Focus: Infection Control

Debunking the assumptions around proper hand hygiene

By Fran Canty / Special to Healthcare Facilities Today
October 20, 2017

The importance of hand hygiene in helping prevent the spread of infection is known throughout the world… or is it? 

In the healthcare setting, the single most effective way to prevent the spread of infection is consistently performing hand hygiene. Facilities have access to hand hygiene products and hand hygiene stations, plus updated technological processes, guidelines and observations. 

Additionally, new protocols, programs and products are continuously developed to help raise awareness and increase compliance with the simple – but critical – act of hand hygiene.

Hand hygiene in healthcare involves not only washing hands with soap and water, but also the use of alcohol-based hand sanitizers. While soap and water offer a reliable solution for patients, it is not always feasible for all patients at all times. 

The 2002 CDC guidelines stated that alcohol-containing hand wipes were not an efficacious substitute for gel or foam alcohol-based hand rubs, or ABHRs. Over the years, alcohol-containing wipes have been reported to have similar efficacy to ABHR gel and foam against, for example, influenza virus. Some formulations of alcohol-based wipes with at least 65% alcohol are now comparable to alcohols delivered by other dispensing methods. 

Plus, alcohol-based hand sanitizers are available in various formats, from hand wipes to gels, foams and rinses. Wipes offer a convenient option for bed-bound patients, first responders in the field and others who cannot easily get to sinks or wall-mounted dispensers. All of these options supplement the need for and convenience of frequent hand hygiene in healthcare. 

Yet actual compliance is suboptimal. And, none of these actions have earned a 100% success rate. 

Studies show that healthcare workers wash their hands less than half the number of times they should, contributing to [patients acquiring] healthcare-associated infections (HAIs), many of which are due to multi-drug resistant organisms. 

According to the World Health Organization (WHO), for every 100 hospitalized patients, at least seven patients from high-income countries and 10 from low to middle-income countries will acquire an HAI. That figure rises to around 30 per 100 among the critically ill and vulnerable patients in intensive care units.

Healthcare providers might need to clean their hands as many as 100 times per 12-hour shift, depending on the number of patients and intensity of care.  In addition to the frequency of hand hygiene required in a single shift by healthcare workers (“HCWs”), it is important to consider skin irritation or dryness as  possible factors in non-compliance. 

Products containing skin softening agents, along with disinfecting properties, are available to mitigate such issues. HCW’s should be provided with efficacious hand hygiene products that have low irritancy potential.

Although healthcare facilities have hand hygiene products and implement hand hygiene protocols around the WHO “5 Moments of Hand Hygiene” (before touching a patient, before cleaning and aseptic procedures, after contact with body fluids, after touching a patient, and after touching patient surroundings), non-compliance continues to be an area noted for improvement on most infection prevention risk assessments.

Hand hygiene is most effective when practiced by everyone:

Not all HCWs, patients and/or visitors have the same education or experience on hand hygiene protocols. The CDC suggests that hand hygiene be a topic of conversation between the healthcare provider and the patient. 

The CDC’s clean hands campaign promotes the importance of hand hygiene in healthcare settings, providing recommendations and guidelines for healthcare providers. But it also encourages patients and visitors to be empowered in their own healthcare, especially around the subject of hand hygiene. 

Patients and their families may not fully understand the importance of observing, and assisting with, hand hygiene techniques. As HCWs, we need to make a concerted effort to include the patient in this process. An empowered patient can assist the healthcare provider in maintaining and improving compliance.

It’s no secret that the types, and the number, of bacteria [on hands] increases with contact in the environment, or with patients and other HCWs. In order to help prevent the spread of life-threatening microorganisms transmitted via hands, it’s important that everyone get involved. 

By working together, we can assess the possible reasons for non-compliance, and avoid reinforcing failed processes. With this improved understanding, we can all reach our gold standard to mitigate preventable infections. 

Fran Canty MA, BSN, RN, VA-BC  is a PDI Clinical Science Liaison for the Northeast Region.


 1. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene, Society for Healthcare Epidemiology of America, 2014.  





6. WHO Guidelines on Hand hygiene in Heathcare:  First Global Patient Safety Challenge Clean Care is Safer Care; WHO 2009 


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