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Jodie Humphries
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23 Mar 2010

Hand hygiene in UK hospitals

Jodie Humphries

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Hand hygieneTackling Healthcare associated infections (HCAI) has always been a hot subject, but in July 2008, primary care, mental health, care and ambulance NHS trusts across England and Wales committed themselves to controlling infections by promoting hand hygiene to all healthcare workers.

Minimising the risks of infection to patients depends on a range of factors; hand hygiene is one important component in the battle against cross-infection. Just by increasing hand hygiene alone you can dramatically reduce the risk of a service user acquiring an infection.

HCAI are estimated to cost 5000 patients their lives and the NHS GBP£1 billion a year. They cause unnecessary suffering and anxiety, and may cause disability or death. Although not all of these infections are preventable, many are.

Such infections include bloodstream infections, surgical site infections, urinary tract infections and chest infections. Many of the micro-organisms that cause such infections can be transmitted on the hands of healthcare workers.

Every human being carries huge numbers of micro-organisms; even people who have no obvious infection will be carrying micro-organisms, which can be transferred on the hands of staff from one person to another and may, once transmitted, cause an infection.

Cleanyourhands campaign

The NHS trusts signed up to the National Patient Safety Agency's (NPSA's) award-winning cleanyourhands campaign, which has up until 2008 had predominantly focused on acute trusts.

The campaign was aimed at reducing the spread of preventable healthcare associated infections, such as MRSA and Clostridium Difficile (C. difficile), by improving the hand hygiene of healthcare workers. Staff are prompted to clean their hands using either alcohol handrub or soap and water at the critical time and place - where and when patient care is provided.

In 2008, 89 percent of primary care trusts, 83 percent of mental health trusts and 75 percent of care trusts have signed up in England and Wales, and it was particularly welcomed by ambulance trusts where 100 percent backed the campaign.

It meant that a variety of healthcare workers such as doctors, care assistants, allied health professionals, nurses, opticians, dentists, physiotherapists and paramedics in a wide range of settings, including community hospitals, clinics, health centres, and people's homes, now have access to the campaign's valuable promotional materials and support.

Speaking of the launch, Chief Executive, Martin Fletcher said, "Our aim is to make hand hygiene an integral part of day-to-day healthcare. The cleanyourhands campaign offers healthcare organisations the opportunity to address both the systems and behavioural factors that contribute to low compliance with hand hygiene. If effectively implemented, the campaign will improve the quality of care and contribute to the reduction of preventable infections."

Washing your hands

The application of water alone is inefficient for cleaning skin because water is often unable to remove fats, oils, and proteins, which are components of organic soil. The removal of microorganisms from skin requires the addition of soaps or detergents to water. Hand hygiene

Hand sanitizers containing a minimum of 60 to 95 percent alcohol are efficient germ killers. Alcohol rub sanitizers kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza, and hepatitis) and fungus.

Alcohol rub sanitizers can prevent the transfer of healthcare associated pathogens better than soap and water.

In the last results from the Health Protection Agency (HPA) on MRSA bloodstream infections and C. difficile infections from July 2007 to September 2009, it was shown that there was a decline.

Overall there has been a 57 percent decrease in the number of episodes reported of MRSA during the surveillance period in England, from 1083 cases in Q3/2007 (July to September) to 465 cases during the same time period in 2009.

For C.difficile, between Q3/2007 and Q3/2009, there was a 61 percent decrease in the counts of trust-apportioned episodes and a 40 percent decrease in the number of all other episodes.

Age-standardised rates for deaths involving MRSA were highest in males. Between 2007 and 2008, the age-standardised rate for deaths involving MRSA in males decreased from 26 to 18 per million population, a fall of 31 percent. In females the rate decreased, from 12 to 10 per million population, a fall of 13 percent over the same period, the Office for National Statistics states.

Most of the deaths involving MRSA were in the older age groups. Mortality rates in 2008 for deaths involving MRSA in the 85 and over age group were 659 and 236 deaths per million population for males and females respectively. In the under 45 age group, there was one death per million population for both males and females.

From April 2010, NHS organisations were set an objective for reducing MRSA infections, relative to the median, with the best-performers setting their objectives locally. The MRSA objective reflects a zero tolerance approach to preventable infections and the aim of reducing variation in performance on MRSA bloodstream infections.

No excuses on poor hand hygiene

Within the NHS, there is no excuses for poor hand hygiene, it puts life in danger. Simply washing your hands properly can make a lot of difference in people's lives - it can save them. Protocols in NHS hospitals aren't up to the standards that they should be, or people wouldn't still be dying from infections which are linked to hand hygiene.


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