By Paul Gallese, PT, MBA
The real-time data providing the answer to whether or not care providers were washing their hands long enough was shocking to one of our customers, with performance well below the 20-second standard recommended by the Centers for Disease Control and Prevention (CDC, 2019) and reinforced by The Joint Commission (2020).
A Vitalacy customer found that hand hygiene duration performance with both soap and alcohol-based hand sanitizer was well below standard. With soap, 54 percent of their care providers hand washed for an average of under five seconds. With alcohol-based hand sanitizer, an even higher percentage of care providers – 63 percent – washed for less than five seconds.
With these performance data in hand, our customer’s care providers underwent thorough retraining on proper hand washing practices.
Vitalacy’s electronic hand hygiene monitoring system can track hand wash duration
Vitalacy’s electronic hand hygiene monitoring system is the only one on the market that can track hand wash duration, as well as compliance. The Vitalacy system uses a SmartBand on the caregiver's wrist to capture duration data for each individual and unit and for the entire organization.
Effective hand hygiene to prevent the spread of bacteria and viruses requires a mix of soap and hand sanitizer
Soap and hand sanitizer are both needed because they are effective at removing different threats of infection. Soap and water lifts and washes Clostridium difficile (C. diff), flu virus, norovirus and dirt down the drain. Alcohol-based hand sanitizers help to control methicillin-susceptible Staphylococcus aureus (MRSA) and other germs that have developed a resistance to antibiotics. In both healthcare and community settings, frequent hand washing is being emphasized as a primary defense against the spread of coronavirus, as well.
However, recent studies show that healthcare workers are not washing their hands properly.
Healthcare workers often use less sanitizer than is required
Research summarized in the American Journal of Infection Control (Kenters, et al., 2019) shows that workers often use less sanitizer than is required and that the sanitizer often dries before it can achieve maximum protection against germs.
The researchers tested both gel and foam versions of alcohol-based hand sanitizers to see how long they took to dry on volunteers’ hands. Testing 0.75-milliliter, 1.5-ml, 2.25-ml and 3-ml dollops of sanitizer, researchers found that the smaller amounts sometimes dried within the 20-second time frame recommended by the CDC. Most volunteers needed at least 2.25 ml or more, depending on the size of their hands, to achieve optimal coverage and a 20-second or longer hand rub.
"Some people with larger hands may need a bit more product, and this paper demonstrates that the amount being dispensed in many standard dispensers is not providing the ideal amount of product," said Elaine Larson, professor emerita at the Columbia University School of Nursing in New York City, in a Reuters Health story about the study (Rapaport, 2019).
The study found that gels evaporate faster than foam, with gels taking 37 second on average and foam 57 seconds.
Because most health care workers use a single pump of sanitizer, the study team concluded that the amount released by a single pump may need to increase to assure effective hand hygiene.
Bacteria can develop resistance to alcohol-based hand sanitizers
According to another recent study (Pidot, et al., 2018), infections caused by E. faecium are increasing due to this bacterium’s tolerance to alcohol used as a killing agent. The study tested the alcohol tolerance of 139 hospital isotopes of E. faecium obtained between 1997 and 2015. E. faecium is a species of enterococcus, which causes 10 percent of the world’s hospital-acquired infections. In the U.S., this bacterium is a leading cause of sepsis, a deadly blood infection.
The study shows that bacteria can develop resistance not only to antibiotic medicines per se, but to other substances, such as alcohol, as well. These findings provide more evidence of how bacterial adaptation is complicating hospital infection control.
Vitalacy explored the proper ways to use both soap and hand sanitizers in a previously blog post that has been freshly updated with the latest research (Vitalacy, 2019). Stay tuned to the Vitalacy blog for more hand hygiene and patient safety updates.
Centers for Disease Control and Prevention. Show me the science – how to wash your hands. July 12. 2019
Kenters N, et al. Produce dose considerations for real-world hand sanitizer efficacy. American Journal of Infection Control, Published online Jan. 13, 2020.
Pidot, et al. Increasing tolerance of hospital Enterococcus faecium to handwash alcohols. Science Translational Medicine, August 1, 2018.
Rapaport L. Health workers may not use hand sanitizer properly. Reuters Health, Jan, 30, 2020.
The Joint Commission. Acceptable practices of using alcohol-based hand rub. 2020.
Vitalacy, Inc. How well does hand sanitizer work? Myths and facts in the hand sanitizer vs. soap debate. Vitalacy blog, May 23, 2017. Updated Feb. 11, 2020.