Hand Hygiene—Of Reason and Ritual

Editorials6 July 2004Hand Hygiene—Of Reason and RitualRobert A. Weinstein, MDRobert A. Weinstein, MDFrom John H. Stroger Jr. (Cook County) Hospital, Rush Medical College, Chicago, IL 60612.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-1-200407060-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Modern infection control is grounded in the work of Ignaz Semelweis, who in the 1840s demonstrated the importance of hand hygiene for controlling transmission of infection on an obstetric ward. Although hand hygiene is the most important activity for preventing health care–associated infections, scores of observational studies demonstrate poor adherence by health care workers. The often-cited drawbacks to hand hygiene are the time required, a perception that the recommended frequency of hand cleansing is excessive, fear that frequent washing will lead to dermatitis, and limited access to sinks and hand hygiene products. To overcome these objections, an expert panel recently ...References1. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002;51:1-45, quiz CE1-4. [PMID: 12418624] MedlineGoogle Scholar2. Pittet D, Simon A, Hugonnet S, Pessoa-Silva CL, Sauvan V, Perneger TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med. 2004;141:1-8. LinkGoogle Scholar3. Weinstein RA, Kabins SA. Strategies for prevention and control of multiple drug-resistant nosocomial infection. Am J Med. 1981;70:449-54. [PMID: 7468626] CrossrefMedlineGoogle Scholar4. Beezhold DW, Slaughter S, Hayden MK, Matushek M, Nathan C, Trenholme GM, et al . Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis. 1997;24:704-6. [PMID: 9145745] CrossrefMedlineGoogle Scholar5. Mortimer EA, Lipsitz PJ, Wolinsky E, Gonzaga AJ, Rammelkamp CH. Transmission of staphylococci between newborns. Importance of the hands to personnel. Am J Dis Child. 1962;104:289-95. [PMID: 14476378] CrossrefMedlineGoogle Scholar6. Vernon MO, Trick WE, Welbel SF, Peterson BJ, Weinstein RA. Adherence with hand hygiene: does number of sinks matter? Infect Control Hosp Epidemiol. 2003;24:224-5. [PMID: 12683516] CrossrefMedlineGoogle Scholar7. Swoboda SM, Earsing K, Strauss K, Lane S, Lipsett PA. Electronic monitoring and voice prompts improve hand hygiene and decrease nosocomial infections in an intermediate care unit. Crit Care Med. 2004;32:358-63. [PMID: 14758148] CrossrefMedlineGoogle Scholar8. Barza M. Efficacy and tolerability of ClO2-generating gloves. Clin Infect Dis. 2004;38:857-63. [PMID: 14999631] CrossrefMedlineGoogle Scholar9. Vernon MO, Blom DW, Hayes RA, Hayden MK, Trick WE, Peterson BJ, et al. Efficacy of chlorhexidine gluconate body cleanser for reducing skin contamination with vancomycin-resistant enterococci among intensive care unit patients [Abstract]. In: Proceedings of the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, 14–17 September; 2003:358. Abstract no. K-1108. Google Scholar10. Hota B, Blom DW, Weinstein RA, Hayden MK. The effect of observation of environmental workers on thoroughness and outcome of environmental cleaning [Abstract]. In: Proceedings of the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, 14–17 September; 2003:369. Abstract no. K-744 Google Scholar11. Bonten MJ, Slaughter S, Ambergen AW, Hayden MK, van Voorhis J, Nathan C, et al . The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med. 1998;158:1127-32. [PMID: 9605785] CrossrefMedlineGoogle Scholar12. Tenorio AR, Badri SM, Sahgal NB, Hota B, Matushek M, Hayden MK, et al . Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant enterococcus species by health care workers after patient care. Clin Infect Dis. 2001;32:826-9. [PMID: 11229854] CrossrefMedlineGoogle Scholar13. 2004 National Patient Safety Goals—FAQs. Accessed at www.jcaho.com/accredited+organizations/patient+safety/04+npsg/04_faqs.htm#goal7 on 31 March 2004. Google Scholar Author, Article, and Disclosure InformationAffiliations: From John H. Stroger Jr. (Cook County) Hospital, Rush Medical College, Chicago, IL 60612.Disclosures: None disclosed.Current Author Address: Robert A. Weinstein, MD, Division of Infectious Diseases, John H. Stroger Jr. (Cook County) Hospital, 1901 West Harrison Street, Chicago, IL 60612; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHand Hygiene among Physicians: Performance, Beliefs, and Perceptions Didier Pittet , Anne Simon , Stéphane Hugonnet , Carmen Lúcia Pessoa-Silva , Valérie Sauvan , and Thomas V. Perneger Hand Hygiene Thomas Filardo Metrics Cited ByMRSA Transmission in Intensive Care Units: Genomic Analysis of Patients, Their Environments, and Healthcare WorkersImplementation scienceImpact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautionsMyth, Manners, and Medical Ritual: Defensive Medicine and the Fetish of AntibioticsOrganisation d’accueil, hygiène et sécurité des locaux et du personnelGerm Free: Hygiene History and Consuming Antimicrobial and Antiseptic ProductsDirect communication, the unquestionable ideal? Oncologists' accounts of communication of bleak prognosesWhy is it so hard to do the right thing in wound care?A statewide approach to systematising hand hygiene behaviour in hospitals: Clean hands save lives, Part IExploring the hand hygiene competence of student nurses: A case of flawed self assessmentWhy don't doctors wash their hands? A correlational study of thinking styles and hand hygieneFallacious Reasoning and Complexity as Root Causes of Clinical InertiaCommon Sense AsepsisHand hygiene among nurses in Turkey: opinions and practicesRisk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literatureUsing a motivational paradigm to improve handwashing complianceHandwashing practice and the use of personal protective equipment among medical students after the SARS epidemic in Hong KongControlling antibiotic-resistant bacteria: What’s an intensivist to do?*Hand HygieneThomas Filardo, MD 6 July 2004Volume 141, Issue 1Page: 65-66KeywordsAlcoholsBacterial pathogensBehaviorHealth care facilitiesHealth care providersHygieneInfantsObservational studiesPathogensPerception ePublished: 6 July 2004 Issue Published: 6 July 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...