Complete Guide to Hand Hygiene

Have you ever thought about how much work your hands actually do during the day, what they touch or even what they pick up along the way?

Cover your mouth when you cough! Wash your hands before you eat! No one would argue that hand hygiene is important. Keeping our hands clean is one of the most important steps we can take to avoid getting sick or spreading germs.

In any health-care or food setting, effective hand hygiene in conjunction with disposable glove use is the most important activity for preventing the spread of infection or contamination. ➀ 

The glove is a protective barrier between pathogens on the hands of glove wearers and the patient or food, but is a general disposable glove enough?

To put it simply… No! 

The human skin is a rich environment for microbes, consisting of around 1,000 species (Grice et al. 2009). The skin surface of human hands contains up to 10 million microorganisms (Price 1938), most of which are resident species. If the glove rips those microbes, or indeed viruses and bacteria, will transfer to contact surfaces. Glove punctures are usually undetected as they are microscopic and are dependant on the quality of the gloves. Therefore to prevent the transfer of pathogens to the contact surfaces, effective hand hygiene together with a good quality, medical grade, disposable glove is required.

 

LET'S TALK HAND HYGIENE

Eagle Protect has partnered with the “Guru of Hand Hygiene,” Barry Michaels, who brings over 50 years’ experience in the field of infectious disease investigation to push the research of disposable gloves farther than anyone ever has. What he has discovered is:

• GLOVE JUICE
  To oversimplify a complex topic, effective hand hygiene is essential because of the environment created within the disposable glove. Hands contain over 400 sweat glands per square centimetre. The nail region, the most difficult to get pristinely clean, contains the richest microbial flora. Any medical grade glove, whether it is nitrile or latex, will create an environment where oxygen levels decrease and skin maceration creates high microbial counts.
  

• LIQUID BRIDGE
  As explained by Barry Michaels in the Glove Hazard Analysis & Mitigation Strategies Research Study, ➁ the real problem occurs when, due to poor skin health and poor hand hygiene, organisms become resident on the hands. When this occurs, combined with a glove puncture what has been described as a “liquid bridge” of microbial contamination can flow to contact surfaces (Cole & Bernard 1964, Fox 1971). Studies have shown that up to 18,000 Staphylococci can pass through a single glove hole during a 20-minute period, even though the hands had been scrubbed for 10 minutes prior to gloving (Guzewich & Ross 1999). 

Medical grade gloves and hand hygiene go hand-in-hand; no pun intended!

The hazards outlined above are just a few of the reasons why hand hygiene plays an essential role in infection & cross-contamination prevention. The microbe promoting environment created inside gloves is inevitable, but there are ways to prevent the spread of disease. A combination of these interventions can be effective in the prevention of the transmission of viruses and bacteria in patients or food borne illnesses. 

 

CONSISTENCY IS THE KEY

The potential dangers of bad hand hygiene practises are obvious; an increased infection risk from the unavoidable close contact between staff, patients or food items. The main reasons given as to why hand hygiene practices are not performed include:

• lack of time and/
• or training, forgetfulness and lack of awareness
• Products/facilities

It is considered vital that all staff members are fully compliant in the process of hand hygiene practices. To avoid increased risks, hand hygiene practices must become consistent, comprehensive, repeated frequently and become second nature.

Using hand hygiene products, hands must be cleaned or disinfected frequently - especially at the following stages for both health & food industries:

• Before and after each session
• Before and after the removal of gloves and/or other PPE (Personal Protective Equipment)
• Following the washing of contaminated instruments or utensils
• Before contact with instruments or utensils that have been steam-sterilised (whether or not these instruments are wrapped)

The World Health Organization (WHO) recommends health-care workers to use the My 5 moments of Hand Hygiene to clean & disinfect their hands while The Food Standards of Australia & New Zealand states that the food handler should clean and disinfect their hands at these specific times.

 

USING CORRECT PROCEDURES

Follow correct hand-washing procedures, including washing around and under fingernails, to limit microbes exposed to the damp inner glove environment.

Since a lot of infections are spread by direct contact, washing your hands & then using an alcohol-based hand rub (ABHR) before touching another person is one of the best ways to help reduce infection in health-care settings. When working with food, a fragrance-free, alcohol-based hand rub can used before donning gloves. 

Hand disinfection procedures can also be carried out in any location without the need for water and washbasins. PPE equipment should be worn once correct hand hygiene steps have been completed.

1. Using the guide below, wash your hands with a liquid soap at the following times:

• When your hands are visibly dirty or contaminated with proteinaceous material, blood or other body fluids.
• At the beginning and end of each session.
• And of course, after a toilet break. ➂

When washing your hands, use sinks dedicated for hand washing purposes that are fitted with non-touch tap ware, or employ a non-touch technique. After hand washing, dry your hands using single-use linen or disposable paper towels (not using an air dryer). Did you know that hand washing alone can prevent about 30% of diarrhoea-related sicknesses and about 20% of respiratory infections (e.g., colds)? ➃ ➄

2. Apply the volume of ABHR specified by the manufacturer. Leave your hands to dry naturally; do not dry them with linen or paper towels. Follow the guide below to prevent transmission of infection.

Damaged skin harbours higher numbers of micro-organisms than intact skin, consequently the risk of skin infection and transmission of infection to others increases:

• Cover superficial cuts or open skin lesions with a waterproof dressing, even if gloves are worn over the affected area/s.
• Refrain from direct physical contact if you have an exudative lesion or weeping dermatitis on the lower arms, hands or face that cannot effectively be dressed to prevent transmission until the condition is resolved.
• Use an aqueous based hand moisturiser regularly to maintain skin health; compatible with the hand hygiene products used. ➂

It is vitally important to clean/rub every area of the hand including the fingernails and wrists. See below for useful guide:

3. Wear appropriate PPE for any procedure or activity associated with a risk of contamination. When gloves are required, they should:

• Fit properly for your hand size, not too tight & not too loose.
• Fingernails should be kept short and clean.
• Refrain from wearing nail polish, nail jewellery, artificial nails, and jewellery on the hands or arms.
• A new pair of gloves for each session.
• Replace gloves as soon as possible if they become soiled or damaged, do not wash gloves as this may damage glove integrity.
• For general procedures, wear non-sterile examination gloves that comply with AS/NZS 4011; or, when a sterile field is required, wear sterile gloves that comply with AS/NZS 4179.
  
  
  

THREE SIMPLE WAYS QUALITY GLOVES HELP HAND HYGIENE 

1. Review of the Type of Glove Touching Your Patient or Product
   Unlike Nitrile gloves and Latex gloves, vinyl glove molecules are not cross-linked leading to more holes in the glove film and higher levels of bacteria and virus permeation. Small holes and breaches to form in vinyl gloves during use will often go unnoticed and can result in measurements of 20,000 bacteria escaping within seconds.
   
   
2. Purchase a Good Quality Glove
   Glove manufacturers can reduce costs by using cheap raw materials which lower glove strength, flexibility, and durability, increasing the rate of glove failure both from the box and during food handling. Glove studies have shown that 50% - 96% of glove punctures go undetected by wearers, and because a single glove hole can release tens of thousands of bacteria from overly moist internal glove surfaces, this becomes an infection risk.  
   
   
3. Know the AQL
   Choose only disposable gloves that are medical grade, with an AQL 2.5 or less (2.5 glove failures per 100 gloves). Read more about AQL and how it affects food safety here. 

 

Contact our food safety experts to answer all your questions about improving your hand hygiene procedures through the correct use of disposable gloves and clothing. Eagle supplies medical grade disposable gloves and clothing to safeguard what matters, your staff, your business and your customers. 

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References:

1. World Health Organization. Infection Control. 2016.
2. Full details and references for all the information included here are taken from the Glove Hazard Analysis & Mitigation Strategies Research Study conducted by Barry Michaels. White Papers of this study are available upon request
3. New Zealand Dental Council. Infection Prevention & Control Practice Standards. May 2016
4. Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008;(1):CD004265.
5. Rabie T, Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health. 2006;11(3):258-67.