Chapter 1. Infection Control
1.3 Hand Hygiene and Non-Sterile Gloves
Hand Hygiene
Hand hygiene is the most important part of practice for healthcare workers and is the single most effective way to stop the spread of infections; failure to properly perform hand hygiene is the leading cause of HAIs and the spread of multi-drug-resistant organisms (MDROs) (BC Centre for Disease Control, 2014; WHO, 2009a). Hand hygiene is a general term used to describe any action of hand cleaning and refers to the removal or destruction of soil, oil, or organic material, as well as the removal of microbial contamination acquired by contact with patients or the environment. Hand hygiene may be performed using an alcohol-based hand rub (ABHR) or soap and water. A surgical hand scrub is also a method of hand hygiene (WHO, 2009a).
To break the chain of infection, there are five key moments at which to perform hand hygiene when working in healthcare, as outlined in Checklist 2 and illustrated in Figure 1.1.
Safety Alert: Factors that Reduce Hand Hygiene Effectiveness
- Jewellery: Rings and bracelets increase microbial count on hands. Rings also increase the risk of torn or pierced gloves. Jewellery should not be worn during patient care (Longtin, Sax, Allegranzi, Schneider, & Pittet, 2011). All jewellery must be removed. In an instance where a bracelet may not be removed due to religious reasons, the bracelet may be pushed as high as possible above the wrist before performing hand hygiene.
- Skin integrity: The condition of the hands can influence the effectiveness of hand hygiene, and proper skin care is essential for infection control (Bissett, 2007). Skin cracks, dermatitis, or cuts can trap bacteria and may place patients at an increased risk (CDC, 2007). Inspect hands for cuts and open sores, and cuticles for tears. Open cuts, sores, or abrasions should be covered prior to starting work. Use barrier creams and lotion after patient care to keep skin healthy and hydrated.
- Artificial nails and nail extenders: Artificial nails and nail extenders increase the viral load of bacteria up to nine times compared with bacteria found on hands. Extenders or artificial nails are not recommended for healthcare workers (Kennedy, 2013).
- Nail length: Nails should be a maximum of 1/4-inch long and should not extend past the end of the finger (Patrick & Van Wicklin, 2012). Most microbes on hands come from under the fingernails. Subungual areas (under the fingernails) can harbour higher concentrations of microorganisms (Kennedy, 2013). In addition, long nails are harder to clean and may lead to more frequent puncture in gloves from the thumb and forefinger (Patrick & Van Wicklin, 2012).
- Nail polish: Nail polish should be freshly applied and be free from chips or cracks. Studies have shown that chipped nail polish and polish older than four days can harbour microorganisms (Patrick & Van Wicklin, 2012).
- Water temperature and products: Warm water removes less protective oils than h