Hand hygiene is a major issue in infection control. It is considered to be the most important infection preventing measures. Many infections are spreading by direct contacts. To prevent contamination, good hand washing techniques must be practised. Hand washing is also the least expensive measure to prevent transmission of nosomical infections. Hand washing is just one important way of avoiding transmission of organisms present on the hands. Hand hygiene is a well researched subject. It is stated to be an important route of transmitting infection (DOH 2001a cited in Dougherty, L. et al 2004). Survey shows that hand washing is not carried out to the high standards desired (Taylor 1978a cited in Dougherty, L. et al 2004).
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Every healthcare professional is aware that they should wash their hands before and after contact with a patient. Observation shows that this happens less often than it should. Hands can easily get contaminated during any activity and contact; therefore hands should be decontaminated before undertaking any activity. The purpose of hand washing is to remove dirt and reduce the amount of bacteria present on the hands (Reybrouck, 1986; Ayliffe 1992 cited in Meers, P. et al 1997). Hands like the rest of the skin, carries two types of microbiological flora. Resident organisms survive deeply on the skin and aren`t easily removable.
These bacteria can survive the application of an antiseptic. They are generally not linked to hospital infections. The resident flora of healthy hands is unlikely to cause infections, though this could vary among immunocompromised patients. Transient organisms can be transferred by direct contact. They reside on the surface of the skin. Transient are organisms that can be viral, bacterial, and fungal. Most of the transient flora is readily removed by good hand washing techniques and when antiseptics are used. The technique of hand washing should be carried out properly to ensure all areas are adequately decontaminated. To achieve fully clean hands, these steps should be followed (Taylor 1978b; Phillips 1989 cited in Dougherty, L. et al 2004):
- Roll up sleeves, remove rings and watches
- Use continuously running water
- Use liquid soap
- Place hands appropriately to avoid contaminating arms
- Avoid splashing clothing and the floor
- Rub hands together vigorously
- Use friction on all surfaces
- Rinse hands thoroughly with hand held down
- Dry hands completely.
When decontaminating hands some areas of the hands are very often missed such as the tips our nails and the thumb (Taylor 1978 cited in Perry Christine 2007). Nails should be kept short, as they harbour micro organisms underneath them. Jewellery shouldn`t be worn for the same reasons. Hands should be dried completely using good quality paper towels. Wet hands or poorly dried hands can transmit micro organisms to other surfaces easily. Drying of hands is absolutely crucial after hand washing. Electric drying reduces the damage caused due to frequent hand washing. Disposable paper towel and electric air dryers are commonly used, depending on the area providing the hand washing facility. Research indicates that there is no significant difference between the two drying methods (Gustafson et al 2000 cited in Dougherty, L. et al 2004).
Alcohol hand gel is another method used to decontaminate visibly clean hands. Alcohol gel is a powerful antiseptic that evaporates easily and rapidly on application. It kills transient and a proportion of resident bacteria and then vanishes. Washing of hands can be replaced by the application of alcohol gel if hands are visibly clean. Alcohol gel is not effective in removing physical dirt or soiling. Alcoholic hand rub dispenser should be placed in accessible areas. Alcohol based hand gels are a useful method of cleaning hands in areas that are scarce in hand washing facility; however in some cases it may be less effective against viruses such as Clostridium Difficile spores. Hand washing with liquid soap and water is necessary if an individual has experienced episode of diarrhoea.
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Hands are inseparable from healthcare and are also recognised as a route of transmission to infections. There is good evidence that health professionals do not use the appropriate techniques to decontaminate their hands. In practice it seems that hands aren`t washed as often as they should be. Studies show that up to 89% of staff misses some parts of the skin surface on their hands during washing (Taylor 1978a cited in Dougherty, L. et al 2004). Hands hygiene compliance is vital to prevent infections. Perhaps we need to think of cash incentives, “No compliance, and no payâ€Â. This will surely focus staff attention and they will have to abide by these rules and eventually will be an increased hand washing rate. Compliance with effective hand washing can be improved by further educating all members of staff (Colombo et al 2002 cited in Dougherty, L. et al 2004). Posters reminding healthcare staff and patients about the increased importance of hand hygiene in the healthcare environment may increase their awareness. Patients and visitors should be guided and encouraged to decontaminate their hands when needed and in helping improve hand hygiene compliance amongst the healthcare staff.
To be able to provide a high standard of care all staff should be fully educated in regards to infection control. There is a wide range of infections that can be prevented by a simple hand washing activity or the use of alcohol hand gel. Although healthcare staff do wash their hands but not using the appropriate techniques means hands aren`t fully decontaminated. Staff should be taught further on how to and when to decontaminate hands. Hand washing facilities should be made more accessible to staff patient and relatives in order to make a real difference in reducing infection rates and improve health service overall.
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