Nursing

The WHO offers a new twist to hand-hygiene guidelines

Nurse Leader Weekly, December 15, 2005

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The World Health Organization (WHO) released new hand hygiene guidelines last month aimed at reducing hand-spread infections in hospitals and healthcare centers. The guidelines are part of the WHO's "Clean Care is Safer Care" campaign.

The goal of the campaign is to combat healthcare-acquired infections (HAI) in healthcare environments, which annually leaves about 1.4 million people seriously ill worldwide. Between 5% and 10% of patients admitted to hospitals in wealthy countries acquire HAIs, according to the WHO. In some developing countries, the proportion of patients affected can exceed 25%.

Good hand hygiene is considered the best means of reducing these infections. The current recommendations used in the United States are the Centers for Disease Control and Prevention (CDC) guidelines for hand hygiene.

Gail Bennett, RN, MSN, CICM, executive director of ICP Associates in Rome, GA, says the CDC guidelines will continue to be the primary guidelines used in the United States. The WHO guidelines are more important to countries that do not already follow those from the CDC, she says.

A rundown of WHO recommendations

Consider these suggestions in the WHO guidelines:

  • Wash your hands with soap and water when visibly dirty or contaminated with proteinaceous material, when visibly soiled with blood or other body fluids, if exposure to potential spore-forming organisms is strongly suspected or proven, or after using the restroom
  • If your hands are not visibly soiled, use an alcohol-based hand rub for routine hand antisepsis before and after direct contact with patients; after removing gloves; before handling an invasive device for patient care; after contact with bodily fluids or excretions, mucous membranes, nonintact skin, or wound dressings; if moving from a contaminated body site to a clean body site during patient care; or after contact with inanimate objects (not including medical equipment) in the immediate vicinity of the patient
  • Wash your hands with either plain or antimicrobial soap and water or rub hands with an alcohol-based formulation before handling medication or preparing food
  • Do not use antimicrobial soap concomitantly after using alcohol-based hand rubs

Differences between guidelines

Although the WHO guidelines resemble those from the CDC, there are differences, Bennett says. For example, the CDC recommends that healthcare practitioners who care for high-risk patients not wear artificial nails, while the WHO suggests that practitioners who care for patients in general avoid them.

Another difference is that under hand-hygiene technique for alcohol-based products, the WHO recommends applying a palmful of the product. Infection control professionals generally use the manufacturer's recommendation regarding the amount of product to be applied, Bennett says.

The WHO's hand-hygiene guidelines take on increased importance when viewed in the context of the recent concerns over a potentially deadly avian flu pandemic. In the case of a new influenza pandemic, the WHO said the huge number of patients seeking treatment would pose a challenge to healthcare providers and greatly increase the risk of disease spread within healthcare facilities.

Although transmission by large droplets when people cough or sneeze is considered the major route of influenza spread, transmission via contaminated hands may be a contributing factor, the WHO said.

Therefore, the agency said in addition to other infection control actions, hand-hygiene measures suggested in the present guidelines should be included among the essential measures for responding to pandemic influenza.

The WHO's hand-hygiene guidelines are currently available for review. To read the guidelines in their entirety, visit the Who's Web site.

Source: This article is adapted from Briefings on Infection Control (December 2005), published by HCPro, Inc.



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