New updated guidelines on hand hygiene to prevent healthcare-associated infections (HCAIs) draw attention to fingernails, sinks and sink drains and dry/cracked hands as likely sources of infection. These new recommendations were released earlier this week by five leading organizations - Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA) and the Joint Commission and are published in the journal Infection Control & Hospital Epidemiology.¹

While reiterating the need to perform hand hygiene as recommended by the WHO/CDC, the updated guidelines highlight clean nails and healthy hand skin as an essential practice.

Hand nails should be trimmed and not kept longer than the fingertips. Healthcare practitioners, especially those engaged in intensive care and in perioperative areas should not wear artificial nails. Specifically, those who are part of the surgical teams or work in perioperative areas or ICUs should avoid wearing nail polish or gel shellac. Chipped nails and artificial nails, can harbor microorganisms.

Alcohol-based hand sanitizers containing at least 60% alcohol should be used for routine hand hygiene. There should be one dispenser in the patient room and one in the hallway.

“Maintaining healthy skin is a crucial element of hand hygiene”, note the authors. Too frequent and too much of hand washing can cause the skin to become dry and develop cracks, predisposing to cuts and infections. 

Gloves should be worn at all times when in contact with patients or their immediate surroundings especially when pathogens like Clostridium difficile and noroviruses are suspected. However, the HCP should bear in mind the likelihood of self-contamination and environmental contamination with gloves. Needless to say, hands should be cleaned immediately after removing gloves.

“Premise plumbing” (hospital sinks) has also been now recognized as a source of contamination. Hence, sinks should be used only for handwashing as much as possible. Substances that encourage formation of biofilms, such as food, beverages, IV solutions, medications, human waste, should not be discarded in handwashing sinks to prevent aerosolization of infectious organisms and environmental contamination. Sink bowls and drains should be cleaned every day using EPA approved disinfectants that can remove biofilms to prevent/reduce the risk of environmental transmission of pathogens in the biofilms.

The guideline further recommends against use of individual pocket-sized hand sanitizers. Instead, sanitizer dispensers should be “visible and accessible” to healthcare workers. Single use dispensers for sanitizers, soaps or moisturizers should not be refilled. Use of triclosan-containing antimicrobial soaps should be avoided.

The new guidelines are an update of the earlier published 2014 guidelines “Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene”.

Reference

1. Glowicz JB, et al. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol. 2023 Feb 8;1-22. doi: 10.1017/ice.2022.304.