Hand hygiene: simple and complex

Abstract

This review gives an overview of hand hygiene in healthcare and in the community, including some aspects which have attracted little attention, such as hand drying and cultural issues determining hand hygiene behaviour. Hand hygiene is the most effective measure for interrupting the transmission of microorganisms which cause infection both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors which determine hand hygiene behaviour makes the study of hand hygiene complex. It is now recognised that improving compliance with hand hygiene recommendations depends on altering human behaviour. Input from behavioural and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs. New strategies to promote hand hygiene worldwide include the formation of public-private partnerships.

Hand Hygiene

“…Handwashing with soap and water has been considered a measure of personal hygiene for centuries 48,49 and has been generally embedded in religious and cultural habits (see Part I, Section 17). Nevertheless, the link between handwashing and the spread of disease was established only two centuries ago, although this can be considered as relatively early with respect to the discoveries of Pasteur and Lister that occurred decades later.…”

“…761,762 Research has already been conducted into religious and cultural factors influencing health-care delivery, but mostly in the field of mental health or in countries with a high influx of immigrants where unicultural care is no longer appropriate. 49,763 In a recent world conference on tobacco use, the role of religion in determining health beliefs and behaviours was raised; it was considered to be a potentially strong motivating factor to promote tobacco control interventions. 764 A recent review enumerates various potential positive effects of religion on health, as demonstrated by studies showing its impact on disease morbidity and mortality, behaviour, and lifestyles as well as on the capacity to cope with medical problems.…”

“…[926][927][928] These data must be interpreted in the light of the actual direct impact on patient care, however, and some additional considerations need to be discussed. 49,929 Glove use is not sufficient to prevent germ transmission and infection if…”

“…impregnated glove materials that release chlorine dioxide when activated by light or moisture to produce a disinfecting micro-atmosphere), 910 but none of them has so far led to changes in glove use recommendations. 49 The correct and consistent use of existing technologies with documented effectiveness is encouraged before new technologies are introduced. The main feature of examination gloves to bear in mind is that they are meant to be single-use and to be discarded.…”

“…49,216,661,672,739 Several studies found that HCWs who wore gloves were less likely to cleanse their hands upon leaving a patient's room, 661,688,739,908,930 and two established an association between inappropriate glove use and low compliance with hand hygiene. 908,930 In contrast, three other studies found that HCWs who wore gloves were significantly more likely to cleanse their hands following patient care.…”