When it Comes to Hand Hygiene, What’s Really Important?

May 6, 2016 by CDC's Safe Healthcare BlogAuthor: Angela Vassallo, MPH, MS, CIC
APIC Communications Committee Member

A recent study published in Infection Control and Hospital Epidemiology comparing CDC’s three-step hand hygiene process using hand rubs with the WHO’s six-step process gained tremendous media attention and had the whole world (or so it seemed) talking about hand hygiene. The study found that the lengthier steps outlined by the WHO, taking 42.5 seconds, resulted in a higher reduction of bacterial count on hands compared to the CDC process taking approximately 35 seconds.1 While the study certainly got folks talking, its outcome might have complicated hand hygiene messaging in terms of what is truly important to keep patients and healthcare professionals safe from infection.

Ultimately, the formal number of steps taken during hand hygiene isn’t as important as technique, consistency, and adherence. The focus needs to be oncleaning one’s hands at all of the right times. Hand hygiene remains the number one way for healthcare providers, patients, and their loved ones to prevent the spread of healthcare-associated infections. On average, healthcare providers clean their hands less than half of the times they should. This is unacceptable and a contributing factor to the spread of healthcare-associated infections that affect 1 in 25 hospital patients on any given day.

These hand hygiene directions by the CDC2 and WHO3 might be best absorbed through what I like to call “The Finger Paint method.” These are practice exercises that you can do in quick, 10-15 minute in-service for healthcare staff. I learned how to do this several years ago from my first infection prevention boss, Linda Miller in Dallas, Texas. You will have to do a bit of prep by purchasing washable finger paint from a toy store or art supply store in advance, but it will be well worth it.

The Finger Paint method:

Ask healthcare professionals to put on gloves.
Place a dollop of the washable finger paint on their hands.
Ask them to close their eyes and begin to wash their hands as they normally would.
Count to at least 20 seconds and ask them to stop.
Have everyone open their eyes and look at all of the places on their gloves where there is no finger paint.

This fun exercise really opens peoples’ eyes to how they can make improvements in their own hand hygiene practice. You will find that people enjoy being able to see their mistakes with their own eyes on their own hands. Making the instructions practical vs. theoretical often makes it easier for people to absorb and retain. Plus, people have fun doing it!

In addition to running drills with finger paint, healthcare providers should be educating patients and families on hand hygiene. CDC’s new “Clean Hands Count” materials inform both consumers and healthcare professionals on what’s truly important when it comes to hand hygiene. Similarly, APIC has created a number of “Clean Hands Stop Germs ” materials to help patients and care providers talk to each other about infection prevention and hand hygiene. APIC will also be launching a number of new resources for International Infection Prevention Week, October 16-22, around the theme of how to “Break the Chain of Infection.” And as we know, performing hand hygiene at the appropriate times is the number one way to break that chain of infection.

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