Hand hygiene in Ambulatory Settings
As we reenter the brave new post-COVID pandemic world with increased vaccination and decreased masks, now is a good reminder about the importance of hand hygiene by health care professionals (HCP). Hand hygiene is not only a simple and effective way to prevent the spread of pathogens and infections in the healthcare settings, but also the single most important method of preventing the transmission of infectious disease.
Alcohol-based Hand Rub (ABHR)
Hand washing mechanically removes pathogens and laboratory data demonstrate that alcohol-based hand rub (ABHR) formulations in the range of alcohol concentrations 60-95% recommended by CDC, inactivate SARS-CoV-2 and reduces the number of pathogens that may be present on the hands of healthcare providers after brief interactions with patients or the care environment. The use of ABHR is preferred over soap and water in most clinical situations due to evidence of better compliance, (convenient, acts rapidly, and highly effective) especially in the absence of a sink. It is important to remind everyone to cover all surfaces of the hands and fingers and continue rubbing hands together until hands are dry.
In addition, in the clinical setting, the World Health Organization recommends 5 moments for hand hygiene:
- Before touching a patient
- Before cleaning and aseptic procedures
- After body fluid exposure and/or risk
- After touching a patient
- After touching patient surroundings.
Soap and Water
Soap and water should be used instead of ABHR whenever they are visibly soiled or contaminated with blood or other body fluids, if exposure to spores and certain viruses possibly occurred, before eating and after using the toilet. When using soap and water, remember that hands should be washed for at least 20 seconds. The Society for Healthcare Epidemiology of America recommends using plain soap for hand hygiene when soap and water are indicated as opposed to antibacterial soap.
Hand washing should consist of the following steps:
- Wet hands with warm (not hot) water
- Apply soap to hands
- Vigorously rub the hands together for at least 15 seconds, covering all of the surfaces of the hands and fingers
- Rinse the hands with warm water
- Dry the hands with a disposable towel
- Use the towel to turn off the faucet
If hand lotions are used, 1) they should be available in containers that are not refilled but rather replaced frequently to avoid contamination and 2) should not be petroleum based because petroleum can cause deterioration and reduce the effectiveness of latex gloves.
Hand hygiene and Outpatient Procedures
Hand hygiene before performing procedures (such as incision and drainage, joint aspirations, etc) should consist of prewashing with soap and water and thorough drying followed by the use of an alcohol-based surgical scrub with persistent activity or washing with an antimicrobial surgical scrub agent (such as chlorhexidine or povidone-iodine) for the length of time specified by the manufacturer, usually 2 to 6 minutes.
Nails and jewelry
Employees who perform direct patient care activities in ambulatory surgery settings, practices with patients at high risk of infection, or immunocompromised should keep fingernails short and avoid wearing jewelry, artificial nails, and extenders because these have been shown to harbor microorganisms that are not easily removed by hand hygiene. Fingernails need to be kept trimmed and cleaned with soap and water, paying special attention to the undersides of nails.
References:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/hand-hygiene.html
Infection Prevention and Control in Pediatric Ambulatory Settings
Mobeen H. Rathore, Mary Anne Jackson, COMMITTEE ON INFECTIOUS DISEASES, Pediatrics Nov 2017, 140 (5) e20172857; DOI: 10.1542/peds.2017-2857
