Patricia Revolinski, RN, MSN, CIC
Nurse Consultant, Infection Prevention and Control
Eisenhower Army Medical Center

Hand hygiene is one of the most important things to do to prevent the spread of infection in hospitals.

When you enter Eisenhower Army Medical Center, or any hospital or clinic, you generally will see hand sanitizer dispensers on walls, soap dispensers adjacent to sinks, pump-style bottles of hand sanitizer, and signs that remind staff and visitors of the that hand hygiene is one of the most important steps we should take to prevent spreading infections.

We grow up being taught that we must use soap and water to clean our hands properly. Indeed, I often joke with new employees that "Mom" was probably the first Infection Prevention and Control expert in their lives because she recognized the importance of clean hands and enforced the rule.

In 1847, Dr. Ignaz Semmelweis proved that washing hands reduced the spread of "childbed fever" -- postpartum bacterial infections of the female reproductive tract following childbirth infections, also known as puerperal fever -- from 12 percent to 2 percent in mothers who delivered in hospitals. However, his colleagues didn't share his belief that hand-washing with a chlorinated lime solution would be better for patient outcomes and so they publicly dismissed his findings and ridiculed him.

Louis Pasteur came to the same conclusion as Semmelweis, and further supported the assertion of our mothers that germs are everywhere and they can cause disease.

Fast forward to the late 20th century and the role of the hands in spreading germs is no longer being disputed, so the focus switches to how to perform hand hygiene and with what type of product.
The first national hand-hygiene guidelines were published in the 1980s. In 1995 and 1996, the Centers for Disease Control and Prevention recommended using antimicrobial soap or a waterless antiseptic agent when leaving the rooms of patients with infections caused by organisms that are resistant to antibiotics once used to treat them, such as Methicillin-resistant Staphylococcus Aureus, more commonly known as MRSA.

A 2002 publication by the CDC defined alcohol-based hand rubs as the standard of care for hand-hygiene practices in health care settings, and hand-washing was reserved for particular situations.

Hospitals and clinics needed guidelines to decide which of the products being marketed for hand hygiene would be the best for their patient population so respected agencies such as the CDC, World Health Organization, Agency for Healthcare Research and Quality and a taskforce made up of representatives of the Healthcare Infection Control Practices Advisory Committee Society of Healthcare Epidemiologists, Association of Professionals in Infection Control, and Infectious Diseases Society of America offered guidelines for choosing products based on the being efficient without being extremely irritating to the hands of the user, especially those who must use the product several times per day.

The selection of hand-hygiene products for EAMC is not just based on costs. The initial consideration is always effectiveness and appropriateness. EAMC's Infection Prevention and Control staff review the available research articles and guidelines from CDC, WHO, AHRQ, IDSA, SHEA and APIC for any changes in the recommendations since the last time EAMC needed to select a product.

We meet with the key stakeholders in the organization such as environmental services leaders and infectious disease physicians before selecting the product to be recommended for purchase. Other less formal discussions take place with staff representatives on the Infection Liaison Committee and their feedback is included in discussion with the stakeholders. These decisions are constrained by standardization of products across the Defense Healthcare Agency. Once all this has been considered, the IPs take their findings and recommendations to the Infection Control Functional Management Team where discussion is invited before a final vote occurs.

EAMC recently changed its anti-microbial soap because the FDA banned the use of Triclosan, one of the ingredients in the existing product. It was one of 19 chemicals being evaluated for appropriateness in soaps and the ruling was that it needed to be removed.

The team wanted to purchase a product that contained chlorohexidine gluconate, one of the products recommended by the HICPAC and known to us as being an optimal choice. That product is currently being placed throughout the facility for hand-washing.


To wash or to sanitize?
If your hands are visibly dirty or contaminated with body fluids, wash your hands with EAMC's new soap, using friction and covering the hands completely for 20 seconds before rinsing with lukewarm water is the appropriate option. If your hands are not visibly soiled or contaminated with body fluids, use hand sanitizer by applying to the palm of one hand and then rubbing hands together vigorously for at least 15 seconds, covering all the surfaces of the hands and fingers.

Hand sanitizer is more effective at reducing the number of organisms on the hands. EAMC's alcohol sanitizer has an emollient product in it so it is coating the hands to protect them with each use. If your hands are sticky after multiple uses of hand sanitizer, rinse them under lukewarm water and dry with a paper towel. After this, you should use the hand sanitizer again for hand hygiene before returning to your duties.

EAMC also provides products for protecting your hands, such as Provolon lotion, which is safe to use and easily obtained from Logistics.

Infection Prevention insists that EAMC staff use the approved hand-hygiene products only and not those that can be purchased and carried in your pocket or placed in your work area. Besides the obvious obligations and requirements of DHA, EAMC's products are compatible with each other and the gloves available throughout the facility, and will not result in a potential breach in the effectiveness of the products.

Hand hygiene remains one of the most important things to do to prevent the spread of infection. EAMC's patients have a right to expect the best care. Using appropriate hand hygiene when indicated is one of the best things we can do to show them EAMC not only cares for them but cares about them.

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