Interview with Rita McCormick, RN, CIC, Senior Infection Control Practitioner, University of Wisconsin Hospital & Clinics Authority
McCormick: This is a common observation and a very vexing problem for most infection control practitioners. There are numerous studies showing that you cannot remove gloves without contaminating your hands. We tell staff, even though you throw the majority of the organisms away when you put the gloves in the wastebasket, you don't throw them all away; some remain on your hands. If you put on a clean pair of gloves, these microorganisms are simply going to multiply on your skin while in the warm, moist confines of the glove. And if you peel off your gloves and rub your eyes or touch your nose, as people often do without thinking, you could inoculate your own eye or nose. Staphylococcus aureus is an organism that thrives in the nose. But this concept is a very hard sell.
The whole concept of hand sanitizing is a hard sell. You will find many people who are just as vigilant as they can be, but there are always the lackadaisical ones who will take their chances. Some individuals simply don't believe that they may be responsible for transmission of infection to others because the time interval between transmission and evidence of disease can be lengthy; the causal relationship just isn't obvious. Everything we've discussed-purchasing good quality products, establishing and enforcing strict hand sanitation regimens-has to be brought to bear to make sure that healthcare workers don't take chances with patients and place them at increased risk of infections.
Because healthcare workers are required to do a lot of "wet work"-for example, bathing patients or frequent handwashing-skin irritation can be a real occupational risk. In fact, skin irritation has been identified as a major impediment to hand hygiene. The risk can be minimized significantly by routine use of hand lotions. We did a study in our hospital in which we identified workers with very irritated hands and required that they apply lotion at least four times per eight-hour shift. We then checked the condition of their hands every week. Very significant improvement was seen in the first week and was maintained throughout the month-long study.
The new CDC hand hygiene guideline emphasizes the need for the application of hand lotion to prevent skin irritation, and employers should provide these lotions. These products should be carefully selected to ensure compatibility with handwashing agents and gloves. Many of the lotions on the market for healthcare workers provide label information about compatibility with latex gloves and antimicrobial ingredients, such as chlorhexidine gluconate.
In sum, hand hygiene sounds like a rather simple concept and an easy procedure, but in reality good hand hygiene with optimal compliance is complex and requires continued vigilance by all healthcare workers to prevent cross-transmission of infectious agents between them and their patients.
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