The document discusses hand hygiene history, guidelines, and standards. It compares the CDC and WHO hand hygiene guidelines and examines updates to the AORN hand hygiene standards. The CDC established guidelines in 2002 and the WHO built upon these to be more applicable globally. The AORN recently updated standards on nail length, polish, hand washing/rub timing and products. Going forward, adherence will need to be monitored and strategies implemented to sustain compliance with hand hygiene practices.

1. Hand Hygiene
by Kimberly B. Merritt
MHA, BSN, RN, CNOR

2. Session Objective
 Discuss basic hand hygiene history and principles
 Examine CDC vs WHO guidelines
 Provide updates to AORN hand hygiene standards
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3.  CDC: Center for Disease Control – Established
Guideline for Hand Hygiene in Health-Care Settings
in Oct 2002
 Current Campaign:
Clean Hands Count
 WHO: World Health Organization – Build upon the
who guidelines to make a more applicable model
for other regions and countries
 Current Campaign:
SAVE LIVES – Clean Your Hands
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Glossary
 Hand Hygiene: Any activities related to hand
condition and cleansing. Includes handwashing,
antiseptic hand wash, antiseptic hand rub, or
surgical hand antisepsis. It is the primary step that
sets the foundation for patient safety in preventing
healthcare associated infections.
 Hand Washing: Using soap and water to perform
hand hygiene.
 Antiseptic Hand Wash: Use of an over-the-counter
alcohol-based hand cleanser.
 Surgical Hand Antisepsis: Hand wash or hand rub
using a surgical hand antiseptic, performed
preoperatively by the surgical team to remove
transient flora and reduce resident skin flora.
 Surgical Hand Antiseptic: A product that is a
broad-spectrum, fast-acting, and nonirritating
preparation containing an antimicrobial ingredient
designed to significantly reduce the number of
microorganisms on intact skin. Surgical hand
antiseptic agents demonstrate both persistent and
cumulative activity.

4.  AORN: Association of Peri-Operative Registered Nurses
 Artificial nails: Substances or devices applied to the natural nail to augment or enhance
the wear’s own nail. This includes, but is not limited to acrylic nails, gel nails, bonding,
tips, wrappings, and tapes.
 Direct Patient Care Providers: Any staff member performing a task that involves directly
touching the patient or their environment.
 Good Repair: Free from peeling, chips, or cracks.
 Suspected contamination: Hands may be contaminated after contact with a source of
microorganisms (such as body fluid and other potential infectious material).
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Glossary continued

5. History
and
Basic Principles
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6.  Handwashing has been deeply rooted in cultural and
religious practices for centuries
 Inherent hand hygiene (the need to remove dirt from
the skin) are usually established in the first 10 years of
life
 Elective handwashing practices (handwashing in
specific opportunities) correspond to specific
indications such as a religious ritual or a healthcare
need
 In 1846, Ignaz Semmelweis studied two separate
maternity wards and postulated women in the doctor’s
ward developed puerpal fever because doctors
performed autopsies and midwives didn’t
 He then advocated for handwashing with chlorides of
lime and soda. Unfortunately, his recommendations
were not well received because of his blatant
reprimands and haphazard theories.
Hand Hygiene History

7.  In the early 19th century, Dr. Joseph Lister built upon the practices of Dr. Louis Pasteur of exposing the
wound to chemicals to prevent post-operative infections. These were sometimes called “ward-fever”
or at the beginning of the 20th century “hospitalisms”.
 Dr. Lister experimented with handwashing and introduced sterile surgery. He advocated the
sterilization of instruments and the spraying of carbolic within the surgical theater. His empirical data
supported the practice and acceptance of handwashing.
 He is known as the father of antiseptic surgery.
 CDC published guidelines starting in 1975; main guideline 2002.
 TJC incorporated hand hygiene as national patient safety goal in 2004.
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History continued

8.  One in 25 hospital patients has at least one healthcare acquired illness (HAI). Estimated costs for care of HAIs in 2009
up to $33.8 billion.
 HAIs are the top priority for the Department of Health and Human Services.
 The most common mode of transmission for most organisms is by hand contact.
 The least costly and one of the fundamental basics of prevention is hand hygiene!
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Why Hand Hygiene?
BARRIERS
Forgot
Too Many Opportunities
Location Inconvenient

9. When to Use & What Type of Hand Hygiene
HAND WASHING (SOAP AND WATER)
 Visibly soiled
 Before preparing or eating food
 Restroom
 When caring for patients with
spore-forming organisms
(Clostridium difficile)
ANTISEPTIC HAND WASH
 Before and after patient contact
 Before performing a clean or
sterile task
 After risk of blood and body fluid
exposure
 After contact with patient
equipment or environment
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10. How to Perform Hand Hygiene
 Hand washing with soap and water:
 Performed for a minimum of 15 seconds
 Water temp should be 70-80 degrees Fahrenheit
 Wet hands, Lather all sides, Rinse and Dry
 Open door with a paper towel to exit if needed
 Hand washing with antiseptic handwash:
 Fill the palm with product
 Rub together covering all surfaces
 Should take approximately 20 seconds to complete
and dry
 Surgical Hand Antisepsis:
 The first surgical hand scrub does
not have to be soap and water
before an alcohol-based hand
rub unless recommended by the
manufacturer.
 Follow manufacturer
recommendations for the FDA
approved alcohol-based hand
rub.
 Always remove all rings,
bracelets, and watches.
 Don’t use bristles of brushes on
skin if doing hand scrub
 Dry hands thoroughly before
donning gowns and gloves
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11. CDC
vs
WHO
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12. Required Protocol per
The Joint Commission
CDC
 Latest guideline published in
2002. Appended with updates
 Created in conjunction with
other organizations such as the
Association of Professionals in
Infection Control and
Epidemiology
WHO
 Built upon the CDC guidelines
 Expands to global infection
control concerns with regional
and country emphasis
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or

13. AORN
Updates
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14. AORN Update
 Evidence cited
 Fingernail tips < 6.4mm (0.25in)
 Nail polish acceptable unless chipped
 Hand wash upon arrival/before
leaving
 Hand wash before putting gloves on
 For surgical antisepsis, alcohol + CHG
product preferred
 Evidence RATED
 Fingernail tips < 2mm (0.08in)
 Healthcare organization should decide
if nail polish allowed (including gel &
Shellac)
 Great practice, but not included (no
citation/evidence)
 Conflicting evidence, perform hand
hygiene before clean or sterile task
 FDA approved surgical hand
antiseptics, conflicting evidence
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15. What’s Next?
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Sept 2, 2016 FDA issued
ban on antimicrobial
soap
Perceived barriers to
hand hygiene
Lack of resources (global
impacts)
Educate – families,
patients, all staff
Implement strategies to
sustain compliance
Monitor adherence

16. Summary
 Basic hand hygiene history and principles
 Reviewed CDC and WHO differences
 Examined AORN updates
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17. References
 Guideline for hand hygiene. In: Guidelines for
Perioperative Practice. Denver, CO: AORN, Inc.
 https://www.aorn.org/guidelines/clinical-
resources/clinical-faqs/hand-antisepsis-hygiene>
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18. Thank You for Participating!
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For questions or more information,
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info@courtemanche-assocs.com
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