Hand Hygiene in Healthcare Settings

Literature Search

Steve Kahn, MSIII

Feb., 2009


Search Text = ˇ°hand gloves hygieneˇ±

3/29 review articles selected.

5/184 journal articles selected.




1.      Infect Control Hosp Epidemiol. 2002 Dec;23(12 Suppl):S3-40.  Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.


Link to Hand Hygiene Guideline:  http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf


List of review articles:

1.      Women Health. 1989;15(4):77-92.  Hand protection and protection from hands: hand-washing, germicides and gloves.

2.      Clin Microbiol Rev. 2004 Oct;17(4):863-93, table of contents.  Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs.

3.      Int J Hyg Environ Health. 2003 Oct;206(6):465-72.  State-of-the-art hand hygiene in community medicine.


List of journal articles:

1.        Infect Control Hosp Epidemiol. 2007 Sep;28(9):1099-102. Epub 2007 Jul 25.  Hand hygiene and glove use behavior in an Italian hospital.

2.        Pediatrics. 2007 Sep;120(3):650-65.  Infection prevention and control in pediatric ambulatory settings. 

3.        Am J Infect Control. 2008 Aug;36(6):430-5.  Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants.

4.        Mater Manag Health Care. 2008 Feb;17(2):34-6.  Up in arms over clean hands.

5.        Nurs Stand. 2007 May 9-15;21(35):45-8.  Appropriate glove use in the prevention of cross-infection.


List of abstracts:


Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.


Boyce JM, Pittet D; Healthcare Infection Control Practices Advisory Committee. Society for Healthcare Epidemiology of America. Association for Professionals in Infection Control. Infectious Diseases Society of America. Hand Hygiene Task Force.

Hospital of Saint Raphael, New Haven, Connecticut, USA.

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.

PMID: 12515399 [PubMed - indexed for MEDLINE]

Hand protection and protection from hands: hand-washing, germicides and gloves.


Borgatta L, Fisher M, Robbins N.

Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, NY.

A variety of soaps, detergents, germicides, and protective gloves are available for use by health care workers. Appropriate hand-washing and glove use will reduce the possibility of spread of infectious organisms from patient to staff, from patient to patient, and from staff to patient. Both hand-washing and glove use can have adverse effects. Excessive hand-washing, mechanical irritation from scrubbing, use of germicides, and wearing of gloves can result in irritant and allergic dermatitis. Dermatitis will result in an increased risk of infection to both the worker and the patient.

PMID: 2515660 [PubMed - indexed for MEDLINE]

Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs.

Kampf G, Kramer A.

Bode Chemie GmbH & Co., Scientific Affairs, Melanchthonstrasse 27, 22525 Hamburg, Germany. guenter.kampf@bode-chemie.de.

The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.

PMID: 15489352 [PubMed - indexed for MEDLINE]

State-of-the-art hand hygiene in community medicine.

Kampf G.

Bode Chemie GmbH, Melanchthonstr. 27, D-22525 Hamburg, Germany. guenter.kampf@bode-chemie.de

Hand hygiene becomes more important in community medicine not only since antibiotic resistant bacteria such as MRSA spread within the community. Hands may be colonized with transient microorganism in up to 75%. Among those transient pathogens S. aureus, C. difficile or the hepatitis C virus may be found. During patient care the number of microorganisms on the hands steadily increases. In addition hands may be contaminated with different kinds of germs even if only "clean" activities are carried out. Gloves may be worn but do not provide complete protection from contamination due to leaks. Therefore hands should always be treated after gloves are taken off. State-of-the-art treatment of hands is the hygienic hand disinfection with alcohol-based hand rubs. They are more effective, quicker to carry out, better tolerated by the skin, with a positive effect on compliance, and cost effective in comparison to antiseptic soaps based on chlorhexidine or triclosan and in comparison to normal non-medicated soaps. Healthy skin easily tolerates alcohol-based products from the beginning on. Only health care workers with an underlying irritative contact dermatitis which is often caused by bar or liquid antiseptic soaps may have difficulties to use alcohol-based products initially. In such a case treatment of the underlying skin condition is the way to go and not staying with a preparation which has caused the dermatitis. All this knowledge is now reflected in current guidelines on hand hygiene. Beside liquids alcohol-based gels can be used if they have an antimicrobial activity equal to alcohol-based liquid preparations. Hand hygiene remains the single most important tool to avoid cross transmission of microorganisms between patients. This state-of-the-art hand hygiene should also be emphasized more in community medicine. This review may help to go the first step into this direction.

PMID: 14626894 [PubMed - indexed for MEDLINE]


Hand hygiene and glove use behavior in an Italian hospital.

Pan A, Mondello P, Posfay-Barbe K, Catenazzi P, Grandi A, Lorenzotti S, Patroni A, Poli N, Soavi L, Carnevale G.

Istituto di Malattie Infettive e Tropicali, Spedali Civili, Universita di Brescia, Piazzale Spedali Civili 1, 20123 Brescia, Italy. ange.pan@tiscali.it

In an Italian hospital, we observed that hand hygiene was performed in 638 (19.6%) of 3,253 opportunities, whereas gloves were worn in 538 (44.2%) 1,218 of opportunities. We observed an inverse correlation between the intensity of care and the rate of hand hygiene compliance (R2=0.057; P<.001), but no such association was observed for the rate of glove use compliance (R2=0.014; P=.078). Rates of compliance with hand hygiene and glove use recommendations follow different behavioral patterns.

PMID: 17932835 [PubMed - indexed for MEDLINE]

Infection prevention and control in pediatric ambulatory settings. 

American Academy of Pediatrics Committee on Infectious Diseases.

Since the American Academy of Pediatrics published a statement titled "Infection Control in Physicians' Offices" (Pediatrics. 2000;105[6]:1361-1369), there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated annually, and enforced. The standard precautions for hospitalized patients from the Centers for Disease Control and Prevention, with a modification from the American Academy of Pediatrics exempting the use of gloves for routine diaper changes and wiping a well child's nose or tears, are appropriate for most patient encounters. As employers, pediatricians are required by the Occupational Safety and Health Administration to take precautions to identify and protect employees who are likely to be exposed to blood or other potentially infectious materials while on the job. Key principles of standard precautions include hand hygiene (ie, use of alcohol-based hand rub or hand-washing with soap [plain or antimicrobial] and water) before and after every patient contact; implementation of respiratory hygiene and cough-etiquette strategies for patients with suspected influenza or infection with another respiratory tract pathogen to the extent feasible; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices and evaluation and implementation of needle-safety devices; appropriate use of personal protective equipment such as gloves, gowns, masks, and eye protection; and appropriate sterilization, disinfection, and antisepsis.

PMID: 17766540 [PubMed - indexed for MEDLINE]

Impact of a standardized hand hygiene program on the incidence of nosocomial infection in very low birth weight infants.

Capretti MG, Sandri F, Tridapalli E, Galletti S, Petracci E, Faldella G.

Department of Preventive Pediatrics and Neonatology, St Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy. mariagrazia.capretti@virgilio.it

BACKGROUND: This study examined the effects of a standardized hand hygiene program on the rate of nosocomial infection (NI) in very low birth weight (VLBW) infants (birth weight < 1500 g) admitted to our neonatal intensive care unit (NICU). METHODS: We compared the rate of NI in VLBW infants in 2 separate periods. In the first period, staff were encouraged to perform handwashing using a plain fluid detergent (0.5% triclosan). In the second period, a standardized hand hygiene program was implemented using antimicrobial soap (4% chlorhexidine gluconate) and alcohol-based hand rubs. RESULTS: NI after 72 hours of life was detected in 16 of the 85 VLBW infants in the first period and in 5 of the 80 VLBW infants in the second period. The rate of central venous catheter colonization was significantly lower in the second period (5.8%) than in the first period (16.6%). CONCLUSION: In our NICU, the incidence of NI in VLBW infants was significantly reduced after the introduction of a standardized handwashing protocol. In our experience, a proper hand hygiene program can save approximately 10 NI episodes/year, at a cost of $10,000 per episode. Therefore, improving hand hygiene practice is a cost-effective program in the NICU.

PMID: 18675149 [PubMed - indexed for MEDLINE]


Up in arms over clean hands.


Sosovec D.

Cardinal Health, Dublin, Ohio, USA.

Hand hygiene has been proven to be one of the most effective, cost-efficient methods of controlling nosocomial infections. For that reason, the hand hygiene practices of health care workers are being scrutinized more than ever. This article focuses on some of the many questions health care workers have about hand hygiene practices.

PMID: 18390285 [PubMed - indexed for MEDLINE]



Appropriate glove use in the prevention of cross-infection.


Flores A.

Mayday Hospital, Croydon, Surrey. ashley.flores@mayday.nhs.uk

This article aims to promote evidence-based practice in glove use and infection control. Evidence indicates that improvements in infection control practice can reduce the incidence of healthcare-associated infection and exposure to communicable disease among healthcare workers. The correct use of gloves is vital in the healthcare environment. Gloves should be worn for invasive procedures, any contact with sterile sites, non-intact skin, mucous membranes and exposure to blood, body fluids and sharp or contaminated instruments. They should be worn only once, for one aspect of care and one patient, disposed of as clinical waste, and the hands decontaminated after removal.

PMID: 17515152 [PubMed - indexed for MEDLINE]