Hand Hygiene Handwashing and Clean Hands Saves Lives


Number of Microorganisms on Your Hands

Where do you think the most germs are located on your hands?
microorganisms on hands

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.

- 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.


Costs of Implementing a Hand Hygiene Program

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!

- 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.


Preventing Swine Flu

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.

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