Hand hygiene steps. Hand Hygiene: Essential Steps for Effective Germ Prevention

27.09.202304.07.2023 by alexxlab

How do germs spread. What are the key times to wash hands. How can proper hand washing technique prevent illness. When should hand sanitizer be used instead of soap and water. Why is hand hygiene crucial for public health.

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The Importance of Hand Hygiene in Disease Prevention

Hand hygiene is a cornerstone of personal and public health. It’s one of the most effective ways to protect yourself and others from illness. By understanding how germs spread and when to clean your hands, you can significantly reduce the risk of infections.

How Germs Spread

Germs can spread in various ways, often through simple everyday actions:

Touching your face with unwashed hands
Handling food without proper hand hygiene
Coming into contact with contaminated surfaces
Coughing or sneezing into your hands and then touching objects

Understanding these transmission routes emphasizes the critical role of hand hygiene in breaking the chain of infection.

Critical Moments for Hand Hygiene

Knowing when to wash your hands is as important as knowing how. Here are some key moments when hand hygiene is crucial:

Before, during, and after food preparation
Before and after eating
Before and after caring for someone who is ill
After using the bathroom or changing diapers
After coughing, sneezing, or blowing your nose
After handling animals or animal waste
After touching garbage

During the COVID-19 pandemic, additional situations call for hand hygiene:

Before touching your face
After touching your mask
After being in public spaces
After touching frequently-used surfaces

The Five-Step Hand Washing Technique

Proper hand washing technique is essential for effective germ removal. Follow these five steps:

Wet your hands with clean running water and apply soap.
Lather your hands thoroughly, including the backs, between fingers, and under nails.
Scrub for at least 20 seconds (sing “Happy Birthday” twice).
Rinse well under clean running water.
Dry using a clean towel or air dry.

This method ensures that all areas of your hands are cleaned effectively, maximizing germ removal.

The Science Behind Hand Washing

Why is this technique so effective? Soap molecules have hydrophilic heads and hydrophobic tails. The hydrophobic tails attach to the fatty outer layer of viruses and bacteria, while the hydrophilic heads bond with water. As you rinse, the soap molecules – along with the trapped germs – are washed away.

Hand Sanitizers: When and How to Use Them

While soap and water are the gold standard for hand hygiene, hand sanitizers can be an effective alternative when washing isn’t possible.

Choosing the Right Hand Sanitizer

For maximum effectiveness, choose a hand sanitizer with at least 60% alcohol content. Check the product label to ensure it meets this requirement.

Proper Application of Hand Sanitizer

Apply the correct amount of gel to your palm (check the label for guidance).
Rub your hands together, covering all surfaces.
Continue rubbing until your hands are dry (about 20 seconds).

While convenient, it’s important to note that hand sanitizers have limitations. They may not be as effective on visibly dirty hands and don’t remove all types of germs or harmful chemicals.

Hand Hygiene in Healthcare Settings

In healthcare environments, hand hygiene takes on even greater importance. Healthcare workers must practice rigorous hand hygiene to prevent the spread of infections among patients.

The Five Moments for Hand Hygiene in Healthcare

The World Health Organization identifies five critical moments for hand hygiene in healthcare settings:

Before patient contact
Before an aseptic task
After body fluid exposure risk
After patient contact
After contact with patient surroundings

Adhering to these guidelines significantly reduces the risk of healthcare-associated infections.

Promoting Hand Hygiene in Communities

Effective hand hygiene isn’t just an individual responsibility; it’s a community effort. Here are some ways to promote good hand hygiene practices:

Display informative posters in public areas
Share educational content on social media
Provide easy access to hand washing facilities and sanitizers
Incorporate hand hygiene education in schools and workplaces

By making hand hygiene a community priority, we can collectively reduce the spread of infectious diseases.

Hand Hygiene During Emergencies

During emergencies or disasters, maintaining hand hygiene can be challenging but remains crucial. Here are some tips for emergency situations:

Stock up on alcohol-based hand sanitizers
Keep a supply of clean water and soap for hand washing
Use bottled water if tap water is unavailable or contaminated
If water is scarce, prioritize hand cleaning before handling food

Being prepared ensures that you can maintain good hand hygiene even in difficult circumstances.

The Future of Hand Hygiene

As our understanding of disease transmission evolves, so do hand hygiene practices. What developments might we see in the future?

Technological Innovations

Emerging technologies could revolutionize hand hygiene:

Smart sinks that monitor hand washing duration and technique
UV light sanitizers for quick and thorough disinfection
Wearable devices that remind users to clean their hands

Behavioral Science Applications

Researchers are exploring ways to improve hand hygiene compliance through behavioral interventions:

Gamification of hand hygiene practices
Personalized feedback systems
Environmental cues to prompt hand cleaning

These advancements could significantly enhance hand hygiene practices in various settings.

Common Misconceptions About Hand Hygiene

Despite its importance, hand hygiene is often misunderstood. Let’s address some common myths:

Myth: Hot water is necessary for effective hand washing

Fact: Water temperature doesn’t significantly affect germ removal. Comfortable water temperature encourages longer washing.

Myth: Antibacterial soap is always better

Fact: Regular soap is equally effective for most situations. Overuse of antibacterial products may contribute to antibiotic resistance.

Myth: Hand dryers are more hygienic than paper towels

Fact: Both methods can be hygienic. The key is thorough hand washing before drying.

Understanding these facts helps promote more effective hand hygiene practices.

Global Initiatives for Hand Hygiene Promotion

Hand hygiene is a global health concern. Several international initiatives aim to improve hand hygiene worldwide:

Global Handwashing Day

Observed on October 15th, this annual event raises awareness about the importance of handwashing with soap.

WHO’s “Save Lives: Clean Your Hands” Campaign

This ongoing campaign focuses on improving hand hygiene in healthcare settings globally.

UNICEF’s Water, Sanitation and Hygiene (WASH) Program

This program works to improve access to clean water and sanitation, including hand hygiene facilities, in developing countries.

These initiatives play a crucial role in promoting hand hygiene on a global scale.

The Economic Impact of Hand Hygiene

Improved hand hygiene doesn’t just benefit health; it also has significant economic implications:

Reduced Healthcare Costs

Better hand hygiene leads to fewer infections, reducing the burden on healthcare systems.

Increased Productivity

Fewer sick days due to preventable illnesses can boost overall workforce productivity.

Cost-Effectiveness

Investing in hand hygiene education and facilities is highly cost-effective compared to treating preventable diseases.

Understanding these economic benefits can help motivate individuals and organizations to prioritize hand hygiene.

Hand Hygiene in Different Cultural Contexts

Hand hygiene practices and perceptions can vary across cultures. Understanding these differences is crucial for effective global health initiatives.

Religious Considerations

Some religions have specific hand washing rituals that can be incorporated into public health messages.

Traditional Practices

In some cultures, traditional medicines or practices may be preferred over modern hand hygiene methods. Public health efforts need to be sensitive to these beliefs while promoting effective hygiene.

Resource Availability

In areas with limited access to clean water, alternative hand hygiene methods may need to be promoted.

Culturally sensitive approaches to hand hygiene promotion can significantly improve adoption rates.

The Role of Technology in Hand Hygiene Compliance

Technology is playing an increasingly important role in promoting and monitoring hand hygiene compliance, especially in healthcare settings:

Electronic Monitoring Systems

These systems use sensors to track hand hygiene events, providing real-time feedback and data for quality improvement.

Mobile Apps

Smartphone apps can provide reminders, track personal hand hygiene habits, and offer educational content.

Virtual Reality Training

VR technology can create immersive training experiences for healthcare workers, improving technique and compliance.

While technology can enhance hand hygiene practices, it’s important to remember that it supplements, rather than replaces, basic hygiene education and habits.

Hand Hygiene for Special Populations

While hand hygiene is universally important, some groups may have specific needs or challenges:

Children

Making hand washing fun and engaging through songs, games, or colorful soaps can encourage good habits from an early age.

Elderly Individuals

Those with limited mobility or cognitive decline may need assistance or reminders for proper hand hygiene.

Immunocompromised People

For those with weakened immune systems, extra vigilance in hand hygiene is crucial to prevent infections.

Healthcare Workers

Due to frequent patient contact, healthcare workers need to practice exceptionally rigorous hand hygiene.

Tailoring hand hygiene education and facilities to these specific groups can improve overall compliance and effectiveness.

Environmental Considerations in Hand Hygiene

As we promote hand hygiene, it’s important to consider its environmental impact:

Water Conservation

Proper hand washing technique can help conserve water. Turning off the tap while lathering is a simple but effective step.

Sustainable Products

Choosing eco-friendly soaps and sanitizers can reduce environmental harm without compromising hygiene.

Waste Reduction

Using air dryers or reusable towels can help reduce paper waste from hand drying.

By considering these factors, we can promote hand hygiene practices that are both effective and environmentally responsible.

The Psychological Aspects of Hand Hygiene

Understanding the psychology behind hand hygiene behaviors can help improve compliance:

Habit Formation

Consistent cues and rewards can help turn hand hygiene into an automatic habit.

Risk Perception

People are more likely to practice good hand hygiene when they perceive a higher risk of infection.

Social Norms

When hand hygiene is seen as a social norm, compliance tends to increase.

Leveraging these psychological insights can lead to more effective hand hygiene promotion strategies.

The Role of Education in Promoting Hand Hygiene

Education plays a crucial role in establishing and maintaining good hand hygiene practices:

School-Based Programs

Incorporating hand hygiene education into school curricula can instill lifelong habits.

Workplace Training

Regular hand hygiene training in workplaces can reduce absenteeism and improve overall health.

Public Health Campaigns

Widespread public education campaigns can raise awareness and promote better hand hygiene across communities.

By prioritizing hand hygiene education at all levels, we can create a culture of cleanliness that benefits everyone.

Hand Hygiene in Food Service and Preparation

In food service and preparation, hand hygiene takes on added importance:

Preventing Foodborne Illness

Proper hand washing is crucial in preventing the spread of pathogens that can cause food poisoning.

Regulatory Requirements

Many jurisdictions have specific hand hygiene requirements for food service workers.

Cross-Contamination Prevention

Good hand hygiene practices help prevent cross-contamination between different food items.

Rigorous hand hygiene in food service not only protects customers but also maintains the reputation of food establishments.

The Impact of Hand Hygiene on Antibiotic Resistance

Good hand hygiene practices play a role in combating antibiotic resistance:

Reducing Infection Spread

By preventing the spread of infections, hand hygiene reduces the need for antibiotics.

Limiting Antibiotic Use

Fewer infections mean less antibiotic use, which helps slow the development of resistant bacteria.

Preventing Transmission of Resistant Bacteria

Proper hand hygiene can prevent the spread of already resistant bacteria.

In this way, hand hygiene serves as a simple yet powerful tool in the fight against antibiotic resistance.

Keeping Hands Clean | CDC

Handwashing is one of the best ways to protect yourself and your family from getting sick. Learn when and how you should wash your hands to stay healthy.

How Germs Spread

Washing hands can keep you healthy and prevent the spread of respiratory and diarrheal infections. Germs can spread from person to person or from surfaces to people when you:

Touch your eyes, nose, and mouth with unwashed hands
Prepare or eat food and drinks with unwashed hands
Touch surfaces or objects that have germs on them
Blow your nose, cough, or sneeze into hands and then touch other people’s hands or common objects

Key Times to Wash Hands

You can help yourself and your loved ones stay healthy by washing your hands often, especially during these key times when you are likely to get and spread germs:

Before, during, and after preparing food
Before and after eating food
Before and after caring for someone at home who is sick with vomiting or diarrhea
Before and after treating a cut or wound
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

This list of key times to wash hands was developed based on data from a number of studies. There may be other key times when it is important to wash hands during the COVID-19 pandemic.

To prevent the spread of germs during the COVID-19 pandemic, you should also wash your hands with soap and water for at least 20 seconds:

Before touching your eyes, nose, or mouth
After touching your mask
After leaving a public place
After touching objects or surfaces that may be frequently touched by other people, such as door handles, tables, gas pumps, shopping carts, or electronic cashier registers/screens

If soap and water are not readily available, use a hand sanitizer with at least 60% alcohol to clean your hands.

Follow Five Steps to Wash Your Hands the Right Way

Washing your hands is easy, and it’s one of the most effective ways to prevent the spread of germs. Clean hands can help stop germs from spreading from one person to another and in our communities—including your home, workplace, schools, and childcare facilities.

Follow these five steps every time.

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
Rinse your hands well under clean, running water.
Dry your hands using a clean towel or air dry them.

Why? Read the science behind the recommendations.

Use Hand Sanitizer When You Can’t Use Soap and Water

You can use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

Washing hands with soap and water is the best way to get rid of germs in most situations. If soap and water are not readily available, you can use an alcohol-based hand sanitizer that contains at least 60% alcohol. You can tell if the sanitizer contains at least 60% alcohol by looking at the product label.

Sanitizers can quickly reduce the number of germs on hands in many situations. However,

Sanitizers do not get rid of all types of germs.
Hand sanitizers may not be as effective when hands are visibly dirty or greasy.
Hand sanitizers might not remove harmful chemicals from hands like pesticides and heavy metals.

Caution! Swallowing alcohol-based hand sanitizers can cause alcohol poisoning if more than a couple of mouthfuls are swallowed. Keep it out of reach of young children and supervise their use.

How to Use Hand Sanitizer

Apply the gel product to the palm of one hand (read the label to learn the correct amount).
Rub your hands together.
Rub the gel over all the surfaces of your hands and fingers until your hands are dry. This should take around 20 seconds.

CDC’s Communication Materials

Watch and share hand hygiene videos to raise awareness and educate your community about healthy hygiene behaviors.

CDC has health promotion materials to encourage kids and adults to make handwashing part of their everyday lives.

ORDER FREE posters and display them in highly visible public areas, such as school bathrooms,
work areas, and public restrooms.
Share social media graphics and messages.
Print stickers and place clings on bathroom mirrors.
Distribute fact sheets to share information about hand hygiene for specific audiences.

For more information on handwashing, visit CDC’s Handwashing website or call 1-800-CDC-INFO.

Frequent Questions About Hand Hygiene
Hand Hygiene in Healthcare Settings
Training and Education
Global Handwashing Day
Personal Hygiene During an Emergency

When and How to Wash Your Hands | Handwashing

Español (Spanish)

Cuándo y cómo lavarse las manos
اپنے ہاتھوں کو کب اور کیسے دھوئیں
何时以及如何洗手
Quando e como lavar as suas mãos
কখন এবং কীভাবে আপনার হাত ধোবেন
متى وكيف تغسل يديك
Quand et comment se laver les mains

Handwashing is one of the best ways to protect yourself and your family from getting sick. Learn when and how you should wash your hands to stay healthy.

How Germs Spread

Washing hands can keep you healthy and prevent the spread of respiratory and diarrheal infections. Germs can spread from person to person or from surfaces to people when you:

Touch your eyes, nose, and mouth with unwashed hands
Prepare or eat food and drinks with unwashed hands
Touch surfaces or objects that have germs on them
Blow your nose, cough, or sneeze into hands and then touch other people’s hands or common objects

Key Times to Wash Hands

You can help yourself and your loved ones stay healthy by washing your hands often, especially during these key times when you are likely to get and spread germs:

Before, during, and after preparing food
Before and after eating food
Before and after caring for someone at home who is sick with vomiting or diarrhea
Before and after treating a cut or wound
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

If soap and water are not readily available, use a hand sanitizer with at least 60% alcohol to clean your hands.

Follow Five Steps to Wash Your Hands the Right Way

Follow these five steps every time.

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
Lather your hands by rubbing them together with the soap. Lather the backs of your hands, between your fingers, and under your nails.
Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
Rinse your hands well under clean, running water.
Dry your hands using a clean towel or an air dryer.

Why? Read the science behind the recommendations.

Use Hand Sanitizer When You Can’t Use Soap and Water

Sanitizers can quickly reduce the number of germs on hands in many situations. However,

Sanitizers do not get rid of all types of germs.
Hand sanitizers may not be as effective when hands are visibly dirty or greasy.
Hand sanitizers might not remove harmful chemicals like pesticides from hands.

Caution! Swallowing alcohol-based hand sanitizer can cause alcohol poisoning if more than a couple of mouthfuls are swallowed. Keep it out of reach of young children and supervise their use.

How to Use Hand Sanitizer

Apply the gel product to the palm of one hand (read the label to learn the correct amount).
Cover all surfaces of hands.
Rub your hands and fingers together until they are dry. This should take around 20 seconds.

CDC’s Communication Materials

CDC has health promotion materials to encourage kids and adults to make handwashing part of their everyday lives.

Share social media graphics and messages.
Print stickers and place clings on bathroom mirrors.
Promote handwashing on or around Global Handwashing Day, celebrated each year on October 15.
Distribute fact sheets to share information about hand hygiene for specific audiences.
Order free posters and display them in highly visible public areas, such as school bathrooms,
work areas, and public restrooms.

For more information on handwashing, visit CDC’s Handwashing website or call 1-800-CDC-INFO.

Frequent Questions About Hand Hygiene
Hand Hygiene in Healthcare Settings
Training and Education
Global Handwashing Day
Personal Hygiene During an Emergency

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:

Remove jewelry
Roll up sleeves
Wet hands
Take soap
Rub soap into palms
Rub soap on the back of your hand
Rub soap on wrists
Rub soap on thumbs
Rub soap between fingers
Rub into cuticles
Rinse
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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See other articles in these categories:

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.