Summary
The purpose of this document is to highlight practical recommendations to help acute care hospitals prioritize and implement strategies to prevent healthcare-associated infections through hand hygiene . This document updates strategies to prevent healthcare-associated infections in acute care hospitals through hand hygiene published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA) . It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association of Professionals in Infection Control and Epidemiology, the American Hospital Association, and the Joint Commission, with significant contributions from representatives of several organizations and societies with content expertise.
Role of hand hygiene in acute care
Hand hygiene has long been a critical component of infection prevention in all healthcare settings; However, healthcare personnel (HCP) compliance with hand hygiene protocols has been an ongoing challenge, complicated by the lack of a national standard for measurement and increasingly complex care settings. Additionally, the proliferation of hand hygiene products in recent decades has created challenges for healthcare administrators and infection prevention leaders to select the most effective, safe, and non-irritating products to support HCP hand hygiene. . The purpose of this document is to provide practical guidance, based on up-to-date evidence, for decision-making regarding the implementation of hand hygiene programs in healthcare facilities.
In the years since the publication of Strategies to Prevent Healthcare-Associated Infections (HAI) through Hand Hygiene: 2014 Update, patients receiving healthcare have faced the continued threat of infections. and antibiotic-resistant organisms potentially spread by HCP hand contact. Interaction with the healthcare environment can lead to hand contamination after activities as brief as touching the bed rail. Increases in the number of patients colonized with extended-spectrum β-lactamase-producing Enterobacterales were observed, while the incidence of carbapenem-resistant Enterobacterales remained stable. Healthcare facilities experienced the emergence of Candida auris, a resistant fungus, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus.
Essential Practices This section highlights updated recommendations based on evidence that was not available for consideration in the 2014 Compendium. There are 7 essential practices , and 5 of these are previously recommended practices with updated elements. However, 2 practices are new : the use of gloves and the prevention of environmental contamination. The recommendation for the promotion of healthy skin and nails is reinforced by high-quality evidence and emphasizes the preferential use of alcohol-based hand sanitizer (ABHS) in most clinical situations, which has been shown to be superior to washing of hands in the preservation of health care personnel (HCP) regarding the integrity of the skin of the hand. 1. The document states that policies regarding the use of nail polish and gel lacquer are at the discretion of the infection prevention program, except among HCPs scrubbing for surgical procedures, for whom nail polish and the gel lacquer. 2. The document recommends that facilities seeking alcohol-based hand sanitizer (ABHS) with ingredients that may improve efficacy against organisms that are expected to be less susceptible to biocides should consider manufacturers’ product-specific data. 3. The recommendation for placement of ABHS dispensers emphasizes unambiguous and visible accessibility within the HCP workflow. 4. The document provides minimum thresholds for dispensers to ensure accessibility of hand hygiene supplies. 5. The document contains additional recommendations for the proper use of gloves: to. The health care person (HCP) should receive competency-based training to ensure knowledge and skill to avoid contamination during doffing. b. Routine double gloving is not recommended except when specifically recommended for certain work roles or in response to certain high-impact pathogens. 6. The document contains additional recommendations to reduce environmental pollution associated with handwashing sinks and sink drains. 7. Methods for monitoring hand hygiene compliance now include direct overt observation, direct covert observation, automated hand hygiene monitoring systems, remote video observation, indirect measures, and audits accessibility and functionality of supplies. |
Comments
Only 7% of healthcare personnel clean their hands completely
Five medical organizations recommend updated best practices for hand hygiene to protect patients and staff in healthcare settings. The recommendations emphasize the importance of healthy skin and nails and easy access to alcohol-based hand sanitizers.
Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene: 2022 Update, one of a series of expert guidance documents known collectively as the Compendium, was published today in the journal Infection Control and hospital epidemiology.
"Hand hygiene is a basic function of health care safety," said lead author Janet Glowicz, PhD, RN, CIC, of the Centers for Disease Control and Prevention. “By engaging healthcare staff and establishing reliable processes outlined in the Compendium, we can achieve effective and consistent hand hygiene. “Commitment from healthcare leaders is also necessary to establish a culture of safety.”
The document addresses how institutions can train healthcare personnel in proper technique, monitor their compliance, involve them in selecting products to keep their skin healthy, and use gloves appropriately. It also discusses where facilities should be located and how they should maintain alcohol-based sanitizer dispensers and sinks.
The guide reviews the evidence on nail polish, gel and shellac, showing that short, natural nails with standard polish or no polish are easier to clean. The authors found no new evidence specific to chipped nail polish and artificial nails, but they point to previous findings that they can harbor germs. The guidance leaves specific policies on nail polishes, gels, shellac, and artificial nail extenders to the discretion of the infection prevention programs at each facility, with the exception of policies for those washing their nails for surgery or working in high risk areas. These staff must keep nails short and natural without polish or nail extenders.
Citing research showing that only 7% of healthcare personnel effectively clean all surfaces of their hands, the guidance recommends continued training on handwashing and proper use of sanitizer. Thumbs and fingertips were most commonly lost.
The authors recommend that healthcare personnel should not be provided with individual pocket-sized hand sanitizers in lieu of wall-mounted hand sanitizer dispensers and emphasize that hand sanitizer dispensers should always be widely available and never prohibited, even in situations where which indicate washing with soap and water. When healthcare personnel suspect organisms that are difficult to kill, such as C. difficile and norovirus, healthcare personnel should wear gloves and follow structured techniques for hand washing and disinfection. Additionally, facilities should not refill disinfectant dispensers intended for single use or provide antimicrobial soaps containing triclosan. Facilities should also discourage double gloving except in certain circumstances.
To encourage compliance and support skin and nail health, facilities should include healthcare personnel in the selection of hand sanitizers and moisturizers, while ensuring products are compatible with antiseptics and gloves. that are used in the place. Maintaining healthy skin is a crucial element of hand hygiene.
Surgical settings require special care, but waterless hand hygiene with surgical hand sanitizers is acceptable, especially as it improves compliance. Brushes should be avoided in surgery preparation due to their negative impact on skin health.
This document updates the 2014 Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. The Compendium, first published in 2008, is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, with the Infectious Diseases Society of America, the Association of Professionals in Infection Control and Epidemiology, the American Hospital Association, and the Joint Commission, with significant contributions from representatives of several organizations . and companies with content expertise. The Compendium is a highly collaborative, multi-year guideline writing effort of more than 100 experts from around the world.
Future updates to the Compendium will include strategies to prevent catheter-associated urinary tract infections, Clostridium difficile infections, methicillin-resistant Staphylococcus aureus infections, and surgical site infections. Strategies to prevent central line-associated bloodstream infections and pneumonia were updated in early 2022. Each article in the Compendium contains example infection prevention strategies, performance measures, and implementation approaches. The compendium’s recommendations are derived from a synthesis of systematic literature review and evidence evaluation, practical and implementation-based considerations, and expert consensus.
