Hand Hygiene and Skin Flora Management in Healthcare

Furthermore, certain items should be removed or avoided to ensure hygiene integrity:

• Jewelry and watches should be removed.
• Artificial nails must be avoided.
• Chipped nail polish should be avoided, as it may support the growth of a large number of microorganisms.

Hand Washing Techniques and Agents

The primary rationale for hand washing is to reduce the number of microbes on the hands through the process of cleaning and the antimicrobial effects of germicidal soaps.

Soap and Water

When using soap and water, it is recommended to use antimicrobial soaps. Common agents include:

• Chlorhexidine Gluconate (CHG): Available at concentrations of 0.75% to 4%. CHG at 4% is typically marketed for surgical scrubs and may provide a residual effect, remaining on the skin as a protectant after 4–5 repeated washes.
• Iodine liquid: A potent antimicrobial agent.
• Triclosan: Available in liquid, gel, or foam, though it is generally considered less powerful than CHG or Iodine-based soaps.

Clinical Tip: Soaps dispensed as foam are often more economical to use than liquid soaps.

Routine Hand Washing Procedure:

1. Remove jewelry and examine hands.
2. Wet hands with warm water.
3. Dispense an adequate amount of soap.
4. Thoroughly rub both surfaces of the hands, including around the thumbs and fingers, for 30–60 seconds.
5. Rinse with warm water and dry with paper towels.
6. Use the towel to turn off the water to avoid re-contaminating clean hands.

Hand Sanitizers

Alcohol-based hand rubs are acceptable when hand washing is impractical or when water is unavailable. Effective products should contain 60% to 95% ethanol or isopropyl alcohol.

While alcohol gels are often "kinder" to the skin because they contain moisturizers and can kill 99.8% of germs, they have limitations. Do not use alcohol gel if hands are visibly dirty; in such cases, you must wash with soap and water. Additionally, alcohol gel is not effective against certain diarrhea-causing viruses.

Surgical Hand Washing

In surgical settings, particularly when bone exposure is involved, a more rigorous surgical hand wash is required. The goal is to reduce the multiplication of resident skin microbes. This is crucial because if a surgical glove is compromised (torn or punctured), the bacteria on the skin could be released into the surgical field, leading to wound infections.

Surgical Scrub Protocol:

• Use antimicrobial soap with broad-spectrum activity and a high kill rate.
• Scrub for 2–6 minutes using a sterile, single-use disposable sponge or scrub brush to remove dead cells and resident bacteria.
• Dry hands with sterile towels or paper towels.
• Don sterile gloves without touching the outer surface.

Compliance and Skin Care

Despite the importance of these protocols, several factors can lead to poor compliance among healthcare workers:

• Lack of time or inconvenience.
• Hand irritation or dryness.
• Forgetfulness or skepticism regarding the importance of hygiene.
• The false belief that gloves alone provide sufficient protection.

To combat dryness, especially when washing multiple times a day, a good quality skin cream or emollient should be used at the end of the day. Failure to maintain skin integrity can lead to issues; for example, wearing rings can trap moisture, leading to infections like dermatomycosis if hands are not dried properly.

Exam Reminder: Always remember the "5 Moments for Hand Hygiene":

1. Before patient contact
2. Before an aseptic task
3. After body fluid exposure risk
4. After patient contact
5. After contact with patient surroundings.