with soap and water or an alcohol-based
product will be celebrated during National Hand Washing Awareness Week,
Dec. 8 to Dec. 14.
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Hand hygiene highlights
- Use of alcohol-based hand rubs is recommended for patient care --
these products are more convenient than thoroughly washing hands with
soap and water between patients.
- Physicians and other health care personnel should still use soap and
water when their hands are visibly soiled.
- The use of gloves does not eliminate the need for hand hygiene. Hand
rubs should be used before and after each patient just as gloves should
be changed before and after each patient.
- Improved adherence to hand hygiene has been shown to terminate
outbreaks in health care facilities, reduce the transmission of
antimicrobial-resistant organisms and reduce overall infection rates.
Source: Centers for Disease Control and Prevention
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Weblink
Hand Hygiene in Healthcare
Settings, guidelines from the CDC (http://www.cdc.gov/handhygiene/)
Your
Hands, Your Health -- the AMA endorses hand hygiene awareness
(http://www.ama-assn.org/ama/pub/article/3216-6792.html)
Hand Hygiene Resource Center
from Saint Raphael Healthcare System (http://www.handhygiene.org/)
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Copyright 2002 American Medical Association. All
rights reserved.
