Washing, care, and gloves – they play a big part, too!

Hand hygiene: more than just disinfection

On May 5th, the World Health Organization (WHO) celebrates its international awareness day dedicated entirely to the topic of hand hygiene. Because hand hygiene applied correctly at the right time is one of the most important measures for interrupting infection chains. This makes hand hygiene, and hand disinfection in particular, one of the essential infection prevention measures. Thus, it’s worth thinking about it. And in principle, it’s simple, too. We asked our experts what is most important to them when it comes to the topic of hand hygiene and which aspects should be paid particular attention to.

In the following interview, our colleagues from Research & Development, Marketing and Sales are asked a total of five key questions on the subject of hand hygiene and their mottos on the subject:

1. Hand hygiene – which elements are involved, what constitutes good hand hygiene?

Dr Henning Mallwitz: The term hand hygiene is often used synonymously with hand disinfection in the healthcare sector. Hand disinfection is undoubtedly a main pillar of basic hygiene: it has been proven to prevent nosocomial infections and contributes significantly to patient safety. But the components of hand washing, skin care and gloves are also part of hand hygiene. Because hands also need to be cleaned, cared for, and protected. They are our most important tool. We touch many things and many people with our hands. Thus, contaminants and pathogens can be transmitted, which is why disinfecting and washing hands according to the indication protects both patients and staff. But the hands themselves must also be protected: by gloves against contamination with body fluids or chemicals. Careful skin care helps to protect the skin and strengthen the natural protective barrier.

All components of hand hygiene are thus important and complement each other. At the same time, they also influence each other. Only the observance of all four components, compliance with the respective indications and responsible implementation lead to good hand hygiene. And thus, to more patient safety and good occupational safety. If everyone considers all components equally, hand hygiene compliance increases overall – and infection risks decrease ultimately.

Reminder # 1:

2. Hand disinfection – what should be considered?

Dr Heide Niesalla: Thanks to the 5 moments of hand hygiene, the indications when to perform hygienic hand disinfection should be well known to everyone in the healthcare sector. Regarding patient safety, the indication "before aseptic tasks" is particularly important, as this is where pathogens can enter the patient's body. Unfortunately, it is precisely this indication that is most often forgotten in practice. We therefore urge everyone to pay special attention to hand disinfection "before aseptic tasks" in addition to the other moments: i.e., to be sure to disinfect hands without fail, for example, before any contact with non-intact skin and mucous membrane, before any contact with wounds, between removing an old dressing and putting on the new, sterile dressing, before placing catheters of any kind, etc..

It is not only important to disinfect hands according to the indications, but also to do the hygienic hand disinfection correctly. Here, too, everyone can make their personal contribution to patient safety by disinfecting their hands properly: Despite all the discussion about the rub-in time (15 sec. vs. 30 sec.), effective hand disinfection is only given if the hands are completely wetted. This is because pathogens are only inactivated where the skin comes into contact with sufficient disinfectant. Overall, there are three factors that influence wetting: The volume of the disinfectant, the rub-in technique, and the rub-in duration. Accordingly, for effective hand disinfection, it is necessary to apply enough hand disinfectant to dry (!) hands so that the hands are completely wetted, and then rub the disinfectant thoroughly into the hands. We recommend that you use your own rub-in technique instead of following a specific sequence of steps, as the wetting results are proven to be better then. Since the fingertips can be the strongest carriers of pathogens, they should be disinfected first. Likewise, one should also pay special attention to the thumbs and finger gaps because these can be easily forgotten.

Reminder # 2:

3. Washing hands – do you have to do it at all?

Merle Haldenwang: Children learn to wash their hands as their first hand hygiene measure, which should be well known to us. For private everyday life, we know that hand washing is our hand hygiene measure of choice. Hand washing is a must. But what is the role of washing hands in the healthcare context?

In healthcare institutions, the most common hand hygiene measure is hand disinfection. However, there are situations or indications where hands should be washed. It is important to note that both measures are complementary: while disinfection is intended to inactivate pathogens to prevent infections, washing serves to clean hands. Accordingly, wash lotion does not have a disinfecting effect, because no antimicrobial ingredients are added; this part is taken over by the disinfectant. This means that hands are usually washed when they are actually "dirty". Similar to private life: For example, when you come in from outside at the beginning of work, after going to the toilet, after sneezing or if your hands are (visibly) dirty for other reasons. Since washing with wash lotion and water also washes off skin lipids, you should only wash your hands when it is really necessary. The choice of a suitable product is also crucial.

There is indeed one special case in healthcare where an indication for hand washing also serves to remove pathogens: in the case of infections with bacterial spores. As hand disinfectants are not effective against bacterial spores, transmission to other patients can only be prevented if the spores are thoroughly washed off the hands. Therefore, after hygienic hand disinfection, hand washing after caring for a patient with a Clostridioides difficile infection is a very important indication. Because it is crucial to first inactivate the spores on the skin and then remove them mechanically.

Decisive for effectiveness when washing, as with disinfection, are also the rubbing technique and duration. The hands are first moistened with water and then thoroughly rubbed with sufficient wash lotion for min. 20-30 seconds, with special emphasis on the fingertips and finger gaps. The hands are then rinsed under running water and dried thoroughly with a disposable towel. Ideally, the water temperature should not exceed lukewarm so as not to stress the skin too much.

Reminder # 3:

4. Skin care – what is its significance in hand hygiene?

Dr Sven Eggerstedt: Healthy skin is the basis for all other components of hand hygiene. A smooth skin surface offers less surface for microorganisms to attack, while cracked skin favours their colonisation. Moreover, only intact skin can be disinfected effectively. Therefore, you should apply it regularly. In addition, the condition of the skin is affected by other components of hand hygiene: especially, frequent hand washing impairs the natural lipid layer and can lead to rough and cracked skin. Wearing gloves, on the other hand, leads to a moist environment under the glove after some time, which causes the skin to swell. Here, skin care is of course particularly important and becomes part of proper hand hygiene at the latest.

But how does proper skin care work? Are there also special indications for skin care and a technique for carrying it out? First, it has to be distinguished between skin protection and skin care, for each of which there are usually different products: skin protection cream forms a "barrier" on the skin to protect against possible irritation caused by e. g. moisture. This is used when regularly performing activities that are harmful to the skin for more than two hours a day, before prolonged glove use and before working with aqueous media. Skin care products prevent cracked and dry skin. It is advisable to apply skin care products at the end of the workday, during breaks, after washing hands and regularly as needed. Combined products that protect and care at the same time are used accordingly in each of the moments described. Products with as few as possible, but maximum caring ingredients are certainly recommended.

Not to be neglected: As the efficacy of alcohol-based hand disinfectants can be affected by the use of skin care products, the compatibility of care product and hand disinfectant should be considered.

Reminder # 4:

5. Gloves – which role do they play in hand hygiene?

Dr Christian Jenke: Gloves are indeed a relevant part of hand hygiene. When using gloves, a distinction must be made between medical devices (MD) and personal protective equipment (PPE). As a MD, they serve primarily for the (infection) protection of the patient and as a part of the PPE, they explicitly serve for self-protection. Because gloves protect staff from contamination with potentially infectious body fluids of a patient or from chemicals.
Accordingly, gloves should be worn when working or in situations which are afflicted with a risk of contamination or transmission of pathogens. For example, when sampling blood, washing a patient, but also when administering cytostatics or preparing disinfectant solutions.

Unfortunately, in practice this is sometimes confused, and the gloves are not always used correctly; gloves are worn, even though they are not necessary, not indicated. In these situations, gloves are even a hindrance from an infectiological point of view: gloves are often used as an alternative to hand disinfection, or the indications for hand hygiene are not observed because gloves are worn. Thus, gloves can even have a negative impact on patient safety, as there is a risk of transmission via contaminated gloves. Gloves therefore in no way replace hand disinfection, but merely complement it as an important component of hand hygiene for certain indications.

Hand disinfection, in turn, complements the use of gloves, as certain medical procedures always require certain indications for hand disinfection to be fulfilled met in addition to the use of gloves, such as: before aseptic tasks, during blood sampling, after contact with potentially infectious material during wound care. Hand disinfection is absolutely essential after removing the gloves, as there is a high risk of contamination of the hands with potentially infectious material such as blood when removing gloves.

Reminder #5:

Many thanks to all interview partners for the interview.

Interested to read more about hand hygiene and hygiene measures? Here you can learn more about the elements of basic hygiene, for example.

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