CDC joins WHO push for better hand hygiene in healthcare

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

The WHO is in its second year of a "Save Lives: CleanYour Hands Campaign," a global effort to help clinicians improve handhygiene to reduce the number of healthcare-associated infections (HAIs). Tobuild support for the campaign, the WHO has said it hopes to register 10,000healthcare 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 holdingthe event on May 5 to symbolize five fingers on the hand as well as thecampaign's "My Five Moments for Hand Hygiene" list, which urgeshealthcare 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 wayto prevent HAI, but adherence is generally low, ranging around 40%. "Thisis a good time to take stock," she said. She added it can be difficultstrike the right balance with hand hygiene messages and recommendations. Soapand water is a mainstay and is effective against a range of pathogens, whilealcohol-based rubs have boosted adherence but are not as effective againstcertain spores, such as that of Clostridium difficile, rapidly gaining as an HAI source.

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

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

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

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

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

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

See also:

Background information on WHO May 5 hand hygiene campaignevents

CDC hand hygiene Web page

University of Iowa iScrub Web page

FDA list of fraudulent pandemic H1N1 products

CDC clinicians conference call information

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