Hand hygiene is a fundamental aspect of infection control and prevention in healthcare settings and everyday life. Effective hand hygiene not only reduces the risk of infection transmission but also plays a crucial role in maintaining public health. Infections pose a significant risk in care homes, where residents often have compromised immune systems. Preventing infections is crucial to maintaining the health and well-being of the elderly population in these settings. Regular handwashing is a simple yet powerful measure to reduce the spread of infections. In care homes, it is vital that staff are trained on proper hand hygiene techniques and encouraged to wash their hands frequently, especially after contact with residents, handling medications, or touching potentially contaminated surfaces. Additionally, residents should be educated on hand hygiene, to reduce the spread of infections.
Victor Adendorff, managing director Scientific Sanitation Solutions (SSS), explores the importance of hand hygiene and its challenges, and argues that to improve infection control and hygiene practices in care homes, a step-change in hand hygiene strategy could be the catalyst for greater compliance and reduced transmission of infectious diseases.
Why hand hygiene matters
Hand hygiene is a cornerstone of infection prevention, recognised as a simple yet powerful measure to reduce the transmission of infectious agents. The hands, being in constant contact with the environment, can serve as vehicles for the transfer of pathogens from surfaces to mucous membranes, leading to infections.
Human hands are adept at collecting and carrying microorganisms. Touching contaminated surfaces or interacting with infected individuals introduces pathogens onto the skin. Subsequent contact with the face, especially the eyes, nose, and mouth, provides a direct route for these pathogens to enter the body. Pathogens such as bacteria and viruses can survive on hands for varying durations, depending on factors such as the type of microorganism, environmental conditions, and the presence of organic matter.
Failure to practise proper hand hygiene contributes significantly to the spread of infectious diseases. In a care home setting, inadequate hand hygiene among workers can lead to healthcare-associated infections for residents, compromising their safety.
Scientific evidence supports the effectiveness of hand hygiene in reducing the incidence of infections. The use of soap and water, disinfectants or alcohol-based hand sanitisers disrupts the lipid envelope of many viruses and the cell walls of bacteria, rendering them inactive. Proper handwashing, following recommended techniques, ensures the removal of a significant proportion of pathogens. Additionally, the regular and thorough practice of hand hygiene contributes to the overall reduction of microbial load on hands, mitigating the risk of transmission.
Hand hygiene is a global public health imperative. Initiatives promoting hand hygiene awareness and compliance have a substantial impact on reducing the burden of infectious diseases, particularly in resource-limited settings. Simple, cost-effective interventions, such as providing access to clean water and soap, can significantly improve hand hygiene practices, leading to positive health outcomes on a large scale.
The scientific evidence overwhelmingly supports the critical role of hand hygiene in preventing infections. Understanding the scientific underpinnings of hand hygiene empowers healthcare workers, care professionals, and policymakers to implement effective strategies that contribute to a healthier and safer community.
Why disinfectants? A step change in hand hygiene strategy
Disinfectants have a big role to play in hand hygiene. They can often complement other more widely used sanitisers such as alcohol based on the go gels. While alcohol based sanitisers have their merits in terms of convenience and portability, they can be harsh on the skin with prolonged use. Alcohol can strip the skin of its natural oils, leading to dryness, irritation, and even cracking. A recent RCN survey found that 93% of nursing staff had experienced some form of skin condition, including dryness, redness, cracking, itching and pain, in the previous year. Not only does this impact worker health but adds further strain to our already under-resourced secondary care system. We need to think of alternatives and milder disinfectants is one of them in our hand hygiene arsenal.
Disinfectants formulated for skin use often contain mild ingredients that are gentle on the skin. They are designed to kill germs while maintaining the skin’s moisture balance, preventing excessive dryness and irritation. Additionally, some disinfectants may also include soothing or moisturising components that further nourish and protect the skin. Therefore, when it comes to maintaining healthy and well-nourished skin, choosing a suitable disinfectant designed for skin use can provide a more gentle and beneficial experience.
Disinfectants also offer a broader spectrum of action. They are designed to eliminate various types of microorganisms, including bacteria, viruses, fungi, and even spores. One significant advantage of disinfectants is their ability to provide a lasting residual effect. Once applied, many disinfectants create a protective barrier, preventing the recontamination of the treated area for an extended period. This residual effect is particularly crucial in high-traffic environments such as care homes where continuous sanitisation is challenging. Alcohol-based sanitisers, in contrast, evaporate quickly and do not leave a lasting protective layer, necessitating frequent reapplication.
Another benefit of disinfectants, especially those with specific virucidal properties, is that they can effectively combat both enveloped and non-enveloped viruses, ensuring comprehensive protection against a broad range of infectious agents.
Disinfectants can also offer an added benefit of improved cleaning capabilities. Many disinfectants contain surfactants and detergents that aid in the removal of dirt, grease, and organic matter. This dual action of cleaning and disinfection ensures not only the eradication of harmful pathogens but also the removal of visible impurities, leading to cleaner and more hygienic hands and environments.
Disinfectants come in a variety of forms, including sprays, wipes, and solutions, making them adaptable to different cleaning scenarios. This versatility allows for effective disinfection of a wide range of surfaces, including hard surfaces, fabrics, and electronic devices.
The selection of disinfectants must be meticulously done, considering their effectiveness against prevalent and medically significant pathogens. However, there are some negatives to disinfectants. For example, chemical disinfectants, by their very nature, possess the capacity to harm living organisms, including humans. While they aim to protect us from illness, they also carry inherent dangers. Numerous disinfectants contain volatile organic compounds (VOCs), notorious for causing chronic respiratory ailments and other health issues. These compounds have been linked to allergies, asthma, cancer, autoimmune diseases, and even skin damage.
So, what’s new?
Fortunately, solutions to this predicament have emerged. There are different types of disinfectant which are devoid of both alcohol and chlorine and are therefore safe to use, but these have traditionally lacked the required potency. At SSS, we have developed products suitable for use on any hard surface or as a hand sanitiser – SANI-99.
Proven to kill pathogens on contact, the NHS has verified that SANI-99™ is BS EN 14885 (2022) approved meaning it has passed all tests to substantiate claims for products used in the medical area. It has now been added to the NHS supply chain catalogue and available across all trusts. In fact, it is nearly 2,000 times more potent than concentrated (undiluted) bleach when it comes to eliminating pathogens per million, all the while being significantly safer and providing longer-lasting effects compared to standard disinfectants. In addition, it is laboratory certified to Log 7 purity reduction, the highest possible standard. In essence, it kills 99.99995% of all known germs and harmful bacteria. Testing was carried out by TÜV SÜD, Bio-science Technologies Ltd, BluTest Laboratories Ltd and SMT laboratories during 2019-2022. SANI-99™ was found to comply with the requirement for enveloped viruses and is suitable for handrubs and handwashes. It met the requirements of EN 1040, EN 1276, EN 13727, EN 13697, EN 14476 and EN 1500. All this shows the efficacy of SANI-99™ as a step change for sanitation and hand hygiene overall.
Why is hand hygiene top of the agenda?
Hand hygiene is universally recognised as a fundamental measure in preventing the spread of infections. It involves the removal or destruction of microorganisms from the hands to minimise the risk of transmission. While handwashing with soap and water is the preferred method, the use of disinfectants is essential when access to water and soap is limited, when care professionals are ‘on the go’ where strict infection control measures are part of daily protocol.
Healthcare-associated infections (HAIs) pose a significant threat to patient and elderly residents with pre-existing conditions, with hand transmission being the primary mode of pathogen spread. Extensive evidence supports the effectiveness of hand hygiene in reducing the incidence of HAIs, however according to research, the rate of adherence to hand hygiene among healthcare providers has been estimated at 20–40%. Various factors contribute to non-compliance, including inadequate placement of dispensers or sinks, time constraints, forgetfulness or distraction, ineffective education, lack of accountability, skin irritation concerns, language and cultural barriers and insufficient safety culture.
Addressing the challenges posed in hand hygiene requires a multi-faceted approach, including comprehensive education and training programmes, implementation of effective monitoring systems, fostering a positive safety culture, ensuring easy access to hand hygiene products, and addressing systemic issues such as workload and staffing levels.
For those with with compromised immune systems or underlying medical conditions, infections can be life-threatening. Therefore, strict adherence to hand hygiene protocols is vital in reducing HAIs and improving patient safety.
Training programmes are essential to raise awareness about the importance of hand hygiene and to teach individuals the correct techniques. Care homes should provide regular training sessions to staff and educate patients and their families about hand hygiene.
Convenient access to handwashing stations is also critical for promoting compliance. Care homes should ensure that sinks are readily available, well-maintained, and stocked with necessary supplies.
Behavioural interventions, such as monitoring and feedback, can be employed to encourage compliance. Facilities can implement systems to observe and provide feedback to staff on their hand hygiene practices, promoting accountability.
Hand sanitisers are another convenient alternative to handwashing when soap and water are not readily available. They are effective in killing a wide range of pathogens and can be strategically placed in healthcare settings and public spaces.
Hand disinfection serves as a critical line of defence against pathogens. It helps to:
a. Reduce the transmission of infectious agents: Many pathogens, including bacteria, viruses, and fungi, can survive on the skin and contribute to the spread of diseases. Proper hand disinfection significantly reduces the microbial load on the hands, minimising the risk of transmission.
b. Prevent healthcare-associated infections (HAIs): HAIs are a major concern in healthcare settings. Effective hand disinfection by healthcare professionals helps prevent cross-contamination between patients and reduces the incidence of HAIs.
c. Protect public health: Infection control is not only essential in healthcare settings but also in everyday life. Regular hand disinfection can reduce the risk of common infections, such as respiratory and gastrointestinal illnesses, and contribute to overall public health.
d. Impact the whole community: Infection control is not limited to healthcare settings alone. It plays a crucial role in preventing the transmission of infectious diseases within the wider community. By practicing regular hand disinfection, individuals can help break the chain of infection and protect vulnerable populations, including children, the elderly, and those with weakened immune systems.
e. Address germs in occupational settings: Infection control is vital in various occupational settings, such as food handling, childcare, hospitality, and manufacturing industries. Proper hand hygiene practices, including disinfection, are essential for preventing the contamination of food, surfaces, and products, ensuring a safe and healthy working environment.
f. Combat emerging infectious diseases: With the constant emergence of new infectious diseases and the potential for pandemics, hand disinfection becomes even more critical. It serves as a key preventive measure in reducing the spread of novel pathogens and mitigating the impact of outbreaks.
g. Promote personal protection: Infection control not only helps protect others but also safeguards individuals from acquiring infections. By practicing regular hand disinfection, individuals can minimise the risk of self-contamination and stay healthier.
h. Enhance behavioural change and education: Promoting proper hand disinfection requires effective communication and education. By raising awareness about the importance of hand disinfection and providing education on proper techniques, we can encourage behavioural change and enhance overall hygiene practices in both healthcare and non-healthcare settings.
In conclusion, hand hygiene is a critical component of infection control for care homes. Hand hygiene improvement strategies are essential for reducing the transmission of infectious diseases and protecting vulnerable populations. Disinfectants play a pivotal role in maintaining clean and safe hands. By adhering to the right-hand hygiene improvement strategies and using the latest in disinfectants which are better for hand health than traditional alcohol-based sanitisers yet still highly, if not more effective, we can collectively work towards a healthier and safer society. Hand hygiene is not just a personal responsibility; it is a global imperative in the fight against infectious diseases.
Scientific Sanitation Solutions (SSS) has developed a White Paper entitled Hand Hygiene and the Role of Disinfectants which is available to read and download here. The paper discusses the importance of hand disinfection, and the different types of disinfectants commonly used. It also explores the efficacy, guidelines, and considerations for selecting appropriate disinfectants to ensure optimal hand hygiene practices.