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HAND HYGIENE
maintaining healthy skin condition by keeping the skin soft and supple and avoiding dryness, soreness and cracking, especially when hands are washed frequently.
When to cleanse and when to sanitise
According to the BHTA, there needs to be more education and awareness regarding the appropriate use of soap and water and alcohol based hand sanitisers. There must be a clear understanding of how and when these different applications should be used. Hand cleansing: using the correct technique with mild soap and water and then drying hands with paper towels is the best policy to help prevent the spread of germs, and for cleaning visible dirt from hands as well as many bacteria and viruses. Hand sanitising: with an alcohol based
sanitiser, with a minimum of 60% alcohol as an active ingredient, can be a very good substitute to washing hands provided hands are not actually dirty, for use without water, to kill germs and provide a high level of hand hygiene and skin disinfection on visibly clean hands.1
The World Health Organization (WHO) claims that ‘hand sanitising may be of benefit when used after hand cleansing but it should not be regarded as a substitute for soap and water since sanitisers will not remove any contamination from the hands. It should therefore be remembered that alcohol sanitisers are not suitable for use on hands that are dirty, contaminated and soiled, e.g. faeces and secretions, or during outbreaks of diarrhoeal illness, e.g. norovirus and C difficile. In these instances, washing hands with mild soap and water is necessary.2
What type of soap and sanitisers do I need to be using?
There is a common misconception that anti- bacterial soaps provide a better level of protection than ordinary soaps and therefore should be used widely. In reality, infection control nurses advocate that the use of a
mild soap (preferably dermatologically tested), which is kind to the hands and therefore encourages regular hand washing, coupled with good hand washing technique is much more important than the use of an anti-bacteria soap.
In a study which split a thousand households into two groups, one group received anti-bacterial cleaning soaps and the other plain soaps. Neither the researchers nor the participants knew which type of soap they were using. “In terms of infection rates and sickness, we found absolutely no difference between anti- bacterial soap and regular soap,” said Dr Elaine Larson, director of the Centre of Disciplinary Research on Anti-Microbial Resistance at Colombia University. Anti-bacterial soap is not recommended for wide use as there is a concern that germs will develop resistance and those using it will become lazy from using high-tech soaps. It is however recommended that Anti-bacterial soap is to be used in certain high risk areas such as food preparation and handling areas, in surgical conditions, treatment rooms and clinical areas.
The risk, when using low specification soaps, is that they can contain harsh chemicals which irritate the skin, leading to drying out, cracking, and redness which in turn can cause occupational dermatitis. This then leads to less regular hand washing for fear of exacerbating the problem and hand hygiene levels deteriorate, hence the importance of using a good quality mild soap.3,4
How much alcohol should a hand sanitiser contain?
The Centres for Disease Control and Prevention (CDC) in the USA says that washing hands with soap and water is the best way to reduce the number of microbes on them in most situations. If soap and water are not available it is recommended to use an alcohol based hand sanitiser that contains at least 60% alcohol as the active ingredient and use enough to cover all surfaces of the hands and fingers to achieve effective disinfection. The average hand sanitiser contains about 62% alcohol.
Which type of soap dispensers should I be using?
There are two main types of soap dispensers, safe sealed cartridge systems and bulk fill or refillable dispensers and it is really important to understand why one is so much more hygienic than the other. We wash our hands with soap to kill germs and bacteria, however if we are using soap from a bulk-fill or refillable soap dispenser we could be washing our hands with contaminated soap as bulk-fill soap dispensers are a breeding ground for bacteria and are often inadequately cleaned. The issue is you can’t always see the harmful germs and bacteria, but they can result in the risk of germs spreading. Refillable bulk dispensers can leave hands with 25 times more bacteria after washing. Once the lid is removed and refilled with soap, airborne germs and bacteria can enter the reservoir and can contaminate the soap. Dispensers are rarely cleaned and filled correctly and there is an increased risk of spreading germs and bacteria by washing hands with contaminated soap.
There are typically more bacteria in a bulk filled soap dispenser than in a toilet in the same bathroom. The Centre for Disease Control and Prevention (CDC) warns do not add soap to a partially empty soap dispenser. This practise of topping off dispensers can lead to bacterial contamination of soap. The safe alternative to bulk fill dispensers are hygienically sealed cartridge systems which are ultra-sonically airtight being free from complete air and gases for maximum hygiene.
Hygienic hand drying
We often say that hand washing is the key to preventing the spread of illness. But wet hands increase the risk of transmitting bacteria, “so drying is an equally important
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