Bacterial count on skin rises after hand wash with soap: Study

Despite advances in infection control and hospital epidemiology,the message is not consistently translated into clinical practice on hand hygiene,Shastri,who led the study on ‘hand hygiene of health care workers’ (HCWS),said.

The study has shown the baseline hand washing frequency even by some of the doctors observed to be just nine per cent.

A study on hand hygiene practices in health care workers among all cadres of staff especially in critical care areas carried out for two months showed that HCWS do not adhere to hand hygiene which is crucial for patients’ safety.

Good hand hygiene is one of the most critical control strategies in disease outbreak management in hospitals and in the light of emergence of Methicillin Resistant Staphylococcus Aureus (MRSA) or superbug causing skin disease,resistant to all antibiotics,effective infection control measures,such as hand hygiene are essential to prevent nosocomial infections (hospital infection),Shastri told a reporter.

Hand hygiene prevents cross infections in hospitals but health care workers’ adherence to guidelines is poor,she said.

“We observed in our study that 52 per cent of the female HCWs had long nails and polish on them. This could be one of the reasons for high concentration of bacterial counts even after hand wash,” she said.

The sub-ungual areas of the hand harbor high concentration of bacteria. “Chipped nail polish may support the growth of large number of organisms on finger nails,” she said. It was also observed that 88 per cent of the HCWs had jewellery including rings,bangles and bracelets during hand wash.

Studies have shown that skin underneath rings is more heavily colonised by bacterial than comparable areas of skin on fingers without rings.

Some of the facts observed in hospital which were also shocking was that there was lack of awareness on hand hygiene.

There was absence of good quality antimicrobial liquid soaps,

no alcohol-based hand rub at bed side.

The HCWS were using wet and visibly dirty towels,newspaper cuttings were used as sterile papers to dry hands which released ink when in contact with wet skin.

Sinks were not fixed at proper height or were too small.

No elbow operated faucets were found,Shastri said.

This study was carried out in critical care areas (Medical,Surgical,and Neonatal & Pediatric ICUs) in a tertiary care hospital and the highest adherence to hand hygiene was observed in Neonatal and Pediatric ICUs and the least was observed in surgical ICUs.

Seventy HCWs were included in this study from all the critical care areas.

Lack of adherence and awareness was more in surgical ICUs among both doctors and nursing staff. In medical ICU the non adherence was more in nursing staff and physiotherapists.

Some of the recommendations of Microbiology Department include implementation of multidisciplinary programmes to improve adherence,make improved hand hygiene an institutional priority,provide antimicrobial liquid soaps with dispensers,provide sterile roll paper or clean towels to dry hands,construction of good sinks with elbow operated taps.

Alcohol-based hand rubs at each beside in all the ICUs.

Rewards to be given for compliance of hand hygiene if the public hospitals are working for the safety of the patients.