Hand Hygiene Handwashing and Clean Hands Saves Lives


Medical Exam Gloves Causing Reduced Hand Hygiene Compliance

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.

Debunking the Not-so Common Knowledge of Hand Hygiene

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.

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.