Hand Hygiene—Of Reason and Ritual

Modern infection control is grounded in the work of Ignaz Semelweis, who in the 1840s demonstrated the importance of hand hygiene for controlling transmission of infection on an obstetric ward. Although hand hygiene is the most important activity for preventing health care–associated infections, scores of observational studies demonstrate poor adherence by health care workers. The often-cited drawbacks to hand hygiene are the time required, a perception that the recommended frequency of hand cleansing is excessive, fear that frequent washing will lead to dermatitis, and limited access to sinks and hand hygiene products. To overcome these objections, an expert panel recently issued revised national recommendations that promote sinkless alcohol-based hand-rub solutions for degerming hands that are not grossly soiled (1). This recommendation seemed like excellent advice because these solutions are as effective as traditional hand-washing with an antimicrobial soap, can be applied when needed from dispensers conveniently located throughout health care facilities, and can be rubbed on within seconds as health care workers move from patient to patient. In addition, the emollients in alcohol-based hand-rub solutions actually improve the condition of the skin, so repeated application is beneficial.

How are we doing? It is too early to tell in the United States, where hand hygiene rates average 40% to 60% on a good day. However, European hospitals have been using alcohol-based rubs for many years, so it seems reasonable to look to Europe for evidence of success of the alcohol hand-rub strategy. In this issue (2), Pittet and colleagues report an observational study of hand hygiene practices, coupled with an assessment of “cognitive factors” (beliefs and …