CDC approves alcohol gels for pre-op hand cleaning
Alcohol-based products are effective for preoperative cleaning of surgical staff members’ hands, when preceded by use of a nonantimicrobial soap, according to Guidelines for Hand Hygiene in Health Care Settings released recently by the Centers for Disease Control and Prevention (CDC).
In examining the research, the CDC said alcohol-based solutions were more effective than washing hands with plain soap, and they reduced bacterial counts on the hands more than antimicrobial soaps or detergents most of the time. In addition, most alcohol-based preparations were more effective than povidone-iodine or chlorhexidine, the agency said. In addition, the CDC says alcohol-based products are more effective for standard hand washing or hand antisepsis by health care workers than soap or antimicrobial soaps.1
"I think [the new guidelines] are great and long overdue," says Etta Hodge, RN, MBA, director of surgical services at Christus St. Joseph Hospital in Houston. "This concept has been used in other countries for some time now."
In the guidelines, the CDC also said staff should not wear artificial fingernails or extenders when having direct contact with patients at high risk, such as those in operating rooms.
The Joint Commission on Accreditation of Healthcare Organizations is considering ways in which these guidelines may be incorporated into the accreditation process. The Accreditation Association for Ambulatory Health Care in Wilmette, IL, had no comment.
One of the advantages of the alcohol-based antiseptics is that they save time, Hodge says. They require three minutes, vs. five to seven minutes for soap, she says. "It should be ideal for [ambulatory surgery]," Hodge says. "Time is an added value, but the efficacy is what everyone should be interested in."
Alcohol-based products also result in better compliance with hand-hygiene protocols, according to the CDC. Pocket containers of alcohol-based hand-rub solutions, combined with bedside dispensers, has been associated with significant improvement in adherence to hand-hygiene protocols.2,3 Data show that health care workers may be more inclined to use alcohol-based hand rubs because they are more convenient to use.
Don’t throw out the soap yet, however. Some alcohol products require you to start with clean hands, even outside of the preoperative hand-hygiene area, Hodge says. "It is important that you have some kind of way to ensure hand-washing compliance if you use the product that requires washing before application," she says.
Since the alcohol-based solutions don’t remove visible dirt or blood, when those substances are present, health care workers still need to wash their hands with soap and water, according to the CDC. Surgical gloves still are necessary, the CDC emphasizes. "Gloves reduce hand contamination by 70% to 80%, prevent cross-contamination, and protect patients and health care personnel from infection," the agency says.1 Hand rubs should be used before and after each patient, just as gloves should be changed before and after each patient, the CDC adds.1 Hand lotions and creams used twice a day can help prevent and treat irritant contact dermatitis caused by hand-hygiene products, the agency advises.
The CDC is asking health care facilities to develop and use a system for measuring improvements in compliance with the hand hygiene recommendations. Some of the suggested performance indicators include:
- periodic monitoring of hand-hygiene adherence and providing feedback to personnel regarding their performance;
- monitoring the volume of alcohol-based hand rub used/1,000 patient days;
- monitoring adherence to policies dealing with wearing artificial nails;
- focused assessment of the adequacy of health care personnel hand hygiene when outbreaks of infection occur.1 (For more information, see Same-Day Surgery, July 2001, p. 73.)
References
1. CDC. Guideline for hand hygiene in health care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/ APIC/IDSA Hand Hygiene Task Force. MMWR 2002; 51 (RR16):1-44.
2. Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospitalwide programme to improve compliance with hand hygiene. Lancet 2000; 356:1,307-1,312.
3. Pittet D. Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001; 48(suppl A):S40-S46.
Resource
To view the hand-hygiene guidelines, go to the web site: www.cdc.gov/handhygiene. At press time, the Centers for Disease Control and Prevention expected to have materials available soon on the web site to promote hand hygiene in health care facilities.
Alcohol-based products are effective for preoperative cleaning of surgical staff members hands when preceded by use of a nonantimicrobial soap, according to guidelines released recently by the Centers for Disease Control and Prevention.
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