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KIMCARE Cassette Skin Care system from Kimberly-Clark

Healthy, intact skin serves as a barrier to infection, which is why it’s so important for the healing hands of HCWs to be hands that are healed themselves. So much is demanded of HCWs’ hands. If handwashing protocol is performed properly, HCWs may be expected to wash their hands up to 70 times per shift, according to Cheryl Littau, PhD, senior program leader for skin care products, Ecolab, St. Paul, MN.

"If HCWs performed the complete hand-hygiene protocol every time they’re supposed to, it would add up to more time than they have on their shift," added Deborah Davis, PhD, vice president of technical and clinical marketing, Cardinal Health, McGaw Park, IL. "If there’s no time for handwashing, there’s no time for applying lotion either."

Moisturizing is a vital component of good hand care. With each handwash, lipids that naturally moisturize the skin are washed away. Hands can become dry and cracked, which hurts. One of the most common complaints for not complying with handwashing guidelines is because it’s so painful to damaged skin.

Damaged skin isn’t just uncomfortable; it can be lethal. Dry, cracked skin provides perfect little hidey-holes for bacteria picked up by HCWs’ hands in the course of duty. The bacteria can be transferred to patients whose immune systems may be compromised and cannot fight it off, putting their lives at risk. Healthcare workers and their families are also at risk, because the bacteria can be carried home. "Healthcare workers need to be able to care for patients without compromising their own health and that of their families," declared Littau.

Cal Stat Plus antiseptic hand wash with emollients in dispenser, STERIS Corporation

"There’s not enough time" is another complaint often cited when the subject of compliance is aired. Jeanne Medvick, MT (ASCP), CIC, clinical studies group manager, STERIS Corporation, Mentor, OH, believes that "Numerous articles make compliance seem complex, but it really boils down to time constraints. People are living longer with life-threatening illnesses and are requiring more hospital care. There’s more to do now one-on-one with the patient."

More one-on-one care requires more frequent handwashing and moisturizing. If hands aren’t adequately moisturized, more frequent handwashing equals pain, and naturally there’s the tendency to shy away from what causes the pain.

Caring for hands properly means selecting a line of products designed especially for healthcare professionals. Some HCWs have chosen to bring products from home, but is that wise? Hand-care products for healthcare professionals are designed to battle the big bacterial guns. Are consumer products as efficacious in battling pathogens? Medvick advised: "People shouldn’t think that because a product has an antiseptic ingredient, it’s top-performing. For example, in an independent laboratory’s test comparing the efficacy of a consumer product with our Kindest Kare Antimicrobial Foaming Handwash, the Kindest Kare product was shown to kill 28 different types of organisms, whereas the tested consumer product killed only 3. In a hospital setting, this is a critical difference."

Proven efficacy is important. Antiseptic ingredients are regulated by the U.S. Food and Drug Administration (FDA). FDA evaluations have shown that not all antiseptic ingredients on the market are efficacious. "The FDA demands that an antiseptic ingredient stands alone and does not depend on other ingredients to boost efficacy," stated Medvick. "STERIS tests its products to meet the standards of the FDA’s ‘Topical Antimicrobial Drug Products for Over-the-Counter Human Use; Tentative Final Monograph on Health-Care Antiseptic Drug Products."

Endure Revitalizing Skin Lotion and Crème, Ecolab

For more info on FDA requirements, go to www.accessdata.fda.gov/scripts/oc/
ohrms/frbydocket.cfm, and search for docket #75N-183H.

New from Clorox Professional Products Company is the Clorox Anywhere Hand Sanitizing Spray for hopsital and professional use. The sanitizing spray is strong enough to kill 99.999 percent of germs within 15 seconds, yet contains a glycerin moisturizer so it’s gentle on hands. According to Clorox, the spray helps target hard to reach areas where bacteria can hide, including fingernails, knuckles and spaces between fingers, and no rinsing is required. Clorox Anywhere Hand Sanitizing Spray meets FDA TFM requirements for hand sanitizers.

Medvick believes that "Wall dispensers are preferable over consumer bottles, because fingers do not need to touch the dispenser opening and present the risk of cross-contamination. Household products are just not designed for 20 to 30 people a day using the container."

Endure Revitalizing Skin Lotion and Crème, Ecolab

Germ Pro Products, Inc, Tampa, FL, offers a touch-free auto dispenser. Their Hand Sanitizing Lotion kills pathogens for up to 4 hours. The lotion should be applied at the beginning of the work day and reapplied every 3 to 4 hours or after a hard scrub, to keep the hands from becoming re-infected between normal hand washings. The alcohol-free sanitizing lotion forms a polymeric film on the hands, which is not water-soluble, helping to provide protection against the drying effects of alcohol washes. Vitamin E and other emollients moisturize and help heal the hands.

Kimberly-Clark Professional, Roswell, GA, has a new skin-care system, KIMCARE Cassette Skin Care, which offers interchangeable 1-L cassettes of foam or lotion soap in eight different formulas. Refill cassettes simply slip into the dispenser, so the formula can be changed easily by just refilling the system, using the same dispenser.

Fortunately, in recent years, handwashing and hand care have become the subjects of increased attention. That’s a good thing, because the history of compliance hasn’t been impressive. "Studies show that compliance has been in the 30% to 40% range," noted Littau.

Apparently there’s a dearth of role models. "Studies show that more experienced and seasoned employees are much less compliant than newer healthcare personnel. Physicians are also contributing to poor compliance, as they are not very good role models. Their visible lack of compliance breeds the same actions by those who work beside them," averred Cooper.

Sterillium Comfort Gel hand antiseptic, Medline Industries

Medvick added: "Role models are needed to show how things need to be done. Infection control professionals can teach and motivate, but what’s needed is someone (a nurse, doctor, or physical therapist, for example) to serve as a role model on a daily basis. We need constant reminders, to keep the message fresh. We’ve been encouraged by doctors who’ve stepped up, and we need more of them demonstrating they believe what they say."

Lack of compliance is expensive and, worse yet, it can be deadly, observed Cooper. "Noncompliance and associated results cost the average U.S. hospital $6 million per year. There are 2 million HAIs per year, leading to 80,000 deaths annually. The Centers for Disease Control and Prevention strongly recommends regular use of products to prevent and treat dryness and irritation. In addition, gloves can protect patients by lowering contamination and subsequent transmission of pathogens to other patients."

Some gloves have the added benefit of delivering moisturizers, such as Cardinal’s Neu-Thera. "It’s a convenient way to help condition the HCW’s skin while they’re helping patients," said Davis.

The link between HCWs’ skin health and HAIs has also resulted in increased attention to noncompliance. "Starting in October 2008, Medicare/Medicaid will no longer reimburse for the additional cost of treatment for ‘preventable errors,’ including preventable HAIs," stated Littau. "According to Pennsylvania’s ‘Health Care Cost Containment Council Report,’ the average hospital stay without an HAI costs $31,389; with an HAI, that figure can bumped up to $185,260. Hospitals are focusing on improvement. Of course they worry about saving lives, but they also are concerned with keeping solvent."

Kindest Care antimicrobial foaming hand wash from STERIS

A number of companies well-known for their hand-hygiene and hand-care products are expanding their efforts to include educational programs, with a view to helping healthcare facilities improve compliance. The companies invest time and money researching the science and crunching the data. All healthcare facilities need to do is implement the resulting programs.

Ecolab is one of those companies. Ecolab’s "skin-friendly" skin-care lines are designed to be compatible with antimicrobials present in hand-cleansing products, as well as with gloves and safety equipment, but Ecolab has taken skin care and compliance a step farther with their "Hand Hygiene Monitoring Compliance Program" for healthcare facilities. The program "gives a concrete way to address Joint Commission patient safety goals #7 and #13," explained Littau. "There’s also a patient-empowerment component, which increases public awareness of the importance of hand hygiene and encourages a culture where it’s okay to speak up and not feel intimidated about asking HCWs to wash their hands."

Other components of the program include measurement of compliance data, which enables hospitals to measure the progress of the program and to promote improvements, and benchmarking, so hospitals can compare their data against other healthcare facilities’ experiences.

"Ecolab partnered with Maryann McGuckin, Dr. ScEd/MT (ASCP), president, McGuckin Methods International, Ardmore, PA, to develop this program," said Littau. "McGuckin’s studies show a 56% improvement in handwashing compliance after a 5-month period. That means if you started out with 40% compliance, by instituting this program, you could go to 96% compliance."

Ecolab’s Quik-Care Foam one-step waterless antimicrobial hand rinse

Measurement of hand-hygiene compliance is a hot topic. The Joint Commission is seeking examples of hand-hygiene measurement methods, which will be published in a free, educational monograph in early 2008. The project is funded by an unrestricted educational grant from GOJO Industries, Akron, OH.

For more information, go to http://www.jointcommission.org/
NewsRoom/NewsReleases/
nr_021607.htm.

Resurgent Health and Medical, Golden, CO, offers a system that sanitizes hands automatically in 10 seconds and is capable of measuring compliance as well. The touchless system, CleanTech IC, dispenses the identical amount of water and sanitizing solution with every hand wash. By means of RFID technology, the system automatically measures handwashing activity, recording each HCW’s hand-hygiene practices—including in-formation such as the time, date, complete or incomplete hand-wash cycle, and department—to a database and generating reports that provide real time, comprehensive data. To see a video of how it works, go to http://resurgenthealth.com.

The All Hands Clean program from STERIS seeks to promote effective hand hygiene compliance through a combination of optimal product choice and placement, engagement/awareness materials including pamphlets, buttons and other visual reminders, as well as an intervention measurement program for tracking and bench-marking compliance. Partners In Your Care (PIYC) Plus is an internet based system from STERIS that allows facilities to track hand hygiene compliance and compare rates to other hospitals.

Poster encouraging handwashing compliance, a component of STERIS Corporation’s All Hands Clean program.

Cardinal Health offers continuing-education study guides. The self-study guides explain the basics of hand-hygiene protocol, including pro-per handwashing; how to select hand-hygiene products; and the need for regular use of moisturizers. They also offer advice on selecting gloves for the task at hand, sensitivities and allergies, user comfort, defense against pathogens, and more. The study guides are approved for two continuing-education contact hours.

Medline Industries also offers educational support. "Medline Industries, Mundelein, IL, offers soaps, alcohol-based hand-hygiene products, lotions, and therapeutic exam gloves designed to improve skin and offer convenience, two proven barriers to hand-hygiene compliance," Alecia Cooper, RN, vice president of clinical services, told Healhcare Purchasing News. "Compliance is poor for many reasons. Lack of time, lack of access, poor skin condition, and lack of education and training are reasons cited for poor compliance. In addition, the patient and family traditionally have not been included in education and training, but they need to be included as part of the solution. We need to knock down all the barriers to compliance."

"Medline Industries has been working over the past 12 months with industry thought leaders and international experts to develop a comprehensive infection-prevention program that includes a hand-hygiene—compliance component," continued Cooper. "The Hand Hygiene Compliance Program will extend for 2 years. Volume I will be available in December. This training program includes all of the necessary forms and tools. Ongoing reinforcement of the education and training has been included to facilitate the necessary cultural change. Data, research, and science are provided to back it up."

The "Just Say NOsocomial" Infection Control Training Program, offered by Health Care Logistics, Circleville, OH, is designed to entertain while it educates and motivates workers to make proper handwashing a habit. It combines a customizable PowerPoint presentation with talking points, posters, brochures, and employee premiums. Characters such as Handy the Hand Washing Octopus, Perry the Pathogen, and Sophie Soap and Water explore the dos and don’ts of infection control.

Standard ways to increase awareness of the need for observing handwashing protocol have included posters, buttons, and recorded reminders, but some facilities are thinking outside the box. Davis recounted the story of a hospital in Houston that is trying an innovative program that hits where it hurts. When the CEO is spotted not washing his hands when he should, he has to pay $20 to the person who caught him breaking protocol. That certainly takes accountability to a new level.