Hand Hygiene Saves Numerous Lives

It is not uncommon that we frequently touch the face, eyes, nose, and mouth without even realising it. Therefore, there are chances that microorganisms enter the body, so having clean hands becomes essential to prevent it.  Research has shown that handwashing can prevent about 30 per cent of diarrhea-related sicknesses and about 20 per cent of respiratory infections (CDC, 2020). Oftentimes, antibiotics are prescribed unnecessarily for these health conditions and the reduction of chances of infections by washing hands frequently helps prevent the overuse of antibiotics which is the single most important cause of the development of antibiotic resistance. 

Approaches

Each year, hundreds of millions of patients around the world are affected by healthcare-associated infections (HAIs) and thousands of people across the world succumb to infections acquired while receiving healthcare. Thus, hygiene is imperative to reduce the spread of diseases and infections. Most HAIs are preventable if we practise good hand hygiene in a proper way at the right times. 

Frequent hand washing with soap and water and the use of alcohol-based hand rub as one of the ways to reduce infection risk as advocated by the World Health Organisation (WHO) and other organizations. As our hands touch different surfaces that support the viability of viruses from hours to more than a day, frequent and/or regular hand washing is an effective measure to contain the spread of infections. Clean water or warm water without soap help reduce the number of microbes but cannot completely remove most of the viruses and bacteria. Therefore, in case of unavailability of soap and hand rub sanitiser, washing hands with clean water is also good but soap adds effectiveness.

Cleaning hands by rubbing alcohol-based formulation is an effective hand sanitising technique in case hands are not visibly soiled. Although this method is faster and better tolerated compared to washing hands with soap and water as alcohol-based hand sanitizers kill most germs and are one of the most preferred methods of maintaining hand hygiene.

However, soaps work better as their lather comes in contact with all parts of the hand. A small amount of alcohol may not cover all parts of the hands; thus, a sufficient amount of alcohol-based sanitiser should be utilised. Water then removes inactive (dead) viruses from the hand while alcohol. Though it quickly reduces the number of microbes, it does not get rid of all types of germs and is not as effective as soap and water. To be effective, hand washing should be done for at least 20 seconds and sanitiser should contain at least 60 per cent of alcohol. 

Our behaviour is responsible for spreading those serious infections in healthcare settings and hand washing at the right time in the right way is essential to prevent infections. However, studies show that on average, healthcare providers clean their hands less frequently than they should. It was found that nurses complied with handwashing procedures 42 per cent of the time and physicians even less.

Healthcare workers need to perform hand washing countless times for a myriad of reasons throughout the shift. However, it is not an easy task to keep track of each of the specific instances in which a hand wash is vital and necessary. For this purpose, WHO promotes the five moments of hand hygiene. These moments include different circumstances such as before touching a patient which has been shown to have only 39 per cent compliance. It is important to wash away any pathogens picked up from previous activities while entering a patient’s room. Having said so, it is essential even if healthcare providers do not touch the patient as they may come in contact with items the patient later touches, potentially passing on dangerous microbes.

Similarly, there has been only about 60 per cent compliance with hand washing in the case of clean/aseptic procedures. The activities such as conducting tests, drawing blood, placing an IV, and preparing for surgery, must require a hand hygiene event prior to performing the task. This is the critical moment in which patients are particularly susceptible to harmful pathogens.  

Oftentimes, healthcare workers come in contact with bodily fluid exposure/risks such as blood, saliva, urine, and fecal matter and hand washing is important in order to avoid infections for both the patient and provider. Hand hygiene becomes a must event when the provider touches a patient and compliance was found to have occurred only two-thirds of the times. The most neglected instance is when a provider touches the patient's surroundings which have only about 40 per cent compliance. Even when a provider does not touch the patient directly, there is still a chance of cross-contamination. Therefore, it is important for healthcare workers to remember to wash their hands every time they come in contact with the patient’s surroundings.

Implementation

Most easy but often neglected, hand hygiene practices can prevent up to half of the avoidable infections. The low level of hand hygiene practices particularly in low- and middle-income countries have caused millions of avoidable deaths and have placed a financial burden on both the patient and healthcare facilities. 

Handwashing facilities, such as the installation of sinks, running water, and sewage systems, have been a major deterrent to the implementation of hand hygiene in healthcare facilities. Therefore, the implementation of such measures as well as raising awareness among healthcare providers about hand hygiene is extremely important to prevent the spread of infection to patients.

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)