Healthcare Hygiene magazine May 2020 | Page 26

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