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Note:
Alcohol wipes should not be used for hand antisepsis as a substitute for
alcohol-based hand rubs because they are not as effective.
Use only alcohol-based hand rubs or antimicrobial soap products which have
Drug Facts Labeling.
Alcohol-based hand rubs are the only products acceptable to FDA for leave-on,
no-rinse application to perform antisepsis. Leave-on antiseptic hand rubs
containing, e.g., benzalkonium chloride or benzathonium chloride are not
permitted for use as antiseptic products to be left on the hands, they are only
approved for use as rinse-off products.
Periodically evaluate employees for proper hand antisepsis and hand washing
technique and demonstrate the proper method. Pay close attention to duration of
application (at least 15 seconds), amount of product applied (some dispensers
dispense too little product; 2 3 ml is typically required for proper antisepsis)
and technique (whether product is applied to all surfaces of hands, fingers
and nails).
2. Hand-hygiene technique
A. When decontaminating hands with an alcohol-based hand rub, apply product
to palm of one hand and rub hands together, covering all surfaces of hands
and fingers, until hands are dry.
B. When washing hands with soap and water, wet hands first with water, apply
an amount of product recommended by the manufacturer to hands, and rub
hands together vigorously for at least 15 seconds, covering all surfaces of the
hands and fingers. Rinse hands with water and dry thoroughly with a
disposable towel.
5. Skin care
A. Provide HCWs with hand lotions or creams to minimize the occurrence of
irritant contact dermatitis associated with hand antisepsis or hand washing.
B. Solicit information from manufacturers regarding any effects that hand
lotions, creams, or alcohol-based hand antiseptics may have on the persistent
effects of antimicrobial soaps being used in the institution.
Nurses with dermatitis have a greater number of colonizing germ species on their
hands than nurses with healthy skin.4 Select a non-greasy formulation which
contains no mineral oil or petrolatum for compatibility with latex gloves.
The active ingredient Chlorhexidine Gluconate (CHG) is seldom used in antiseptic
hand washes in long-term care facilities. If used, make certain that moisturizing
lotions used in the facility are cationic emulsions or they can neutralize the
efficacy of the CHG.
8. Administrative measures
A. Make improved hand-hygiene adherence an institutional priority and provide
appropriate administrative support and financial resources.
B. Implement a multidisciplinary program designed to improve adherence of
health care personnel to recommended hand-hygiene practices.
Invest in alcohol hand rub dispensers to help drive infection costs down.
Administrator attendance at hand hygiene in-services sends a message that hand
hygiene is a facility priority.
Several studies document that ongoing, multi-disciplinary approaches to hand
hygiene compliance are the most effective at achieving sustainable increases
in compliance.6
See 1. A. B. Comments above
B. Monitor the volume of alcohol-based hand rub (or detergent used for
handwashing or hand antisepsis) used per 1,000 resident-days.
Footnotes:
(1) Guideline for Hand Hygiene in Health-Care Settings, Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force, John M. Boyce, M.D., Hospital of Saint Raphael,
New Haven, Connecticut, Didier Pittet, M.D., University of Geneva, Geneva, Switzerland
(2) Tentative Final Monograph for Health Care Antiseptic Drug Products, Federal Register, Vol. 59, No. 116, p. 31444.
(3) Bacterial Contamination of Liquid Hand Soaps, Marisa Chattman, Sheri L. Maxwell, and Charles P. Gerba, Department of Soil, Water and Environmental Science, University of Arizona, Tucson, AZ 85721.
(4) Changes in bacterial flora associated with skin damage on hands of health care personnel, Elaine L., Larson, PhD, et al., American Journal of Infection Control, Vol 26, No. 5, pp. 513-521
(5) Validation of a Comprehensive Infection Control Program in LTC, Maryanne McGuckin, Dr. Sced., MT, et.al., The Director, Vol. 12 and No. 1, pp. 14-17
(6) Testing the WHO Guidelines on hand hygiene in health care in eight pilot sites worldwide, World Health Organization www.who.int/gpsc/country_work/pilot_sites/introduction