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On October 25, 2002, the Centers for Disease Control
and Prevention (CDC) issued its new “Guideline
for Hand Hygiene in Healthcare Settings: Recommendations
of the Healthcare Infection Control Practices Advisory
Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene
Task Force” <www.cdc.gov/handhygiene>.
This is a comprehensive (56 pages), well-referenced
document (423 references, 12 tables and figures) that
reminds us to do what all of our mothers long ago
admonished us to do: WASH YOUR HANDS!
Unfortunately too many of us have forgotten that simple
lesson. Depending upon the study, as few as 5 percent
(the overall average is 40 percent) of all health
care workers adhere to currently recommended hand-hygiene
procedures. Being a physician was associated with
a diminished compliance. Several studies have documented
the very clear relationship between poor attention
to hand-washing hygiene and health care-associated
infection rates.
The guideline acknowledges this consistently low compliance
with existing hand-washing policies and takes steps
for improvement in this public health hazard. Of importance
to the practice of anesthesiology is the endorsement
of the use of alcohol-based hand rubs to improve hand
hygiene practice.1 This
recommendation has particular pertinence to the practicing
anesthesiologist who is frequently in a situation
that demands hand washing (before and after a procedure
or placement of lines and after exposure to blood
or various body fluids) but is unable to leave the
bedside to go to a scrub sink. In this situation and
many others common to the practice of anesthesiology,
the guideline encourages the use of alcohol-based
hand rubs with persistent activity as a suitable substitute
for the traditional surgical scrub with antimicrobial
soap.
The guideline devotes considerable attention to the
impact of wearing gloves on adherence to hand-hygiene
practices. Anesthesiologists should be reminded that
gloves do not provide complete protection from hand
contamination. Bacterial flora and various viral pathogens
from patients can be recovered from the hands of as
many as 30 percent of health care workers who wore
gloves during patient contacts. The bottom line is
that hand-washing protocols must be followed regardless
of glove use.
The Task Force on Infection Control of the ASA Committee
on Occupational Health had been asked previously to
comment on the CDC document while it was in the preparatory
stage. Several of our suggestions and concerns were
addressed in the final form of the document. One of
our primary concerns remains that the frequent use
of alcohol-based hand washings might result in increased
occurrences of drying of the skin and contact dermatitis.
As many as 85 percent of health care workers report
skin problems that they ascribe to frequent use of
soaps and other detergents.2
Contact dermatitis is of particular concern to anesthesiologists
because disturbed integrity of the skin on the hands
may play a role in the increased risk of latex allergy
seen among anesthesia care providers.3
The guideline suggests that the addition of emollients
to the alcohol-based hand rub and the supplemental
use of hand lotions and creams can help to prevent
these occurrences of irritant contact dermatitis.
However, we remain concerned that the hand lotions
and creams recommended could exacerbate a susceptibility
to latex sensitization by further solubilizing the
allergens found in latex gloves.
This is an important and relevant guideline for anesthesiology
practice. The information is a useful supplement to
materials available in the ASA pamphlet “Recommendations
for Infection Control for the Practice of Anesthesiology.”
References:
1. Parienti JJ, et al. Hand-rubbing with an
aqueous alcoholic solution vs. traditional surgical
hand-scrubbing and 30-day surgical site infection
rates: A randomized equivalence study. JAMA.
2002: 288(6):722-727.
2. Larson E, et al. Prevalence and correlates
of skin damage on the hands of nurses. Heart
Lung. 1997; 26(5):404-412.
3. Brown RH, Schauble JF, Hamilton, RJ. Prevalence
of latex allergy among anesthesiologists: Identification
of sensitized but asymptomatic individuals.
Anesthesiology. 1998;89(2):292-299.
4. <www.asahq.org/publicationsAndServices/Infection/
infection_TOC.html>. |
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Jonathan D. Katz, M.D., is Clinical Professor
of Anesthesiology, Yale University School of
Medicine, New Haven, Connecticut. |
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FEATURES
2002 ASA Annual Meeting — Greetings From Orlando
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The views expressed herein are those of the authors and
do not necessarily represent or reflect the views, policies
or actions of the American Society of Anesthesiologists.
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