About Medicine: Hand washing
Posted by
MDMH
Alida Merritt, MSN, RN, CPHQ
Department Head
Quality Improvement/Infection Control
Marcus Daly Memorial Hospital
Hamilton, MT 59840
406-375- 4472
Hand Washing
Hand washing seems like such a simple task and although we know that it
is an important means of reducing your chance of getting sick, many people
still do not understand or recognize its value. During this time of the
year when illnesses such as influenza and norovirus can spread quickly,
it is all the more important to take those several seconds needed to clean
your hands with soap and water or a hand sanitizer.
The origins of handwashing as a means of reducing the spread of infection
can be traced to a Hungarian physician, Ignaz Semmelweis, who was practicing
at a hospital in Vienna, Austria. In 1847, Dr. Semmelweis noticed a high
incidence of postpartum fever and death in women cared for by interns
who had performed autopsies. Dr. Semmelweis had the interns wash their
hands with a chlorinated lime solution, which in today's world plays
an important role in public health and environmental hygiene through its
disinfecting, sanitizing and bleaching properties. Dr. Semmelweis noted
an immediate reduction in the incidence of fatal postpartum fever from
around 10% to 1-2%. Envision Dr. Semmelweis saying, "Here is the
proof," only to be rejected, ridiculed and ignored. He was dismissed
from the hospital, and harassed so much by the Vienna medical community
that he moved away to Budapest. He spent many years arguing with prominent
European medical professionals only to eventually be committed to a mental
institution where he died. It was only after his death, when Louis Pasteur
developed his germ theory of disease, that Dr. Semmelweis' practice
of hand washing became more accepted.
Fast forward to today and let's examine what has changed. Various
studies have shown that hand washing compliance has improved in some instances,
but remains poor in others. The American Society for Microbiology has
been monitoring hand washing habits of U.S. adults since 1996. During
recent phone surveys, 96% of adults report washing their hands after using
a public restroom, whereas observations showed 93% of women and 77% of
men actually performed the task. When the studies began in 1996, overall
hand washing compliance in public restrooms was 68%, but despite this
apparent improvement, 81% of us have seen (or heard) someone leave a public
restroom without washing their hands. Additional data shows hand washing
prior to handling or eating food hovers around 83% for women and 71% for
men, that 43% of mothers do not wash their hands after changing a diaper,
and only 39% of Americans reporting washing their hands after coughing
or sneezing!
Microorganisms are either "resident" and normally reside on
our skin in stable numbers or "transient" and attach loosely
to the skin through contact with other people, surfaces and equipment.
Some microorganisms are pathogens, causing disease and surviving for hours,
days or months on some surfaces. The good news is that many transient
microorganisms can be easily removed with regular hand hygiene practices.
When asked why hand washing or hand hygiene was not done, most people
indicate they don't think it's necessary or important, they forgot,
they didn't have time, soap & water or hand sanitizer were not
readily available, or their hands were too dry and irritated.
In the healthcare industry, proper hand washing with soap and water, and
the use of hand sanitizer are clearly associated with reducing the risk
of healthcare associated infections (HCAIs). It is important for people
to realize that the risk for HCAIs is no longer restricted to the hospital
environment; skilled nursing facilities, medical clinics, and home health
and hospice settings also present as areas of risk. The Centers for Disease
Control and Prevention (CDC), the World Health Organization (WHO), and
various other organizations have joined forces to promote hand hygiene
improvement in health care around the world. Hand hygiene is just one
element of reducing the incidence and burden of HCAIs, and performing
hand washing or hand hygiene at the right time and in the right way goes
a long way to protect the lives of the individuals we health care workers
have our hands on.
So which is better - soap and water or hand sanitizer? Many studies found
that alcohol-based hand sanitizers or rubs (ABHRs) that contain an alcohol
concentration of 60-95% are more effective at killing microorganisms than
hand sanitizers that do not contain alcohol or contain lower concentrations
of alcohol. When used correctly, ABHRs very effectively inactivate and
reduce many microbes on one's hands, but people frequently do not
use enough or they wipe it off before it has dried. ABHRs are not as effective
as soap and water with certain microorganisms, such as Clostridium difficile
and Norovirus, and ABHRs are not as effective when your hands are visibly
or heavily soiled.
Hand washing with soap and water must also be done correctly to be effective.
Studies show that roughly 5% of people wash their hands properly and long
enough. People frequently miss fingertips, the thumb, the back of the
hand and the wrist area and wash for an average of 6 seconds, and that's
providing they even use soap. The CDC says that at least 20 seconds is
needed in order to remove disease-causing germs from your hands. Another
important note is that antibacterial soaps are not more effective than
regular soap, and liquid soap is generally recommended for public places
as germs can grow on bar soap and can be passed from one person to another.
Last, but not least, is that in order to be effective, either method must
be used regularly! That means before making or eating food, after playing
with animals, after using the toilet, after playing outdoors, after coughing
or blowing your nose, and any other time you believe your hands may have
been contaminated. ABHRs come as gels and foams in small, convenient-sized
containers and as hand wipes, so if soap and water is not available, ABHRs
are an acceptable substitute and can contribute handily to improving personal
compliance with hand hygiene. And remember that hand hygiene protects
you as well as family and friends, particularly when you are sick.
For questions and or comments contact Alida Merritt, Katherine Herczeg,
MSN, RN, CPHQ, at Marcus Daly Memorial Hospital's Quality Improvement/Infection
Control Department. Working together to build a healthier community!