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29th August 2014

Hand hygiene – the beginning

Washing handsThis is the first of a series of articles over the coming weeks reviewing the importance of hand hygiene in the reduction of the transmission of pathogenic microorganism.

Some of the key facts globally, as outlined within the WHO Health care-associated infections fact sheet are as follows:

  • Healthcare-associated infections, or infections acquired in healthcare settings, are the most frequent adverse event in healthcare delivery worldwide.
  • Hundreds of millions of patients are affected by health care associated infections worldwide each year, leading to significant mortality and financial losses for health systems.
  • Of every 100 hospitalised patients at any given time, seven in developed and 10 in developing countries will acquire at least one health care associated infection.
  • The endemic burden of healthcare associated infection is also significantly higher in low- and middle-income countries than those in high-income nations, in particular in patients admitted to intensive care units and in neonates.

Globally the burden of healthcare associated infections affects every individual in different ways. Most individuals at some stage in their lives will have an infection and get better while others will die as a result. Some will acquire the infections during their stay in a healthcare setting.

What are Health Care Associated Infections (HCAIs)?

Health Care Associated Infections (HCAI), or “nosocomial” and “hospital” infections, affect persons in a hospital or other healthcare facility, and are not present or incubating at the time of admission. HCAIs can develop either as a direct result of healthcare intervention (such as medical or surgical treatment) or from being in contact with a healthcare setting.

The common aim amongst governments globally is to identify and reduce the transmission of HCAIs. Containment and management of infections preventing transmission is also a priority in making healthcare safer for everyone. The impact of HCAIs implies additional financial burden through prolonged hospital stay, possible long-term disability and increased resistance of microorganisms to antimicrobials. The impact on the person with the acquired infection is the difference between life and death. The probability of dying increases if the person lives in a developing country where the knowledge of measures to prevent the transmission is limited and medical care is inadequate.
A basic method that can be used to prevent the transmission of HCAIs is hand hygiene. Hand Hygiene is a general term referring to any action of hand cleansing. Hand hygiene has a massive impact on the prevention of the transmission of pathogenic microorganism.

Historically the link between handwashing and the spread of disease was established only two centuries ago. Handwashing with soap and water has been embedded in religious and cultural habits for centuries.

In the mid-1800s, studies by Ignaz Semmelweis in Vienna, Austria, and Oliver Wendell Holmes in Boston, USA, established that hospital-acquired diseases were transmitted via the hands of healthcare workers. Ignaz Philipp Semmelweis was born on July 1st 1818 and is known as an early pioneer of antiseptic procedures. Semmelweis discovered that the incidence of puerperal fever could be reduced by the use of hand disinfection in obstetrical clinics. Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10–35 per cent. Semmelweis proposed the practice of washing with chlorinated lime solutions in 1847 while working in Vienna General Hospital's First Obstetrical Clinic, where doctors' wards had three times the mortality of midwives' wards.

Unfortunately, both Holmes and Semmelweis failed to observe a sustained change in their colleagues’ behaviour and experienced great difficulties in convincing colleagues and administrators of the benefits of this procedure.

Semmelweis's practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister, acting on the French microbiologist's research, practiced and operated, using hygienic methods.

Recent changes

The 1980s represented a landmark in the evolution of concepts of hand hygiene in health care. In England the first national hand hygiene guidelines were published in the 1980s, followed by several others in more recent years in different countries. Globally healthcare officials are working together on the same principle that hand hygiene is extremely important in the prevention of the transmission of HCAIs.

World Health Organisation (WHO) Strategy

The WHO Patient Safety Clean Care Safer Care programme is actively working towards establishing effective ways of reducing health care associated infections globally. It has placed a major emphasis on hand hygiene as one of the core methods of reducing the transmission of pathogenic microorganisms to healthcare workers
The WHO has published guidelines and recommendations on Hand Hygiene in Health Care. These specific recommendations are aimed at providing further information on improving practices. Click here for the guidlines: WHO Guidelines on Hand Hygiene in Health Care

Public Health England Strategy

Public Health England has published the Annual Epidemiological Commentary: Mandatory MRSA, MSSA and E. coli bacteraemia and C. difficile infection data, 2013/14

The key findings were:
Every year over 300,000 patients in England acquire a healthcare associated infection whilst in hospital. These infections cost the NHS more than £1 billion a year. More details can be found in the report by clicking here: Reducing Healthcare Associated Infection in Hospitals in England

For the full commentary click here: Annual Epidemiological Commentary

The Health Protection Agency became part of Public Health England (PHE) in April 2013 and provides information on many topics of public health including hand hygiene.

The National Health Service (NHS) has set out its framework on improvements to be made. Standard 5 of the NHS Outcomes Framework 2014 to 2015 set out in 5.2 the improvement area concerning infection control.  The framework can by found by clicking here: NHS Outcomes Framework 2014 to 2015

This is ‘Treating and caring for people in a safe environment and protecting them from avoidable harm’. The improvement areas concern the incidence of healthcare associated infection (HCAI) both:

5.2 (i) MRSA
5.2 (ii) C. difficile

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider the National Institute for Health and Care Excellence (NICE) quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. The NICE Quality Standard lays out six specific statements for NHS staff on preventing and controlling infections.

This quality standard covers the prevention and control of infection for people receiving healthcare in primary, community and secondary care settings. The different healthcare settings include hospitals, general practices, dental clinics, health centres, care homes, the person's own home, schools and prisons providing healthcare, and care delivered by the ambulance service and mental health services.

The next articles will review the different types of hand hygiene methods and what would be recommended as the most effective at preventing the transmission of HCAIs. QCS provide polices and forms to be used by healthcare workers within the different healthcare settings to manage the prevention of HCAIs.


WHO Guidelines on Hand Hygiene in Health Care

Quarterly Epidemiological Commentary: Mandatory MRSA, MSSA and E. Coli bacteraemia, and C. difficile infection data (up to January–March 2014)

Infection: Prevention and control of healthcare-associated infections in primary and community care

Policy paper NHS Outcomes Framework 2014 to 2015

Health care-associated infections FACT SHEET

Annual Epidemiological Commentary: Mandatory MRSA, MSSA and E. coli bacteraemia and C. difficile infection data, 2013/14

House of Commons - Public Accounts Committee - Reducing Healthcare Associated Infection in Hospitals in England

Health and Social Care Act 2012

Sally Beck RGN, BSc (Hons), MSc, CMIOSH – QCS Expert Infection Control Contributor

Sarah Riley

Senior Customer Care Executive

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