As flu infects D.C., hand-washing in the hospital is a first line of defense

by Glenn Wortmann, MD, Section Director, Infectious Diseases
February 2, 2018

In the district and the U.S. as a whole, the influenza virus is surging, with roughly 200 new cases reported to the D.C. Department of Health each week. Hospital staff must take many steps to prevent infections from spreading: Healthcare providers often wear gloves, gowns and masks; medical instruments and rooms are thoroughly sanitized; we even use high-tech tools such as ultraviolet light to kill potentially dangerous bacteria.

But the first line of defense against what is known as healthcare-associated infections is much more low-tech: hand-washing. Healthcare providers may wash their hands as many as 100 times during a 12-hour shift. This is important because we often need to touch a patient during an examination or procedure. If we don’t rid ourselves of potential germs, we can spread them to each patient we see after—or be infected ourselves.

And it’s not just healthcare providers who are responsible for practicing good hand hygiene. Patients and visitors also play a critical role in preventing the spread of dangerous infections by keeping their hands clean and reminding healthcare providers to do so as well.

When you should wash your hands in a healthcare setting

Most people know they should wash their hands after using the bathroom; before eating or preparing food; after touching their eyes, nose or mouth; or after blowing their nose, coughing or sneezing. These rules still apply when you’re in a healthcare setting—whether as a patient or visitor—but there are a few additional actions that should trigger you to wash your hands.

One of the main hand-washing rules that healthcare providers follow is, “Wash in, wash out.” That means we wash our hands upon entering a patient’s room and again when we leave. This is a good rule for everyone in a healthcare setting to follow. Throughout the hospital, we have cough courtesy stations that hold alcohol hand gels and tissues in waiting areas for visitors and patients to use – all to try to help prevent the spread of flu and other illnesses.

Wash your hands after touching hospital surfaces such as bed rails, tables, doorknobs or remote controls to kill germs that may have settled on them. This may seem obvious, but don’t forget to wash your hands before and after you change bandages. And just because you wear gloves does not mean your hands are clean. Dirty gloves can contaminate your hands, so wash them after you remove gloves.

Did your healthcare provider wash their hands? If not, speak up

We want patients to feel empowered to remind healthcare providers to wash their hands. Don’t be afraid to say, “I didn’t see you wash your hands when you came in. Would you mind doing it again before the exam begins?”

This also goes for visitors or hospital staff members such as housekeeping. If a loved one has been in your room for quite a while, don’t feel bad about asking them to wash their hands again. And don’t forget to keep your own hands clean!

Are you following proper hand-washing procedures?

Even if a person washes their hands regularly, they may not be doing it correctly. That can be as bad as not doing it at all. We recommend two hand-washing methods: using soap and water or using alcohol-based hand sanitizer.

Soap and water 

  • Wet your hands and apply the amount of soap recommended by the manufacturer.
  • Rub your hands together until the soap foams, and then rub it all over the top of your hands, in between your fingers and under the fingernails. Do this for 15 seconds—the amount of time it takes to sing the “Happy Birthday” song twice.
  • Rinse your hands well, and dry them completely.

Alcohol-based hand sanitizer 

  • Put the amount of sanitizer recommended by the manufacturer on one hand. The sanitizer dispensers at MedStar Washington Hospital Center will automatically squirt the right amount in your hand.
  • Rub your hands together and cover all surfaces until your hands feel dry. It takes about 20 seconds.

Alcohol-based hand sanitizer does not kill the antibiotic-resistant bacteria C. diff (clostridium difficile), which can cause severe abdominal distress. When treating these patients, we’ll wear a gown and gloves and wash our hands with soap and water.

How we are working to further reduce infection transmission

Even without the recent flu outbreak, on any given day, one in 25 U.S. hospital patients has an infection they picked up from being in a hospital. This includes antibiotic-resistant bacteria ,such as C. diff and MRSA (methicillin-resistant Staphylococcus aureus).

For the 2017-2018 influenza season to-date, 824 positive cases have been reported in D.C. as of January 20, 2018, and we’re continually working to reduce the rates of all infection. Because hand-washing plays such a crucial role in infection prevention, we periodically monitor compliance with a “secret shopper.” This person, often a nurse, will observe healthcare providers as they work. When they notice someone not wash their hands properly or in a timely manner, they’ll perform a quick intervention.

Along with hand-washing and manual cleaning and disinfection, we also added a new tool in late 2016 to aid in our battle against potentially deadly infections: an ultraviolet light called UVC.

After an operating room or patient room has been manually cleaned and disinfected, a portable machine emits UVC light for about 30 minutes. The light bounces around the room and reflects into hard-to-reach spaces, killing bacteria by disrupting their DNA. UVC helps us kill bacteria that survived or were missed during manual cleaning.

Our use of UVC is fairly recent, so we don’t yet have hard numbers about its effect, but multiple studies have shown such technology does reduce infection rates. For example, a February 2017 study found that the use of UVC machines cut transmission of four major antibiotic-resistant infections by 30 percent.

We’ll never get rid of all bacteria, nor would we want to. Our bodies are full of good and helpful bacteria. But the CDC reports this season’s flu activity is likely to continue for several more weeks. By following proper hand-washing and disinfecting protocols, we can prevent the spread of dangerous bacteria and infections.

Category: Healthy Living, In the News     Tags: C. diffhand sanitizerhand-washingMRSA