Hand hygiene to prevent health care-associated infections and its relevance to prevent Covid-19

Purnima Gupta Bhoi[1], Dr. Swati Mishra[2] , Nilakantha Bhoi[3]

Abstract: Hand hygiene is universally accepted because it is the most effective strategy for preventing and reducing healthcare-associated infections (HCAIs). It is our hands that we use to care, to impart comfort and reassure our patients safety, but sometimes our hands can act as vehicles to transmit microorganisms which may impact on quality of care and patient safety, causing harm and even killing. Promotion of improved hand hygiene is thus recognised as being an important measure to improve health and is considered to be an essential factor for infection prevention. The purpose of this article is to give an insight into hand washing concepts, its importance, and technique of doing it.

 

Key words: Hand hygiene, Nosocomial infection, Covid-19.

 

 

Introduction

Hand hygiene is universally accepted because it is the most effective strategy for preventing and reducing healthcare-associated infections (HCAIs). We use our hands to care, to give comfort and assure our patients safety but sometimes our hands can act as vehicles to spread microorganisms which may impact on quality of care and patient safety, causing harm and even killing. Promotion of improved hand hygiene is thus recognised as being an important measure to improve health and is considered to be an essential factor for infection prevention.

It was in the early 19th century when hand washing began by some healthcare professionals in patient-care settings. The practice grew over the years with documented proof that it is of vast importance and if paired with other hand-hygienic practices, reduces pathogens responsible for nosocomial or hospital-acquired infections (HAI).

Hand hygiene, as per Centers for Disease Control and Prevention (CDC), is an important practice which helps in the decrease of the transmission of infection in the healthcare setting [1]. Even during this Covid-19 pandemic, among other preventative measures, such as wearing mask and social distancing, proper hand hygiene has been considered as an effective tool to fight against the virus.

 

Importance of hand hygiene

Hand hygiene practices are the best way to reduce cross-transmission of microorganisms, nosocomial or hospital-acquired infections and the risk of occupational exposure to infectious diseases. It may be noted that there is an increase in mortality and morbidity due to nosocomial infections, thus meticulous hand hygiene is essential to provide safe, cost-efficient, and quality care to our patients [2]. According to world health organization (WHO), few accurate data provide facts on activities related to patient-care which are mostly responsible for transmission of bacteria to health care worker (HCW) hands. The HCWs do not only get contaminated with bacteria, when they come in direct contact with the patients but also get contaminated by touching the contaminated surfaces including the contaminated charts, reports etc. at the nursing stations [3]. Several studies have confirmed that handwashing almost eradicates the carriage of super bug Methicillin Resistant Staphylococcus aureus (MARS) which are often present on the hands of health care practitioners working in Intensive Care Units (ICUs) [4]. It has also been documented that with improvement in hand hygiene practices, spread of Health-care associated Klebsiella sp. has reduced [5]. Evidence also suggests that hand hygiene, if practiced properly can reduce the rates of hospital acquired infections [6]. Hence washing hands is a simple proven solution to prevent the spread of infections. Even in current global pandemic COVID -19, the most important, cheapest, and easiest way to prevent the transmission is to wash hands regularly with soap and water and with alcohol-based hand rub disinfectants.

Indication for hand hygiene

While providing care to patients, hand hygiene should be performed in specific moments. As per WHO, the “My five moments for hand hygiene” (Figure -1) [7] approach, indicates five important hand hygiene moments like before touching a patient, before performing a procedure, after exposure to blood or any other body fluids, after caring and touching a patient, and after touching the patient’s immediate surroundings (as shown in figure 1).

 

Figure – 1: “My five moments for hand hygiene” (Source – WHO)

In the context of COVID -19 prevention, at community and at personal level, we should practice frequent hand washing and should ensure that we wash our hands after coughing and sneezing. Hand washing also has to be practiced if we visit any public space like markets, community gatherings, park or use any public transport, and visit places of worship. It should also be ensured after touching any surface in public places outside of the home. It is recommended that, when our hands are visibly dirty and if we are caring for a sick person, we need to wash our hands before and after touching the sick person [8].

 

Agents used for hand hygiene: There are various products available which can be categorised into hand rubs and hand washing agents, like alcohol -based (hand) rub, antimicrobial soap, antiseptic agent, antiseptic hand wipes, and plain soaps [9]. These can be used appropriately as and when required.

 

Methods of hand hygiene:

  1. The preferred means for routine hand hygiene is cleaning hands by rubbing with an alcohol – based formulation if hands are not visibly soiled. It is quicker, increasingly successful, and well tolerated by your hands than washing with soap and water [10].
  2. For washing hands when they are visibly dirty or stained with body fluids like blood, urine, nasal fluid, amniotic fluid etc, soap and water should be used.[11]. To do this, wet your hands with water and put on the proper amount of soap needed to clean it properly. After Washing hands dry it thoroughly. Each and every time clean, running water should be used [12]. WHO and Centre for Disease Control (CDC) also recommend to wash hands thoroughly for 20-30 seconds for proper disinfection of hands. This is the most economical and best means of hand hygiene technique which must be followed at community level, specifically in developing and least developed countries having limited resources [11]. Figure -2 illustrate the technique of hand rub and hand washing.

 

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Figure-2: Hand rub and hands washing technique (Source – WHO).

 

Challenges: There are various factors responsible for poor hand hygiene practices like clinical factors, environmental, institutional, behavioural and other factors. In some health care set up, minimal effort is given for prevention and control of hospital acquired infection. It is pertinent to mention here that the developed countries are widely implementing the evidence-based guidelines to prevent Hospital Acquired Infections (HAIs), however, in developing countries, there is lack of basic health care services including poorly implemented surveillance system and necessary resources to prevent HAIs [13]. Sometimes non availability of basic facilities for hand cleaning like running water, sinks and alcohol-based hand rub disinfectants are barriers for hand hygiene. [11]. In spite of the available evidences and established facts that hand hygiene helps to reduce the transmission of infections it is often difficult to establish rigorous handwashing habits even by people who have been highly trained and should know better. Additionally, hospital staff generally overestimate the frequency and quality of their handwashing behaviour [14].

 

Conclusion:  Maintaining hand hygiene is the most successful means to prevent transmission of infections including Hospital acquired infection (HAI) and pandemics like Covid-19. Practicing proper hand hygiene with proper technique can ensure the quality of care, safety of patient and safety of healthcare workers too. The health care workers need to practise simple hand hygiene in patient care activities and set an example as the role model for future health care work force. Hand hygiene is noted as one of the top patient safety technique that can be encouraged for acceptance and implementation. Looking at the prevailing Covid-19 pandemic, healthcare workers and the community should frequently wash their hands as this is the most cost-effective means to prevent transmission of infections. Though hand washing compliance is high among healthcare workers, the same is not true for the public. Thus, the healthcare workers including doctors, pharmacist, and nurse should educate the patient on the importance of hand washing. All stakeholders including Government, donors, and NGOs should also promote hand hygiene amongst general public and the resources and facilities for the same should be provided to ensure quality and safety.

 

 

 

 

 

 

 

 

 

 

 

References:

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[1] Purnima Gupta Bhoi – Faculty (Hospital Management), KIIT School of Public Health Bhubaneswar, Odisha and Research Scholar, Suresh Gyan Vihar University, Jaipur, Rajasthan.

[2] Dr. Swati Mishra, Associate Professor – I.S.B.M, Suresh Gyan Vihar University, Jaipur, Rajasthan.

[3] Mr. Nilakantha Bhoi- Research Scholar, Suresh Gyan Vihar University, Jaipur, Rajasthan.