How does proper hand hygiene impact health. What are the key steps for effective handwashing. Why is using soap crucial in hand hygiene. How long should you wash your hands for optimal cleanliness. What is the best way to dry your hands after washing.

The Importance of Hand Hygiene in Healthcare Settings

Hand hygiene is a critical practice in healthcare settings, playing a vital role in preventing the spread of infections and maintaining overall public health. Proper handwashing techniques can significantly reduce the transmission of harmful pathogens, protecting both healthcare workers and patients alike.

The Centers for Disease Control and Prevention (CDC) emphasizes the importance of hand hygiene in lowering infectious disease transmission. Research has demonstrated that effective handwashing can reduce rates of respiratory infections by up to 23% and gastrointestinal infections by up to 48%. These statistics underscore the profound impact that this simple yet crucial practice can have on community health.

The Science Behind Effective Handwashing

Understanding the science behind handwashing helps us appreciate its importance and effectiveness. When we wash our hands, we’re not just rinsing away visible dirt; we’re also removing microscopic pathogens that could cause illness.

Why Running Water is Essential

Clean running water is crucial for effective handwashing. Standing water in a basin can become contaminated through previous use, potentially recontaminating hands. While using non-potable water when necessary can still improve health, clean running water is ideal for optimal hygiene.

The Role of Soap in Hand Hygiene

Soap plays a pivotal role in hand hygiene. Its surfactants lift soil and microbes from the skin, making it more effective than using water alone. Additionally, people tend to scrub their hands more thoroughly when using soap, further enhancing germ removal.

• Soap creates friction, which helps lift dirt, grease, and microbes from the skin
• The entire hand should be scrubbed, as microbes are present on all surfaces
• Antibacterial soaps have not shown added health benefits for consumers compared to plain soap

Step-by-Step Guide to Proper Handwashing

To ensure thorough hand hygiene, follow these steps recommended by health organizations worldwide:

1. Wet your hands with clean, running water (warm or cold)
2. Apply soap and lather well
3. Scrub all surfaces of your hands, including palms, backs, fingers, between fingers, and under nails
4. Continue scrubbing for at least 20 seconds
5. Rinse thoroughly under clean, running water
6. Dry your hands using a clean towel or air dry

The Optimal Duration for Handwashing

How long should you wash your hands for maximum effectiveness? While the optimal length of time for handwashing can depend on various factors, evidence suggests that washing hands for about 15-30 seconds removes more germs than washing for shorter periods. Many countries and global organizations recommend washing hands for about 20 seconds, with an additional 20-30 seconds for drying.

Common Misconceptions About Hand Hygiene

Despite the widespread promotion of hand hygiene, several misconceptions persist. Let’s address some of these to ensure a more accurate understanding of effective handwashing practices.

Water Temperature Myths

Does water temperature affect the effectiveness of handwashing? Contrary to popular belief, the temperature of the water does not appear to significantly impact microbe removal. While warmer water may feel more comfortable, it can cause more skin irritation and is more environmentally costly. Cold water is just as effective for proper hand hygiene.

Antibacterial Soap vs. Regular Soap

Are antibacterial soaps more effective than regular soap? Studies have shown no added health benefit for consumers using soaps containing antibacterial ingredients compared to using plain soap. In fact, the FDA issued a final rule in September 2016 stating that 19 ingredients in common “antibacterial” soaps were no more effective than non-antibacterial soap and water.

The Importance of Proper Hand Drying

Hand drying is an often overlooked but crucial step in the hand hygiene process. Proper drying can further reduce the risk of germ transmission and complete the handwashing routine effectively.

Why Drying Matters

Why is hand drying so important? Germs can be transferred more easily to and from wet hands. Therefore, thoroughly drying hands after washing is essential to minimize the risk of recontamination and further spread of microbes.

Drying Methods: What’s Most Effective?

What’s the best way to dry your hands after washing? While the debate continues, studies suggest that using a clean towel or air drying are the most effective methods. However, it’s important to note that most studies compare overall concentrations of microbes, not just disease-causing germs, on hands following different hand-drying methods.

• Clean, disposable paper towels
• Electric air dryers
• Clean cloth towels (changed frequently)

Hand Hygiene in Different Settings

While the basic principles of hand hygiene remain consistent, the application may vary depending on the setting. Let’s explore how hand hygiene practices might differ in various environments.

Healthcare Settings

In healthcare settings, hand hygiene is particularly crucial. Healthcare workers may need to wash their hands more frequently and thoroughly due to their increased risk of contact with disease-causing germs. They may also use alcohol-based hand sanitizers when soap and water are not immediately available.

Home and Community Settings

In home and community settings, regular handwashing with soap and water is typically sufficient. Key times to wash hands include:

• Before, during, and after preparing food
• Before eating
• After using the toilet
• After changing diapers or cleaning up a child who has used the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal, animal feed, or animal waste
• After handling pet food or pet treats
• After touching garbage

The Global Impact of Hand Hygiene

Hand hygiene has far-reaching implications beyond individual health. It plays a significant role in global public health, particularly in preventing the spread of infectious diseases.

Hand Hygiene in Disease Prevention

How does hand hygiene contribute to disease prevention on a global scale? Proper hand hygiene is one of the most cost-effective ways to prevent the spread of infectious diseases. It’s particularly crucial in areas with limited access to healthcare and in controlling outbreaks of diseases like cholera, ebola, and even the common flu.

Global Handwashing Initiatives

Several global initiatives promote hand hygiene awareness and practices worldwide. These include:

• Global Handwashing Day (October 15th)
• WHO’s “SAVE LIVES: Clean Your Hands” campaign
• UNICEF’s handwashing promotion programs in schools and communities

These initiatives aim to increase awareness about the importance of hand hygiene and promote proper handwashing techniques across different cultures and communities.

Innovations in Hand Hygiene

As our understanding of hand hygiene evolves, so do the tools and technologies associated with it. Let’s explore some recent innovations in the field of hand hygiene.

Advanced Hand Sanitizers

While not a replacement for proper handwashing, hand sanitizers play a crucial role in hand hygiene, especially when soap and water are not readily available. Recent advancements include:

• Long-lasting formulations that provide extended protection
• Foam-based sanitizers for better coverage
• Natural and eco-friendly sanitizer options

Smart Handwashing Stations

Technology is also making its way into handwashing practices. Smart handwashing stations are being developed that can:

• Monitor handwashing duration and technique
• Provide real-time feedback on handwashing effectiveness
• Track handwashing compliance in healthcare settings

These innovations aim to improve hand hygiene practices and increase compliance, particularly in critical environments like hospitals and food service industries.

Overcoming Barriers to Proper Hand Hygiene

Despite its importance, maintaining proper hand hygiene can face several challenges. Understanding these barriers is crucial for developing effective strategies to promote better hand hygiene practices.

Common Obstacles to Hand Hygiene

What are some common reasons people fail to practice proper hand hygiene? Some barriers include:

• Lack of awareness about the importance of hand hygiene
• Time constraints, especially in busy environments
• Skin irritation from frequent washing
• Limited access to hand hygiene facilities
• Cultural or behavioral factors

Strategies for Improving Hand Hygiene Compliance

How can we overcome these barriers and improve hand hygiene compliance? Some effective strategies include:

• Education and awareness campaigns
• Making hand hygiene facilities more accessible
• Using gentle, skin-friendly hand hygiene products
• Implementing reminders and prompts in key areas
• Leading by example, especially in workplace settings

By addressing these barriers and implementing targeted strategies, we can work towards improving hand hygiene practices across various settings and populations.

Show Me the Science – How to Wash Your Hands | Handwashing

Why? Because hands could become recontaminated if placed in a basin of standing water that has been contaminated through previous use, clean running water should be used ¹. However, washing with non-potable water when necessary may still improve health ³. The temperature of the water does not appear to affect microbe removal; however, warmer water may cause more skin irritation and is more environmentally costly ^4-6.

Turning off the faucet after wetting hands saves water, and there are few data to prove whether significant numbers of germs are transferred between hands and the faucet.

Using soap to wash hands is more effective than using water alone because the surfactants in soap lift soil and microbes from skin, and people tend to scrub hands more thoroughly when using soap, which further removes germs ^2,3,7,8.

To date, studies have shown that there is no added health benefit for consumers (this does not include professionals in the healthcare setting) using soaps containing antibacterial ingredients compared with using plain soap ^{9, 10}. As a result, FDA issued a final rule in September 2016 that 19 ingredients in common “antibacterial” soaps, including triclosan, were no more effective than non-antibacterial soap and water and thus these products are no longer able to be marketed to the general public. This rule does not affect hand sanitizers, wipes, or antibacterial products used in healthcare settings.

Why? Lathering and scrubbing hands creates friction, which helps lift dirt, grease, and microbes from skin.  Microbes are present on all surfaces of the hand, often in particularly high concentration under the nails, so the entire hand should be scrubbed ^11-15.

Why? Determining the optimal length of time for handwashing is difficult because few studies about the health impacts of altering handwashing times have been done. Of those that exist, nearly all have measured reductions in overall numbers of microbes, only a small proportion of which can cause illness, and have not measured impacts on health. Solely reducing numbers of microbes on hands is not necessarily linked to better health ¹⁶. The optimal length of time for handwashing is also likely to depend on many factors, including the type and amount of soil on the hands and the setting of the person washing hands.  For example, surgeons are likely to come into contact with disease-causing germs and risk spreading serious infections to vulnerable patients, so they may need to wash hands longer than someone preparing their own lunch at home. Nonetheless, evidence suggests that washing hands for about 15-30 seconds removes more germs from hands than washing for shorter periods ^{15, 17, 18}.

Accordingly, many countries and global organizations have adopted recommendations to wash hands for about 20 seconds (some recommend an additional 20-30 seconds for drying):

• The Benefits of Hand Washingexternal icon
• New Zealand. Step-by-Step Guide to Hand Washingexternal icon
• The Global Public-Private Partnership for Handwashing. Why Handwashing?external icon
• World Health Organization. Guidelines on Hygiene in Health Care: A Summary pdf icon[PDF – 64 pages]external icon

Why? Soap and friction help lift dirt, grease, and microbes—including disease-causing germs—from skin so they can then be rinsed off of hands. Rinsing the soap away also minimizes skin irritation ¹⁵. Because hands could become recontaminated if rinsed in a basin of standing water that has been contaminated through previous use, clean running water should be used ^{1, 12}.While some recommendations include using a paper towel to turn off the faucet after hands have been rinsed, this practice leads to increased use of water and paper towels, and there are no studies to show that it improves health.

Why? Germs can be transferred more easily to and from wet hands; therefore, hands should be dried after washing ^{15, 19}. However, the best way to dry hands remains unclear because few studies about hand drying exist, and the results of these studies conflict. Additionally, most of these studies compare overall concentrations of microbes, not just disease-causing germs, on hands following different hand-drying methods. It has not been shown that removing microbes from hands is linked to better health¹⁶. Nonetheless, studies suggest that using a clean towel or air drying hands are best ^{18, 20, 21.}

How to Wash Your Hands Properly

Washing your hands is an important step to not only your health but the health of your community.

According to the Centers for Disease Control and Prevention (CDC), proper hand hygiene is vital to lowering infectious disease transmission.

In fact, research has shown that handwashing lowers the rates of certain respiratory and gastrointestinal infections up to 23 and 48 percent, respectively.

According to the CDC, washing your hands frequently is particularly important to help prevent the spread of the new coronavirus known as SARS-CoV-2, which causes the disease known as COVID-19.

In this article, we’ll look at the key steps to washing your hands correctly to ensure they’re free of germs that can cause serious infections.

Below is the seven-step handwashing technique endorsed by the CDC and World Health Organization (WHO):

Steps to washing your hands properly

1. Wet your hands with clean — preferably running — water.
2. Apply enough soap to cover all surfaces of your hands and wrists.
3. Lather and rub your hands together briskly and thoroughly. Make sure to scrub all surfaces of your hands, fingertips, fingernails, and wrists.
4. Scrub your hands and wrists for at least 20 seconds.
5. Rinse your hands and wrists under clean — preferably running — water.
6. Dry your hands and wrists with a clean towel, or let them air-dry.
7. Use a towel to turn off the faucet.

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The key to washing your hands is to make sure you thoroughly clean all surfaces and areas of your hands, fingers, and wrists.

Here are more detailed handwashing steps recommended from the WHO. Follow them after you’ve wet your hands with water and soap.

After you’ve completed these steps, you can rinse and dry your hands.

Plain soap is just as good at disinfecting your hands as over-the-counter antibacterial soaps. In fact, research has found that antibacterial soaps aren’t any more effective at killing germs than regular, everyday soaps.

In 2017, the Food and Drug Administration (FDA) banned the use of the antibacterial agents triclosan and triclocarban. The reasons cited by the FDA for the ban of these agents included:

• antibacterial resistance
• systemic absorption
• endocrine (hormone) disruption
• allergic reactions
• overall ineffectiveness

So, if you happen to have older bottles of antibacterial soap stocked away, it’s best not to use them. Throw them out, and just use regular soap instead.

Also, there’s no evidence to suggest that the water temperature makes a difference. According to one study, washing your hands in warm water doesn’t seem to get rid of more germs.

The bottom line is that it’s safe to use whatever water temperature is right for you, and use any regular liquid or bar soap you have on hand.

Washing your hands is particularly important when you’re in situations where you’re more likely to acquire or transmit germs. This includes:

• before, during, and after you prepare food
• before and after you:
  • consume foods or drinks
  • are exposed to someone with an infectious illness
  • enter a hospital, doctor’s office, nursing home, or other healthcare setting
  • clean and treat a cut, burn, or wound
  • take medication, such as pills or eye drops
  • use public transportation, especially if you touch railings and other surfaces
  • touch your phone or other mobile device
  • go to the grocery store
• after you:
  • cough, sneeze, or blow your nose
  • touch visibly dirty surfaces, or when there’s visible dirt on your hands
  • handle money or receipts
  • have touched a gas pump handle, ATM, elevator buttons, or pedestrian crossing buttons
  • shake hands with others
  • engage in sexual or intimate activity
  • have used the bathroom
  • change diapers or clean bodily waste off others
  • touch or handle garbage
  • touch animals, animal feed, or waste
  • touch fertilizer
  • handle pet food or treats

Dry, irritated, raw skin from frequent handwashing can raise the risk of infections. Damage to your skin can change the skin flora. This, in turn, can make it easier for germs to live on your hands.

To keep your skin healthy while maintaining good hand hygiene, skin experts suggest the following tips:

• Avoid hot water, and use a moisturizing soap. Wash with cool or lukewarm water. Hot water isn’t more effective than warm water, and it tends to be more drying. Opt for liquid (instead of bar) soaps that have a creamy consistency and include humectant ingredients, such as glycerin.
• Use skin moisturizers. Look for skin creams, ointments, and balms that help keep water from leaving your skin. These include moisturizers with ingredients that are:
  • occlusive, such as lanolin acid, caprylic/capric triglycerides, mineral oil, or squalene
  • humectants, such as lactate, glycerin, or honey
  • emollients, such as aloe vera, dimethicone, or isopropyl myristate
• Use alcohol-based hand sanitizers that contain skin conditioners. Alcohol-based hand sanitizers with humectants help ease skin dryness, while emollients replace some of the water stripped by alcohol.

FDA Notice

The Food and Drug Administration (FDA) has announced recalls of several hand sanitizers due to the potential presence of methanol.

Methanol is a toxic alcohol that can have adverse effects, such as nausea, vomiting, or headache, when a significant amount is used on the skin. More serious effects, such as blindness, seizures, or damage to the nervous system, can occur if methanol is ingested. Drinking hand sanitizer containing methanol, either accidentally or purposely, can be fatal. See here for more information on how to spot safe hand sanitizers.

If you purchased any hand sanitizer containing methanol, you should stop using it immediately. Return it to the store where you purchased it, if possible. If you experienced any adverse effects from using it, you should call your healthcare provider. If your symptoms are life threatening, call emergency medical services immediately.

When handwashing isn’t feasible or your hands aren’t visibly soiled, disinfecting your hands with alcohol-based hand sanitizers can be a viable option.

Most alcohol-based hand sanitizers contain ethanol, isopropanol, n-propanol, or a mixture of these agents. The most effective antimicrobial activity comes from alcohol solutions with:

• 60 to 85 percent ethanol
• 60 to 80 percent isopropanol
• 60 to 80 percent n-propanol

Ethanol seems to be the most effective against viruses, whereas propanols work best against bacteria.

Alcohol-based hand sanitizers quickly and effectively destroy many disease-causing agents, including:

• the flu virus
• HIV
• hepatitis B and C
• MRSA
• E.coli

A 2017 study also found that alcohol-based hand sanitizer formulations with ethanol, isopropanol, or both were effective at killing viral pathogens, such as:

• severe acute respiratory syndrome (SARS) coronaviruses
• Middle East respiratory syndrome (MERS) coronavirus
• Ebola
• Zika

Like handwashing, the effectiveness of hand sanitizers depends on using the right technique.

To apply hand sanitizer properly, follow these steps:

1. Apply about 3 to 5 mL (2/3 to 1 teaspoon) in your palm.
2. Rub vigorously, making sure to rub the product all over the surfaces of both your hands and between your fingers.
3. Rub for about 25 to 30 seconds, until your hands are completely dry.

Hand hygiene is a simple, low cost, evidence-based intervention that can help protect your health and the health of others.

In the wake of the COVID-19 pandemic, governments and community leaders worldwide have called for rigorous and collective efforts to improve public hygiene practices such as handwashing.

Although washing your hands with plain soap and clean, running water is the preferred method for hand hygiene, using an alcohol-based hand sanitizer with at least 60 percent alcohol can also be an effective option.

Good hand hygiene isn’t a measure to be used only during pandemics and other disease outbreaks. It’s a time-tested intervention that needs to be practiced consistently and mindfully to have the greatest effect on individual, community, and global health.

What is the hand washing protocol? – Royal Brinkman

Diseases and pests can be easily spread by hand, causing extensive crop damage. To prevent this, it is important to maintain good production hygiene in greenhouses. Hand disinfection is an important aspect of enterprise hygiene. This includes hand washing. In this article, our expert explains the handwashing protocol.

Handwashing protocol

Washing your hands properly is essential to remove all bacteria and other harmful micro-organisms from your hands. Therefore, we provide a handwashing protocol that consists of several steps.

The hand washing protocol consists of the following steps:

1. Remove jewelry
2. Roll up sleeves
3. Wet hands
4. Take soap
5. Rub soap into palms
6. Rub soap on the back of your hand
7. Rub soap on wrists
8. Rub soap on thumbs
9. Rub soap between fingers
10. Rub into cuticles
11. Rinse
12. Dry hands

Handwashing Protocol Steps

Hygienic handwashing must be performed in a routine manner. Simply moisturizing, washing and rinsing does not give the desired result. The following shows the different steps of handwashing in the correct order. You can print out the handwashing protocol for your employees and other visitors to take note of.

The right hand soap

Also make sure you choose the right soap for hand washing. It depends not only on the type and degree of contamination of the hands, but also on the crop being grown.

About the author: Jasper Verhoeven

Jasper Verhoeven, Disinfectant Specialist, is the main point of contact for farmers in matters of hygiene. “Due to the ever-increasing demands for hygiene measures in the agro-industrial sector and all the associated complications, individual consultations and advice become especially important. I solve problems that arise and constantly help farmers to create the best hygiene situation in their greenhouse complexes.”

Have questions about this article?

Please contact our Product Specialist using the form below and we will respond within 24 hours on business days.

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• Disinfection

from the beginning to the present day

Material Information

org/Person” title=”Автор: “>

I. Kalyuzhnaya

07 August 2015

Prologue to hand hygiene

Hand washing has long been given special importance. For example, among the ancient Jews, it was a symbolic act, cleansing from sin and guilt. So, Pontius Pilate, knowing that he is sending the innocent Jesus Christ to the cross, washes his hands before pronouncing the condemnation, wanting to say: “I do not shed the blood of an innocent person.”

Later, in the Middle Ages, hand washing was associated with the preservation of human health. In the Rules of Health from Salerno (13th century) there is a recommendation to wash your hands more often, as this is good for health. Why this is useful, medieval doctors did not know.

Discovery of Semmelweis

The true meaning of hand washing and the role of hand cleansing in maintaining health was understood by mankind only after the discovery of the Viennese physician Philipp Semmelweis. In 1847, he introduced into the practice of the obstetric clinic of the Vienna General Hospital the treatment of hands with 4% bleach during childbirth, and this achieved a significant reduction in the death rate of women from “puerperal fever”.

Faced with the problem of the high mortality of puerperas, Semmelweis drew attention to the fact that in the first and second obstetric clinics the mortality rates are very different: in the first clinic they are significantly higher. He pondered for a long time about the reasons for these differences. The answer was prompted by the case: Semmelweis was present at the autopsy of his teacher, a forensic doctor by profession, who died of a fever after cutting himself with a scalpel while performing an autopsy. Looking at the opened body, Semmelweis discovered that the teacher had died from the same disease as the unfortunate puerperas who suffered from “puerperal fever”, and suddenly realized that the answer to the question should be sought here. The decision came by itself: they died from “cadaveric bodies that got into the blood”, and “cadaverous bodies” are transferred by the hands of doctors participating in the autopsy, and then going to take birth in the clinic. The difference in mortality rates between departments is explained by the fact that the first clinic trains doctors whose training program includes work in the prosector, and the second clinic trains midwives who do not go to autopsies.

Semmelwes’s discovery was accepted not without resistance by colleagues, who recognized that the doctor’s hands are often the cause of obstetric or surgical fevers and require treatment. The study of the procedure for processing hands led to the allocation of the doctrine of hand hygiene.

Discovery of the infectious nature of obstetric and surgical fevers. First disinfectants

The great discovery of Louis Pasteur, who discovered the participation of microorganisms in the processes of fermentation and putrefaction and was able to destroy them with the help of high temperature, led the Glasgow surgeon Joseph Lister to suggest that suppuration of surgical wounds also occurs with the participation of microorganisms. But where do they come from in a wound? In Lister’s opinion, the surrounding air is filled with them, and therefore the surgical wound must be protected with ordination. By this point, the disinfecting effect of carbolic acid had already been discovered, and Lister sprayed it into the air during wound treatment and dressing changes. The results exceeded all expectations. The number of suppurations and wound sepsis has sharply decreased.

Hands are the main vector of wound infections

A few years later, Robert Koch proved that air is not the main cause of surgical infections, the main reason is contact with objects on the surface of which there are microorganisms. And the main one is the doctor’s hands. This discovery laid the scientific foundation for hand hygiene.

The concept of resident and transient flora

A new stage in the development of this doctrine was the discovery of the presence on the hands of two types of microflora: one’s own, inhabiting all layers of the skin, and “foreign”, caught on the surface of the skin in contact with other objects. This discovery happened at 1900 year. It became clear that to get rid of different types of flora on the hands, different processing methods are needed: it is easy to get rid of the surface microflora with simple methods, and the deep microflora requires special approaches. Subsequently, these types of microflora were given names: transient and resident. The author of these terms is the surgeon Philip Price.

Development of strategies against transient and resident hand microflora

In the early 20th century, strategies were developed to protect hands from infection.

Strategies against resident flora

The use of clean surgical gloves has been suggested to protect the surgical wound from microorganisms on the surgeon’s hands. V.S. Halstad introduced the use of surgical gloves for this purpose at his clinic in New York in 1890. Previously, they were used to protect the surgeon’s hands.

However, it soon became clear that the gloves are not reliable protection, they are often damaged during the operation. Therefore, patient protection with gloves was supplemented by surgical hand debridement, which initially consisted of thoroughly washing the hands with soap and water using a brush for several minutes. Then, realizing that this method gives only a twofold decrease in the number of microflora, hand washing was supplemented with treatment with an antiseptic. Over time, they began to give preference to antiseptics with a residual effect that continues after the end of the treatment and the preparation dries on the hands. Thus, if resident microorganisms located in the deep layers of the skin migrate to its surface, there they will “meet” the antiseptic effect of the drug, which treated the hands before putting on gloves, despite the fact that several hours have already passed since that time.

Strategies against transient flora

This strategy assumes that it is better to keep hands clean than to keep clean. Therefore, in order to keep hands clean, non-contact methods of work should be used, using medical instruments for this. In addition, the use of medical gloves contributes to the preservation of the cleanliness of the doctor’s hands.

But what to do if your hands are still dirty? In this case, they should be cleaned in order to eliminate transient microorganisms. Washing hands and treating hands with a disinfectant (antiseptic) were recognized as the main methods of cleaning hands from microorganisms. Semmelweis also showed that washing hands with soap is not enough to prevent “puerperal fever” in parturient women and introduced their treatment with bleach. Semmelweis did not know about the existence of microorganisms and proceeded from the fact that the chemical decomposition of “cadaverous particles” by chlorine is more effective than washing them off with water and soap.

The concept of hand sanitizer without soap and water

Developing the idea of ​​cleaning hands from transient microflora, the German hygienist Speck showed that microorganisms washed off hands can spread in the environment with splashes and water flow, contaminating the health worker himself, the sink, the surrounding walls and floor, and sewers. He insisted that before washing, contaminated hands be treated with an antiseptic, and only then their “dead bodies”, being harmless, were washed off with soap and water. Thus, it was in the German-speaking regions that the technique of hygienic hand antisepsis was developed, which involved the “killing of microorganisms” without the use of water.

Development of skin antiseptics

A separate area in the study of hand hygiene has become the development and implementation of antiseptics that allow effective hand hygiene without harming the health of health workers and patients. It turned out that there is no universal remedy that would be active against all types of microorganisms. And each remedy must pass serious tests before its use in practical medicine begins. To obtain conclusions, uniform principles for testing antiseptics were developed.

Modern stage of development of hand hygiene of medical personnel:

partial cessation of handwashing and switching to alcohol-based hand sanitizer at points of care

The current stage in the development of hand hygiene is associated with the WHO Cleanliness for Safe Care program. Studying the factors that threaten patient safety, the experts found that, first of all, it is necessary to focus on healthcare-associated infections (HAIs). The main cause of HAIs are the hands of medical personnel. Thus, it became clear that in order to achieve the maximum effect of the patient safety program, attention should be focused on the problem of hand hygiene of medical personnel.

At first, it seemed to the program participants that to solve the problem, it was enough to unify hand hygiene procedures and train all health workers in their correct implementation. Based on this assumption, the rules for washing hands and treating them with antiseptics were clarified, indications for hand hygiene were determined, relevant recommendations were issued, various visual aids were printed and hung at the workplaces of nurses and doctors, and trainings were conducted. The time has come to sum up the first results, but it soon became clear that, despite the work done, the developed rules are being violated everywhere. Different studies have given different numbers, however, none has achieved 100% compliance with established hand hygiene requirements. According to various data, from 5% to 80% of medical workers neglected hand hygiene – they did not carry it out when necessary, or did it according to a reduced program, violating the order and duration of procedures. This confused the researchers and they began to look for the causes of such massive violations. The reasons turned out to be simple and objective: doctors and nurses, as a rule, are physically unable to perform the required number of hand treatments, each of which requires 2-3 minutes. Thus, observations of the work of a nurse in the intensive care unit, for example, showed that within an hour she should clean her hands at least 15–20 times. Multiply by 2 minutes and you get 40 minutes of handwashing in an hour. This is, in principle, impossible. In this situation, it was necessary to look for a radical solution to the problem. They were offered to abandon hand washing altogether (except in cases of massive, visible contamination) and switch to hand treatment with an alcohol-containing antiseptic, which takes only 30 seconds. In addition, handwashing required sinks and water supplies and drains. For antiseptic treatment, this is not necessary. And antiseptic dispensers can be placed in all places where a health worker meets with a patient to provide medical care. So it was possible to realize the formula: “treat hands at the point of medical care.”

True, here it is immediately necessary to emphasize one important detail: for such a short treatment, only an alcohol-containing antiseptic is suitable, and no other. It was necessary to clarify the concentrations of alcohols that provide adequate efficiency at such a low exposure. For example, for ethyl alcohol, this concentration should be at least 75–80%. More dilute alcohol is not an alcohol-containing antiseptic and is not suitable for a short waterless treatment.

New information has been communicated to medical professionals. There were fears that alcohols would negatively affect the skin, but the opposite soon became clear – regular skin treatment with alcohol not only does not dry the skin of the hands, but often has a beneficial effect on it.

Organizational hand hygiene problems

In the current situation, everyone expected that health workers would quickly respond to innovations and the problem of effective hand hygiene would be solved. However, here too, new problems awaited enthusiasts. The adherence of healthcare workers to new hand hygiene procedures was still low and could not be guaranteed to protect patients from HCAI. Exploring the reasons for this phenomenon, the researchers realized that such a large-scale transition to a new hand hygiene technology requires serious organizational measures that need to be carried out at the level of regional health systems and medical organizations. First of all, medical workers should be provided with antiseptics at all points of medical care and in the right quantities. This requires a serious analysis, which should involve doctors, nurses, epidemiologists. In addition to the analysis, additional and not small costs are necessary. It is clear that such decisions are made at the management level. And therefore, while the chief doctors and their deputies believe that the treatment of hands is the business of nurses, the problem is not solved. Meanwhile, the number and severity of STEMIs are not decreasing, and thousands of patients die from them every year. That is why the World Health Organization (WHO), continuing the program “Cleanliness is the key to safe medical care”, is distributing documents and recommendations on new principles for hand hygiene for medical personnel addressed to heads of healthcare systems and institutions. The implementation of these recommendations will increase the adherence of health workers to hand hygiene procedures and thereby protect patients from HCAI.

In our country, which takes part in this program, on the basis of WHO documents, guidelines have been developed and approved that contain new approaches to hand hygiene for medical workers. We are talking about the Federal clinical recommendations “Hygiene of the hands of medical personnel”, which were approved by

by the National Association of Health Care Infection Control Professionals (NP NASKI) in 2014.