Promoting Proper Hand Hygiene in the Home

Healthcare-associated infections or HAIs can severely affect the health and overall quality of life of long term care residents. By conservative estimates, there are over 1.4 million cases of HAIs at any given time, and these can be caused by overlooking a necessary practice in healthcare settings: proper hand hygiene.

Because of the lack of vigilance when it comes to hand hygiene, patients and healthcare practitioners may acquire HAIs such as blood infections, urinary tract infections, gastrointestinal infections, chest or respiratory infections, and surgical site infections. Caregivers and home care workers often facilitate the spread of these infections unknowingly. It may be because they come in contact with infected patients who already have the microbes but do not exhibit any symptoms or signs of an infection. This makes the promotion of proper hand hygiene crucial.

A recent study conducted by the Long-Term Care in the Sunnybrook Health Sciences Centre in Toronto centered on the relationship between the compliance rate of proper hand hygiene and the norovirus attack rate. Norovirus is an infection associated with gastroenteritis, which can cause diarrhea or vomiting. The center found that the more people washed their hands, the fewer people exhibited these symptoms of norovirus.

Hand hygiene is universally accepted and recommended as the single most important method to prevent the spread of HAIs and avoid the even bigger problem of an outbreak. What makes it an even more viable solution is it is inexpensive and not at all time consuming. It is a precaution that can save not only the patients’ lives but also dollars spent on healthcare.

How Organisms are Transmitted

Every day, caregivers and home care employees do a variety of tasks that include interacting with residents and patients. A seemingly harmless task such as changing the position of a resident in bed can lead to the transfer of thousands of microorganisms, some potentially harmful. Without proper hand hygiene, these microorganisms can lead to HAIs and other occupants.

When then should hand hygiene protocol be observed? Here are 4 moments which are essential in practicing hand hygiene:

1. Before initial contact with the resident or a resident’s environment
2. Before sterilized procedures
3. After exposure to body fluids
4. After contact with the resident or a resident’s environment

Also, in long term care communities, residents gather for group activities such as meal times and social events. It is thus recommended that all residents, caregivers, home care staff, and family members who will take part in these group activities observe proper hand hygiene to minimize the spread of these microorganisms. 

Here are other specific instances when one should practice proper hand hygiene:

• Prior to eating
• Before and after direct contact with a patient’s skin, such as checking for pulse, taking blood pressure, performing physical examinations, and lifting the patient in bed.
• After exposure to blood, body fluids or excretions, mucous membranes, non-intact skin, or wound dressings
• After touching inanimate objects such as medical equipment in the immediate vicinity of the patient
• During patient care, if hands will be moving from a contaminated-body area to a clean-body area
• After removing gloves
• After using the washroom

How to Wash Hands

There are two common ways to observe proper hand hygiene. First is the alcohol-based hand rub, which kills microorganisms in seconds and is the most effective method when hands are not visibly dirty. The second is the use of soap and water, which will remove these microorganisms and wash them down the drain.

What’s the difference between the two? A hand sanitizer that has at least 70-90% alcohol can kill most of the bad germs that can make one sick. It is the preferred method in most home care settings. The only downside to an alcohol-based hand hygiene is the sanitizer cannot kill C. difficile, which is a common bacteria that causes diarrhea. Those who have C. difficile need to wash their hands with soap and water, and those who care for infected residents need to wear gloves and gowns when coming into contact with them.

Another advantage of an alcohol-based hand rub is that it is less drying to the skin compared to using soap and water, and it does not allow for antibiotic-resistant superbugs. To use a alcohol-based hand sanitizer properly: put alcohol or alcohol-based sanitizer on dry hands and rub them together and make sure that all surfaces are covered. You know you are done when the hands dry from the sanitizer after about 20 seconds.

Meanwhile, here are the CDC Guidelines for Hand Hygiene in Healthcare Settings:

• Before using soap, wet your hands first with water. Next, apply the amount of soap recommended by the manufacturer to your hands. Rub your hands together vigorously for about 15-20 seconds, making sure all surfaces of the hands and fingers are covered.
• Rinse your hands of soap with water and use paper towels to dry them. Use the paper towel to turn off the faucet.

Whichever of the two you decide to use in the long term care setting, the important thing is to observe proper hand hygiene. By using the steps and notes above as a reminder and guideline for all home care staff and residents, you will eliminate the risk of HAIs in your community in no time.

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