Hand Hygiene: Importance, Compliance, and Strategies for Prevention of Healthcare-Associated Infections

HAND HYGIENE
Introduction:
Health care associated infections (HCAI) also known as nosocomial infections are the
infections which the patient acquires in health care settings (Gould, Moralejo, Drey,
Chudleigh and Taljaard,2017; "The burden of health care-associated infection worldwide",
2019; Haque, Sartelli, McKimm and Baker,2018; Kingston, O’Connell and Dunne,2016).
WHO report states that worldwide millions of patients suffer from HCAIs with the
prevalence in developed countries being 3.5 to 12% (Dettenkofer et al.,2016). This results in
adverse patient outcome such as increased mortality, morbidity, lengthened hospital stay,
long term disability, psychological stress, flourishing of antibiotic resistant micro- organisms,
increased health care cost for the patient and burden on the health care system ("The burden
of health care-associated infection worldwide",2019; Kingston et al.,2016). Cross
contamination of the pathogenic organisms between the patients and health care providers
result in HCAI. The WHO guidelines for prevention and control of HCAIs include execution
of standard protocols such as hand hygiene. It also suggests surveillance and reporting at
national and international levels ("The burden of health care-associated infection worldwide",
2019). The WHO guidelines suggest implementation of hand hygiene as the most important
and effective strategy to prevent and control HCAIs. It is a very simple, low cost but effective
method to reduce the risk of HCAIs. A 5 moment hand hygiene protocol is recommended by
WHO for improved efficiency. The procedure of hand hygiene including the duration,
method of hand rub and amount of sanitizer used is also crucial for effectively removing the
micro- organisms from the surface of the hands of the healthcare providers. However, there is
a lack of compliance to hand hygiene practice amongst healthcare workers. Strategies such as
training and education are important to ensure compliance for hand hygiene for prevention
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and control of HCAI leading to well- being of the patient (Doronina, Jones, Martello, Biron
and Lavoie- Tremblay,2017).
Mechanism of spread of infections in healthcare environment:
The commonest route of spread of HCAIs is by direct contact particularly the hands
of the healthcare providers. Cross contamination between patients and healthcare workers
results in HCAIs. Some of the other modes of spread of HCAIs are interventions such as
intravascular catheterization, urinary catheterization and endotracheal intubation. The
presence of the micro-organisms on hospital floors, door knobs, taps, working surfaces can
spread to patients causing HCAIs. Contaminated hospital waste such as surgical waste is
another reservoir of the micro-organisms increasing the risk of HCAIs (Haque et al.,2018).
Some of the common risk factors for HCAI are depicted in figure 1 (Presterl, Schahawi,
Lusignani, Paula and Reilly,2018).
Fig 1: Health care associated infections and risk factors (Persterl et al., 2018)
Strategies to reduce and prevent the occurrence of HCAI:
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WHO guidelines have recommended strategies for reduction and prevention of
HCAIs. These include the following ("The burden of health care-associated infection
worldwide", 2019; Dettenkofer et al., 2016):
 Identification of determinants of HCAI
 Reporting and surveillance at local and national level
 Provision of components of infection control such as decolonisation, disinfection and
antiseptics
 Implementation of standard protocols such as hand hygiene procedures
 Ensuring staff compliance by providing staff education and improving responsibility
 Encouraging research to improve surveillance
 Conducting research to involve patients in control and prevention of HCAI
Importance and method of hand hygiene in prevention and control of HCAI:
Hand hygiene is regarded as the most effective method for prevention and control of
HCAIs. The principle behind it is that hand hygiene can effectively halt the chain of infection
thereby lowering the risk of HCAI (Gould, Creedon, Jeanes, Drey, Chudleigh and Moralejo,
2017). Hand hygiene removes the micro-organisms mechanically from the hands of the
healthcare workers thereby preventing spread of the micro-organisms to the patients or the
surroundings. This mechanical removal can be achieved by the following methods:
 Washing the hands with soap and water and drying
 Use of aqueous antiseptic such as chlorhexidine gluconate
 Use of alcohol based hand rubs.
Amongst the above methods of hand hygiene, alcohol based hand rubs are more
convenient, require less amount of time to be effective and have a higher rate of anti-
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