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

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.

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!’

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!

SURVEY: Swine flu doesn’t change hand washing habits!

Hands on hand hygiene: how good is your hand washing habit? A new US survey has indicated that despite the swine flu, many people haven’t changed their washing hands habits. Did you try to improve your hand washing habit? The survey was conducted online July 28-31 and involved 1,020 American adults across the country aged 18 to 65. Jon Dommisse, director of marketing and product development at Bradley Corporation (conductor of the survey) said: “…they wash their hands no more or less frequently. We found the response to the H1N1 question extremely surprising, especially since the medical community has said over and over that hand washing is the best defense against the spread of cold and flu viruses.” Overall, 87 percent of respondents said they did wash their hands after using public lavatories, but other responses indicated that some may have exaggerated how often they actually did the job correctly. When asked if they had also used soap, the numbers declined only slightly, to 86 percent; yet 55 percent of the group admitted on occasion they’ve simply rinsed, without using soap. Just remember… THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION SAYS … HAND WASHING IS CRITICAL IN PREVENTING ILLNESS!!! Only a few days ago a few more swine flu facts were described by World Health Organisation Director General Margaret Chan in an interview: “…This virus [H1N1 influenza A] travels at an unbelievable, almost unheard of speed. In six weeks it travels the same distance that other viruses take six months to cover. … Sixty percent of the deaths cover those who have underlying health problems. This means that 40 percent of the fatalities concern young adults – in good health – who die of a viral fever in five to seven days. This is the most worrying fact, up to 30 percent of people in densely populated countries risked getting infected …While 90 percent of severe and fatal cases occur in people aged above 65 in seasonal flu, most of those who die from swine flu are under the age of 50.” 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!

How to stop the swine flu? No handshaking, try Barack Obama’s fist bump!

Last year you could have seen president Barack Obama and First Lady Michelle doing the fist bump on many occasion during the election campaign. Now Obama’s lovely greeting gesture might help to stop the swine flu epedimic! Why? Swine flu prevention has become for a large part become a matter of “hand hygiene”, so the handshake is now no longer recommended to greet other people in daily life. Instead the fist bump is much more harmless in terms of hand hygiene! Philip M. Tierno Jr., PhD, director of clinical microbiology and immunology at New York University Medical Centre says: “Eighty percent of all infectious diseases are transmitted by contact both direct and indirect – direct such as kissing, indirect such as shaking someone’s hand. Frequent hand washing is the single most important weapon we have against the swine flu disease.” With the all the focus on H1NI or swine flu, the alternative of the fist bump might become very helpfull in the battle with the ‘influenza A’ virus. For, over the past weeks various reports from around the world indicate that despite the danger, people find it very hard not to use the handshake merely because in many countries handshaking has become so normal – especially in the business and workplace etiquette! So, don’t hesitate … no handshaking anymore, try the obama’s fistbump! SUGGESTION FOR FURTHER READING: • The history of the fist bump! • Shake it up Barack Obama: let’s do the fist bump! • The swine flu etiquette: use good hand hygiene, no handshaking, no mask, to prevent a pandemic! • What the swine flu could do to a young girl in Uganda!

The clinician handwashing poll results at Medscape Today!

In april 2009 Medscape Today presented the results of a poll among clinicians focussed on their response when patients “speak up” with questions about care and hand hygiene. Let’s take a look at the clinicians responses. Posters in hospitals encourage patients to “Speak Up” with questions about their care, such as about clinician hand washing. Although many patients don’t speak up, according to a recent Wall Street Journal article, the ones that do are met with a variety of reactions. How do you respond when patients request that you wash your hands? THE POLL RESULTS: A. I appreciate the reminder - 56% (2831) B. I appreciate the reminder, but I don’t really need it. 22% (1113) C. I’m annoyed, but still appreciate the reminder. 6% (348) D. I’m slightly irritated because I always wash my hands before entering a patient’s room, they just don’t see it. 14% (700) (Total Responses: 4992; Poll was conducted during the period: 21-Apr-2009 – 28-Apr-2009) INTERESTING SUGGESTIONS RELATED TO HANDWASHING: • The swine flu etiquette: use good hand hygiene, no handshaking, no mask, to prevent a pandemic! • Health warning: why hand sanitizers may increase risk of swine flu exposure! • Hand hygiene: warm air dryers increase bacteria on hands! • Hand-washing prevent food-borne illnesses! • A kiss is healthier than a handshake!

The swine flu etiquette: use good hand hygiene, no handshaking, no mask, to prevent a pandemic!

DO YOU KNOW the “etiquette rules” to prevent a swine flu pandemic? It is all about hand hygiene & no handshakes! Six of the most important swine flue etiquette rules to prevent a swine flue pandemic – all are related to hand hygiene – are: • No handshaking! – No handshake, high five, nor intimate greatings such as: beso-beso, touching cheeks, air kisses; • Do not sneeze nor cough in your hands! – Use a handkerchief, tissue, or your t-shirt; • Wash your hands frequently! – Even at home, and don’t forget the soap; • Wash your hands before and after eating! Additional options are: • You can use alcohol hand cleaners when washing your hand; • The ultimate protection is to stay at home & wear a face mask – though the experts agree that the biggest benefit of a mask is when they are worn by those who are already sick! Dr. Richard Besser (acting director of the U.S. Centers for Disease Control) says: “I would rather people really focus on hand washing, not giving that little kiss of greeting when you’re meeting someone, of doing those sorts of things, covering your cough and your sneeze.” Source: The Canadian Press

Washing hands: ‘clean hands may weaken your moral judgement!’

Last year a Britsh study was presented which pointed out a remarkable effect of washing hands: people are more likely to be tollerant in making decisions if they have just washed their hands. The study included 2 experiment. In the first study, 44 people were asked to watch a disgusting three-minute clip from the hit film ‘Trainspotting’: 22 people had washed their hands just before seeing the movie, and 22 had not. All 44 people were then asked to rate on a scale of one to nine the morality of a series of acts in the movie (varying from stealing a wallet, to abusing a kitten). In the second study a group was asked to read sentences with words such as ‘purity’ and ‘cleanliness’, and then they were posed the same moral dilemmas of the first experiment. Another group was given sentences including more neutral words. Surprisingly, in both hand washing experiments the ‘clean’ group judged the unethical behaviour less harshly. • Dr. Simone Schnall (psychologist) says: “When we exercise moral judgment, we believe we are making a conscious, rational decision, but this research shows that we are subconsciously influenced by how clean or ‘pure’ we feel.” Source: Cleanliness can compromise moral judgment • Professor Cary Cooper (psychologist) says: “It suggests that washing can make us more prepared to accept wrongdoing. It is very scary when you think of the implications, especially in the judicial world.” Source: Washing hands affects moral judgement