Thorough hand washing can have a steep price
Frequent hand washing is recognized as one of the single most important factors in preventing nosocomial infections and the costs associated with them. But that prevention can come with a high price tag, according to an ICU-based study.1
The authors explain that negligence isn’t the reason most health care workers don’t wash their hands. Rather, it most often is due to limitations on time and convenience lack of a nearby sink and pressure to provide care in an environment where resources are stretched. And according to the model they constructed, if all workers followed hand washing guidelines, an ICU could lose the equivalent of two full-time employees per shift. A less costly alternative they suggest is alcoholic hand disinfection.
Based on published literature and the structure of an ICU at a university hospital in the Netherlands, the authors developed a model to predict the time health care workers spent daily on hand washing. They noted levels of compliance, duration of hand disinfection, and use of medicated soap or alcoholic rub. The model was adapted to a 14-bed ICU with 12 workers and used the following baseline variables: 40% compliance, two to three hand disinfections per health care worker per hour, and disinfection duration of 40 to 80 seconds for hand washing and 20 seconds for alcoholic hand disinfection.
Hand washing duration included time spent walking from the patient to the sink, turning on and adjusting the tap, washing and drying hands, and returning to the patient. Alcoholic hand disinfection times were based on a bedside dispenser. Workers were asked to wash their hands after patient contact.
Minimum and maximum times were calculated for hand washing and alcoholic hand disinfection for 40%, 60%, and 100% compliance. For 40% compliance, between 2.1 and 6.4 hours per shift are devoted to hand washing, while only 1.1 to 1.6 hours would be necessary if only alcoholic hand disinfection were used. For 100% compliance, hand washing would require up to 16 hours, or two full-time nurse equivalents, while simple disinfection with alcohol would require only four hours.
Gloves can be as big a threat as unwashed hands, says John Boyce, MD, professor of medicine at Brown University in Providence, RI. At the conference of the American Society for Microbiology earlier this year, he reported on a study in which hospital workers donned gloves picked up in the rooms of patients with bacterial infections. The gloves were analyzed and found to contain the same bacteria as was infecting the patients.
Reference
1. Voss A, Widmer AF. No time for handwashing? Handwashing versus alcoholic rub: Can we afford 100% compliance? Infect Control Hosp Epidemiol 1997; 18:205-208.
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