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*,**,,★★

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Abstract

Summary

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

Section snippets

Historical perspective

For generations, handwashing with soap and water has been considered a measure of personal hygiene.1 The concept of cleansing hands with an antiseptic agent probably emerged in the early 19th century. As early as 1822, a French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the foul odors associated with human corpses and that such solutions could be used as disinfectants and antiseptics.2 In a paper published in 1825, this pharmacist stated that

Categories

These recommendations are designed to improve hand-hygiene practices of HCWs and to reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This guideline and its recommendations are not intended for use in food processing or food-service establishments, and are not meant to replace guidance provided by FDA's Model Food Code.

As in previous CDC/HICPAC guidelines, each recommendation is categorized on the basis of existing scientific data, theoretical

Part III. Performance indicators

The following performance indicators are recommended for measuring improvements in HCWs' hand-hygiene adherence:

  • 1.

    Periodically monitor and record adherence as the number of hand-hygiene episodes performed by personnel/number of hand-hygiene opportunities, by ward or by service. Provide feedback to personnel regarding their performance.

  • 2.

    Monitor the volume of alcohol-based hand rub (or detergent used for handwashing or hand antisepsis) used per 1,000 patient-days.

  • 3.

    Monitor adherence to policies

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      In addition, studies that employ small samples of hand hygiene opportunities by direct observation are likely to be biased by the “Hawthorne effect” (the effect of the observer on an observed person influences compliance).1,3 Current evidence supports electronic hand hygiene monitoring systems as a method to supplement but not supplant direct observation, since current systems are not able to evaluate the quality of each hand hygiene episode that HCWs perform, nor do they typically allow for immediate peer-to-peer correction at the point of care.1,3,5 There are several limitations.

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    *

    The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, MD, Director; and the Division of Healthcare Quality Promotion, Steve Solomon, MD, Acting Director.

    **

    This article is being published simultaneously in American Journal of Infection Control and Infection Control and Hospital Epidemiology. It was also published in the Morbidity and Mortality Weekly Report 2002; 51 (No. RR-16) and can be accessed at www.cdc.gov/ncidod/hip/default.htm. The MMWR version contains a continuing education examination.

    Am J Infect Control 2002;30:S1-S46.

    ★★

    Publication of the full text of this guideline is made possible through an unrestricted educational grant from GOJO Industries, Akron, Ohio.

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