Difference between revisions of "AY Honors/Home Nursing/Answer Key"

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'''Infection control and health care epidemiology'''
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{{howto}}
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is the discipline concerned with preventing the spread of infections within the health-care setting.
 
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As such, it is a practical (rather than an academic) sub-discipline of [[epidemiology]].
 
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It is an essential (though often underrecognized and undersupported) part of the infrastructure of health care.
 
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Infection control and hospital epidemiology are akin to [[public health]] practice, practiced within the confines of a particular health-care delivery system rather than directed at society as a whole.
 
  
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Infection control concerns itself both with prevention (hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, surveillance) and with investigation and management of demonstrated or suspected spread of infection within a particular health-care setting (e.g. outbreak investigation). It is on this basis that the common title being adopted within health care is '''"Infection Prevention & Control".
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[[Image:SchoolchildrenWashingHands.jpg|right|thumb|Schoolchildren washing their hands before eating lunch.]]
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'''Hand washing''' is the act of [[cleaning|cleansing]] the [[hand]]s with [[water]] or another [[liquid]], with or without the use of [[soap]] or other [[detergent]]s, for the [[Sanitation|sanitary]] purpose of removing [[soil]] and/or [[microorganism]]s.
  
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==Infection control in healthcare facilities==
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==Purpose==
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===Hand hygiene===
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[[Image:Fingerprint.jpg|left|thumb|An example of how minuscule particles can be caught between dermal ridges in the hand, yet remain unseen by the naked eye. Washing one's hands removes such contaminants.]]
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Independent studies by [[Ignaz Semmelweis]] in [[1847]] in [[Vienna]] and [[Oliver Wendell Holmes, Sr.|Oliver Wendell Holmes]] in [[1843]] in [[Boston]] established a link between the hands of health care workers and the spread of [[Nosocomial infection|hospital-acquired]] disease.<ref>[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm CDC Guideline for Hand Hygiene in Health-Care Settings]</ref> The [[Centers for Disease Control and Prevention|Centers for Disease Control and Prevention (CDC)]] has stated that “It is well-documented that the most important measure for preventing the spread of pathogens is effective handwashing.” <ref>[http://www.cdc.gov/nceh/vsp/cruiselines/hand_hygiene_general.htm CDC General information on Hand Hygiene]</ref>  In the United States, [[Hand washing#Medical hand washing|hand washing]] is mandatory in most health care settings and required by many different state and local regulations as well as good sense http://www.safechemdirect.co.uk]
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The main purpose of washing hands is to cleanse the hands of [[pathogen]]s (including [[bacterium|bacteria]] or [[virus]]es) and chemicals which can cause personal harm or disease. This is especially important for people who handle food or work in the medical field.  The [[Centers for Disease Control and Prevention]] (CDC) has stated that "It is well-documented that the most important measure for preventing the spread of pathogens is effective handwashing."  A large body of research is available on the topic.[http://www.globalhandwashing.org/Publications/Lit_review.htm]
  
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In the United States, [[Occupational Safety and Health Administration|Occupational Safety and Health Administration (OSHA)]] standards<ref>[http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 OSHA Bloodborne Pathogens Regulations 1910.1030]</ref> require that employers must provide readily accessible hand washing facilities, and must ensure that employees wash hands and any other skin with soap and water or flush mucous membranes with water as soon as feasible after contact with blood or other potentially infectious materials (OPIM).
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While hot water may more effectively clean your hands, this is primarily due to its increased capability as a solvent, and not due to hot water actually killing germs.  Hot water is more effective at removing dirt, oils and/or chemicals, but contrary to popular belief, it does not kill microorganisms. A temperature that is comfortable for hand washing (about {{convert|45|C|F|0|lk=on|abbr=on}}) is not nearly hot enough to kill any microorganism.  It takes a much higher temperature to effectively kill germs (typically {{Convert|100|C|F|lk=on|abbr=on}}).
  
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===Cleaning, disinfection and sterilization===
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==Personal hand washing==
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To maintain good [[hygiene]], hands should always be washed after using the toilet, changing a diaper, tending to someone who is sick, or handling raw meat, fish, or poultry, or any other situation leading to potential contamination. Hands should also be washed before eating, handling or cooking food. Conventionally, the use of soap and warm running water and the washing of all surfaces thoroughly, including under fingernails is seen as necessary. One should rub wet, soapy hands together outside the stream of running water for at least 20 seconds, before rinsing thoroughly and then drying with a clean or disposable towel.<ref>[http://www.mayoclinic.com/health/hand-washing/HQ00407 Hand washing] from [[Mayo Clinic]]</ref> After drying, a dry paper towel should be used to turn off the water (and open the exit door if one is in a restroom or other separate room).  Moisturizing [[lotion]] is often recommended to keep the hands from drying out, should one's hands require washing more than a few times per day.<ref>[http://www.tufts.edu/med/apua/Patients/handwashing.html Hand washing] from [[Tufts University]]</ref>
  
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Cleaning, [[disinfection]] and [[sterilization (microbiology)|sterilization]]...
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Antibacterial soaps have been heavily promoted to a health-conscious public.  To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic-resistant organisms in nature.<ref>{{cite journal |author=Weber DJ, Rutala WA |title=Use of germicides in the home and the healthcare setting: is there a relationship between germicide use and antibiotic resistance? |journal=Infect Control Hosp Epidemiol |volume=27 |issue=10 |pages=1107–19 |year=2006 |pmid=17006819 |doi=10.1086/507964}}</ref>  However, antibacterial soaps contain common antibacterial agents such as [[Triclosan]], which has an extensive list of resistant strains of organisms.  So, even if antibacterial soaps do not select for antibiotic resistant strains, they might not be as effective as they are marketed to be.  These soaps are quite different from the non-water-based hand hygiene agents referred to below, which also do not promote [[antibiotic resistance]].<ref>[http://www.cdc.gov/cleanhands/ Clean hands] from the [[Centers for Disease Control and Prevention|CDC]]</ref>
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{{sect-stub}}
 
  
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Sterilization is a process intended to kill all microorganisms and is the highest level of microbial kill that is possible. Sterilizers may be heat only, steam, or liquid chemical. <ref> (Miller, Chris H.. Infection Control and Management of Hazardous Materials for the Dental Team, 3rd Edition. Mosby Elsevier Health Science, 2005. chpt 11).</ref>
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==Medical hand washing==<!-- This section is linked from [[IgnazMa Semmelweis]] -->
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Effectivenss of the sterilizer (oftern called an autoclave") is determined in three ways. <ref> (Miller, Chris H.. Infection Control and Management of Hazardous Materials for the Dental Team, 3rd Edition. Mosby Elsevier Health Science, 2005. chpt 11).</ref>
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[[Image:Hand desinfection test with blood agar plate.jpg|thumb|right|Microbial growth on a cultivation plate without procedures (A), after washing hands with soap (B) and after disinfection with alcohol (C).]]
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First by the mechanical indicators and gauges on the machine itself, second the heat sensitive inicators or tape on the sterilzing bag turn color, and thirdly and most importantly is the biological test. With the biological test, a highly heat and chemical resistant microorganism (often the bacterial endospore) is selected as the standard challenge. If the process kills this microorganism, the sterilizer is considered to be effective. It should be noted that in order to be effective, instruments must be cleaned, otherwise the debris may form a protective barrier, shielding the microbes from the lethal process. Similarly care must be taken after sterilization to ensure sterile instruments do not become contaminated prior to use.<ref> (Miller, Chris H.. Infection Control and Management of Hazardous Materials for the Dental Team, 3rd Edition. Mosby Elsevier Health Science, 2005. chpt 11).</ref>
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The purpose of hand washing in the health care setting is to remove or destroy (disinfect) [[pathogens|pathogenic microorganisms]] ("germs") to avoid transmitting them to a patient. The application of water alone is ineffective for cleaning skin because water is unable to remove fats, oils, and proteins, which are components of organic soil. Therefore, removal of microorganisms from skin requires the addition of soaps or detergents to water. Plain soap does not kill pathogens. However, the addition of antiseptic chemicals to soap ("medicated" or "antimicrobial" soaps) does confer killing action to a hand washing agent. Such killing action may be desired prior to performing surgery or in settings in which antibiotic-resistant organisms are highly prevalent.<ref>[http://www.who.int/patientsafety/events/05/HH_en.pdf WHO Guidelines on Hand Hygiene in Health Care]</ref>
  
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Disinfection refers to the use of liquid chemicals on surfaces and at room temperature to kill disease causing microorganisms. Disinfection is a less effective process than sterilization because it does not kill bacterial endospores. <ref> (Miller, Chris H.. Infection Control and Management of Hazardous Materials for the Dental Team, 3rd Edition. Mosby Elsevier Health Science, 2005. chpt 11).</ref>
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The proper washing of hands in a [[medicine|medical]] setting generally consists of the use of generous amounts of soap and water to lather and rub each part of ones hands systematically for 15 to 20 seconds. Hands should be rubbed together with digits interlocking. If there is debris under fingernails, a bristle brush is often used to remove it. Finally, it is necessary to rinse well and wipe dry with a paper towel. After drying, a dry paper towel should be used to turn off the water (and open any exit door if necessary).
  
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===Personal protective equipment===
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To 'scrub' one's hands for a [[surgery|surgical operation]], a tap that can be turned on and off without touching with the hands, some [[chlorhexidine]] or [[povidone-iodine|iodine]] wash, sterile towels for drying the hands after washing, and a sterile brush for scrubbing and another sterile instrument for cleaning under the fingernails are required. All jewellery should be removed. This procedure requires washing the hands and forearms up to the elbows, and one must in this situation ensure that all parts of the hands and forearms are well scrubbed several times. When rinsing, it is ensured at all times that one does not allow water to drip back from the elbow to your hands. When done hands are dried with a sterile cloth and a surgical gown is donned.
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[[Image:Disp-med-ppe.jpg|thumb|120px|Disposable PPE]]
 
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[[Personal protective equipment|Personal protective equipment (PPE)]] is specialized clothing or equipment worn by a worker for protection against a hazard. The hazard in a health care setting is exposure to blood, saliva, or other bodily fluids or aerosols that may carry infectious materials such as [[Hepatitis C]], [[HIV]], or other blood borne or bodily fluid [[pathogen]]. PPE prevents contact with a potentially infectious material by creating a physical barrier between the potential infectious material and the healthcare worker.  
 
  
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In the United States, the [[Occupational Safety and Health Administration|Occupational Safety and Health Administration (OSHA)]] requires the use of [[Personal protective equipment|Personal protective equipment (PPE)]] by workers to guard against blood borne pathogens if there is a reasonably anticipated exposure to blood or other potentially infectious materials. <ref>[http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051#1910.1030(d)(2)(i) OSHA Bloodborne Pathogens Regulations 1910.1030(d)(2)(i)]</ref> 
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In the late 1990s and early part of the 21st century, [[Alcohol rub|non-water-based hand hygiene agents]] (also known as alcohol-based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity.  Most are based on [[isopropyl alcohol]] or [[ethanol]] formulated together with a [[thickening agent]] such as [[Carbomer]], and a [[humectant]] such as [[glycerin]] into a gel, liquid, or foam for ease of use and to decrease the drying effect of the alcohol. The increasing use of these agents is based on their ease of use, rapid killing activity against microorganisms, and lower tendency to induce irritant contact dermatitis as compared to soap and water hand washing. Despite their effectiveness, the non-water agents do not clean hands of organic material, they simply disinfect them. However, disinfection does prevent transmission of infectious microorganisms.
  
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Components of [[Personal protective equipment|Personal protective equipment (PPE)]] include [[Medical gloves|gloves]], [[Hospital gown|gowns]], bonnets, shoe covers, [[face shield]]s, [[CPR mask]]s, [[goggles]], [[surgical mask]]s, and respirators. How many components are used and how the components are used is often determined by regulations or the infection control protocol of the facility in question. Many or most of these items are [[disposable]] to avoid carrying infectious materials from one patient to another patient and to avoid difficult or costly [[disinfection]]. In the United States, [[Occupational Safety and Health Administration|OSHA]] requires the immediate removal and disinfection or disposal of worker's PPE prior to leaving the work area where exposure to infectious material took place.<ref>[http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051#1910.1030(d)(3)(vii) OSHA 1910.1030(d)(3)(vii)]</ref>
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Visible soiling of any sort on the hands must be washed with soap and water because alcohol-based hand rubs are ineffective in the presence of organic material. In addition, alcohols are ineffective against non-lipid-enveloped viruses (e.g., Noroviruses) and the spores of bacteria (e.g., Clostridium difficile) and protozoa (e.g., Giardia lamblia). When such microorganisms are likely to be encountered, soap and water hand washing is preferable.  
  
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===Vaccination of health care workers===
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The [[New England Journal of Medicine]] reports that lack of hand washing remains at unacceptable levels in most medical environments, with large numbers of doctors and nurses routinely forgetting to wash their hands before touching patients.<ref>{{cite journal |author=Goldmann D |title=System failure versus personal accountability--the case for clean hands |journal=N. Engl. J. Med. |volume=355 |issue=2 |pages=121–3 |year=2006 |pmid=16837675 |doi=10.1056/NEJMp068118}}</ref> One study has shown that proper hand washing and other simple procedures can decrease the rate of catheter-related bloodstream infections by 66 percent.<ref>{{cite journal |author=Pronovost P, Needham D, Berenholtz S, ''et al'' |title=An intervention to decrease catheter-related bloodstream infections in the ICU |journal=N. Engl. J. Med. |volume=355 |issue=26 |pages=2725–32 |year=2006 |pmid=17192537 |doi=10.1056/NEJMoa061115}}</ref>
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Health care workers may be exposed to certain infections in the course of their work.  [[Vaccine]]s are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for [[Hepatitis B#Prevention|hepatitis B]]; [[Influenza vaccine| influenza]]; [[MMR vaccine|measles, mumps and rubella]]; [[TDaP|Tetanus, diphtheria, pertussis]]; [[Neisseria meningitidis#Vaccines|N. meningitidis]]; and [[Varicella vaccine|varicella]]. In general, [[vaccine]]s do not guarantee complete protection from disease, and there is [[Vaccine#Potential for adverse side effects in general|potential]] for adverse effects from receiving the vaccine. <ref>[http://www.cdc.gov/node.do/id/0900f3ec8005df1f CDC Vaccine Site]</ref>
 
  
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===Post exposure prophylaxis===
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== Truths, myths, and misinformation ==
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In some cases where vaccines do not exist Post Exposure prophylaxis is another method of protecting the health care worker exposed to a life threatening infectious disease. For example, the viral particles for HIV-AIDS can be precipited out of the blood through the use of an antibody injection if given within 4 hours of a significant exposure.
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{{rewrite-section}}
  
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===Surveillance for emerging infections===
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;Alcohol-free hand sanitizers are not as effective as alcohol hand rubs: ''This is misinformation''
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Surveillance is the act of infection investigation using the CDC definitions.  Determining an infection requires an ICP to review a patient's chart and see if the patient had the signs and symptom of an infection.  Surveillance definition cover infections of the bloodstream, Urinary tract, pneumonia, and sugical sites.
 
  
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Surveillance traditionally involved significant manual data assessment and entry in order to assess preventative actions such as isolation of patients with an infectious disease. Increasingly, integrated computerised software solutions are becoming available, such as [http://www.rl-solutions.com/infection-control/infection-monitorpro.html Infection Monitor Pro]. Such products actively assess incoming risk messages from microbiology and other online sources. By reducing the need for data entry, this software significantly reduces the data workload of Infection Control Practitioners (ICP), freeing them to concentrate on clinical surveillance.
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The [[efficacy]] of alcohol-free hand sanitizers are heavily dependent on their [[ingredients]] and [[formulation]]. In the past, alcohol-free hand [[sanitizer]]s tended to significantly under-perform [[alcohol]] or [[alcohol rub]]s as germ killers in [[clinical studies]] using standard [[protocols]] such as EN1500. More recently, advanced [[formulation]]s have been developed, some of which have been shown to out-perform [[alcohol]]. A further aspect of [[efficacy]] that is sometimes overlooked is the effect of repeated use. The [[efficacy]] of [[alcohol]] as a hand [[disinfectant]] has been shown to decrease after repeated use, thought to be due to progressive adverse skin reactions, whereas the efficacy of an alcohol-free hand [[sanitizer]] based on [[Benzalkonium Chloride]] as its [[active ingredient]] has been shown to increase with repeated use. <ref>AORN; Dyer, etal; Aug 1998; VOL 68, No2;http://www.aornjournal.org/article/abstracts?terms1=&terms2=&terms3= </ref> 
  
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As approximately [http://www.cdc.gov/ncidod/eid/vol4no3/weinstein.htm one third of healthcare acquired infections are preventable] , surveillance and preventative activities are increasingly a priority for hospital staff. In the United States, a study on the Efficacy of Nosocomial Infection Control Project (SENIC) by the CDC found that hospitals reduced their nosocomial infection rates by approximately 32 per cent by focusing on surveillance activities and prevention efforts.
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; Washing your hands with soap and water kills germs:''This is misinformation''
  
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==Outbreak investigation==
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Plain [[soap]]s have minimal if any [[antimicrobial]] activity. In several [[clinical studies]], hand washing with plain soap failed to remove bad microorganisms ([[pathogens]]) from the hands of hospital personnel. Hand washing with plain soap can result in an increase in bacterial counts on the skin. Occasionally, contaminated plain soaps have colonized hands with [[Gram-negative bacteria]].<ref name="hhforhw">{{cite web| url = http://www.learnwell.org//handhygiene.htm |title = Hand Hygiene for Healthcare Workers | accessdate = 2007-04-27| publisher = LearnWell Resources, Inc, a California nonprofit public benefit 501(c)(3) corporation}}</ref>
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When an unusual cluster of illness is noted, infection control teams  undertake an investigation to determine whether there is a true outbreak, a pseudo-outbreak (a result of contamination within the diagnostic testing process), or just random fluctuation in the frequency of illness. If a true outbreak is discovered, infection control practitioners try to determine what permitted the outbreak to occur, and to rearrange the conditions to prevent ongoing propagation of the infection. Often, breaches in good practice are responsible, although sometimes other factors (such as construction) may be the source of the problem.
 
  
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==Training in infection control and health care epidemiology==
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;Killing germs on your hands decreases your immunity:''This is a myth''
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Practitioners can come from several different educational streams. Many begin as nurses, some as medical technologists (particularly in clinical microbiology), and some as physicians (typically infectious disease specialists). Specialized training in infection control and health care epidemiology are offered by the professional organizations described below. Physicians who desire to become infection control practitioners often are trained in the context of an infectious disease fellowship.
 
  
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In the United States, [http://www.cbic.org Certification Board of Infection Control and Epidemiology] is a private company that certifies infection control practitioners based on their educational background and professional experience, in conjunction with testing their knowledge base with standardized exams. The credential awarded is CIC, Certification in Infection Control and Epidemiology. One must have 2 years of Infection Control experience in order to sit for the boards. Certification must be renewed every five years.
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The [[skin]] on your body is covered with microorganisms. Our environment is contaminated with good and bad microorganisms. You cannot kill all of the microorganisms on your hands. Your [[large intestine]] contains large numbers of microorganisms. All of these sources of germs stimulate your [[immune response]]. [[Centers for Disease Control and Prevention|CDC]] guidelines for health care workers call for [[alcohol rub]]s to be used 60 or more times a day between patients and after touching contaminated surfaces. Killing germs on your hands will not decrease your immunity but it will help prevent disease.<ref name="hhforhw"/>
  
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A [http://www.shea-online.org/about/shea_courses.cfm course] in hospital epidemiology (infection control in the hospital setting) is offered jointly each year by the Centers for Disease Control and Prevention (CDC) and the Society for Healthcare Epidemiology of America.
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;Alcohol rub hand sanitizers do not kill germs:''This is misinformation''
  
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http://www.apic.org/ offers a training course for practitioners called EPI 101 and 102.
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Hand sanitizers containing a minimum of 60 to 95% [[alcohol]] are very efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria ([[MRSA]] and [[VRE]]), [[tuberculosis]], and [[viruses]] (including [[HIV]], [[herpes]], [[RSV]], [[rhinovirus]], [[vaccinia]], [[influenza]], and [[hepatitis]]) and [[fungus]]. Alcohol rub sanitizers containing 70% alcohol kill 3.5 log<sub>10</sub> (99.9%) of the bacteria on hands 30 seconds after application and 4 to 5 log<sub>10</sub> (99.99 to 99.999%) of the bacteria on hands 1 minute after application. Alcohol rub sanitizers can prevent the transfer of health-care associated pathogens ([[Gram-negative bacteria]]) better than soap and water. Alcohol rub sanitizers are not appropriate for use when your hands are visibly dirty, soiled or contaminated with blood. Use soap and water for dirty or soiled hands.<ref name="hhforhw"/>
  
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== Footnotes ==
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;Don’t kill the good germs &mdash; the good germs protect our hands from the bad germs:''This is a myth''
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{{reflist}}
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Good germs are microorganisms normally found on human skin and bad germs are [[pathogenic]] (disease producing) microorganisms. The numbers of good germs and bad germs on the hands are variable from one person to the next but remain relatively constant for each individual. Good germs cannot protect you against bad germs. Anyone can become contaminated with bad germs (pathogens). Bad germs (pathogens) do not always cause disease and good germs can, under the right conditions, cause disease.<ref>{{cite journal |author=Schaberg DR, Culver DH, Gaynes RP |title=Major trends in the microbial etiology of nosocomial infection |journal=Am. J. Med. |volume=91 |issue=3B |pages=72S–75S |year=1991 |pmid=1928195 |doi= |doi=10.1016/0002-9343(91)90346-Y}}</ref><ref>{{cite journal |author=Richet H, Hubert B, Nitemberg G, ''et al'' |title=Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients |journal=J. Clin. Microbiol. |volume=28 |issue=11 |pages=2520–5 |year=1990 |pmid=2254429 |doi=}}</ref>
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;Alcohol will dissolve the natural oils on your skin and cause dry skin:''This is true''
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Frequent use of alcohol-based formulations for hand sanitizers can cause [[dry skin]] unless [[emollient]]s and/or skin [[moisturizer]]s are added to the formula. The drying effect of alcohol can be reduced or eliminated by adding [[glycerin]] and/or other emollients to the formula. In several prospective clinical trials, alcohol based hand sanitizers containing emollients caused substantially less skin irritation and dryness than soaps or antimicrobial [[detergents]]. [[Allergic contact dermatitis]], contact [[urticaria]] syndrome or hypersensitivity to alcohol or additives present in alcohol hand rubs rarely occurs.<ref name="hhforhw"/><ref name="act_safe_as_ag"/>
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;Alcohol rubs cause (bacterial) mutation and resistance:''This is misinformation''
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Dead microorganisms don’t [[mutate]]. Alcohol rubs (biocides) kill microorganisms. Current scientific evidence has not shown a link exists between the use of topical antimicrobial formulations and [[antiseptic]] or [[antibiotic]] resistance. Antiseptics (biocides) have multiple (thousands) of nonspecific killing sites on and in the microbial cell which cannot easily mutate. Antibiotics and antibacterial soaps ([[triclosan]]) have one very specific killing site on and in the microbial cell which can easily mutate. Antibiotic resistance has no effect on the effectiveness of antiseptics.<ref>{{cite journal |author=Jones RD |title=Bacterial resistance and topical antimicrobial wash products |journal=Am J Infect Control |volume=27 |issue=4 |pages=351–63 |year=1999 |pmid=10433675 |doi= |doi=10.1016/S0196-6553(99)70056-8}}</ref><ref>{{cite journal |author=Barry AL, Fuchs PC, Brown SD |title=Lack of effect of antibiotic resistance on susceptibility of microorganisms to chlorhexidine gluconate or povidone iodine |journal=Eur. J. Clin. Microbiol. Infect. Dis. |volume=18 |issue=12 |pages=920–1 |year=1999 |pmid=10691210 |doi= |doi=10.1007/s100960050434}}</ref>
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;Alcohol rub and combination hand sanitizers kill germs better than soap and water:''This is true''
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Alcohol rubs and combination hand sanitizers are effective at killing germs on your hands, but not effective at removing dirt. Conversely, soap and water are very effective at cleaning dirty or soiled hands, but are not good at killing germs (as discussed above).<ref>{{cite web| url = http://www.cec.health.nsw.gov.au/pdf/AlcoholHandRub061013.pdf| title = Alcohol Hand Rub and Hand Hygiene | accessdate=2007-04-27 | publisher= Clinical Excellence Commission, Health, New South Wales, Australia }}</ref>
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;Alcohol rubs with two germ killers are significantly more effective germ killers than alcohol rubs with one germ killer:''This is true''
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Many clinical studies have shown that alcohol rubs containing two germ killers (ie. Alcohol and [[Chlorhexidine gluconate]] or [[Benzalkonium chloride]]) are significantly better germ killers than alcohol rubs containing alcohol alone.<ref name="act_safe_as_ag">{{cite journal |author=Hibbard JS |title=Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review |journal=J Infus Nurs |volume=28 |issue=3 |pages=194–207 |year=2005 |pmid=15912075 |doi= |doi=10.1097/00129804-200505000-00008}}</ref>
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==Hand washing as compensation==
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Excessive hand washing is commonly seen as a symptom of [[obsessive-compulsive disorder]] (OCD).
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It has also been found that people, after having recalled or contemplated unethical acts, tend to wash hands more often than others, and tend to value hand washing equipment more. Furthermore, those who are allowed to wash their hands after such a contemplation are less likely to engage in other "cleansing" compensatory actions, such as volunteering.<ref>Benedict Carey. [http://www.nytimes.com/2006/09/12/health/psychology/12macbeth.html Lady Macbeth Not Alone in Her Quest for Spotlessness.] ''[[The New York Times]]'', 12 September 2006</ref><ref>{{cite journal |author=Zhong CB, Liljenquist K |title=Washing away your sins: threatened morality and physical cleansing |journal=Science |volume=313 |issue=5792 |pages=1451–2 |year=2006 |pmid=16960010 |doi=10.1126/science.1130726}}</ref>
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==Symbolic hand washing==
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[[Image:Tsukubai2.JPG|Tsukubai|thumb|[[Tsukubai]], provided at a Japanese temple for symbolic hand washing and mouth rinsing]]
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[[Ritual purification|Ritual handwashing]] is a feature of many religions, including [[Bahá'í Faith]], [[Hinduism]] and [[Ablution in Judaism|tevilah and netilat yadayim]] in [[Judaism]].  Similar to these are the practises of [[Lavabo]] in [[Christianity]], [[Wudu]] in [[Islam]] and [[Misogi]] in [[Shintō]].
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== Idioms ==
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When someone "washes their hands of" something, this means that they are declaring their unwillingness to take responsibility for it or share complicity in it.  [[Gospel of Matthew|Matthew]] 27:24 gives an account of [[Pontius Pilate]] washing his hands of the decision to crucify [[Jesus]]:  "When Pilate saw that he could prevail nothing, but that rather a tumult was made, he took water, and washed his hands before the multitude, saying, I am innocent of the blood of this just person: see ye to it."
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In [[Shakespeare]]'s [[Macbeth]], [[Lady Macbeth (Shakespeare)|Lady Macbeth]] begins to compulsively wash her hands in an attempt to cleanse an imagined stain, representing her guilty conscience regarding crimes she had committed and led her husband to commit.
  
 
== See also ==
 
== See also ==
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* [[Infectious disease]]
 
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* [[body substance isolation]]
 
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* [[Nosocomial infection]]
 
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* [[Public health]]
 
  
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==External links==
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* [[Antibacterial soap]]
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* [http://www.apic.org Association for Professionals in Infection Control and Epidemiology] is primarily composed of infection  prevention and control professionals with nursing or medical technology backgrounds
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* [[Escherichia coli O157:H7|E. coli O157:H7]]
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* [http://shea-online.org The Society for Healthcare Epidemiology of America] is more heavily weighted towards practitioners who are physicians or doctoral-level epidemiologists.
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* [[Antibiotic resistance]]
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* [http://www.comtec-presentations.com/icna The 37th Annual Infection Control Conference, September 24th to 26th 2007, The Brighton Centre, Brighton, England
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* [[Ignaz Semmelweis]]
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* [http://www.safechemdirect.co.uk Manufacturer of Infection Control Cleansers.
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* [[Soap dispenser]]
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* [http://www.handwashinghelp.com HandwashingHelp.com] Handwashing and handwashing signal information.
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== References ==
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{{reflist|2}}
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== External links ==
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* [http://www.cdc.gov/handhygiene/ Centers for Disease Control on hand hygiene in healthcare settings]
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* [http://www.handhygiene.net/handwashing.html Good Hand Washing Techniques]
  
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[[Category:Epidemiology]]
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[[Category:Hygiene]]
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[[Category:Medical hygiene]]
  
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[[ja:感染管理]]
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[[de:Händedesinfektion]]
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[[fr:Hygiène des mains]]
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[[mn:Гар угаалт]]
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[[ja:手洗い]]
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[[simple:Hand washing]]
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[[sv:Handtvagning]]

Revision as of 15:20, 16 May 2008

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Schoolchildren washing their hands before eating lunch.

Hand washing is the act of cleansing the hands with water or another liquid, with or without the use of soap or other detergents, for the sanitary purpose of removing soil and/or microorganisms.

Purpose

An example of how minuscule particles can be caught between dermal ridges in the hand, yet remain unseen by the naked eye. Washing one's hands removes such contaminants.

The main purpose of washing hands is to cleanse the hands of pathogens (including bacteria or viruses) and chemicals which can cause personal harm or disease. This is especially important for people who handle food or work in the medical field. The Centers for Disease Control and Prevention (CDC) has stated that "It is well-documented that the most important measure for preventing the spread of pathogens is effective handwashing." A large body of research is available on the topic.[1]

While hot water may more effectively clean your hands, this is primarily due to its increased capability as a solvent, and not due to hot water actually killing germs. Hot water is more effective at removing dirt, oils and/or chemicals, but contrary to popular belief, it does not kill microorganisms. A temperature that is comfortable for hand washing (about Template:Convert) is not nearly hot enough to kill any microorganism. It takes a much higher temperature to effectively kill germs (typically Template:Convert).

Personal hand washing

To maintain good hygiene, hands should always be washed after using the toilet, changing a diaper, tending to someone who is sick, or handling raw meat, fish, or poultry, or any other situation leading to potential contamination. Hands should also be washed before eating, handling or cooking food. Conventionally, the use of soap and warm running water and the washing of all surfaces thoroughly, including under fingernails is seen as necessary. One should rub wet, soapy hands together outside the stream of running water for at least 20 seconds, before rinsing thoroughly and then drying with a clean or disposable towel.& After drying, a dry paper towel should be used to turn off the water (and open the exit door if one is in a restroom or other separate room). Moisturizing lotion is often recommended to keep the hands from drying out, should one's hands require washing more than a few times per day.&

Antibacterial soaps have been heavily promoted to a health-conscious public. To date, there is no evidence that using recommended antiseptics or disinfectants selects for antibiotic-resistant organisms in nature.& However, antibacterial soaps contain common antibacterial agents such as Triclosan, which has an extensive list of resistant strains of organisms. So, even if antibacterial soaps do not select for antibiotic resistant strains, they might not be as effective as they are marketed to be. These soaps are quite different from the non-water-based hand hygiene agents referred to below, which also do not promote antibiotic resistance.&

Medical hand washing

Microbial growth on a cultivation plate without procedures (A), after washing hands with soap (B) and after disinfection with alcohol (C).

The purpose of hand washing in the health care setting is to remove or destroy (disinfect) pathogenic microorganisms ("germs") to avoid transmitting them to a patient. The application of water alone is ineffective for cleaning skin because water is unable to remove fats, oils, and proteins, which are components of organic soil. Therefore, removal of microorganisms from skin requires the addition of soaps or detergents to water. Plain soap does not kill pathogens. However, the addition of antiseptic chemicals to soap ("medicated" or "antimicrobial" soaps) does confer killing action to a hand washing agent. Such killing action may be desired prior to performing surgery or in settings in which antibiotic-resistant organisms are highly prevalent.&

The proper washing of hands in a medical setting generally consists of the use of generous amounts of soap and water to lather and rub each part of ones hands systematically for 15 to 20 seconds. Hands should be rubbed together with digits interlocking. If there is debris under fingernails, a bristle brush is often used to remove it. Finally, it is necessary to rinse well and wipe dry with a paper towel. After drying, a dry paper towel should be used to turn off the water (and open any exit door if necessary).

To 'scrub' one's hands for a surgical operation, a tap that can be turned on and off without touching with the hands, some chlorhexidine or iodine wash, sterile towels for drying the hands after washing, and a sterile brush for scrubbing and another sterile instrument for cleaning under the fingernails are required. All jewellery should be removed. This procedure requires washing the hands and forearms up to the elbows, and one must in this situation ensure that all parts of the hands and forearms are well scrubbed several times. When rinsing, it is ensured at all times that one does not allow water to drip back from the elbow to your hands. When done hands are dried with a sterile cloth and a surgical gown is donned.

In the late 1990s and early part of the 21st century, non-water-based hand hygiene agents (also known as alcohol-based hand rubs, antiseptic hand rubs, or hand sanitizers) began to gain popularity. Most are based on isopropyl alcohol or ethanol formulated together with a thickening agent such as Carbomer, and a humectant such as glycerin into a gel, liquid, or foam for ease of use and to decrease the drying effect of the alcohol. The increasing use of these agents is based on their ease of use, rapid killing activity against microorganisms, and lower tendency to induce irritant contact dermatitis as compared to soap and water hand washing. Despite their effectiveness, the non-water agents do not clean hands of organic material, they simply disinfect them. However, disinfection does prevent transmission of infectious microorganisms.

Visible soiling of any sort on the hands must be washed with soap and water because alcohol-based hand rubs are ineffective in the presence of organic material. In addition, alcohols are ineffective against non-lipid-enveloped viruses (e.g., Noroviruses) and the spores of bacteria (e.g., Clostridium difficile) and protozoa (e.g., Giardia lamblia). When such microorganisms are likely to be encountered, soap and water hand washing is preferable.

The New England Journal of Medicine reports that lack of hand washing remains at unacceptable levels in most medical environments, with large numbers of doctors and nurses routinely forgetting to wash their hands before touching patients.& One study has shown that proper hand washing and other simple procedures can decrease the rate of catheter-related bloodstream infections by 66 percent.&

Truths, myths, and misinformation

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Alcohol-free hand sanitizers are not as effective as alcohol hand rubs
This is misinformation

The efficacy of alcohol-free hand sanitizers are heavily dependent on their ingredients and formulation. In the past, alcohol-free hand sanitizers tended to significantly under-perform alcohol or alcohol rubs as germ killers in clinical studies using standard protocols such as EN1500. More recently, advanced formulations have been developed, some of which have been shown to out-perform alcohol. A further aspect of efficacy that is sometimes overlooked is the effect of repeated use. The efficacy of alcohol as a hand disinfectant has been shown to decrease after repeated use, thought to be due to progressive adverse skin reactions, whereas the efficacy of an alcohol-free hand sanitizer based on Benzalkonium Chloride as its active ingredient has been shown to increase with repeated use. &

Washing your hands with soap and water kills germs
This is misinformation

Plain soaps have minimal if any antimicrobial activity. In several clinical studies, hand washing with plain soap failed to remove bad microorganisms (pathogens) from the hands of hospital personnel. Hand washing with plain soap can result in an increase in bacterial counts on the skin. Occasionally, contaminated plain soaps have colonized hands with Gram-negative bacteria.&

Killing germs on your hands decreases your immunity
This is a myth

The skin on your body is covered with microorganisms. Our environment is contaminated with good and bad microorganisms. You cannot kill all of the microorganisms on your hands. Your large intestine contains large numbers of microorganisms. All of these sources of germs stimulate your immune response. CDC guidelines for health care workers call for alcohol rubs to be used 60 or more times a day between patients and after touching contaminated surfaces. Killing germs on your hands will not decrease your immunity but it will help prevent disease.&

Alcohol rub hand sanitizers do not kill germs
This is misinformation

Hand sanitizers containing a minimum of 60 to 95% alcohol are very efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza, and hepatitis) and fungus. Alcohol rub sanitizers containing 70% alcohol kill 3.5 log10 (99.9%) of the bacteria on hands 30 seconds after application and 4 to 5 log10 (99.99 to 99.999%) of the bacteria on hands 1 minute after application. Alcohol rub sanitizers can prevent the transfer of health-care associated pathogens (Gram-negative bacteria) better than soap and water. Alcohol rub sanitizers are not appropriate for use when your hands are visibly dirty, soiled or contaminated with blood. Use soap and water for dirty or soiled hands.&

Don’t kill the good germs — the good germs protect our hands from the bad germs
This is a myth

Good germs are microorganisms normally found on human skin and bad germs are pathogenic (disease producing) microorganisms. The numbers of good germs and bad germs on the hands are variable from one person to the next but remain relatively constant for each individual. Good germs cannot protect you against bad germs. Anyone can become contaminated with bad germs (pathogens). Bad germs (pathogens) do not always cause disease and good germs can, under the right conditions, cause disease.&&

Alcohol will dissolve the natural oils on your skin and cause dry skin
This is true

Frequent use of alcohol-based formulations for hand sanitizers can cause dry skin unless emollients and/or skin moisturizers are added to the formula. The drying effect of alcohol can be reduced or eliminated by adding glycerin and/or other emollients to the formula. In several prospective clinical trials, alcohol based hand sanitizers containing emollients caused substantially less skin irritation and dryness than soaps or antimicrobial detergents. Allergic contact dermatitis, contact urticaria syndrome or hypersensitivity to alcohol or additives present in alcohol hand rubs rarely occurs.&&

Alcohol rubs cause (bacterial) mutation and resistance
This is misinformation

Dead microorganisms don’t mutate. Alcohol rubs (biocides) kill microorganisms. Current scientific evidence has not shown a link exists between the use of topical antimicrobial formulations and antiseptic or antibiotic resistance. Antiseptics (biocides) have multiple (thousands) of nonspecific killing sites on and in the microbial cell which cannot easily mutate. Antibiotics and antibacterial soaps (triclosan) have one very specific killing site on and in the microbial cell which can easily mutate. Antibiotic resistance has no effect on the effectiveness of antiseptics.&&

Alcohol rub and combination hand sanitizers kill germs better than soap and water
This is true

Alcohol rubs and combination hand sanitizers are effective at killing germs on your hands, but not effective at removing dirt. Conversely, soap and water are very effective at cleaning dirty or soiled hands, but are not good at killing germs (as discussed above).&

Alcohol rubs with two germ killers are significantly more effective germ killers than alcohol rubs with one germ killer
This is true

Many clinical studies have shown that alcohol rubs containing two germ killers (ie. Alcohol and Chlorhexidine gluconate or Benzalkonium chloride) are significantly better germ killers than alcohol rubs containing alcohol alone.&

Hand washing as compensation

Excessive hand washing is commonly seen as a symptom of obsessive-compulsive disorder (OCD).

It has also been found that people, after having recalled or contemplated unethical acts, tend to wash hands more often than others, and tend to value hand washing equipment more. Furthermore, those who are allowed to wash their hands after such a contemplation are less likely to engage in other "cleansing" compensatory actions, such as volunteering.&&

Symbolic hand washing

Tsukubai, provided at a Japanese temple for symbolic hand washing and mouth rinsing

Ritual handwashing is a feature of many religions, including Bahá'í Faith, Hinduism and tevilah and netilat yadayim in Judaism. Similar to these are the practises of Lavabo in Christianity, Wudu in Islam and Misogi in Shintō.

Idioms

When someone "washes their hands of" something, this means that they are declaring their unwillingness to take responsibility for it or share complicity in it. Matthew 27:24 gives an account of Pontius Pilate washing his hands of the decision to crucify Jesus: "When Pilate saw that he could prevail nothing, but that rather a tumult was made, he took water, and washed his hands before the multitude, saying, I am innocent of the blood of this just person: see ye to it."

In Shakespeare's Macbeth, Lady Macbeth begins to compulsively wash her hands in an attempt to cleanse an imagined stain, representing her guilty conscience regarding crimes she had committed and led her husband to commit.

See also

References

  1. ↑ Hand washing from Mayo Clinic
  2. ↑ Hand washing from Tufts University
  3. ↑ Template:Cite journal
  4. ↑ Clean hands from the CDC
  5. ↑ WHO Guidelines on Hand Hygiene in Health Care
  6. ↑ Template:Cite journal
  7. ↑ Template:Cite journal
  8. ↑ AORN; Dyer, etal; Aug 1998; VOL 68, No2;http://www.aornjournal.org/article/abstracts?terms1=&terms2=&terms3=
  9. ↑ 9.0 9.1 9.2 9.3 "Hand Hygiene for Healthcare Workers". LearnWell Resources, Inc, a California nonprofit public benefit 501(c)(3) corporation. http://www.learnwell.org//handhygiene.htm. Retrieved 2007-04-27.
  10. ↑ Template:Cite journal
  11. ↑ Template:Cite journal
  12. ↑ 12.0 12.1 Template:Cite journal
  13. ↑ Template:Cite journal
  14. ↑ Template:Cite journal
  15. ↑ "Alcohol Hand Rub and Hand Hygiene". Clinical Excellence Commission, Health, New South Wales, Australia. http://www.cec.health.nsw.gov.au/pdf/AlcoholHandRub061013.pdf. Retrieved 2007-04-27.
  16. ↑ Benedict Carey. Lady Macbeth Not Alone in Her Quest for Spotlessness. The New York Times, 12 September 2006
  17. ↑ Template:Cite journal

External links

de:Händedesinfektion fr:Hygiène des mains mn:Гар угаалт ja:手洗い simple:Hand washing sv:Handtvagning

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