Handwashing or hand hygiene is an important measure for preventing cross-transmission of micro-organisms.

University Degree Subjects allied to Medicine

September 2003 intake

Handwashing.

In 1847 Ignaz P. Semmelweis performed what is believed to be the first study to demonstrate that effective handwashing decreased the potential for cross-infection. His study showed that handwashing had a major part to play in controlling infection. This essay shall explain why handwashing and it’s guidelines are important in healthcare and as Semmelweis found their important role in infection control. It shall also explore the variety of substances that can be used in the procedure and their relevance.

Handwashing or hand hygiene is an important measure for preventing cross-transmission of micro-organisms. Reybrouck (1986) says that the purpose of handwashing is to reduce the load on the hands of these said micro-organisms. Indeed, McCulloch (1998) also acknowledges it’s importance, determining the procedure as being the most principle within infection control. Micro-organisms naturally live on the skin, they are known as resident flora. Embedded deep and impossible to completely eradicate, they are occasionally associated with cross-infection. More significant in the area of infection control are transient bacteria, which are picked up, usually from other patients, and transferred to objects or people by touch (Roper, Logan & Tierney, 1996). The hands are a key source of transport (Holland, Jenkins, Soloman et al 2003), especially when coming into contact with body fluids, dressings, and equipment. Transient bacteria can have adverse outcomes, susceptible patients and susceptible sites, i.e. wounds can become infected. NursesNetwork (2003) agree that secondary endogenous infections result from micro-organisms transported by hands of healthcare workers and colonising on other patients. Parienti, Thilbon, Heller et al (2003) thought that 10% of patients will develop a hospital acquired infection (HAI). This according to O’Donoghue & Allen (1992) resulted in the patients’ stay in hospital being prolonged by at least 17 days, and at an extra cost over approximately £2200.

The techniques and procedures used in handwashing have been studied over time to find the correct, most effective method, this has led to guidelines being established (Department of Health 2001). Guidelines ensure all the hand is washed, emphasising areas that may be missed and the need to ensure hands are thoroughly dried after the procedure. Damp or wet hands can provide an environment for additional bacteria to grow (Ayliffe, Frasise & Geddes et al 2000). Recommendations are that handwashing should be performed upon arrival at work, before approaching and examining each patient, again after examining and caring for patients, ...

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Handwashing is usually performed with an unmedicated detergent, hand disinfection refers to the use of an antiseptic solution (Hugonnet & Pittet 2000). Which substance is used will be dependent upon the situation of care. Soap and water removes transient bacteria from blood, food, dirt and faeces (Ehrenkranz 1992). However, antiseptic soap removes not only transient bacteria, but can inhibit or kill a proportion of resident bacteria (Hinchliff, Norman & Schober 1998). This method is used more often in high-risk areas, such as patients that are immunocompromised or prior to invasive procedures. Alcohol handrubs are also suited to disinfecting the skin, they act upon bacteria, viruses, yeast and fungi (Hugonnet & Pittet 2000). Mallett & Dougherty (2000) found that rinsing hands with an alcohol solution removed a greater proportion of resident bacteria than washing with a detergent soap, and Parienti et al (2003) also agreed with this thought. Larson (1995) notes that the intensity of the contact with the patient and the equipment involved will be a deciding factor in which substance will be needed.

Hands are without doubt a key source of infection. Bacteria resident on the hands as well as transient bacteria have been identified as potential sources of HAI’s. The acquirance of such an infection prolongs patients stay and their recovery and adds to the financial cost of care. Guidelines are established to ensure all healthcare workers are aware of the need for good handwashing techniques, and that all follow established protocol. Healthcare workers also have a professional responsibility to protect those in their care by adhering to these guidelines. There are various solutions that can be used to clean the hands, which one is used will be dependent upon the individual situation and the level of decontamination necessary. Much research has been undertaken over time, developments in solutions used and their effectiveness are evident. It is without a doubt that still the seemingly simple gesture of handwashing is essential in the role of infection control.

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References

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