Why can’t Hospitals get Health Care Workers to Wash their Hands?

Dr. Nosanchuk, Associate Professor of Medicine (Division of Infectious Diseases) and Microbiology/Immunology at the Albert Einstein College of Medicine, Bronx, New York, considers the fact that while healthcare workers know that they should wash their hands, nosocomial infections associated with the transmission of microbes from health care workers to patients remains an enormous problem:

“We know from various studies as well as observing our fellow clinicians on the wards that hand washing rates dramatically improve when clinicians are observed in the course of routine healthcare delivery. What I didn’t know was that electronic systems that can detect alcohol present in microbicidal gels and soaps. From a pubmed search, I learned that these systems have been in development for several years!”

“The systems available vary, but basically you wear an indicator that, for example, blinks when you wash your hands at a monitored sink. The system registers that you applied a gel or soap. If you approach a patient while wearing the badge without washing your hands at the appropriate sink, the badge vibrates to remind you to return to the hand washing area. If you fail to wash your hands despite the warning, you are flagged (but not directly flogged!) by the system.”

Full article is available at:

http://boards.medscape.com/forums?128@@.2a0928da

More articles about hand hygiene:

http://www.handresearch.com/news/hands-on-hand-hygiene.htm

FINGERPRINTS – An Impression of the Life around Your Sweat Pores!

Sweat drops in the pores of the skin ridges (dermatoglyphs)

Many people sometimes wonder about the function of their ‘fingerprints’. Why do we have them? The answer is foundstarts in the sweat pores!

As you probably know, the whole body is featured with sweat pores (featured with eccrine sweat glands) – except for the lips & the sexual organs.

 

But in the hands & the feet the sweat pores have a highly specialized role. Because in the inner palm and on the sole the sweat pores manifest on so-called ‘friction ridge skin’ – the so-called skin ridges (see the picture above) that became especially known in the perspective of the fingerprints.

 

Skin ridges & grooves!

 

In the skin ridges the sweat pores are found – in a fingerprint the ridges manifest as the ‘black lines’ and in a high quality fingerprint one can sometimes even see the sweat fore: see the picture below!

 

The surrounding ‘grooves’ serve as a transport channel to distribute the sweat through the hands & feet. And the combination of these element prevent our hands & feet to become ‘slippy’!

 

Because skin friction arises from the interaction between the sweat & the skin of the body, and is directly related to the area of the surface of the body that is in contact with the fluid. An important feature in order to have effective ‘grip’ in your hands!

 

“But keep your head cool, otherwise your sweat glands will start produce too much moisture resulting in a reduced grasp stability!”

 

 

Learn more about the life in the skin of your hand:

Discover 20 skin-facts you didn’t know - including hands, fingerprints & dermatoglyphics!

 

SLIDESHOW – The many faces of eczema in hands!

- THE BASICS OF MEDICAL HAND ANALYSIS - Dyshidrotic eczema is a chronic relapsing form of vesicular palmoplantar dermatitis of unknown etiology. Although the etiology is unclear, there is a strong association with atopy. Fifty percent of patients with dyshidrotic eczema will also have atopic dermatitis. Exogenous factors, especially metals (such as nickel), may trigger episodes. Patients typically report pruritus of the hands and feet with a sudden onset of vesicles. On examination, patients will have symmetric crops of clear vesicles and/or bullae on the palms as well as lateral aspects of the fingers and toes, feet, and soles (shown). The distribution of lesions is 80% hands only, 10% feet only, and 10% feet and hands. Lichen simplex chronicus is a thickening of the skin with variable scaling that arises secondary to repetitive scratching or rubbing. It is not a primary process, but develops when patients sense pruritus, repetitively excoriate the area, and develop lichenification. The etiology of the pruritus may be due to any underlying pathology, or none at all. Patients typically report stable pruritic plaques, most commonly on the scalp, nape of the neck, extensor forearms, elbows, vulva, scrotum, upper medial thighs, knees, lower legs, and ankles. Erythema is found in early lesions. The plaques are typically well demarcated, lichenified, firm, and rough with exaggerated skin lines. Hyperpigmentation may be present. Treatment is aimed at reducing pruritus with topical corticosteroids or oral antihistamines. In some patients, antianxiety medications are require. Irritant contact dermatitis is a nonspecific response of the skin to direct chemical damage. It is the clinical result of inflammation arising from the release of proinflammatory cytokines from skin cells, principally keratinocytes. The major pathophysiologic changes are skin-barrier disruption, epidermal cellular changes, and cytokine release. Although a wide range of chemicals may be responsible, the most common causes are repeated exposure to low-grade irritants, such as soaps and detergents. Acute irritant contact dermatitis may develop within minutes to hours of exposure, whereas the cumulative form may be delayed by weeks. On examination, patients may exhibit macular erythema, hyperkeratosis, or fissuring over vesiculation with a scalded appearance of the epidermis (shown). Healing typically beings promptly after removal of the offending agent, although creams containing ceramides or dimethicone may be useful to help restore the epidermal barrier. SUGGESTIONS FOR FURTHER READING: • Medical palm reading: the basics of hand diagnostics! • The nail tutur: find the cause of fingernail disorders! • Medscape presents: ‘the many faces of eczema’

How hand washing may affect your mind!

The benefits of washing hand go far beyond hand hygiene! • Hand hygiene: you better avoid unclean hands! After British scientists unveiled in 2008 that hand washing can weaken moral judgement, now US scientists confirmed that hand washing also helps to ease the mind! In the journal Science, researchers Spike W. S. Lee and Norbert Schwarz write that hand washing seems to lower the amount of second-guessing and rationalization that occur after making a decision: “After choosing between two alternatives, people perceive the chosen alternative as more attractive and the rejected alternative as less attractive. This postdecisional dissonance effect was eliminated by cleaning one’s hands. Going beyond prior purification effects in the moral domain, physical cleansing seems to more generally remove past concerns, resulting in a metaphorical “clean slate” effect.” Obviously, soaping up your hands may do more than just get rid of germs. It may scrub away the inner turmoil you feel right after being forced to make a choice between two appealing options. So it turns out that Shakespeare was really onto something when he imagined Lady Macbeth trying to clean her conscience by rubbing invisible bloodstains from her hands. A few years ago, scientists asked people to describe a past unethical act. If people were then given a chance to clean their hands, they later expressed less guilt and shame than people who hadn’t cleansed. SUGGESTION FOR FURTHER READING: • More news reports about hand hygiene! • Clean hands may weaken your moral judgement! • Hands on hand hygiene: the benefits of clean hands! • How hand-washing helps ease your mind • Cleanliness can influence decision making Language of the hand when confronted with moral dilemmas.

Alcoholic hand gel & health troubles: prisoners used it to get drunk, now children drink it!

Alcoholic hand gel ‘is being drunk by children’. • Hand hygiene – the latest new headlines! After 2009 reports about prisoners misusing alcoholic hand gel (they drank it to get drunk), recently the Irish National Poisons Information Centre (NPIC) made another report of worisome side-effects of alcoholic hand gel. It appears that a relatively high percentage of children got ingested after using alcoholic hand gel. John Herbert, NPIC spokesman, said that the organisation was concerned at the trend, which reflected the increasing availability of these products in hospitals, businesses and other healthcare institutions in 2009: “We saw a pretty steady increase in the number of calls around November last year. however, that since the spike in calls, numbers had dropped to eight in 2010 so far.” The NPIC received 54 enquiries and 74pc of these related to children. In 2008, there were just 20 calls from concerned doctors who were treating patients who had ingested alcohol hand gel! SUGGESTION FOR FURTHER READING: • Hand hygiene news: 2010-2008 headlines! • Hand Hygiene: warm air dryers increase bacteria on hands! • Swine flu prevention is a matter of ‘hand hygiene’! • Misleading hand gel sanitizers… waist of money?’

Misleading hand gel sanitizers… waist of money?

New study reports: hand gels are misleading, only killed 60 per cent of germs at best. • Hands on proper hand hygiene! Last year, when swine flu hit, sales of some products rocketed by 70 per cent. Yet do hand gels really help? A study carried out in December 2009 by Ottawa University found that some brands that claimed to kill ’99 per cent’ of germs did not – at the very best they killed 60 per cent, and at worst just 46 per cent. A dailymail report describes: “The Medicines and Healthcare Products Regulatory Agency says it has had to investigate numerous hand-cleaning products for making claims that they can kill specific viruses such as swine flu or MRSA. They are not allowed to make these claims, because it gives the impression they have some medical effect. Gels can only really help kill everyday germs, such as those that cause the common cold. Yet few people realise that the hands have to be clean in order for many hand gels to work. ‘Like many cleaning agents, most hand gels will be less effective in the presence of protein matter, such as food, mud, faecal matter or blood,’ says Dr Ron Cutler, a microbiologist from Queen Mary, University of London. ‘You really need to wash off all visible signs of dirt before they will be totally effective.’ Many hand gels contain alcohol, which kills germs by attacking their outer membrane. For maximum benefit, a hand gel should contain at least 62 per cent alcohol – but no more than 80 per cent. This is because the gel should contain some water, as once the outer membrane of the bacteria or virus has been penetrated it is water that kills it. But new research suggests that hands gels won’t protect against gastroenteritis or viral stomach bugs such as norovirus. Furthermore, a recent study by the Agri-Food and Biosciences Institute, Belfast, found that even Spirigel, the alcohol-based gel used in NHS hospitals, stops working within seconds of use. A non-alcohol gel offered much longer protection, killing viruses for up to 24 hours after it was applied. Should we abandon alcohol hand gels? Non-alcohol gels work in a variety of ways. Byotrol, the gel used in this study, contains mainly water, but the gel forms an invisible layer that stays on the hands and literally pulls bacteria and viruses apart. Some others, such as No Germs, use chemical antibacterial agents or even essential oils. ‘When alcohol hand gels were first introduced years ago, it was so much better than anything else,’ says microbiologist Stephen Falder, who helped develop Byotrol. ‘But if you were going to start designing a hand gel now from scratch, you would abandon alcohol.’ He adds: ‘Alcohol stops working almost as soon as it’s dry, and does not give you residual protection.’ other experts disagree and say that while the effects of non-alcohol hand gels may last longer, alcohol is better at killing germs. Professor John oxford, a virus expert from St Barts and Royal london Hospital, says he would always prefer an alcohol-based gel. ‘Yes, it might not work against things like norovirus, but norovirus is a very difficult bug to get rid of and nonalcohol gels won’t work against it either – little will. ‘The alcohol ones do work and certainly work against things like swine flu.’ Mr Cutler backs him up. ‘If my hands were dirty, I would wash them first with soap and water, using lots of agitation. ‘This cleans off all visible dirt. I would then apply an alcohol hand gel to get rid of any residual bacteria. ‘There are non-alcohol based products, some for example contain citrus oils, but I am not sure how strong an alternative these are. Washing your hands is the best option. ‘This should definitely be done after you go to the loo, after changing a nappy, after you sneeze, before you eat, before preparing food and after handling raw foods such as meat.’” “The gold standard of hand washing is using hot running water and soap.” “‘You need to wash both the palms and the finger tips and around rings of the fingers, as bacteria can lodge there,’ says Dr Anthony Hilton, a reader in microbiology from Aston University. ‘Then you should dry with a paper towel or hand drier. However if this is not available, then alcohol-based hand gels can be a very good substitute.’” So, the essential is: do not consider hand gel sanitizers as a ‘safe’ alternative for hand washing!!! SUGGESTION FOR FURTHER READING: • October 15 – ‘Global hand washing day!’ • July 18 – ‘Nelson Mandela day!’ • Swine flu prevention is a matter of ‘hand hygiene’! • Hand Hygiene: warm air dryers increase bacteria on hands! • Youtube video contest: ‘it’s in your hands!’

‘It’s in Your Hands’ – Hand Hygiene YouTube™ Video Contest!

• 10 commandments for hand hygiene! DENVER & ST. PAUL, Minn., Mar 16, 2010 – With a video featuring healthcare professionals demonstrating hand hygiene practices while singing a version of the Hokey Pokey, Billings Clinic of Billings, Mont., was named the winner of the “It’s in Your Hands” YouTube video contest, sponsored by 3M and the Association of periOperative Registered Nurses (AORN). With more than 2,500 votes, Billings Clinic was announced as the winner last night during the AORN annual Congress in Denver, and received a $5,000 educational grant that can be redeemed for any AORN program or service or to purchase AORN reference materials. “Hand hygiene is an integral part of patient safety at Billings Clinic and our team united to share a serious message in an entertaining way,” said Jackie Hines, RN, the AORN member who submitted the video on behalf of Billings Clinic. “We are honored to be recognized by our industry and thank AORN and 3M for bringing attention to the important work of perioperative professionals.” The Billings video competed against two other finalists from John Muir Medical Center, Walnut Creek, Calif., and Chapel Hill Tubal Reversal Center, Chapel Hill, North Carolina. The three finalists were selected by AORN’s Recommended Practices Committee using several contest criteria including adherence to AORN’s Recommended Practices for Hand Hygiene in the Perioperative Setting, an evidence-based set of guidelines for practicing optimal hand hygiene. “It has been incredibly exciting to have professionals around the country rally behind this initiative and show both their colleagues and patients how they follow these critical hand hygiene best practices” said Patrick Voight RN, BSN, MSA, CNOR, president of AORN. “We congratulate Billings Clinic on their selection as contest winner. Billings Clinic demonstrated perfect adherence to the Recommended Practices, while also incorporating creativity.” The “It’s in Your Hands” YouTube video contest was created as part of a partnership between 3M Infection Prevention and AORN to raise awareness of the deadly risks associated with improper hand hygiene techniques and the importance of the Recommend Practices, while encouraging best practices among OR nurses and other healthcare professionals. SUGGESTION FOR FURTHER READING: • Swine flu prevention is a matter of ‘hand hygiene’! • Hand Hygiene: warm air dryers increase bacteria on hands! • More swine flu prevention: the 10 commandments for hand hygiene!

H1N1 FLU PREVENTION – When to use a alcohol based hand sanitizer?

A hand sanitizer is an excellent alternative to hand washing when soap & water are not available!

About H1N1 Prevention & hand hygiene! Alcohol-based hand sanitizers — which don’t require water — are an excellent alternative to hand washing, when soap and water aren’t available. A hand sanitizer is actually MORE effective than soap and water in killing bacteria and viruses that cause disease! For, organisms cannot develop resistance to alcohol, and commercially prepared hand sanitizers contain ingredients that help prevent skin dryness.

But one should be aware that not all hand sanitizers are created with likewise substances. Some “waterless” hand sanitizers do not contain any alcohol. In general one should use only the alcohol-based products. The American CDC (Centers for Disease Control and Prevention) recommends choosing products that contain at least 60 percent alcohol. This is how to use an alcohol-based hand sanitizer: • 1 – Apply 1/2 teaspoon of the product to the palm of your hand. • 2 – Rub your hands together, covering all surfaces of your hands, until they’re dry. NOTICE:If your hands are visibly dirty, however, wash with soap and water, if available, rather than a sanitizer!!! SUGGESTIONS FOR FURTHER READING: • ‘Hand hygiene’: a starting point for H1N1 flu prevention! • About health, hands & ‘hand hygiene’! • Did you know that warm air dryers increase bacteria on hands? • Hand facts on hand hygiene! PICTURE: How a hand sanitizer works!

OCTOBER 15 – Did you miss the ‘Global HandWashing Day’ as well?

The driving theme for Global Handwashing Day is children and schools, and the main objectives of this global celebration are: • Foster & support global culture of handwashing with soap. • Shine a light on state of handwashing in each country. • Raise awareness about benefits of handwashing with soap. Read more at: GlobalHandWashingDay.org and remember: Handwashing & Hand Hygiene is the major prevention against swine flu! A funny recommendation: “Wash your hands with hands!” A few more important reminders in the perspective of the current H1N1 swine flue pandemic are: • Don’t think that you can wash your hands properly without using soap! • Don’t think that a hand sanitizer is meant to replace handwashing! • The best way to make sure your hands are clean is to wash them for twenty seconds several times a day! MORE DETAILS AVAILABLE AT: • Hands on ‘hand hygiene’! • Swine flu prevention is a matter of ‘hand hygiene’! • Hand Hygiene: warm air dryers increase bacteria on hands! • More hand hygiene news!

HAND HYGIENE – Still the best strategy for swine flu prevention? (H1N1 influenza virus)

Is hand hygiene still the best strategy for swine flu prevention?

Research on hand hygiene & swine flu (H1N1 influenza) prevention! New research points out: ‘hand-to-face touch’ is a crucial link in catching swine flu and infection is likely not limited to body-contact! The global death toll arrived beyond 5000, and the stronger ‘momentum’ of the second wave of the H1N1 virus is now observed on 3 continents.

On wednesday september 8, Barack Obama told students at Wakefield High School in Arlington, Virginia: “I hope you’ll all wash your hands a lot, and stay home from school when you don’t feel well, so we can keep people from getting the flu this fall and winter.” But the new reports indicate that washing hands is likely not enough to stop the H1N1 influenza virus – so it does make sense that governments recommend an anti-virus swine flu shot! Anyway, just remember: ‘… think about your hand hygiene!’ SUGGESTION FOR FURTHER READING: • Swine flu prevention is a matter of ‘hand hygiene’! • A kiss is healthier than a handshake! • Your health is in your hands! • More hand hygiene reports!