Hand Hygiene — Information and Guidelines

lic. rat. med. Jerzy A. Kozłows­ki

On aver­age, there are 150 dif­fer­ent species of bac­te­ria, virus­es, and oth­er pathogens on the hands. Hand hygiene is impor­tant in pre­vent­ing the trans­mis­sion of dis­eases. This is espe­cial­ly true for med­ical per­son­nel and those in con­tact with sick indi­vid­u­als, where hand hygiene is of para­mount impor­tance. Hos­pi­tal infec­tions pose a very seri­ous epi­demi­o­log­i­cal and eco­nom­ic prob­lem world­wide.

Hand Hygiene of Medical Personnel

Hand hygiene and the use of gloves are the cheap­est and sim­plest, yet high­ly effec­tive meth­ods of pre­vent­ing hos­pi­tal and com­mu­ni­ty-acquired infec­tions. Obser­va­tion­al stud­ies show a cor­re­la­tion between the lev­el of hand hygiene and the inci­dence of infec­tions and mul­ti-resis­tant strains [1].

Ręce należy dezyn­fekować każ­do­ra­zowo przed i po kon­tak­cie z pac­jen­tem i jego środowiskiem. Dane Nar­o­dowego Pro­gra­mu Ochrony Anty­bio­tyków wskazu­ją, że per­son­el medy­czny nie zawsze dba o czys­tość rąk w należy­ty sposób [2]. Niekiedy naduży­wane jest stosowanie rękaw­iczek medy­cznych, których uży­wa się zami­ast mycia lub dezyn­fekcji rąk, a nie jako dodatkowe zabez­pieczenia.

Read also When should gloves be worn?

Washing or Disinfection?

Before and after con­tact with a patient, hands should be dis­in­fect­ed. Hygien­ic hand­wash­ing should be con­duct­ed in sit­u­a­tions where the staff is fin­ish­ing a vis­it, enter­ing the staff room, before meals, after and before using the toi­let, or when hands are vis­i­bly soiled. In oth­er sit­u­a­tions, dis­in­fec­tion should be per­formed, which is faster and more effec­tive [2].

The use of med­ical gloves does not exempt from the oblig­a­tion to main­tain hand hygiene. Dis­in­fec­tion should be car­ried out every time before putting on gloves and after tak­ing them off [2].

Everyday Hand Hygiene — Infection Prevention and Control

Not only med­ical staff are oblig­ed to main­tain skin clean­li­ness. This applies to every­one, as hand wash­ing and dis­in­fec­tion are the sim­plest ways to lim­it the spread of infec­tions, includ­ing com­mon ones like colds, flu, or the SARS-CoV­‑2 virus, which the world is cur­rent­ly strug­gling with.

Prop­er hand wash­ing, along with adher­ing to oth­er hygiene and pre­ven­tive mea­sures, sig­nif­i­cant­ly reduces the risk of trans­mit­ting infec­tions. We uncon­scious­ly and instinc­tive­ly touch our face areas with our hands, which can lead to the entry of virus­es and bac­te­ria through the mucous mem­branes of the mouth and nose.

Guidelines on Hand Hygiene

Indi­ca­tions for hand hygiene include: vis­i­ble soil­ing or con­t­a­m­i­na­tion with body flu­ids, con­tact with a patient and their envi­ron­ment, and per­form­ing asep­tic pro­ce­dures. Hand wash­ing or dis­in­fec­tion is also per­formed after remov­ing non-ster­ile and ster­ile gloves, before prepar­ing med­ica­tions, food, after using the toi­let, and in all oth­er sit­u­a­tions where there is a like­li­hood of trans­fer­ring microor­gan­isms [4].

Hand Hygiene Technique Using a Disinfectant Agent

The pro­ce­dure lasts 20–30 sec­onds:

1. Apply the dis­in­fec­tant to the sur­face of your hands.

2. Rub the dis­in­fec­tant, spread­ing it over the inner parts of the hands.

3. Place one hand on the back of the oth­er hand and rub the dis­in­fec­tant in, then switch sides and do the same.

4. Inter­lace your fin­gers with the palms fac­ing each oth­er.

5. Tuck the backs of the fin­gers into the palm of the oth­er hand, inter­lock­ing them, and make sev­er­al move­ments.

6. Rotate and rub the thumb of one hand, and then the oth­er.

7. Rotate and rub the inside of your palm with the clenched fin­gers of the oth­er hand, then switch sides [4].

Hand Hygiene Technique Using Water and Soap

The dura­tion of the hygien­ic hand wash­ing pro­ce­dure is 40–60 sec­onds

1. Dis­pense soap from the dis­penser.

2. Rub your palms togeth­er with fin­gers extend­ed.

3. Place one hand on the back of the oth­er hand, rub the soap in, and then switch sides.

4. Inter­lace your fin­gers with palms togeth­er and rub.

5. Hook the back of the fin­gers of one hand against the oth­er, inter­lock­ing them, and then make slid­ing move­ments.

6. Wash the thumbs with a rotat­ing motion inside a clenched fist.

7. Mas­sage the inside of the palm with clenched fin­gers [4].

8. Rinse hands under run­ning water.

9. Dry hands with a dis­pos­able tow­el.

10. Do not touch the faucet with your hands, use your elbow or a paper tow­el to turn off the water.

Med­ical per­son­nel should have access to effec­tive pro­tec­tive mea­sures, but hand wash­ing and dis­in­fec­tion should not be com­bined unless there is vis­i­ble soil­ing. In the case of con­t­a­m­i­na­tion and vis­i­ble dirt, hand wash­ing should be done before dis­in­fec­tion. Rękaw­ice medy­czne nie mogą zastępować higieny rąk. When­ev­er nec­es­sary and rea­son­able, gloves should be used, and after the task is com­plet­ed, they should be removed and hands dis­in­fect­ed.

The 5 Moments of Hand Hygiene.

When to prac­tice hand hygiene in hos­pi­tal set­tings and when in con­tact with patients is well described by the so-called “5 Moments of Hand Hygiene:

• Before touch­ing a patient – pri­or to each con­tact with a patient, it is essen­tial to per­form hand hygiene to pro­tect the patient from microor­gan­isms.
• Before clean/aseptic pro­ce­dures – imme­di­ate­ly before per­form­ing a med­ical pro­ce­dure. Hand dis­in­fec­tion is car­ried out to pro­tect the patient from harm­ful microor­gan­isms.
• After body flu­id exposure/risk – when you come into con­tact with any body flu­ids, per­form hand hygiene to pro­tect your­self and the hos­pi­tal envi­ron­ment after remov­ing gloves.
• After touch­ing a patient – to pro­tect your­self and the hos­pi­tal envi­ron­ment.
• After touch­ing patient sur­round­ings – as microor­gan­isms are also present there, hand hygiene of med­ical per­son­nel should include every sit­u­a­tion after con­tact with objects touched by the patient [3].

Bibliography:

1. Euro­pean Cen­tre for Dis­ease Pre­ven­tion and Con­trol. Infec­tion pre­ven­tion and con­trol for COVID-19 in health­care set­tings – Fourth update. 3 July 2020. ECDC: Stock­holm; 2020;

2. dr n. med. Tomasz Ozorows­ki, Higiena rąk per­son­elu medy­cznego w Polsce, por­tal mp.pl )04.05.2018);

3. Gene­va, World Health Orga­ni­za­tion „Your 5Moments for Hand Hygiene”. May 2009

4. Wyty­czne WHO doty­czące higieny rąk w opiece zdrowot­nej – pod­sumowanie” ©World Health Orga­ni­za­tion 2009 WHO/IER/PSP/2009.07

5. dr med. Jacek Mrukow­icz, Higiena rąk, por­tal mp.pl (06.10.2016)