Monoplace Delivery System

Monthly Hyperbaric Safety Notice: September 2006

Hand Hygiene

Background

Improved adherence to hand hygiene has been proven to prevent outbreaks in health care facilities, to reduce transmission of resistant organisms (e.g. MRSA, VRE, Strep A) and reduce overall infection rates. Proper hand washing with antimicrobial soap and water remains a sensible and effective strategy. However, alcohol-based hand rubs have found increasing use in health care facilities. This notice will discuss the pros and cons of alcohol as a hand cleanser in the hyperbaric medicine facility.

The Issue

A 2002 Center for Disease Control (CDC) national guideline recommends frequent use of alcohol-based hand rubs by healthcare workers. It was felt that many hand washes using antimicrobial soap and water were performed too fast (<15 seconds) and, therefore, incompletely effective. Alcohol-based cleansing offers a better all round effectiveness for non-visibly soiled hands. Publication of this guideline resulted in widespread installation of alcohol dispensers. Soon thereafter, local fire marshals in several jurisdictions considered that dispensers in hallways and areas of high temperature and potential ignition sources represented a potential fire hazard. Based upon interpretation of local and regional fire codes some of these marshals demanded that these dispensers be removed. Several healthcare and fire safety organizations are working together to revise related fire codes to address this issue.

This safety concern is not without merit. There has been one report of a flash fire and injury when a healthcare worker applied alcohol-based rub to her hands. She immediately removed her polyester isolation gown (generating static electricity) then touched a metal door fitting. An electrostatic spark was generated and ignited unevaporated alcohol on her hands, causing burn wounds. There have also been reports of dermatologic reactions.
When using alcohol-based rubs it is important, therefore, that the hands be rubbed together until all alcohol has evaporated and the hands are dry. When done correctly, however, antimicrobial soap and water is the most effective option. When hands are soiled, soap and water should always be used.

While proper hand hygiene is required, whether soap or alcohol rub is used, universal precautions are to be practiced at all times in the patient care setting. Keeping hands clean is easier than making hands clean, thus using gloves while performing patient care and cleaning the environment is recommended. Gloves are to be disposed of immediately after each interaction. Gloves reduce hand contamination by up to 80%.

Bottom Line

Hand washing, when done properly, greatly decreases the incidence of contamination and cross-contamination. Antimicrobial soap and water is the preferred process for visibly soiled hands. Alcohol-based hand rubs are effective when hands are not otherwise soiled.
Ensuring evaporation of all alcohol from the hands is important before moving on to any other task. Rinsing hands with water alone is entirely ineffective. The use of gloves does not eliminate the need for hand hygiene; likewise, the use of hand hygiene does not eliminate the need for gloves.

References:

2006 NFPA 101; 21.3.2.6
Department of Health and Human Services, CMS-3145-IFC, Federal Register Vol 70,
No. 57, Friday, March 25, 2005, Rules and Regulations pgs 15229-15239.

Contributing Author: Dick Clarke, CHT

Dick Clarke Dick is President of National Baromedical Services, which he founded in 1986. His previous background included service in the British Royal Navy, diving instructor and underwater photographer, assistant director of the seabed habitat 'HydroLab' and several years in the offshore commercial diving industry. Dick heads the Baromedical Research Foundation where he serves as Principal Investigator for several international clinical trials. He is course director for 'Primary Training in Hyperbaric Medicine' and the 'HBO 2000' series of advanced hyperbaric symposia. Dick has been a NOAA Diving Medical Officer Training Course faculty member since 1983. He pioneered the Certification in Hyperbaric Technology (CHT) program, is a past president of the National Board of Diving and Hyperbaric Medical Technology and remains active at the committee level within the Undersea and Hyperbaric Medical Society.

Full Panel of Safety and Technical Correspondents

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