CDC joins WHO push for better hand hygiene in healthcare

Lisa Schnirring  Staff Writer

May 4, 2010 (CIDRAP News) – A day before the May 5 call to action from the World Health Organization (WHO) to improve hand hygiene practices in healthcare workers, the Centers for Disease Control and Prevention (CDC) held a clinicians teleconference on the topic and said it would unveil a new online resource tomorrow as part of the day's events.

The WHO is in its second year of a "Save Lives: Clean Your Hands Campaign," a global effort to help clinicians improve hand hygiene to reduce the number of healthcare-associated infections (HAIs). To build support for the campaign, the WHO has said it hopes to register 10,000 healthcare facilities to participate in the movement by May 5. As of Apr 23, 8,173 had registered, according to the WHO.

Katherine Ellingson, PhD, an epidemiologist with the CDC, told clinician participants at today's teleconference that the WHO is holding the event on May 5 to symbolize five fingers on the hand as well as the campaign's "My Five Moments for Hand Hygiene" list, which urges healthcare workers to clean their hands:

• before touching a patient,
• before clean/aseptic procedures,
• after body fluid exposure/risk,
• after touching a patient, and
• after touching patient surroundings.

Ellingson said good hand hygiene practices are the best way to prevent HAI, but adherence is generally low, ranging around 40%. "This is a good time to take stock," she said. She added it can be difficult strike the right balance with hand hygiene messages and recommendations. Soap and water is a mainstay and is effective against a range of pathogens, while alcohol-based rubs have boosted adherence but are not as effective against certain spores, such as that of Clostridium difficile, rapidly gaining as an HAI source.

The CDC's hand hygiene experts have fielded lots of questions about pandemic H1N1 flu, Ellingson said. Though there is little research on hand-washing as a means of reducing contact transmission of the pandemic H1N1 virus, she said the CDC's community-setting hand hygiene recommendation—wash hands often with soap and water—was based on evidence of contact transmission of respiratory viruses and the method's efficacy against flu viruses.

Though alcohol-based products are the CDC's preferred form of hand sanitizer, she said some makers of non-alcohol-based products were aggressive in marketing their products as effective against the pandemic virus. Ellingson told the group that some producers received warning letters from the US Food and Drug Administration (FDA). Five hand sanitizer companies are on the FDA's list of firms that made fraudulent 2009 H1N1 products.

Infection control experts are always looking for new tools to improve hand hygiene adherence in medical facilities, she said. For example, she pointed to iScrub, an application for iPhones and iPod Touches that helps personnel to easily and discreetly record and compile their observations on hand hygiene practices.

The application is still in the pilot phase and is part of a research project by the University of Iowa's computational epidemiology group. Christopher Hlady, a doctoral candidate with the program, told clinicians that the project's budget constraints so far have limited application development to just the Apple devices, but the group is considering developing versions for other hand-held devices. A basic version of iScrub is available for free on Apple's iTunes store. The Iowa group is also working on an expanded version that offers more customization and data analysis options.

Ellingson said other cutting-edge technologies are being used to track hand-hygiene adherence, such as monitoring devices that track usage of, for example, hand sanitizer. "There's a whole industry that has developed around monitoring," she said.

She urged participants to check the CDC's hand hygiene Web site tomorrow for new resources, including a video on patient empowerment, a relatively new tool in the fight against HAI, which urges patients to monitor their healthcare team's hand hygiene measures and to voice concerns when they don't see them washing their hands before patient contact.

See also:

Background information on WHO May 5 hand hygiene campaign events
http://www.who.int/gpsc/5may/en/

CDC hand hygiene Web page
http://www.cdc.gov/handhygiene/index.html

University of Iowa iScrub Web page
http://vinci.cs.uiowa.edu/index.php/Research/IScrub

FDA list of fraudulent pandemic H1N1 products
http://www.accessdata.fda.gov/scripts/h1n1flu/#HandSanitizer

CDC clinicians conference call information