Hand Hygiene Products
If your hands are known or suspected of being contaminated handwashing and/or decontamination is required to help prevent the transmission of hand associated pathogens
There are several hand hygiene products and each has different antimicrobial ability.
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Alcohol hand disinfectact
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what is an alcohol hand disinfectant?
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correct application
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which solution should I be using?
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correct handwashing technique
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which solution should I be using?
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correct surgical hand washing technique
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(NB Healthcare settings are not the same as community setting. In community setting, washing with soap and water remains very effective).
Alcohol Based Hand Rub (including Gels, Liquid Rubs & Foams)
Alcohol-based Hand Antisepsis is strongly recommended by
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Centre for Disease Control guidelines (2002).
An alcohol-based hand disinfectants can improve adherence to hand hygiene practice because:
1. It can be conveniently located:
- alcohol hand disinfectants can be placed at every bed / cot side, entrances of rooms and on procedural trolleys
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2. It requires less time than a traditional handwash
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It normally only takes 10-15 seconds for the application. If hands are drying in less than 15 seconds, it indicates that insufficent amount of alcohol disinfectant has been applied. If forearms are being gelled (before a clinical procedure), 2-3 pumps maybe required to cover the area.
3. More effective and faster acting
- Those solutions containing 60% - 95% alcohol are the most effective; higher concentrations are less potent.
4. Is less drying than soap and water
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Soaps are commonly associated with skin irritation and dryness. In contrast.....
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Alcohol hand disinfectant contains a emollient to prevent dryness
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Alcohol hand disinfectant does not require the use of paper towel, which is often the source of irritation .
Correct Application of an Alcohol Hand Rub
- Squirt onto the palm of the hand
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The hands must be rubbed together vigorously ensuring the alcohol comes in contact wth ALL surfaces - NOT just the palms or fingers !
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Pay particular attention to the tips of fingers, the thumbs and the surfaces between the fingers.
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Continue to rub the the solution until it is evaporated and the hands are dry (10-15 seconds). Never wave hands to hasten drying. The 10-15 seconds of rubbing is crucial. If using ABHR to the elbows as preparation for an invasive procedure, you will need extra pumps of ABHR so all the skin can be rubbed from wet to dry over the full 10-15 seconds.
Application of alcohol hand disinfectant video
Important:
Alcohol Based Hand Rubs (ABHR) are a superior alternative to hand washing in almost all clinical situtions. They are
- 10 times more effective than washing with 2% chlorhexidine hand wash for a full 30 seconds
- 100 times more effective than washing with ordinary plain soap for at least 15 seconds.
As such, they are suitable for ALL clinical situations - including sterile clinical procedures and care of patients with VRE. The exceptions are
- When hands are visibly dirty
- When hands are contaminated with proteinaceous material
- Before or after eating
- After toileting activities
- SURGICAL purposes - there is not yet any approval for this in Australia.
Liquid Soaps ("Handwash")
Plain Soap ("Social Handwash")
- Available as bar or liquid, but liquid is far more sanitary in a hospital setting.
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Has very minimal ability to destroy micro-organisms ( i.e. 'poor antimicrobial activity'.) In several studies, handwashing with plain soap failed to remove pathogens for the hands of hospital personnel. Hand gel is 100 times more effective !
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Removes loosely-adhered transient flora.
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Due to it's poor anti-microbial activity, it has minimal use in the clinical setting.
Examples of its use include
- To remove "build up" or "peeling affect" caused by an alcohol-based hand gel.
- When hands are
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visibly dirty
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contaminated with proteinaceous material
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visibly soiled with blood or other body fluids
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- "Ordinary life" situations at work eg
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After using the toilet, toileting a patient; changing nappies
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Before eating
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To remove food from fingers after meals
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Hand washing can contribute to dryness and skin irritation through "de-fatting"of the skin.
Chlorhexidine Gluconate
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2% Chlorhexidine gluconate soap solution (green colour) is normally used in clinical areas for clinical purposes.
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2% Chlorhexine gluconate can be used for all indications for hand hygiene
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Provides substantial residual activity.
- Slower antimicrobial activity than alcohol-based hand rub (ABHR) - ABHR is 10 times more effective !
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4% Chlorhexidine Gluconate Soap Solution (pink colour) is normally used
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in theatre / when surgical procedures are performed (including CVC insertion)
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for hand-washing needs during the day-to-day care of any patient colonised or infected with VRE.
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Can contribute to dryness and skin irritation.
Anti-Microbial Efficacy of Handwash Products
From least to greatest:
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Plain ("social") - hand gel in 100 times more effective
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Chlorhexidine 2% - hand gel is 10 times more effective
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Povidone Iodine
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Chlorhexidine 4%
If a staff member has a proven skin allergy to Chlorhexidine (diagnosed by patch-testing performed by a dermatologist), alternative anti-microbial hand hygiene products will be specifically prescribed by the dermatologist. Typical alternatives include Triclosan (clinical setting) and Povidone - Iodine (Surgery & for VRE). Staff with hand skin problems should follow the advice on the dedicated page on this site.
Correct Handwashing Technique (Basic)
Surgical Hand Hygiene (Advanced, Surgical)
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Helps prevent intra-operative infections
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Rapid growth of bacteria can occur if hands are washed with a non-antimicrobial soap.
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10 minute scrub is not necessary.The scrub should be within the manufactuer's guidelines / instructions (normally 2-6 minutes).
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Various antimicrobial solutions available (Chlorhexidine 4%, Povidine-iodine).
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Each solution needs to be evaluated for both their immediate and persistent activity
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Hands should be carefully dried with a sterile towel before donning the sterile gloves.
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Alcohol-Based Hand Rub for surgical hand preparation is not yet authorised in Australia.
Surgical hand washing technique
Gloves
Hand Hygiene Australia: Glove Use Policy
Healthcare workers (HCW) should wear gloves to :
- reduce the risk of acquiring infections from patients
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to prevent HCW's skin flora from being transmitted to patients and the health care environment (HCE)
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to reduce transmission of micro organisms from one patient to another.
Gloves must be worn:
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during patient-care activities that may involve exposure to blood or body fluids
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Gloves may not be needed for routine nappy change if the procedure can be done without contaminating the hands with stool or urine.
Gloves must be changed / removed:
- between dirty & clean body sites
- between patients
- IMMEDIATELY after
is complete. - Remember, you cannot perform hand hygiene (wash / gel) while wearing gloves !
Gloves should NOT:
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be worn for all patient care activities (provide an ideal environment for bacterial growth, moisture and warmth)
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have Alcohol-Based Hand Rub (gel) applied over them
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be worn "continuously". Once the task for which they were donned is complete, gloves should immediately be removed & discarded.
Hand Hygiene (ie washing or applying Hand Gel) is necessary immediately before donning gloves and immediately after removing them.
GLOVES ARE NOT A SUBSTITUTE for hand hygiene !!! Hand hygiene is essential every time gloves are donned & removed!
Around 30% of gloves have been demonstrated to fail to protect the wearer against contamination of their hands. This is due to imperceptable, microscopic holes. Thus despite wearing gloves, there is the potential for exposure to contaminated body fluids.
Equally, the patient can be exposed to the Health Care Worker's skin flora and other contaminants.