For many healthcare workers, hand washing has become automatic since we know that maintaining proper hand hygiene is important to preventing the spread of infectious disease. With continued reminders from Infection Control staff combined with the constant watchful eye of peers, healthcare workers are more self-aware that hand hygiene should be practiced as needed. If you know you are doing a proper job at washing your hands at work, how would you rate your performance when it comes to practicing hand hygiene at home? Do the rest of your family members, especially children, wash their hands regularly?

During a study conducted by Nicas and Best at Berkley University, they were able to quantify the amount of times people touch their face with their hands. By observing ten students for three hours, Nicas found that these subjects touched their face 15.7 times per hour on average. If we assume that individuals are awake for 16 hours on average, we are estimating that people touch their own face at least 250 times per day. Although we weren’t able to verify the following, the Hollywood movie Contagion made a bold claim that we touch our face at least two to three thousand times per day. The actual number is not that important because whether we are aware of our actions or not, most of us can agree that we touch our face with our hands frequently enough. The important matter to consider is what our hands have been touching prior to our hands touching our face. When you ask yourself this question, it becomes easier to see why we get sick at times.

Imagine for a moment that you are able to record a full day of your actions from the moment you wake up to the time you fall asleep. Better yet, let’s reflect on what you did when you woke up yesterday morning. To give you an idea of my prior morning, I was woken by the alarm clock at 6am and I hit the snooze. Several minutes later, I turned off the alarm clock, checked my phone for messages, turned on the TV for my morning news, started brewing my coffee and finally hit the shower. It hasn’t even been 5 minutes from the time I awoke and I already touched 5 different objects that I can recollect. I can’t even remember if I touched my face prior to washing up. Here’s some food for thought: When’s the last time you cleaned or disinfected your alarm clock, phone, or remote control? If we track things we touch during the middle of the day, the knowledge alone is enough to give us germ phobia. The point of this is not to disinfect everything you own, but to be aware that even in our homes we are exposed to germs in places we don’t realize. Understand that it is unavoidable to be in contact with germs in our daily lives; however, we can practice good hand hygiene to prevent contraction of harmful viruses and bacteria.

Luckily, the human body has an amazing defense mechanism against harmful pathogens. Our skin is the ultimate first line of defense while our white blood cells are like cavalry coming to the rescue. Unfortunately, there are a lot of areas on our face that does not have the protection of skin such as the eyes, nostrils, and mouth. For this reason, the face is more susceptible to contracting the flu or common cold virus. There’s a reason to every wise proverb and our parents pestering us to wash our hands before dinner is not for naught.

Most importantly, I feel it is our duty to set the right example for our friends and family when it comes to hand washing regularly and properly. If you have children in the household is even more important to set the right example because children are known to mimic adults. Let’s start a good habit of washing hands. As for your friends, don’t be shy about checking to make sure their hands are clean. Asking someone if they washed their hands is not uncouth, it is caring. Checking to see if someone washed their hands will benefit not only that person, but you and your family.

Hand Hygiene References

• Nicas, M. A study quantifying the hand-to-face contact rate and its potential application to predicting respiratory tract infection. Journal of Occupational and Enviornmental Hygiene. June 2008; 5(6):347-52.
• Macias, A. Controlling the novel A (H1N1) influenza virus: don’t touch your face!. Journal of Hospital Infection. 2009: 73, 280-291. August 20, 2009.

Is it true that medical gloves can have a detrimental effect on hand hygiene compliance? I can understand how confusing this statement is. After all, aren’t exam gloves suppose to provide protection against the spread of infections? A recent study published in the Infection Control and Hospital Epidemiology observed that the rate of healthcare workers practicing hand hygiene when exam gloves were used was worse than when medical gloves were not worn. These findings reinforce the idea that we need to keep vigilant with educating everyone on when hand hygiene should be practiced and the importance of it.

In The Dirty Hand in the Latex Glove study, the hand hygiene compliance rate of healthcare workers who used medical gloves was 9% worse than the workers who didn’t wear exam gloves. The study concluded that there was a strong association of medical gloves being used as the reason for this discrepancy. This seems to indicate that there are numerous healthcare professions who believe donning medical gloves alone are sufficient for proper hand hygiene. Similar to drivers who are more inclined to speeding feeling protected by air bags, many of us have grown comfortable with the idea of being sufficiently protected by medical gloves. Just as wearing seat belts is the best protection for drivers, washing our hands is the best protection against hospital acquired infections. Wearing medical gloves is not suppose to act as a substitute for washing hands or using hand antisepsis, but rather be a complementary process for maintaining good hand hygiene practices.

Another reason for the decline in the rate of hand hygiene compliance is attributed to the lack of education of when gloves should be used and when hands should be cleaned with soap & water or alcohol rub. It is easy for us to remember that gloves should be used in high-risk scenarios and that hands should be washed when they are visibly contaminated, but what about the times when you are not in a high-risk scenario or when your hands are not visibly dirty? What is even considered to be a high-risk scenario? Considering how busy healthcare workers are, it is understandable that we would forget over time.

The World Health Organization (WHO) recommends that hands need to be cleaned before donning medical gloves and after taking them off. The WHO recommends that medical gloves should be used whenever you anticipate coming into contact with bodily fluids or when patients need to be protected in a sterile environment. The purpose of medical gloves is to provide barrier protection against harmful microbes, not eliminate them. It is important for everyone to understand gloves may contribute to the spread of infections if proper hand hygiene procedures are not practiced, such as changing exam gloves for new patients and cleaning hands before and after donning gloves.

At the end of the day, continued education of when and how to practice proper hand hygiene is important. Just because a nurse received training at the start of employment does not mean she will retain the information several years later. Let’s be sure our colleagues understand that exam gloves are not a substitute for hand hygiene and that we should be cleaning our hands before and after wearing them. Let’s bring the rate of healthcare acquired infections down to 0. Clean hands save lives!

Hand Hygiene References

• Fuller, Christopher. "The Dirty Hand in the Latex Glove": A Study of Hand Hygiene Compliance When Gloves Are Worn. Infection Control and Hospital Epidemiology. November 11, 2011.
• World Health Organization. World Health Organization on Hand Hygiene. Geneva: WHO, 2009.

It is easy for anyone to admit they wash their hands regularly and that it is a good habit to keep so sometimes it’s easy to overlook the fact that not everyone is knowledgeable in the nuisance details surrounding hand hygiene. Raising the awareness of hand hygiene depends on us sharing our knowledge with one another and we want to share with you that although some information may seem to be common knowledge to us, it is not so with everyone.

We should never be afraid of educating or sharing information regarding the facts on hand hygiene; however, we should do it in a matter that doesn’t discourage others. Be cognizant that encouraging proper behavior is better than any reprimanding.

We Can Easily Tell When Someone Cleaned His or Her Hands

Not true. We can usually tell if a person washed their hands by listening to the sink running or noticing if the hands are still moist, but the important question is not whether or not the person washed their hands. The key question we need to consider is whether or not the person washed their hands properly. If proper hand washing technique was followed, was the right product used for the scenario? Are soap and water being used when alcohol hand rub is not sufficient?

We All Know When We Need To Clean Our Hands

This is not necessarily the case. Most of us know we should wash our hands before we eat and after we use the restroom, but what about the numerous other scenarios such as when healthcare workers come into physical contact with patients? There is nothing wrong with giving someone a gentle reminder of performing hand hygiene when it is forgotten. More often than not, people will be appreciative of this.

People Who Don’t Adhere to Proper Hand Hygiene Don’t Care or Are Lazy

This isn’t really so. Especially within a healthcare setting, most workers try their best to do the right thing and want their patients to be safe. The key to hand hygiene is making the when and how of cleaning the hands a regular part of an individual’s routine. For some individuals, they just don’t know and just need the proper education.

If Everyone Had Excellent Hand Hygiene, Infections Would Be Eradicated

Although infections wouldn’t be eliminated, the number of infections would be reduced if everyone had excellent hand hygiene. According to reports by the CDC and WHO, bad hand hygiene is the number one contributing factor for the spread of infections. Making sure everyone practiced good hand hygiene won’t get rid of diseases, but it will keep our society healthier by helping contain infections that do occur.

Hand Hygiene Resource:

• Center for Disease Control and Prevention: Guideline for hand hygiene in health-care settings. Morbidity and Mortality Weekly Report 51:1-45, Oct. 25, 2002.
• WHO Guidelines on Hand Hygiene in Health Care. World Health Organization, 2006.

As studies have shown, our fingernails house the highest level of pathogens on our hands. The area under the fingernail has at least 75 times more microorganisms per density than anywhere else on the hands.

Researchers have known for long time that the hands are the primary perpetrator to the transmission of microorganisms. Clinicians have thus educated on the importance of handwashing, to restrict the spread of germs. Even with frequent handwashing with soap and water, it is nearly impossible to eliminate the presence of pathogens. For this reason, using antiseptic agents, especially alcohol-based rub or gel, are highly recommended to reduce the density of microorganisms on the hands.

Be sure to rub underneath the fingernails each time you wash your hands or apply alcohol-based antiseptic.

References
- Armitage, P. Statistical methods in medical research.  Blackwell  Scientific Pulblications, Ltd. Oxford. 1971.
- McGinley K, Larson E, Leyden J. Composition and Density of  Microflora in the Subungual Space of the Hand. Journal of Clinical Microbiology. 1988;26(5):950-953.
- Price, P. The bacteriology of normal skin: a new  quantitative test applied to a study of the bacterial flora and the  disinfectant action of mechanical cleansing. The Journal of Infectious Diseases. 1938;63:301-318.

The last thing hospital administrators want to do is raise costs. In light of price increases seen across the board for medical supplies, they would frown upon spending money on incremental materials. It is no surprise that advocating a hand hygiene program can be quite challenging especially if it requires a budget. This article will show how investing in a hand hygiene program can save hospitals in the long run.

Correlation of Hand Hygiene and Infections

In the United States, healthcare associated infections, also  known as hospital acquired infections, lead to nearly 100,000 deaths annually.  The Center for Disease Control and Prevention (CDC) defines healthcare-associated infections (HAIs) as infections acquired during the time the patient was in a  hospital for other conditions. As an example, let’s consider a person who  receives an infection while visiting the doctor for a standard checkup. This  scenario would be classified as a HAI.  On  the flipside, if a person receives an infection due to an existing condition  like an open wound, this infection would not be classified as an HAI.

Healthcare associated infections results from the transmission of germs spread around due to a combination of reasons which include having a high concentration of sick individuals inside hospitals and  poor hand hygiene practices.

Hands are the number one method of transmitting harmful pathogens to another person. This fact is not surprising when you think about how hands touch patients and regularly touch objects where microorganisms can  reside. If handwashing is not done properly, germs will continue to spread and  increase the prevalence of healthcare associated infections. In a study  conducted by the CDC, the average hand hygiene compliance rate in American  hospitals is roughly 40%.  This statistic  is horrible and infection control practitioners agree that if we can have more  healthcare workers and visitors wash their hands regularly, the number of  healthcare associated infections would drastically reduce. Every year there are  nearly 1.7 million HAIs in the United States and this means that at least 5% of  patients admitted in hospitals receive HAIs. This calculates to 5% of victims  to healthcare associated infections leading to death.

Cost of Healthcare Associated Infections

In the state of Pennsylvania, the number of healthcare  associated infections increased 58% to 30,237 reported cases in 2006 compared  to 19,154 cases in 2005. Looking at the data, the mortality rate of patients  who acquired HAIs was 6 times higher than patients without HAIs.  We recognize that the cost of human life is  high, but the study goes beyond and calculates the operational costs of the  healthcare facilities. On average, the hospital charge for admitted patients  without HAIs was $33,260.  In contrast,  the average hospital charge for admitted patient with HAIs was $175,964. In  addition, the average length of stay in hospital while the patient was admitted  was higher by 5 times the amount in patients with HAIs.  The findings of this study draw the  conclusion that HAIs are responsible for a large chunk of health care costs.  Experts agree that the single most effective  measure for combating HAIs in hospitals is improving hand hygiene which leads  to a reduction in the high costs of health care.

Hand Hygiene Program’s Effect on Healthcare Associated  Infections

Hand hygiene programs are an investment to healthcare  facilities because when more and more workers practice good hand hygiene, the  rate of hospital acquired infections are shown to decline. In Switzerland, a  hand hygiene program was implemented at the University of Geneva hospitals and  was able to improve and sustain the hand hygiene compliance rate from 48% to  66% resulting in a significant decline in the number of HAIs. Dr. John Boyce,  chair of Hand Hygiene task force at CDC, stated that if hospitals are able to  sustain hand hygiene compliance rates of 70-80%, a substantial reduction of  healthcare-associated infections would be seen.

Most hospitals in the United States have implemented some  form of hand hygiene program; however, not all hospitals have committed the  same amount of resources. Successful hand hygiene programs report that  campaigns must be implemented hospital-wide to make a lasting impact. The state  of Pennsylvania adopted a campaign encouraging patients to ask clinicians, “Did  you wash your hands?” This campaign continues to see success as efforts are cooperatively  supported from the administration level down to each worker’s unit.

The incremental operating cost of a healthcare associated  infection is calculated at thousands of dollars. If a hand hygiene campaign is able  to prevent one HAI, the efforts will not have been for naught. Experts from CDC  and APIC speak with unison regarding the need to improve hand hygiene around  the world. Preventing healthcare-associated infections is the best way of  attacking the HAI problem and good hand hygiene is recognized as the single  most effective method of preventing HAIs. Handwashing does saves lives!

References
- Pennsylvania Health Care Cost Containment Council. Hospital-Acquired Infections in Pennsylvania - Calendar Year 2006. April 2008. www.phc4.org.
- Haas J, Larson E. Compliance with Hand Hygiene Guidelines. AJN, American Journal of Nursing. August  2008;volume 108, number 8:pages 40-44.
- Littau, C. Clean Up on Hand Hygiene Compliance. Materials Management in Health Care.  October 2007.
- Center for Disease Control and Prevention. Healthcare Associated Infections.
- Association for Professionals in Infection Control and Epidemiology.

Turn on the news today and you can be sure one of the hot  topics being covered is the status of the Influenza A – H1N1 strain, commonly  referred to as “swine flu”. Ever since the World Health Organization (WHO)  raised the pandemic alert level of the swine flu from phase 4 to 5 on April 29,  2009, people have become increasingly cautious. Naturally, prevention comes to  mind and the most popular question recently is how?

Swine flu is a respiratory disease that originates from pigs  as the name would suggest. Although the swine flu originated from pigs, a  common misconception is that people can receive the swine flu from eating pork.  Pork that is cooked well pose no risk of transmitting the virus. Cooking the  meat well kills all bacteria and virus.

The Center for Disease Control and Prevention (CDC) mentions  the most common method of transmission of H1N1 from human to human is through  coughing or sneezing from infected individuals. Similar to the seasonal flu,  swine flu will cause similar symptoms of the standard flu such as coughing,  fever, body aches, and fatigue. To be safe, it is recommended to stay away from  individuals who show signs of being sick. WHO recommends staying away from  public areas crowding with people; however, for most individuals this is nearly  impossible to do. This is where practicing good hand hygiene becomes necessary.

As  with all influenza viruses, the CDC notes that washing hands regularly will be  beneficial in the prevention of contracting the illness. Invisible to the naked  eye, swine flu can reside in droplets of bodily fluids that can fall on doorknobs,  tables, or other public areas. If you were to touch such surfaces and then  touch your nose or mouth, your risk of receiving the swine flu is very high.  Washing the hands or using alcohol-based sanitizers will ensure your hands  remain clean just in case you involuntarily touch your nose.

As we enter the summer months, experts note that the voracity  of the swine flu will die down. The biggest fear is what will happen when we  enter the autumn season. Historically, outbreaks of influenza saw the virus die  down during summer to only pick up during autumn and winter when the virus can  spread easier. The biggest fear from experts is that the swine flu can pick up  elements of the seasonal flu and develop properties of resistance.

Research is currently underway to successfully combat this  virus which includes the development of vaccines. Full development of the H1N1  influenza strain vaccine is closer, but is still racing against the clock since  full-scale production of the vaccine will also take time to make.

Time  will tell how serious the 2009 swine flu is. Perhaps the virus will just go  away or perhaps it will cause an outbreak. In any case, the best thing we can  do in the meantime is be smart about preventing the spread. At this time,  washing your hands regularly is one of the most effective ways to prevent the  spread of influenza. Let’s wash our hands properly and do our part in creating  a healthier environment.

References
-Centers for Disease Control and Prevention. www.cdc.gov.
-World Health Organization. www.who.gov.

At Hand Hygiene, we seem to receive more questions  surrounding the nature of alcohol-free hand sanitizers.  Is alcohol-free better?  Is it safer?   Why should clinicians even consider using an alcohol-free sanitizer?  In this article, the Hand Hygiene team will  outline the pros and cons of using alcohol-free hand sanitizers compared to  alcohol-based alternatives.

Advocates of alcohol-free hand sanitizer products surround  their arguments around 3 primary principles:
1. Alcohol-free products are safer to use.
2. The formulation in alcohol-free sanitizers is as effective as ethanol in killing microorganisms.
3. Repeated use of alcohol-based sanitizers is detrimental to the hands as  essential oils are stripped away from the skin.

Are alcohol-free hand sanitizers safer to use?

Alcohol-based hand sanitizers have high concentrations of  alcohol since the Food and Drug Administration (FDA) recommends sanitizers  should contain 60% to 95% ethanol or isopropanol to effectively kill germs on  the hands. Looking at the high alcohol content required, it is not surprising  to see that most alcohol-based antiseptic products are highly flammable.  Unfortunately, the media took it upon  themselves to hype this concern causing the general public to raise concerns.  Contrary to what the media may think, the  FDA, World Health Organization (WHO), as well as the Association for  Professionals in Infection Control and Epidemiology (APIC) continue to  recommend the use of alcohol-based hand sanitizers in hospital settings.  To this day, the FDA does not recommend any  alcohol-free hand sanitizers for use as an antiseptic agent.

As for concerns over alcohol-based antiseptic causing fires  in healthcare facilities, caution is required when planning to install wall-mounted  sanitizer dispensers within hallways and rooms.   Hospitals must adhere to the local fire department’s regulation on the placement  of such dispensers.  Given the caution  placed in planning the installation of wall dispensers, few hospital  administrators voice concerns over the possibility of a fire. Economically, the  amount of money saved by preventing the spread of infections far outweighs the  possibility that a fire can start due to a hand sanitizer bottle catching on  fire.

Although the healthcare community does not have to worry too  much regarding the safety of alcohol-based sanitizers, arguments for caution  may not be without merit in an environment where children are present. Adults  should always use caution regarding where to store alcohol-based hand  sanitizers. The prime concern with children’s use of alcohol-based sanitizers  is possible ingestion. Most antiseptic dispensers are easy to open making it simple  for children to access. Since most alcohol-based hand sanitizers have high  concentrations of ethanol, alcohol poisoning is very possible if a child were  to consume any. Most sanitizers have a distinct, disgusting taste to prevent  people from consuming, but in the event of accidental ingestion, contact the  Poison Control Center or your local physician.

It is our opinion that the possible “dangers” of  alcohol-based hand sanitizers have been blown out of proportion and would not  warrant a transition to alcohol-free sanitizers in the healthcare industry. The  benefits of killing germs far outweigh the risks. As for replacing the current  standards, if alcohol-free sanitizers are as effective as alcohol-based  sanitizers, it does not hurt to consider the use of such an alternative in the  interest of increasing the safety in healthcare facilities.

Efficacy of Alcohol-free Hand Sanitizers

If you are considering switching to alcohol-free sanitizer,  the key question on your mind will be, “what is the efficacy of alcohol-free  hand sanitizers?” In other words, how well will an alcohol-free agent kill  microbes? The answer: it depends on the agent used. Any comparison of efficacy  rate should be done with an appropriate control: ethanol or isopropanol.

There is no question on effectiveness of ethanol or  isopropanol regarding efficacy rate of killing microbes. First of all, alcohol  is known to kill a wide range of pathogens which include MRSA, salmonella, and  HIV. This is especially important in a hospital environment because both  patients and healthcare workers have high exposure to numerous bacteria and  viruses.  In addition to killing a wide  range of bacteria, virus, and fungi, alcohol has one of the highest killing  rates compared with other agents.   Efficacy of antiseptic agents is measured in logarithmic units.  The higher the concentration of alcohol, the  better the kill rate will be.  In  addition to the efficacy level in terms of percentage, ethanol and isopropanol  kills pathogens quickly in a matter of seconds. The hospital is a fast-paced  environment and clinicians cannot afford to wait around for an antiseptic agent  to disinfect their hands. For this reason, hand antiseptic agents should be  able to kill microorganisms quickly. Finally, alcohol has the added benefit of  providing persistence and residual protection. Simply put, after application of  alcohol-based hand sanitizers, the clinician is protected for a period of time.  For this reason, alcohol hand rubs are widely used in surgical units where  germ-free environments are a necessity to the protection of the healthcare  professionals and patients.  To sum it  up, alcohol has been the preferred antiseptic agent in hand sanitizers because  of its ability to kill a wide range of pathogens quickly and effectively while  providing residual protection. For alcohol-free hand sanitizers to replace  alcohol-based sanitizers, the antiseptic agents used should be just as good, if  not better, than alcohol on efficacy.

The problem of analyzing antiseptic agents used in  alcohol-free hand sanitizers is the lack of standardized agents. New companies  are coming up with unique formulas claiming how their product is better making  analysis inefficient. This is one of the primary reasons it is difficult for  the Center for Disease Control and Prevention (CDC) to give their “stamp of  approval” on any alcohol-free hand sanitizers. Without such standardization on  the acceptable antiseptic agent found in alcohol-free hand sanitizers, it is  difficult for the CDC to give guidelines on the volume of antiseptic agents  that should be used because the efficacy rate may not necessarily be proportionate  to volume as ethanol is.

So how does one check for the efficacy of a particular  alcohol-free hand sanitizer brand? There is no easy way, but to start off, ask  the manufacturer for data on efficacy rate and clinical trials, if any. Once  you have the data, scrutinize it by comparing the data with the efficacy of  alcohol.  If you are seriously  considering the use of an alcohol-free sanitizer, this homework is necessary  because there is no alcohol-free sanitizer product that is recommended for use  by the CDC.

Are alcohol-based hand sanitizers detrimental to healthy hands?

It is true that applying alcohol repeatedly on your hands can be damaging to the skin. Every time alcohol is applied and you rub your hands together, natural oils that retain moisture on the hands are stripped away. However, this phenomenon is not as bad as it seems. Although the natural oils strip away when hand sanitizer is applied, the skin reabsorbs the oils as the alcohol dries off. In addition, most alcohol-based hand sanitizers contain emollients that help the skin retain moisture to minimize any damage that happens. In fact, washing your hands with soap and water is more detrimental to the condition of the skin versus using alcohol-based hand sanitizers because when you wash your hands, the natural oils from your skin are stripped away.

Next Steps

Reading this article, you might get the sense that the general recommendation is to not use alcohol-free hand sanitizers as a substitute for alcohol-based. This is not because all alcohol-free hand sanitizers are inferior, but because there is not enough conclusive evidence to suggest that there is an alternate antiseptic agent that can be used as a substitute to alcohol-based antiseptic agents for hand antisepsis products within the healthcare industry.

Let’s take a scenario where a lab technician accidentally douses your hand with E. Coli and were given a choice of hand sanitizers to choose from. You can bet that I would instinctively reach for the alcohol-based hand sanitizer with the highest alcohol concentration available. We know alcohol has one of the highest efficacy rates of killing harmful pathogens. In addition, there is plenty of research to back up this claim. Why would you want to risk your health by using a product you were not sure of? Although this question raises serious doubt on the use of alcohol-free hand sanitizers, we recognize that there may very well be a product out there that is acceptable for use in hospitals.

If a manufacturer’s finds their product to be comparable or superior to alcohol, the next step would be to share this knowledge with the research community for in depth analysis. In depth analysis would include in vivo testing in addition to in vitro testing to see how the product’s efficacy rate changes when applied on the hands. Also, the long-term effects of the product used should be analyzed to determine how prolonged use affects individuals.

Once this data becomes available to support alcohol-free hand sanitizers, the final step would be to make sure the product is accessible. The product should be cost effective like current alcohol-based hand sanitizers.

At this time, Hand Hygiene agrees and support’s CDC and WHO’s recommendation of using alcohol-based hand sanitizers within hospitals. As alcohol-free hand sanitizers begin to standardize and as more data become available, it will be worthwhile to revisit whether an alcohol-free hand sanitizer can become an acceptable substitute to alcohol-based hand sanitizers.

References
- Pittet D, Rudolph P, Kramer A. Interscience Conference on Antimicrobial Agents and Chemotherapy. Interscience Conference on Antimicrobial Agents and Chemotherapy. 2001 December 16-19; 41: abstract no. K-1338.
- Boyce J, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Centers for Disease Control and Prevention. 2002 October 25; 51(RR16); 1-44.
- Eitzen HE, Ritter MA, French MLV, Gioe TJ. A microbiological in-use comparison of surgical hand-washing agents. The Journal of Joint Bone and Surgery. 1979; 61-A: 403-6.
- Heeg P. Does hand care ruin hand disinfection? Journal of Hospital Infections 2001; 48 (suppl A): S37-S39.

The Staphylococcus Aureus bacteria are known to be  responsible for Methicillin-Resistant Staphylococcus Aureus infections commonly  referred to as MRSA.  MRSA infections can  affect different skin parts of the body and is considered to be serious because  of its resistant nature to numerous antibodies including penicillin.  For this reason, MRSA has been dubbed as the super germ.

The primary cause of the super germ is due to the overuse of  antibiotics.  Since the discovery of  penicillin, antibiotics continue to be effective in treating bacteria related  infections.  However, the continued use  of antibiotics has caused certain bacteria to develop resistance to antibiotic  drugs like MRSA.  This problem is  compounded by the fact that doctors have been overprescribing antibiotics to  patients.

Since antibiotics have been viewed as a “cure-all” drug, numerous  physicians have been prescribing patients with sore throats, common cold, or  flu symptoms with antibiotics.  In some  cases, antibiotics are not needed at all.   In fact, patients also contribute to the rise of MRSA.

In addition to demanding drugs to cure any illness, many patients  who receive antibiotics do not follow instructions given by the doctor and pharmacist.  Patients frequently stop taking antibiotics  once they feel better even though they are told to continue treatment for a  prescribed period.  Others simply forget  to take the drug at the correct time.   These examples of carelessness provide ample conditions for the  remaining bacteria in the body to develop resistance to the drug used.

Fortunately, there are treatments available to cure patients  with MRSA; however, the treatment options are limited.  The fear of MRSA or any super germ is that we  will eventually exhaust all treatment options available.  The more drugs we use, the less the drug  becomes effective.   Although MRSA is known to critically affect  the elderly, children, and individuals with weak immune systems, cases of  healthy individuals becoming victims are rising.  Today, MRSA is responsible for thousands of  deaths every month in the U.S. and we can help minimize the spread of these  bacteria.

The CDC promotes hand hygiene through handwashing as a means  of reducing MRSA infections.  MRSA can be  spread through skin-to-skin contact, cuts on the skin, and even sharing  personal items like towels.  Good hygiene  such as frequent handwashing with soap and water is one of the best ways to  prevent getting MRSA and spreading it. Although MRSA is quite serious, we can do our  part to prevent the spread of MRSA.

Remember,  clean hands save lives!

References
-Centers for Disease Control and Prevention. Community-acquired   methicillin-resistant Staphylococcus aureus infections-Michigan. MMWR.   1981;30:185-7.
-Buckingham S, McDougal L, Cathey L;et al. Emergence of Community-Associated   Methicillin-Resistant Staphylococcus aureus at a Memphis, Tennessee   Children's Hospital. Pediatrics Infection Disease Journal. 23(7):619-624, 2004.

Did you know that each clinician can help reduce the number of healthcare-associated infections by following hand hygiene guidelines? That is our mission: to eliminate  healthcare-associated infections through  education of proper hand hygiene.

I can just hear you now questioning the title of this  article, “How can soap and water be bad for my skin?” I may sound crazy, but bear  with me while I explain.

The skin serves  several purposes, but a couple are  worth pointing out.  First, the outer  skin acts as the body’s first line of defense to foreign objects including  microorganisms.  Secondly, the skin  serves to minimize the amount of water the body loses.  It is easy to see the importance of maintaining  healthy skin.

Looking at the  physiology of the skin, the outermost section of the skin is called the  epidermis and the outermost layer of the epidermis is called the stratum  corneum (also referred to as the “horny layer”). The horny layer is composed of  natural lipids that keep the skin hydrated. Without this layer, the skin would  dehydrate resulting in cracked, damaged skin. The thicker the horny layer is,  the more hydrated the skin is.

Every time we wash our hands, layers of natural lipids are  stripped away reducing the skin’s ability to preserve water. The epidermis will  regenerate the lipids, but if we wash our hands in excess our body cannot keep  up with the production of this protective layer. The end result of frequent  handwashing is contact dermatitis symptoms of skin irritations.

I am not claiming nor suggesting we should stop washing your  hands, but rather we wash in moderation. Washing with soap and water is important  to a healthy lifestyle and should be part of our regular routine. So when  should we wash our hands? Proper hand hygiene states handwashing is required  under the following conditions:

1. Before eating a meal
2. After using the bathroom
3. When hands are visibly soiled or dirty.
4. When contact has been made with bodily fluids or  blood.

If cleaning is required at any other time, hand sanitizers are  recommended to be used as a substitute. Hand sanitizers are alcohol-based and  do not break down the natural lipids of the skin.  For this reason, alcohol-based hand sanitizers  (or antiseptic) are preferred whenever handwashing with soap and water is not  required.

How much washing is considered too much? Proper handwashing  technique states hands should be washed for at least 15 seconds, but not to  exceed 1 minute.  There are many  professions, like the medical industry, that require more frequent handwashing  compared to the average person. It is In these cases, handwashing should be  conducted whenever needed, but extra precaution should be taken by utilizing  skincare cream or lotions to assist in the restoration of the lipid layers.

For healthcare professionals, if the above handwashing  requirements do not apply, use the alcohol-based antiseptic. Alcohol kills the  most amount and broadest range of germs. In addition, the alcohol-based  antiseptic has the quickest kill rate compared to washing with antimicrobial  soap. Best of all, the alcohol-based antiseptic will not strip away the skin’s  lipid layers that locks in moisture.

Although handwashing is known to strip away lipid layers of our  skin, handwashing should not be avoided.   On the contrary, washing hands should be encouraged as it is an important  part of a healthy lifestyle. When handwashing is done properly, soap and water  is not an enemy, but rather a friend to healthy skin.

References
- Commission for Hospital Hygiene and Infectious Disease Prevention of the Robert Koch Institute. Hand hygiene. Bundesgesundheitsbl - Gesundheitsforch - Gesundheitsschutz. 2000;43:230-233.
-Kampf G, Loeffler H. Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygenic hand disinfection. Journal of Hospital Infection. 2003;55:1-7.