Doctors and nurses urged to give up handwashing

[cargal]

http://www.cnn.com/2002/HEALTH/10/28/hand.washing.ap/index.html

Doctors urged to give up hand washing

Monday, October 28, 2002 Posted: 11:27 AM EST (1627 GMT)

CHICAGO (AP) -- The government has issued guidelines urging doctors and nurses to abandon the ritual of washing their hands with soap and water between patients and instead rub on fast-drying alcohol gels to kill more germs.

The goal? Reduce the hospital spread of viruses and bacteria that infect an estimated 2 million people in the United States each year and kill about 90,000.

Many hospitals, anticipating the new guidelines from the Centers for Disease Control and Prevention, have already made the change, and studies show this can cut their infection rates in half.

Soap and water have been the standard for generations. But washing up properly between each patient can take a full minute and is often skipped to save time, especially in busy intensive care units where the risk of spreading germs is greatest.

While the alcohol-based gels and solutions kill more microbes, the main advantage is they are easier to use. With vials clipped to their uniforms, nurses can quickly swish their hands while on the move without stopping at a sink. The CDC estimates this saves an hour in an eight-hour intensive care shift.

"We've learned that using alcohol-based products improves adherence to hand hygiene," said Dr. Julie Gerberding, the CDC's director. "We will end up with more people doing the right thing and cleaning their hands."

She released the guidelines in Chicago at a meeting of the Infectious Disease Society of America.

The solutions are intended only to kill germs, not remove visible dirt. So hospital workers are still expected to wash up if they get messy hands. Also, surgeons have the choice of using the gels or sticking with antimicrobial soap.

Many brands of the solutions are available in grocery stores. They vary in how they look, feel and smell. But all contain 60 percent to 90 percent ethanol or isopropanol, and they are considered equally effective at killing germs.

The new guidelines apply only to hospitals and clinics, where there are many particularly nasty microbes, along with sick people who are susceptible to catching them.

At home, where such dangerous bugs are far less common, experts say ordinary soap and water are probably all people routinely need. But the alcohol gels can make sense in situations where water is not be easily available, such as at picnics, in portable toilets or on airplanes.

Hospital workers are instructed to clean up between each patient, before they put on gloves, after they take them off, when inserting catheters or when doing anything else that involves contact with body fluids.

Besides giving individual containers of gel to their staff, hospitals put dispensers at patients' bedsides, in clinics and wherever sick people are seen.

The alcohol dries in seconds without a towel and is so easy to use that "it is almost indefensible now not to clean your hands. People can't say they are too busy anymore," said Dr. David Gilbert of Providence Portland Medical Center in Portland, Oregon, president of the Infectious Disease Society.

Using the gels involves squirting a dime-size dollop on one palm, then rubbing the hands together, covering all the surfaces, until the hands are dry.

Typically, people carry between 10,000 and 10 million bacteria on each hand. The medical profession has long known this is one way disease is transmitted. Dr. Ignaz Semmelweis pioneered the field in Austria in 1846, when he speculated that doctors spread "cadaverous particles" when they delivered babies after doing autopsies. He insisted that students clean their hands with chlorine.

Introduction of the alcohol gels "is the biggest revolution in hand hygiene since Semmelweis," said Elaine Larson, associate dean for research at Columbia School of Nursing. "We used to say 'hand washing.' Now it's hand hygiene."

--------------------------------------------------------------------------------

Copyright 2002 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

--------------------------------------------------------------------------------

Story Tools

--------------------------------------------------------------------------------

Docs try to curb CT scans in kids

* Schools D.A.R.E. to get real

* Guatemalan twins' homecoming delayed

* Sex discrimination in osteoporosis treatment

Feds to charge suspects

* Group claims Jordan killing

* Questions rage as Russia prepares to bury dead

* Palestinians approve new Arafat Cabinet

--------------------------------------------------------------------------------

Save up to 70%- AccuQuote life insurance

MaleFace.com,The Total Grooming Solution

Make Your "male face" Look Great! MaleFace.com

Eliminate Razor Burn at MaleFace.com

MaleFace 3-Pak 10% off coupon # 42012

MaleFace 6-Pak 10% off coupon # 42012

INFERTILITY NETWORK

Get slim, stay slim

Breast-Cancer-Pins

Free Issues of EW

[MollyMo]

I actually appreciate the waterless handwashing systems because I have an anaphylactic reaction to chlorhexidine gluconate-the antibacterial agent in Hibiclens. It's used where I work. I carry my own soap with me. I use it after I'm done with my patients. In between patients, I use the gel. But I have to wash that stuff off before I eat, go to the bathroom or even sit to chart. I don't like the feel of it, but I'm glad it's available.

[MollyMo]

I actually appreciate the waterless handwashing systems because I have an anaphylactic reaction to chlorhexidine gluconate-the antibacterial agent in Hibiclens. It's used where I work. I carry my own soap with me. I use it after I'm done with my patients. In between patients, I use the gel. But I have to wash that stuff off before I eat, go to the bathroom or even sit to chart. I don't like the feel of it, but I'm glad it's available.

[Agnus]

Our facility uses a foam alcohol cleaner. Easier on my hands than the soap and especially the paper towels we have.

Like one poster said it is not for cleaning it if for degerming. So, I wash as well.

[Agnus]

Our facility uses a foam alcohol cleaner. Easier on my hands than the soap and especially the paper towels we have.

Like one poster said it is not for cleaning it if for degerming. So, I wash as well.

[Youda]

Not too long ago, the local news talked about a local hospital that had replaced all the soap dispensers with alcohol dispensers. I said WHAT?

I just got around to looking it up when I saw this thread. According to my old micro textbooks, alcohol at as low as a 60% solution will kill most microbes at 10 seconds of exposure d/t disruption of the cell membrane, including those with lipids in the cell wall, and also denuration.

These alcohol products will NOT kill spores or endospores (c.diff, for example), or nonenveloped viruses. Also, if there is any organic residues on the hands, microbes will hide there and will not be killed by the alcohol.

Although I am respectful of these studies, particularly those that the CDC thinks is important, after my own reading, I think I would prefer to wash my hands, apply the gel, see the patient, then wash my hands, apply the gel, etc. In other words, use it as an addition to "hands hygiene" but not a replacement to good old fashioned hand-washing. That's MHO.

[Youda]

Not too long ago, the local news talked about a local hospital that had replaced all the soap dispensers with alcohol dispensers. I said WHAT?

I just got around to looking it up when I saw this thread. According to my old micro textbooks, alcohol at as low as a 60% solution will kill most microbes at 10 seconds of exposure d/t disruption of the cell membrane, including those with lipids in the cell wall, and also denuration.

These alcohol products will NOT kill spores or endospores (c.diff, for example), or nonenveloped viruses. Also, if there is any organic residues on the hands, microbes will hide there and will not be killed by the alcohol.

Although I am respectful of these studies, particularly those that the CDC thinks is important, after my own reading, I think I would prefer to wash my hands, apply the gel, see the patient, then wash my hands, apply the gel, etc. In other words, use it as an addition to "hands hygiene" but not a replacement to good old fashioned hand-washing. That's MHO.

[KRVRN, BSN, RN]

I sure hope it's as good as they say it is and really does kill everything on your hands... I work in the NICU and manager told us that aside from an initial 1 minute wash upon arriving at work, we could conceivable NEVER use soap and water unless our hands were visibly soiled. And I asked her that straight out... I could actually go a 12 hour shift and only wash my hands that first time. Unless the emmollients build up and feel yucky.

But certain things concern me... Like, does the stuff really get under your nails and around the cuticles well enough? What if you have fake nails? (no, not starting a debate)

And what really doesn't add up to me is that we only have soap and water in our restrooms. Is the gel not good enough for after using the bathroom? If not, then it's never good enough IMO.

[KRVRN, BSN, RN]

I sure hope it's as good as they say it is and really does kill everything on your hands... I work in the NICU and manager told us that aside from an initial 1 minute wash upon arriving at work, we could conceivable NEVER use soap and water unless our hands were visibly soiled. And I asked her that straight out... I could actually go a 12 hour shift and only wash my hands that first time. Unless the emmollients build up and feel yucky.

But certain things concern me... Like, does the stuff really get under your nails and around the cuticles well enough? What if you have fake nails? (no, not starting a debate)

And what really doesn't add up to me is that we only have soap and water in our restrooms. Is the gel not good enough for after using the bathroom? If not, then it's never good enough IMO.

[NICU_Nurse, BSN, RN]

We *just* had an inservice on this stuff less than a week ago. I also work in the NICU, and we were still encouraged to wash our hands frequently, but they admitted that unless you're vigilant about handwashing you probably won't be vigilant about using the gel either. We were instructed to do a good, up-to-the-elbows scrubbing with Betadine foam upon entering the nursery for the first time, and every time that we leave (i.e., to go to lunch,etc.) and return. We were also told to wash up if we have had any contact with blood or other bodily fluids. We should be using the gel, they said, in addition to and not instead of washing. For instance, if we change a diaper prior to a feeding, we should use the gel before moving from the genitals to the mouth unless we weren't wearing gloves and our hands actually touched the soiled area. Then, after contact with that particular baby is finished, we should use the soap to wash thoroughly before moving on to another baby. I, personally, think it is a great idea to have the pumps (we also have small bottles all over the place now). Unfortunately, our infection rate has managed to stay fairly high relative to some of the other hospitals (whether this is because we're a teaching hospital or not, I don't know...) and anything that helps to bring it down is fine with me. I *like* the gels- they make me feel a little more confident that I'm doing everything I can to decrease my patients' exposure to bugs/bacteria. I am still washing my hands frequently, but I also use the gel as a back-up. It does get greasy/gritty after multiple uses, and I usually do not reapply more than once before I wash my hands again anyway. We were told to put the gel under the fingernails as well, btw, and to allow it to dry before touching anything.

[NICU_Nurse, BSN, RN]

We *just* had an inservice on this stuff less than a week ago. I also work in the NICU, and we were still encouraged to wash our hands frequently, but they admitted that unless you're vigilant about handwashing you probably won't be vigilant about using the gel either. We were instructed to do a good, up-to-the-elbows scrubbing with Betadine foam upon entering the nursery for the first time, and every time that we leave (i.e., to go to lunch,etc.) and return. We were also told to wash up if we have had any contact with blood or other bodily fluids. We should be using the gel, they said, in addition to and not instead of washing. For instance, if we change a diaper prior to a feeding, we should use the gel before moving from the genitals to the mouth unless we weren't wearing gloves and our hands actually touched the soiled area. Then, after contact with that particular baby is finished, we should use the soap to wash thoroughly before moving on to another baby. I, personally, think it is a great idea to have the pumps (we also have small bottles all over the place now). Unfortunately, our infection rate has managed to stay fairly high relative to some of the other hospitals (whether this is because we're a teaching hospital or not, I don't know...) and anything that helps to bring it down is fine with me. I *like* the gels- they make me feel a little more confident that I'm doing everything I can to decrease my patients' exposure to bugs/bacteria. I am still washing my hands frequently, but I also use the gel as a back-up. It does get greasy/gritty after multiple uses, and I usually do not reapply more than once before I wash my hands again anyway. We were told to put the gel under the fingernails as well, btw, and to allow it to dry before touching anything.

[NicuGal, MSN, RN]

We don't even do a scrub at the beginning of the shift anymore...we haven't for years I am not sure about this waterless system either. We were told the same thing, you could go 12 hours and not wash your hands. That is just kinda gross.

And of course our hospital take the lowest bid and the stuff we got could eat the paint off your car! I said, why not just get cheaper and buy us each a bottle of alcohol and we can just douse our hands with that!

[NicuGal, MSN, RN]

We don't even do a scrub at the beginning of the shift anymore...we haven't for years I am not sure about this waterless system either. We were told the same thing, you could go 12 hours and not wash your hands. That is just kinda gross.

And of course our hospital take the lowest bid and the stuff we got could eat the paint off your car! I said, why not just get cheaper and buy us each a bottle of alcohol and we can just douse our hands with that!