5 New Hand Hygiene Practices to Reduce Infection

“Hand hygiene is a proven method that is simple and cost effective to prevent transmission of pathogens—it needs to become a habit, not a task,” stresses Karen deKay, MSN, RN, CNOR, CIC, senior perioperative practice specialist and lead author of AORN’s updated Guideline for Hand Hygiene.

deKay recently gave Periop Today an overview of five hand hygiene practice updates in the revised guideline. She suggests periop team members become familiar with these updates to fuel discussion for improving hand hygiene habits.

1. Ditch ALL nail lacquer for scrub role
   (Recommendation 1)
   • It is well known that nail polish can harbor transmissible bacteria, but with so many kinds of nail polishes on the market, deKay wanted to clarify terms. She looked to cosmetology literature to add terminology updates to these new recommendations:
   • All nail polish is now referred to as nail lacquer to better describe it as “dissolved resins applied and dried to form a hard glossy coat.”
   • Enhanced nail lacquer such as UV, shellac, dipped nails, and nails fixed with adhesive are differentiated.
   • When performing the scrub role, BOTH nail lacquer and enhanced nail lacquer should NOT  be worn.
   • Non-scrub personnel who are permitted to wear lacquered nails should ensure their nail lacquer is “free of chips and cracks.”
2. Reduce the spread of waterborne pathogens at hand hygiene stations
   (Recommendations 5 and 9)
   • In accordance with a 2017 CMS mandate, healthcare facilities are now required to establish a “water management program” based on evidence showing gram negative pathogens that often cause SSIs are present in faucet hardware and sink drains, including hand hygiene sinks. Facilities need to develop a safe water pathogen plan that recognizes and reduces bacterial contamination in periop sinks, faucets, and drains, deKay notes. She says to start with these key actions:
   • Determine whether electronic faucets will be used in the perioperative setting and under what circumstances, considering risk factors such as sink utilization, water flow rate, complexity, and composition of internal components.
   • Reduce splashing or dispersion of water with known solutions, such as using deep sink basins, faucets that don’t discharge directly above the drain, and adjusting water pressure.
3. Make surgical hand rubs/scrubs accessible
   (Recommendations 4 and 6)
   • Surgical hand antisepsis CAN be completed by performing a surgical hand rub or surgical hand scrub, based on new supporting evidence, deKay explains. The guideline suggests:
   • Hand rub and alcohol-based hand hygiene dispensers may be placed inside the OR or procedure room (following NFPA guidelines for fire safety).
   • Along with newly installed hand hygiene dispensers, make sure hand washing stations are still available for soiled hands.
4. Evaluate hand health with specific hygiene products (Recommendation 7)
   • Based on new research deKay found with specific hand hygiene products that identify skin irritation, including transepidermal water loss that can cause skin damage, the guideline suggests periop nurses participate in assessing hand health in these ways:
   • Form an interdisciplinary team that may evaluate hand hygiene products and request information from manufacturers, specifically studies that measure transepidermal water loss.
   • Look to a new table in the updated guideline that lists antiseptics’ irritant potential.
5. Get creative to boost hand hygiene compliance
   • The fast-paced workload in periop care can lead some to make hand hygiene less of a priority, deKay acknowledges. That’s why new compliance recommendations are included in the guideline, such as these:
   • Use electronic or paper reminders as part of quality program to improve hand hygiene.
   • Look at ways to streamline processes and workflow to limit the number of indications for hand hygiene, such as decreasing the number of times gloves must be removed because something was forgotten by making supplies ready ahead of time.
   • Use video observation of specific behaviors that increase or decrease workspace contamination to identify best practices.
   • After new hand hygiene practices are developed, use simulation to evaluate new techniques in a risk-free setting.

deKay says teams that make correct hand hygiene practices habit are making a significant difference in reducing the spread of many risky pathogens, including the SARS CoV-2 virus that causes COVID-19.

Find more on the evidence behind these guideline updates and how they compare to previous recommendations in AORN Journal’s Guideline First Look on hand hygiene.