Hand Hygiene

March 1, 2009 | Aging Services Risk, Quality, & Safety Guidance


According to the Centers for Disease Control and Prevention (CDC), proper hand hygiene by healthcare workers is the most important practice for preventing healthcare-associated infections. In its October 2002 guideline on hand hygiene in healthcare settings, CDC recommends the use of alcohol rubs as the preferred method for routine decontamination of healthcare workers’ hands; however, soap-and-water handwashing is also permitted or required if hands appear visibly soiled. In 2005, the World Health Organization (WHO) issued hand hygiene recommendations that are almost identical to those issued by CDC. Several organizations have endorsed CDC and WHO recommendations, including the Joint Commission, which requires accredited facilities to implement CDC or WHO category I recommendations under its National Patient Safety Goal for controlling the spread of healthcare-associated infections.

Each year, about 2 million individuals develop a healthcare-associated infection, about 90,000 of whom die. Rates of healthcare-associated infections in long-term care facilities are similar to rates in acute care settings. Because of factors such as age-related decline in immunity, immobility, incontinence, use of multiple medications, and high dependence on healthcare workers for activities of daily living, older adults in long-term care settings are at a high risk of infection. Infections are the leading cause of resident transfers to hospitals, resulting in hospital costs totaling about $673 million to $2 billion each year. (Smith et al. “SHEA/APIC”) Overall, treating healthcare-associated infections totals more than $30 billion in preventable healthcare costs per year (The Leapfrog Group).

Despite the focus on hand hygiene as an important resident safety practice, compliance is often low, and data indicates that compliance rates among healthcare workers are below 50% (Littau). Some research indicates that compliance rates among long-term care workers may be lower than among other healthcare workers (Smith et al. “Hand Hygiene”); recent studies found compliance rates of 15% (Smith et al. “Hand Hygiene”) and 18% (Pan et al.) among workers in long-term care facilities.

This Risk Analysis outlines standards and guidelines related to hand hygiene, such as those from CDC, WHO, the Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). In addition, barriers to hand hygiene compliance and strategies for improving compliance are discussed. (See Definitions for definitions of terms related to hand hygiene. ...

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