hands after washing. The healthcare provider should also
wear gloves when a patient requires contact precautions.
Otherwise, hand hygiene is recommended to be done via
the use of ABHRs with at least 60 percent alcohol. These
products are shown to be effective in killing microbes on
the hands and they are also not as irritating as washing with
soap and drying with towels. The guidelines do recommend
handwashing after so many uses of ABHR if the hands
become sticky from residual product.
Some antiseptic hand hygiene products that contain
chlorhexidine gluconate or other antiseptics have a residual
effect and help to decrease the bioburden on skin. When
evaluating hand hygiene products, one should determine if
a residual effect is necessary and then chose an agent that
provides it. The other approach to reducing bioburden on
hands is to consider how the environment is being cleaned
and disinfected. Products that help remove environmental
contamination and keep it to a minimum are important
tools in decreasing the bioburden of the environment that
can lead to acquisition of transient microbes on hands.
Newer disinfectants that have residual effect or even the
new continuous active disinfection have been shown to
control the bioburden for 24 hours as opposed to using other
disinfectants which allow repopulation of the environment
within four to six hours. Since these products are newer,
it will be important to study the overall impact on hand
contamination and subsequent infection prevention.
SOME THINGS
GO WITHOUT
SAYING...
WA S H M I N D.C O M
26
According to the CDC Guideline for Hand Hygiene in
all Healthcare Settings 2002, handwashing should
be performed when hands are visibly soiled.
It helps to understand the microbiological aspects behind
proper hand hygiene. Skin flora is categorized into three
types: resident, transient and infectious. Different microbes
are associated with each category.
Resident flora are the permanent inhabitants of the skin.
They are found on the surface and under the superficial cells
of the stratum cornermen. They are not considered to be
pathogenic but can cause infection if transferred to sterile
body cavities, to the eyes and to non-intact skin. The resident
flora protects against colonization with resistant organisms.
Resident bacterial flora includes Staphyloccocus epidermitis,
Staphylococcus hominis, and other coagulase-negative
staphylococci, coryneform bacterium such as propioni-
bacteria, corynebacteria, dermabacteria, and micrococci.
Resident fungi flora often includes Pityrosporum (Malassezia).
Transient skin flora includes bacteria, fungi, and viruses
that may be found intermittently on the skin. While transient
skin flora do not usually multiply on the skin, they can survive,
occasionally multiply and cause disease. A wide range of
Gram-positive bacteria, Gram-negative bacteria, fungi and
some viruses can be transient skin flora. The patient, medical
devices and environmental surfaces are the common source
of transient skin flora. The transient skin flora can be the
source of HAIs. Common healthcare-associated pathogens
that are transient skin flora include: Gram-negative bacteria
such as Klebsiella sp., Enterobacter species, Acinetobacter,
and Pseudomonas aeruginosa; Gram-positive organisms
such as vancomycin-resistant enterococcus (VRE) and
Staphylococcus aureus. Fungi that can be transient skin
flora such as Candida albicans and Candida auris. Viral
infections such as norovirus and enteroviruses are also
transmitted via the hands.
Infectious skin flora includes streptococcus such as Group
A streptococcus and Staphyloccocus aureus, including both
MRSA and MSSA.
Plain soap has basically no antimicrobial activity and
removes and dilutes the transient skin flora. Handwashing
with it reduces transient flora by 0.5 to 3 log 10 units and
has no effect on resident skin flora. Depending on the
antiseptic hand hygiene product used and the exposure
time, a reduction of transient flora can range from 0.29
to 6.81 log 10 units and has limited effect on residential
flora. When selecting antiseptics, it is important to know
the efficacy of killing specific organisms especially during
an outbreak caused by a specific pathogen,
At the current time, there is not a standard for the
optimal log reduction for hand hygiene that leads to
infection prevention. It is an area that needs more research
to determine if a particular reduction makes a difference in
preventing colonization or infection.
may 2020 • www.healthcarehygienemagazine.com