The World Health Organization's Clean Hands Save Lives: A concept applicable to equine medicine as Clean Hands Save Horses

Abstract

Summary Even before the discovery of germs, the practice of hand hygiene had revealed itself as a crucial element in the fight against infectious diseases. In fact, supported by the historical discoveries and more recent evidence based data, the World Health Organization considers hand hygiene as the pillar of infection control, particularly when related to nosocomial infections. Therefore, the World Health Organization has a strong focus on “Clean Hands Save Lives” campaigns, a principle that is easily translatable into “Clean Hands Save Horses”. Considering the recognised importance given to skin health and integrity as the first principle of good hand hygiene, using decontamination methods and products that are the least harmful to the skin is mandatory. This is why the currently accepted presurgical hand preparation methods do not involve aggressive brushing and disinfecting soaps anymore. Rather, hands should be washed with a neutral pH friendly soap first before a hydroalcoholic solution is applied. Although the principles and benefits of proper hand hygiene have been recognised in the healthcare world, one of the major drawbacks remains the lack of compliance with established protocols. To increase compliance, equine clinics should work on improving product accessibility, enhancing staff and client education as well as helping each other to remember to actually do it. This article reviews historical and current facts on hand hygiene and relates it to equine practice. Clean equine care is safer equine care: it's all in your hands!

Infection control practices employed within small animal veterinary practices—A systematic review

“…The use of the WHO Hand Hygiene Guidelines provided a standardized format for use within the veterinary field (Verwilghen, ). Whether this tool is the most efficient for use in small animal veterinary practices has not been determined.…”

Colloidal Iron Oxide Formulation for Equine Hoof Disinfection

“…In light of the results obtained so far, further studies are desirable to (i) assess the potential of IA formulation when used alone and against other microorganisms, such as mycosis or yeasts; (ii) optimize the use of Iron Animals both in terms of time and methods of application; (iii) evaluate its use for the antisepsis of surgeon hands that still represent a source of bacterial contamination. Currently, 80% of veterinary surgeons use PI or CHx for pre-surgical hand disinfection and the search for new products, less harmful to the skin, becomes mandatory [ 26 , 27 ].…”

Surgical hand preparation in an equine hospital: Comparison of general practice with a standardised protocol and characterisation of the methicillin-resistant Staphylococcus aureus recovered

“…Moreover, the application of alcoholic disinfectants on damaged skin may lead to unpleasant burning and skin irritation resulting in less compliance [5]. As has been described elsewhere, washing of hands can be shortened to one min because time for hand washing had no significant influence on germ reduction (p = 0.270 and p = 0.031), though hand washing with neutral soap can remove loosely adherent transient skin flora [5,26]. Total bacterial counts obtained in both phases of our study were similar to other reports [21,22,[42][43][44][45][46][47].…”

“…Excessive brushing is widely known to damage skin thereby increasing the risk of colonisation by pathogenic bacteria [ 41 ]. Moreover, the application of alcoholic disinfectants on damaged skin may lead to unpleasant burning and skin irritation resulting in less compliance [ 5 ]. As has been described elsewhere, washing of hands can be shortened to one min because time for hand washing had no significant influence on germ reduction (p = 0.270 and p = 0.031), though hand washing with neutral soap can remove loosely adherent transient skin flora [ 5 , 26 ].…”

“…According to a survey amongst ACVS and ECVS surgical specialists, 66% did not adhere to state-of-the-art protocols using hydro-alcoholic solutions [ 4 ]. SSI rates up to 52.6% were reported for equine surgical procedures but it has also been assumed that approximately 35% of SSI are not documented in the medical record system [ 5 – 7 ]. How many infections are diagnosed anyplace after discharge of the patients remains unknown [ 4 ].…”