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Fri 1 Jun 2007 12:00 AM

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Infection control

Technology is playing an important part, but individual hand washing remains the most effective way to keep infection under control.

Healthcare-associated infections affect hundreds of millions of patients worldwide every year. A prevalence survey conducted under the auspices of the World Health Organisation in 55 hospitals in 14 countries representing four WHO regions (South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific) revealed that, on average, 8.7% of hospital patients suffer nosocomial infections.

At any time, over 1.4 million people worldwide suffer from infectious complications associated with healthcare. In developed countries, about 5-10% of patients admitted to acute care hospitals acquire an infection that was not present or incubating on admission.

For most healthcare workers, it’s a question of competing priorities.

In the USA, one in 136 hospital patients becomes seriously ill as a result of acquiring an infection in hospital. This is equivalent to 2,000,000 cases a year and about 80,000 deaths annually. In the UK, 320,000 patients suffer from care-associated infections each year and in Germany the figure is 500,000 people infected every year.

Infections affect patients of all ages. If hospital units are not well maintained and hygiene rules are not followed, the critically ill are particularly vulnerable. An inevitable result of these care-related infections is an increase in public healthcare costs. With some simple procedures, the incidence of infection can be reduced. Handwashing is the single most important means of preventing the spread of infection, but getting doctors and nurses to become obsessive hand washers is proving difficult.

Numerous studies estimate that healthcare workers comply with recommended hand hygiene procedures less than 50% of the time - resulting in some serious consequences. Everyone is at risk, but pregnant women, children, the elderly, and those with weakened immune systems are especially vulnerable.

For most healthcare workers, it's a question of competing priorities. Quick-drying hand gels that kill bacteria without need of soap and water are now standard fare in 95% of US hospitals. Nevertheless, at 30 seconds per hand wash, busy hospital workers who constantly jump from patient to patient could spend 10 minutes per hour washing their hands, leaving them less time to do other important tasks, like examining patients and double-checking drug doses.

Sterilisation has long been the norm in operating rooms, but that thinking doesn't necessarily carry over to other areas of the hospital, where seemingly innocuous tasks such as picking up a patient's chart, touching your necktie, or typing on a computer keyboard can easily spread germs. In many hospitals, infection control specialist find themselves spending a lot of time on the unpleasant task of policing their fellow staff members.

Why is compliance with such a basic task so poor? Sometimes, there simply isn't the time due to heavy workloads. Other times, handwashing facilities may not be at hand, or individuals may be suffering irritation due to the frequent use of soap and water. Often, however, the message that good hand hygiene is essential hasn't been driven home.

Even those adhering to the principle may not use the correct washing technique or the right solution for the situation. Guidelines for hand hygiene can be surprisingly complex.

For example, the guidelines urge healthcare workers to regard all surfaces in the vicinity of the patient as potentially contaminated and to practice hand hygiene accordingly. But does that mean they should wash after they touch any potentially contaminated objects and surfaces in a patient's room?

There are rules about washing in the course of just a single encounter with a patient if, for instance, the clinician touches a contaminated or potentially contaminated part of the patient's body and then moves his or her hands to a "clean" part of the body (such as an intravenous catheter site).

Other rules spell out when it's necessary to wear sterile gloves (when inserting a catheter, for example, and even then, hands should be washed before donning gloves). Soap and water should be when hands are visibly soiled or have been exposed to bodily fluids. An alcohol-based gel or rub must be used for decontamination of hands after most patient contact, but not after contact with a patient who has antibiotic-associated colitis due to Clostridium difficile).

Ideally, liquid soap should be provided in pump dispensers. Soaps containing alcohol and bar soaps should be avoided. Paper towels should be used for hand drying and workers should use a hand towel to turn off taps.

Further measures

Washing hands correctly removes germs, but some technical solutions aim to go further by reducing the incidence of germs. Bioni CS is a German paint and coatings manufacturer targeting the Middle East region through a partnership with Obaid Humaid Al-Tayer Engineering Division. Brian Edwards, general manager of Obaid Humaid Al-Tayer, said: "This co-operation is entirely in accordance with our strategy to promote advanced technology that is environmentally sustainable and provides real benefit to society."

Bioni, working with research scientists of the Fraunhofer Institute for Chemical Technology, have developed a new type of wall coating. The coating, which is non-toxic and based upon nanotechnology, is designed to prevent the formation of mould on walls and reduce common hospital germs that are resistant to antibiotics.

Bioni claims that the coating is far more effective than conventional anti-mould paints that deliver short-term fixes. Whereas these solutions are based on biocides and fungicides, Bioni's offering is based on nano-particulate silver.

Non-toxic silver nano-particles have an average diameter of approximately 10 nanometres, around 1000 times smaller than most of the fungi spores and germs that they target. According to Bioni, when fungi spores come into contact with Bioni Nature and its integrated nano-particles, they are destroyed very quickly.

Washing hands correctly removes germs, but some technical solutions aim to go further by reducing the incidence of germs.

Sterilisation technology, key in the fight against infection control, is also advancing. LTE Touchclave Systems produces sterilisers and ancillary products that include touch control screens and can be programmed. Internal data archiving capabilities and an integrated printer are included to record all relevant information. Control systems incorporate a self-diagnostic feature that will highlight any abnormality in the sterilisation. Modems can even be fitted to allow remote monitoring.

Technical solutions have a part to play in the fight against injection, but better hand hygiene is ultimately the most simple way to control infection and reduce unnecessary illness. Health authorities everywhere must redouble their efforts to promote hand hygiene, so that it becomes an ingrained habit for all healthcare workers.

This article is provided courtesy of Harvard Medical International. © 2007 President and Fellows of Harvard College.

At a glance: Indications for handwashing and hand antisepsis


Wash hands with soap and water when visibly dirty or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids, or if exposure to potential spore-forming organisms is strongly suspected or proven, or after using the restroom.


Preferably use an alcohol-based hand rub for routine hand antisepsis in all other clinical situations described in point C below if hands are not visibly soiled. Alternatively, wash hands with soap and water.


Perform hand hygiene:

• Before and after having direct contact with patients.

• After removing gloves.

• Before handling an invasive device (regardless of whether or not gloves are used) for patient care.

• After contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings.

• If moving from a contaminated body site to a clean body site during patient care.

• After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient.


Wash hands with either plain or anti-microbial soap and water or rub hands with an alcohol-based formulation before handling medication and preparing food.


When alcohol-based hand rub is already used, do not use anti-microbial soap concomitantly.

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