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Scrubbing In

The Importance of Hand Hygiene at Home and in the Hospital

NEW YORK (Apr 3, 2012)

Bacteria are everywhere around us and inside us – in fact there are ten times as many bacterial cells as human cells in a human body, most of them in the intestinal tract – and the average person has about 1,000,000,000,000 bacteria on the surface of his or her skin. Only a fraction of the bacteria, and the fungi and viruses, too, in our environment are pathogenic, or disease-causing, but under certain conditions these microorganisms can cause illnesses ranging from minor to deadly.

One route that pathogens travel from person to person is on our hands, which touch so many things – computers, doorknobs, faucets, railings, as well as other people – and routine hand washing is the most effective way to remove disease-causing microorganisms before they can do harm.

Hand washing with non-antimicrobial soap and water or the use of an alcohol-based hand sanitizer, are two effective hand hygiene approaches. Soap contains detergents that help remove dirt, organic material and microorganisms through mechanical action, and it's useful when the hands are visibly soiled with dirt or organic material. Alcohol-based hand sanitizers work by inactivating microorganisms or suppressing their growth. "Alcohol-based hand sanitizers often contain emollients causing less skin irriration and dryness, which is especially important in the hospital setting where staff need to clean their hands frequently," said Lesley E. Covington, M.S.P.H., C.I.C., an Infection Control Specialist and one of the staff in charge of preventing and reducing health-care acquired infections at NewYork-Presbyterian/Weill Cornell Medical Center.

Like an Expert

Ms. Covington said that to wash your hands correctly, "wet your hands thoroughly with clean, running, warm water; then apply enough soap to cover all the surfaces of your hands up to the wrists."

Lesley E. Covington, M.S.P.H., C.I.C.
Lesley E. Covington,
M.S.P.H., C.I.C.

"Rub your hands together, creating friction for at least 15 seconds, thoroughly covering all surfaces, including the backs of the hands, in between fingers where microorganisms can accumulate, under the fingernails and the thumbs. Next, rinse your hands thoroughly with running water, pat your hands dry with a paper towel – don't rub so hard that you disrupt the integrity of the skin, she cautioned – then turn off the faucet using the paper towel." With hand sanitizer, dispense one "pumpful" of product into your palm covering all surfaces of your hands and fingers until dry.

Like a Surgeon

In the operating room, hand hygiene is taken very seriously and the routine of washing your hands is more intense.

Michael G. Kaiser, M.D., F.A.C.S.
Michael G. Kaiser, M.D.,
F.A.C.S.

"Surgeons follow strict hand-washing protocols to eliminate pathogens from their hands before entering the operating room," said Michael G. Kaiser, M.D., F.A.C.S., a surgeon and Associate Director of the Spine Center at NewYork-Presbyterian/Columbia University Medical Center.

"I think of my hand in terms of four planes: the front, the side, the inside, and the back," said Dr. Kaiser. "For the first scrub of the day I use a chlorhexidine scrub brush, which has a sponge on one side and a plastic-bristle brush on the other. I go across each surface with ten sweeps. I keep doing that, cycling through both hands, up and down the forearms, for five minutes." Dr. Kaiser uses the sponge more than the brush, because studies have shown that after two or three minutes the brush dislodges bacteria deeper down in the dermis and actually increases the number of bacteria on the skin surface.

After the day's first scrub he uses a basic soap, then applies an antiseptic lotion from a dispenser. "You place your fingertips in a small pool of lotion in your palm, predetermined from an automatic dispenser, and rub it across the four planes of your hand, and then you work it down your forearm. You do the same action on the opposite hand, and go through several cycles," Dr. Kaiser said.

Hand drying with a towel is required after a chlorhexidine scrub but not following cleansing with the antiseptic lotion. Following both types of hand cleaning, surgeons put on sterile gloves and a gown supplied by someone who's already sterilely dressed. "There's no way to completely eliminate all flora," Dr. Kaiser said, "but reducing the amount of bacteria and decreasing infection risk is definitely to the advantage of the patient."

Serious Business

Hospitals take infection prevention and control very seriously. At NYP, Infection Prevention Liaisons (IPLs) monitor staff compliance with hand hygiene practices throughout the entire hospital. "If an IPL observes a health-care worker not perform hand hygiene, the IPL will educate the health-care worker about the missed hand hygiene opportunity and also inform his or her manager," said Ms. Covington.

In a home setting, hand washing is also important, she said, particularly before and after using the restroom or changing diapers; before and after eating; before, during, and after preparing food; after touching an animal; after blowing your nose, coughing or sneezing into your hands; and after touching garbage or chemicals.

Contributing to this article:

Michael G. Kaiser, M.D., F.A.C.S., is the Associate Director of the Spine Center at New York-Presbyterian/Columbia University Medical Center and an Associate Professor of Clinical Neurological Surgery at Columbia University College of Physicians and Surgeons.

Lesley E. Covington, M.S.P.H., C.I.C., is an Infection Control Specialist at NewYork-Presbyterian/Weill Cornell Medical Center

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