Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why?


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Lecture on Gloves, Alcohol Hand Rubs, Soap and Water by Patricia Lynch during the 6th International Infection Control Conference 2006

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Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why?

  1. 1. Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why? Patricia Lynch, RN, MBA ICSP Conference, Pakistan, 2006
  2. 2. 2 Decades of New News <ul><li>Some practices are better for certain situations in hospitals than HW </li></ul><ul><li>An architecture of strategies to reduce transfer of organisms on hands exists </li></ul><ul><li>Gloves have significant advantages in some situations </li></ul><ul><li>So do alcohol hand rubs </li></ul>
  3. 3. HW in Non-hospital Settings: Public Health <ul><li>26 intervention, 24 correlational studies </li></ul><ul><li>76% from developing countries </li></ul><ul><li>42% from community, 42% from schools, 15% in individual households </li></ul><ul><li>All 15 studies in which handwashing was the only intervention reported significant reductions in diarrhea </li></ul><ul><li>Larson, APIC 2000 </li></ul>
  4. 4. HW Advantages <ul><li>The ONLY way to clean soilage off skin </li></ul><ul><li>Low cost </li></ul><ul><li>Plain soap & water less irritating than some antimicrobial products </li></ul><ul><li>Equivalent to alcohol hand rub in recent study: Sickbert-Bennett E et al. AJIC 2005 p. 67 </li></ul>
  5. 5. HW Disadvantages <ul><li>People don’t comply </li></ul><ul><li>Hard on hand skin Larson EL Heart Lung 1997 </li></ul><ul><li>Less effective than alcohol rub </li></ul><ul><li>Takes more time </li></ul><ul><li>Requires soap, H2O + towel to dry </li></ul>
  6. 6. HW Disadvantages <ul><li>Soap dispenser problems: dose, drips, etc </li></ul><ul><li>Maintenance: wash, dry, refill--no topoff </li></ul><ul><li>Paper towel problems: Contaminated towel dispensers &/or hands 12% Harrison W AJIC 2003 p 387 </li></ul><ul><li>Cloth towel maintenance problems: wet, soiled, HCWs avoid </li></ul>
  7. 7. HW Compliance Example <ul><li>“ Wash hands before touching MM or NI Skin for all patients” </li></ul><ul><li>Observation study found compliance <40% </li></ul><ul><li>“ Put on clean gloves before touching MM or NI Skin for all patients” </li></ul><ul><li>Observation study: 80-90% consistently </li></ul><ul><li>Lynch et al Am J Infect Control 1990;18:1-12 . </li></ul>
  8. 8. Handwashing Is Indicated: <ul><li>When hands are physically soiled or likely to be physically soiled </li></ul><ul><li>When a better choice is not available </li></ul>
  9. 9. Advantages of HW with Antimicrobial Products <ul><li>Persistent activity against most microbes with CHG, PCMX, less with hexachlorophene, Quats and Triclosan, good coverage but skin irritation with iodophors </li></ul><ul><li>Somewhat equivalent to single use of alcohol, better than plain HW product </li></ul>
  10. 10. Disadvantages of HW with Antimicrobial Products <ul><li>Approximately twice the cost of alcohol in product alone, not counting H2O, towel, maintenance and time of personnel </li></ul><ul><li>Poor compliance </li></ul><ul><li>Skin irritation </li></ul>
  11. 11. HW with Antimicrobial Product is Indicated: <ul><li>When hands are likely to be soiled with microbial substances </li></ul><ul><li>When alcohol rub is not available </li></ul><ul><li>For surgical antisepsis when alcohol and a product with persistent antimicrobial activity is not available </li></ul>
  12. 12. Alcohol Hand Rub Advantages <ul><li>Much better compliance than HW </li></ul><ul><li>More effective than HW with plain or anti-microbial hand products Rotter in Mayhall 1996 </li></ul><ul><li>Actually demonstrated to reduce infections Hilburn J AJIC 2003 p 109 </li></ul>
  13. 13. Alcohol Hand Rub Advantages <ul><li>Less skin damage than HW </li></ul><ul><li>Less waste than HW or gloves </li></ul><ul><li>Less costly in time, fast acting </li></ul><ul><li>Does not require H2O or towels </li></ul>
  14. 14. Alcohol Hand Rub Disadvantages <ul><li>Cost for good emollients: very important </li></ul><ul><li>Philosophical position on alcohol </li></ul><ul><li>Flammability </li></ul><ul><li>May be incompatible with some lotions and antimicrobial hand products </li></ul><ul><li>Alcohol lacks persistent activity </li></ul>
  15. 15. Alcohol Hand Rub is Indicated: <ul><li>Between patient contacts </li></ul><ul><li>Before invasive procedures </li></ul><ul><li>After touching objects </li></ul><ul><li>Before touching patients </li></ul><ul><li>? after removing gloves: 13% had transfer organisms </li></ul><ul><li>Personal hygiene ? Olsen RJ, JAMA 1993 Adams . J Hosp Infect 1992 </li></ul>
  16. 16. Glove Advantages <ul><li>The BEST at reducing transfer of organisms from & to hands </li></ul><ul><li>Cost-effective when used according to directions </li></ul><ul><li>Much variety in types of gloves, appropriate usage and materials </li></ul>
  17. 17. Glove Advantages <ul><li>Reduces bi-directional risk for transfer of organism </li></ul><ul><li>Reduces significantly the amount of blood that penetrates from a puncture: cleans off the outside of the needle Mast JID 1993 </li></ul>
  18. 18. Glove Disadvantages <ul><li>Cost </li></ul><ul><li>Frequency of improper use; failure to change when needed, etc. </li></ul><ul><li>HCWs think the gloves are only to protect THEM </li></ul><ul><li>Poor quality material not uncommon </li></ul><ul><li>Adds to the solid waste stream </li></ul><ul><li>Materials react with some hand products </li></ul>
  19. 19. Indications for Glove Use <ul><li>Use sterile gloves that are sterile at the time of use for likely contact with all normally sterile tissues </li></ul><ul><ul><li>even if tissue is infected </li></ul></ul><ul><ul><li>re-glove for new site or new patient </li></ul></ul><ul><ul><li>gloves may be reprocessed for non-sterile use </li></ul></ul>
  20. 20. Indications for Glove Use <ul><li>Use clean exam gloves that are clean at the time of use for likely contact with mucous membranes or non-intact skin </li></ul><ul><ul><li>even if tissue is infected </li></ul></ul><ul><ul><li>without touching other objects or materials and then touching MM or NIS </li></ul></ul><ul><ul><li>even for children and babies </li></ul></ul><ul><li>Used exam gloves may be used to handle soiled equipment </li></ul>
  21. 21. Indications for Glove Use <ul><li>Use appropriate gloves for likely contact with moist body substances on articles or intact skin </li></ul><ul><ul><li>may be household gloves, reprocessed exam or surgical gloves for handling soiled equipment </li></ul></ul><ul><ul><li>use gloves that are long enough to cover parts that are likely to be exposed </li></ul></ul>
  22. 22. Indications for Glove Use <ul><li>Wear appropriate gloves to protect hands of HCWs when risk of puncture or blood contact is likely </li></ul>
  23. 23. Problems With Glove Re-use <ul><li>Washing gloves increases the frequency and size of leaks Adams . J Hosp Infect 1992 </li></ul><ul><li>Sterilizing or high-level disinfection is difficult </li></ul><ul><li>Some glove material doesn’t hold up well to reprocessing </li></ul>
  24. 24. Key Elements: Frequency & Duration <ul><li>Frequency: several studies show frequency of HH <40% of indicated need (different indications) Increasing frequency is very important </li></ul><ul><li>Duration: Recent study based on 10 seconds of contact activity Sickbert-Bennett E et al. AJIC 2005 p. 67 </li></ul>
  25. 25. Results for Correct Hand Hygiene <ul><li>1. Sterile gloves just before contact with normally sterile sites </li></ul><ul><li>2. Clean gloves just before contact with mucous membranes, non-intact skin </li></ul><ul><li>3. Hand hygiene just before touching patients & when hands are visibly soiled </li></ul><ul><li>Compliance > 90%: Infection & colonization fell 30% </li></ul><ul><li>Lynch P et al. AJIC 1990 </li></ul>