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."

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 This material may not be published, broadcast, rewritten, or redistributed.

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[hoolahan, ASN, RN]

I haven't seen many docs stop to wash their hands between pt's. Maybe keeping a little bottle of gel in their pocket will initiate some compliance.

Thanks for sharing this!!

[WashYaHands]

Great, now I'll have to change my name to "fastdryingalcoholgel". (Kidding)

Actually, I just read this research study yesterday. One of the things mentioned in the study as a caveat was the assumption that health care personnel were actually washing their hands, and washing them correctly. As hoolahan said, some don't wash their hands between patients. So, the 2 million people infected each year is based on data where it is unknown whether or not we're washing and washing properly. Also, a subsequent article in the same journal mentioned that some of the dispensers had the tendency to clog up, which prohibited people from using the gel. At any rate, if it works to reduce nosocomial infection and is easier for nurses to use, I think it's worthwhile. If your facility joins the band wagon, suggest that they use a dispenser that doesnt clog up or break frequently.

Linda

[renerian, BSN, RN]

Thanks for posting this. Good information......

renerian

[kaycee]

We have a dispenser in every treatment room in our ER. It'sfoam not gel so it doesn't clog. I also thought it would be drying and rough on your hands but it's not.

[ShortFuse_LPN, LPN]

Anyone know of any gels that won't make my hands crack and bleed? Alcohol gels are worse on my hands than the powder in gloves!!!

[ResearchRN]

The complete CDC guideline and associated free CEU test can be found at:

http://www2.cdc.gov/ce/availableactivities.asp

[NurseDennie, BSN, RN]

I HATE those alcohol gels! They bother my hands, and they don't FEEL clean. Plus, if you use them more than a couple of times in a row without washing.... you get this nasty pilling up of the gel on your hands.

I really HATE that feeling. I don't mind using them, but I have to wash my hands after I do!

Love

Dennie

[OB/GYN NP]

I sooooo agree, Dennie! I hate alcohol gels! They're terrible for your skin, and what good does it do to keep your hands ultra-clean if your hands are also bleeding all over the patients! LOL (OK, maybe that's a slight exaggeration as to what the alcohol gels do to your hands, but I got a visual...I couldn't help it.) :roll

I seem to recall an article put out by the CDC a couple of years ago about not recommending antibacterial soaps because they kill too many of the beneficial types of bacteria on your hands, allowing the other bacteria that's more likely to be resistant to antimicrobials to overgrow. Maybe someone else remembers this study? I think it was meant for the general public and not the healthcare industry, but if it applies to the genral public, why wouldn't the same be true for healthcare workers? I never followed this, because I figured that, given my frequent contact with such lovely diseases as Herpes, Gonorrhea, Chlamydia... I certainly was not going to abandon antibacterial soaps. But alcohol gels? Not sure I can jump on that bandwagon.

Interesting article, though! Thanks for posting it!

[dawngloves, BSN, RN]

We just got pumps installed with Johnson amd Johnson antibacterial gel. It's great! Leaves my hands soft. I think it has aloe in it. But if you use too much it gets gritty.

[NICUNURSE]

Okay, I'm absolutely appaled at this article. I think we're all forgetting something that is really important...alcohol has not been found to have ANY anti-microbial properties, what-so-ever! Ever wonder why, we use betadine to secure our sterile field, not alcohol. If you think about it, the reason that we do use alcohol swabs/pads is because the friction of the alcohol against the skin will remove some of the bugs (the same concept in handwashing!) But alcohol will not kill bugs that are left on the skin. At least with handwashing, the bugs are washed down the sink. Buth with alcohol get, all you're doing is moving them around on your hands.

[ceecel.dee, MSN, RN]

dawngloves is right!

The Johnson & Johnson gel is the best we've tried!

Thanks for the article.....am copying and will post!:) :kiss