This summer, Americans were reminded about the serious nature of foodborne illness when more than 600 cases of an unidentified stomach flu began to crop up in Iowa, Texas and other states. The U.S. Centers For Disease Control and Prevention linked 240 cases to a Mexican farm, but the remaining cases were left without answers.
Hand washing remains the best lines of defense against foodborne illness and disease. While health experts continuously preach the virtues of hand washing, researchers say hand drying may be just as important in the fight against infection.
The CDC reports that the transmission of bacteria is more likely occur from wet hands than from dry hands. Though, the organization considers proper hand drying after washing an essential component of hand hygiene, researchers at the Mayo Clinic say the role of hand drying has not been widely promoted and is often overlooked in conversations about disease prevention.
There are generally four methods for drying hands: with paper towels, under air dryers, on cloth towels, or through evaporation. While most people express a personal preference toward a particular hand drying method, recent studies aim to shore up anecdotal sentiments with science.
Over the past few years, researchers have indicated that paper towels may provide more hygienic benefits than previously acknowledged. With high consumer preference levels and the ability to physically remove soils and microbes, paper towels have earned their mark as the go-to hand drying method in many building environments.
For jan/san distributors who play an essential role in the health of a facility, it’s important to have a pulse on the research that is coming out of the academic community surrounding hand drying methods, as well as keep an ear to the ground to hear what customers are saying — especially those who operate in healthcare environments where maintaining proper hygiene is paramount.
It’s the perfect position for distributors to flex their consultative muscles, says Jim Smith, executive vice president at HP Products in Indianapolis.
“We try to understand first what a customer’s desire is,” Smith says. “We educate them with the studies and the information that we have. There is going to be different schools of thought. Customers want to be taken care of and they want to be comfortable.”
With paper towels, visitors can dry their hands and “get on down the road,” he adds.
“It’s a well-known fact that cell phones are dirty objects, but just how unclean are they? Fun fact: each square inch of your cell phone contains roughly 25,000 germs, making it one of the filthiest things you come in contact with on a daily basis. That’s something to think about the next time you press your face to your phone.
Ever wonder what objects are actually cleaner than your phone? Surprisingly, toilet seats make the list because they’re usually sanitized often. Watch the video to see how an average cell phone’s bacterial count stacks up compared to other household items,” as reported by Mashables.
Menshealth recently interviewed Dr. Charles Gerba, a professor of microbiology at the University of Arizona who says this is not surprising. “Nobody ever cleans or disinfects their phone, so the germs and bacteria just keep building up,” he explains. What types of germs? E. coli, as well as influenza and MRSA, a germ that causes rashes and skin infections, Gerba adds.
As we use our phones frequently it remains warm, creating the ideal breeding ground for bacteria. “With the advent of touch-screen phones, the same part of the phone you touch with your fingertips is pressed right up against your face and mouth, upping your chances of infection,” Gerba adds.
“The researchers found that 94.5 percent of the phones were contaminated with some kind of bacteria, many of which were resistant to multiple antibiotics. By also testing the participants’ hands, the researchers were able to show that a significant number of germs were transferred from their hands to their phones, and vice versa. In fact, about 30 percent of the bacteria on the phones ended up on the owner’s hands.
Much of the disease-causing bacteria they found are transferred from person to person through touch, which means that once this bacteria is on your hands, you only have to then touch your eyes or nose for the bacteria to find an easy route into your body. This is especially frightening when you consider how often your phone hangs out only millimeters away from your face.
The wide spread use of mobile phones by healthcare workers has become a question of concern. A recent study study on mobile phones and Nosocomial infections reported, “HCWs’ mobile phones may serve as reservoirs for microorganisms that could facilitate the transmission of bacterial isolates from one patient to another in different hospital wards. Whereas strict attention is paid to changing clothes, removing jewelry, undertaking hand hygiene measures (WHO 5 Moments), and storing personal objects in changing rooms to reduce the transfer of microorganisms from the external clinical environment into the operating environment, most expensive mobile phones often accompany staff into the operating environment as currently no local policy restricting the use of mobile phones in clinically sensitive areas is in place. This lack of attention may be indicative of little awareness about potential risks posed by mobile phone microbial contamination and their role as vehicle for transmission of infections.”
The report went on to recommend, “Restriction of mobile phone use in clinically sensitive areas, such as operating environment and ICU as a start point, is recommended. Moreover, screening of HCWs’ mobile phones inside the hospital should be done while doing environmental screening.” This would be supported by, “A major educational campaign to raise awareness” and recommendation that “mobile phones could be produced with protective material against contamination.”
Hand hygiene should be performed between patient contact and before and after accessing a device.
Manufacturer’s guidelines for use, cleaning/disinfection and maintenance should be reviewed to ensure these guidelines meet the standards for cleaning and low-level disinfection that are necessary for exposure to Multi-Drug-Resistant Organisms.
Items that cannot be adequately cleaned should not be used, or should be designated as “clean” and not be accessed in patient rooms or be touched by patients.
If an item cannot be cleaned with a hospital-grade disinfectant and is necessary for patient care, a risk assessment should be done with infection prevention and control to determine the best approach to mitigate the risk of transmission of microorganisms.
All touch-surfaces of IT devices used at, or near, point-of-care must be cleaned and disinfected with a hospital-grade disinfectant if used or touched during the encounter with the patient.
The surface of telephone components, pagers and computer ‘mice’ should be cleaned in a manner that prevents damage to internal systems from excessive fluid.
If an item cannot be adequately cleaned and will be accessed in a patient room or touched by patients, it requires a cleanable cover.
The user/owner of the device is responsible for routine cleaning and disinfection of the device and that responsibility must be clearly communicated.
Hand hygiene education materials for teaching pre-school children when to wash their hands and why it’s important. These include digital copies of the storybook, coloring sheets, music tracks (mp3) and sheet music:
The healing hands of a healthcare professional too often bear the risk of spreading infection while administering care. According to the Centers for Disease Control and Prevention (CDC), failure to engage in proper hand hygiene is the leading cause of healthcare-associated infections and the spread of multidrug-resistant organisms (MDROs), including vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Unfortunately, proper hand hygiene can be easily forgotten by busy healthcare workers. A study of 2,834 opportunities for hand hygiene found that hands were cleansed only 48 percent of the time, according to a World Health Organization (WHO) report (2009).
Diane Jacobsen, director of the Institute for Healthcare Improvement (IHI), says visible reminders to complete hand hygiene can be powerful. “Staff are busy responding to unexpected calls from the bedside,” she says, “so things as simple as making sure that hand hygiene supplies are very visible are helpful. Make sure there are sinks or alcohol-based hand sanitizers outside the patient room, so staff don’t have to go down the hall and the around the corner to find a sink,” she says. “Keep things very much within their work stream. Those are simple changes, but they make a big difference.”
Some programmatic changes can be implemented on one unit to help a hospital see what kind of reminders — such as posters near sinks, –work best for their hospital, Jacobsen says. Starting small can also help the hospital identify the factors particular to their work environment that prevent healthcare workers from practicing good hand hygiene, she adds. “The hospital would look at their own local environment because not the same thing is going to work in every single organization,” Jacobsen says.
The WHO reports indicates that a lack of time, insufficient or inconveniently located sinks and irritated hands as some reasons healthcare professionals give for not engaging in hand hygiene. According to the 2009 WHO report, working as a doctor or nursing assistant was associated with a lower rate of compliance. In addition, working in intensive care, surgical care, and emergency care was associated with poor hand hygiene. Understaffing and overcrowding also contributed to low compliance, according to the report.
Keeping positive data visible can be a powerful technique in encouraging staff to work together to create a culture in which best practices are the priority, Jacobsen says. “Not all infections are totally preventable, but many of them are, and just keeping that kind of information visible to people in their staff lounge − for example, to say it’s been 20 days since an infection. Again, it engages everybody as a team,” she says.
The WHO report (2009) notes that healthcare workers often contaminate their hands or gloves by touching the environment before touching a patient. As such, hand hygiene would be more effective if implemented in conjunction with environmental hygiene, says Philip C. Carling, MD, director of infectious diseases and epidemiology at Caritas Carney Hospital and a professor at Boston University School of Medicine. “If we don’t have good environmental hygiene, then as good as we want to get with hand hygiene, we’re not going to get as much bang for the buck as we could if we had good environmental hygiene, because hand hygiene is not perfect,” Carling says. “You can’t be cleaning (the environment) all of the time, just like you can’t be doing hand hygiene all of the time. And so you need the combination of optimizing both practices.”
The WHO and the CDC recommend established best practices for hand hygiene. According to the WHO, there are five key moments when a healthcare worker should engage in hand hygiene:
– before touching the patient
– after touching a patient
– before touching an area of at risk of infection
– after body fluid exposure risk
– after touching the patient environment
Hand hygiene should also be practiced after touching wound dressings and before handling medication or preparing food. Hand hygiene is also needed before putting on gloves to insert an invasive device, such as a catheter. After removing sterile or non-sterile gloves, hand hygiene should also be practiced. The CDC says that bacteria linger on the hands of healthcare workers after they remove gloves. It is thought pathogens penetrate glove defects or hands get contaminated when healthcare workers remove their gloves. Depending on the procedure, hand hygiene is also recommended before wearing gloves.
Alcohol handrubs and soaps should not be used at the same time. Here is a review of the appropriate times for each:
Handwashing:
– Wash with soap and water after using the restroom, before eating and when hands are visibly contaminated. It is also recommended when multi-resistant spores are present. The mechanical friction of handwashing helps remove the spores and should be practiced in conjunction with wearing gloves. Medicated soap does make a difference in this case.
– Wash hands for 40 to 60 seconds and avoid hot water because it increases skin irritation
– Pat hands dry using paper towels or use hand driers to reduce the risk of recontamination. Patting hands dry reduces hand irritation. Hand dryers should dry hands quickly without aerosolizing pathogens.
– Use a paper towel to turn off the tap to avoid recontamination.
Alcohol-based handrub:
– Use alcohol-based handrubs for hand hygiene at every other hand hygiene opportunity when handwashing is not recommended.
– Use a palm full of alcohol handrub and cover hands completely. Rub hands until dry, this should last between 20 seconds to 40 seconds. If it takes less than 15 seconds you should use more of the product.
