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发表于 2014-9-8 23:00:15
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Is it necessary to perform hand hygiene for healthcare workers before initial patient environment contact?
Authors:
Rong-hui Liu MD Ph.Da, Duo-shuang Xie MD Ph.Db*
Affiliations:
a Department of Infection Control, the First College of Clinical Medical Science, China Three Gorges University & Yichang Central People’s Hospital, Yichang, Hubei, China
b Department of Infection Control, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
* Corresponding author. Address: Department of Infection Control, Taihe Hospital, Hubei University of Medicine, No 32 Renmin Road, Shiyan, Hubei 430030, P.R. China. Tel.: +86 719 8801606. Fax: +86 719 8801379. E-mail address: xieds8@163.com.
To the Editor− Hand hygiene (HH) is considered to be a simple, but the most effective way of preventing healthcare-associated infections and cutting off the spread of pathogens.1 In recent years, more and more attentions has been paid to hand hygiene, meanwhile a plenty of guidelines have been developed already to improve hand hygiene practices among healthcare settings.2,3
According to the WHO Guideline on Hand Hygiene in Health Care 2009, the indications for hand hygiene were divided into 5 groups: (1) before touching a patient, (2) before clean/aseptic procedure, (3) after body fluid exposure risk, (4) after touching a patient, and (5) after touching patient surroundings.4 It’s noted specially that hand hygiene is not required before touching items of the patient zone but before contact with the patient.5
According to the Guideline for Hand Hygiene in Healthcare Settings, which was issued by the healthcare infection control practices advisory committee and the HICPAC/ SHEA/ APIC/ IDSA hand hygiene task force in 2002, the indications for hand-rubbing with an alcohol-based handrub or handwashing with soap and water were consistent with those of WHO.
Meanwhile, in ‘Best Practices for Hand Hygiene in All Health Care Settings’6, Which was developed by the Provincial Infectious Diseases Advisory Committee (PIDAC) of Canada, there are 4 moments when hand hygiene is performed, which are: (1) before initial patient or patient environment contact, (2) before aseptic or clean procedure, (3) after body fluid exposure risk, and (4) after patient or patient environment contact.
So, is it necessary to perform hand hygiene for healthcare workers before initial patient environment contact? There is significant difference between the above guidelines about hand hygiene.
During the process of health-care delivery, a patient’ hands often touch his/her immediate surfaces and substances directly. With each patient-to-surrounding exposure a bidirectional exchange of micro-organisms occurs between the patient and the touched surroundings.1 Therefore, the patient and his/her surroundings, also knows as the patient zone, form an organic whole. The so-called his/her surroundings includes some surfaces and items that are temporarily and exclusively dedicated to him or her. The surroundings includes all inanimate surfaces that are contacted by or in direct physical contact with the patient such as the call button, remote control, bed rail, bedside table, bed linen, infusion tubing and other medical equipment, as well as personal items. It further contains surfaces frequently touched by healthcare workers while caring for the patient, such as knobs, buttons and monitors, and other touchable surfaces.5
Healthcare workers’ hands can become increasingly colonized by germs and potential pathogens during daily practice. 7,8 If healthcare workers don’t perform hand hygiene before touching patients, the germs and potential pathogens on their hands could be transmitted to the patients. While performance without hand hygiene before touching patients’ surroundings, those surfaces and items can be also contaminated by germs and potential pathogens colonized on health-care workers’ hands, and then they could be transmitted to the patients through health-care workers’ hands and the patients themselves.9 Potential pathogens which have been presented on the surrounding environment can be eliminated by cleaning and disinfection, 10 however, those surfaces which are frequently touched by health-care workers’ hands may be quickly contaminated again.
In conclusion, health-care workers should perform hand hygiene right before entering the patient zone, either initial touching a patient or his/her surroundings.
ACKNOWLEDGMENTS
Financial support. This study was no funded.
Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.
REFERENCE
1. Pittet D, Allegranzi B, Sax H, et al. Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006; 6: 641-52.
2. Higgins A, Hannan MM. Improved hand hygiene technique and compliance in healthcare workers using gaming technology. J Hosp Infect 2013; 84:32-37.
3. Scheithauer S, Oude-Aost J, Heimann K, et al. Hand hygiene in pediatric and neonatal intensive care unit patients: daily opportunities and indication- and profession-specific analyses of compliance. Am J Infect Control 2011; 39: 732-7.
4. Pittet D, Allegranzi B, Boyce J, for the World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization Guidelines on Hand Hygiene in Health Care and Their Consensus Recommendations. Infect Control Hosp Epidemiol 2009; 30:611-622.
5. World Health Organization &WHO Patient Safety. Hand hygiene technical reference manual: to be used by health-care workers, trainers and observers of hand hygiene practices, Geneva : World Health Organization 2009. Available at: http:// www. who.int/ iris/ handle/ 10665/44196.
6. Ontario. Provincial Infectious Diseases Advisory Committee. Best Practices for Hand Hygiene in All Health Care Settings. December 2010. Available at: http://www.health.gov.on.ca/english/providers/ program/ infectious/ diseases/ ic.hh.html.
7. Sanderson PJ, Weissler S. Recovery of coliforms from the hands of nurses and patients: activities leading to contamination. J Hosp Infect 1992; 21: 85-93.
8. Landelle C, Verachten M, Legrand P, et al.Contamination of healthcare workers' hands with Clostridium difficile spores after caring for patients with C. difficile infection. Infect Control Hosp Epidemiol 2014;35: 10-5.
9. Boyce JM.Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65: 50-4.
10. Weber DJ, Anderson D, Rutala WA.The role of the surface environment in healthcare-associated infections. Curr Opin Infect Dis 2013;26:338-44.
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