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Any shortcuts to clean hands?
19th of December 2017Hand hygiene is crucial in preventing the spread of illnesses, particularly in the food and healthcare sectors. And experts claim that an effective regime should take between 20-60 seconds. But is this viable, asks Ann Laffeaty? And are there any short cuts?
We all know how to wash our hands: in fact most of us do so several times each day. But it often takes place in the privacy of the washroom where no one is watching and may sometimes be a fairly
cursory affair.
However there are strict guidelines in hygiene-critical healthcare environments regarding the length of time that hand washing should take. The World Health Organisation (WHO) states that a healthcare worker’s visibly-soiled hands should be washed with soap and water for between 40 and 60 seconds.
Frequent and thorough hand washing is also strongly recommended in food processing and preparation areas. While there are no official guidelines here the general consensus is that it should take between 20-30 seconds.
Experts agree that in hygiene-critical environments the hands should be washed and dried after coughing, sneezing, eating, using the washroom, touching any part of the body, throwing anything away in the bin and before and after preparing food. In the healthcare sector hand washing should also take place before and after any patient interaction.
But since food preparation and healthcare workers are characterised by their hectic working lifestyles, how can they feasibly spend up to 60 seconds on hand hygiene after every one of these activities? How will they find the time to carry out their actual jobs? And can anything be done to speed up the process?
Metsä Tissue’s managing director Mark Dewick says his company fully supports WHO’s healthcare recommendations. “If the process is any less thorough it will remove fewer germs from the hands and heighten the risk of cross-contamination, which would defeat the object,” he said.
“At best this could result in staff sickness and at worst it might lead to the cross-infection of patients and all the dangers that brings. The whole point is to remove as many germs as you can so we would recommend completing the entire hand washing process as efficiently as possible and as often as necessary.”
Easy-to-use dispensers
However, the process can be eased in various ways he says. “For example, dispensers should be efficient and easy to use since if they don’t work properly, hand hygiene will take longer,” said Dewick.
“The choice of hand towel can also speed up the regime. A self-presenting towel will be easy to pick up whereas some towels - such as C-folds, for example – provide the user with nothing to grab on to. Worse still, some systems force the user to reach up inside the dispenser to take a towel. This slows up the process and has the potential to cause cross-contamination.”
He says a more absorbent towel can help to speed up hand drying. ”A softer towel will also prevent chafing and damage to the skin which will help to reduce staff absences,” he said. “However it is important to remember that a certain roughness is required in order to mechanically remove germs from the hands. A smooth material such as a textile handkerchief will not be as effective for hand drying as, say, an embossed hand towel.” Metsä’s new Katrin Windmill towels have an embossed surface for effective bacteria removal, he says.
Hand sanitisers add an extra level of protection, according to Dewick. “However, sanitisers should ideally be used as an additional step since washing and drying are key,” he said. “Sanitisers can be particularly helpful when there is no available supply of running water, for instance.”
A good layout in a hospital or food preparation area can help to improve hand hygiene efficiency he says. “The adequate provision of sinks, dispensers, towels and/or sanitisers will make it easier for staff to practise good hand hygiene while good training, simple instructions and easy-to-use information charts are also helpful,” he said.
“For example, the WHO chart features straightforward diagrams and these types of guides should be posted at the entrances to all hospital wards and clearly displayed in food preparation areas.”
Hand sanitiser dispensers can provide an effective hand hygiene shortcut in high-contact commercial environments according to Zenith Washrooms managing director Oliver Johnson. “These will give office workers an acceptable alternative in situations where hand washing is impractical,” he said.
“For example, sanitiser dispensers could be placed in reception areas and meeting rooms where people are likely to shake hands, exchange documents and remain in close proximity with each other for long periods of time.”
Explain why
He adds that it is important to provide explanations for the need for increased hand hygiene in such situations. “Providing statistics on infection control and guidance as to how to use the products will increase the use of hand sanitisers and may also help to reduce staff sickness,” he said.
Essity also supports the WHO hand hygiene recommendations according to product assortment director Gilles Betourne. “This protocol cannot be shortened in healthcare,” he said. “And while there are no official hand washing recommendations in the food sector, many national authorities discuss times of between 20 and 30 seconds.”
However he believes many people will hasten the process in everyday situations. “The WHO recommendations refer to best practice for effective germ removal - but even a quick wash is much better than no wash,” he said.
There should be no shortcuts when it comes to drying, according to Betourne. “Drying the hands helps to mechanically remove skin flakes and germs,” he said. “And if your hands are wet it is much easier to pick up bacteria through contact with objects or by shaking hands and you will leave many more bacteria on the surfaces you touch.
Speed up hand drying
“But a particularly absorbent towel that is delivered quickly and efficiently will help to speed up hand drying without compromising hygiene.” The company offers a range of Tork extra soft hand towels that are said to be particularly absorbent.
The provision of easy-to-use, well-stocked dispensers can also speed up hand hygiene, according to Betourne. And he adds that effective hand sanitisers work well in situations where staff are too busy for a full hand wash.
“While Tork supports the WHO recommendations regarding those situations where hand washing is required, sanitising is now the preferred and most-used hand hygiene method in healthcare,” he said. “This takes only 30 seconds and can be performed anywhere.” Tork Alcohol Gel and Liquid Hand Sanitisers are available in various formats.
He says the key to efficient hand hygiene is to provide the right supplies in the right place. “Those extra steps you need to take to reach a sanitiser dispenser or wash hand basin can significantly add up when you are hand-washing several times an hour,” he said. “So dispensers should be positioned for optimum efficiency.”
Essity makes recommendations to healthcare facilities on where to position hand sanitiser dispensers to help save time and increase their usage by staff and visitors. “For example, dispensers should be situated in clearly visible locations near hospital entrances, on walking routes and in prominent positions near the entrances to nursing stations,” said Betourne.
“Hand sanitisers can also be useful in non-healthcare situations where soap and water are not available, such as in front of a canteen entrance or at a reception desk.”
He adds that sanitisers are not usually a recommended shortcut in food preparation areas, however. “Here the hands are often visibly soiled which means they will need to be washed with soap and water followed by a thorough drying,” he said. “Sanitising will not work on dirty hands and some substances in foods such as parasites and allergens may not be neutralised by alcohol sanitisers.”
He agrees with Dewick that a soft, highly absorbent paper towel can speed up the drying stage. “Also, the dispensers themselves should make it easy for staff to check and refill stocks of soap and towels to ensure they are always available.”
GOJO is another strong advocate of the WHO hand washing recommendations according to commercial vice-president Mike Sullivan. “Whether it is in a healthcare facility, a food environment, office or school, the facts are simple – good hand hygiene helps to prevent the spread of serious infections,” he said.
While he admits that the hand washing process can sometimes be perceived as taking too long, he says: “These practices are vital in helping to prevent the spread of infections, particularly in critical sectors such as healthcare. And the efficacy of soap and sanitiser formulations is crucial.”
Scientifically proven
Only soaps and sanitisers that have been proven to work against germs through independent scientific testing should be used in these types of situations, according to Sullivan. And he
adds that hand rubs that work well with minimal contact times can help to speed up the process.
“The right systems also play a critical role in the promotion of healthy hand hygiene behaviour,” he adds. “To be truly successful they need to combine good aesthetics, accessibility and ease of use. Innovative technology also helps which is why touch-free dispensers are so popular.”
He agrees with Betourne that the positioning of hand washing and sanitising facilities around a building can make the process more efficient. “Eye-catching signage, posters and other visual displays can also work well.”
And he adds that hand sanitising may be carried out when water and soap is not available or as an additional layer of protection. “However, the sanitising process should take at least 20 seconds to be effective.”
A UK news report published this summer1 revealed that Scottish hospital nurses were unable to complete compulsory infection control training because they were too busy.
Fewer than 10 per cent of nurses on one hospital ward at Woodend Hospital in Aberdeen completed essential hand hygiene training and blamed pressure of work for this lapse. And only a third of staff members on a second ward managed to find the time to take a course on preventing the spread of infections.
Meanwhile, a New Zealand report out this September2 claimed that 100 per cent hand hygiene compliance was not practically achievable in diverse and complex healthcare settings. The country’s Health Quality and Safety Commission argued that in emergency situations, hand hygiene may not be as important as life-saving actions.
While a 60 second hand wash may not be practical in an extreme emergency, all commentators agree that this should be the ultimate goal in any hygiene-critical setting. As Metsä Tissue’s Mark Dewick puts it: “Hand washing is a simple process that can actually saves lives, so why would anyone advise shortening the procedure?”
1 https://www.thetimes.co.uk/article/nurses-too-busy-to-receive-training-in-hand-hygiene-jx7h07hx7
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