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19th September 2014

Reducing and preventing the transmission of HCAI in the workplace

Hand SanitizerIn this article I will review hand hygiene methods and the importance of raising awareness of reducing and preventing the transmission of HCAIs in the workplace.

The burden of Healthcare Associated Infection (HCAI)

The World Health Organisation (WHO) report (link at the bottom of page) states that there are more than four million patients affected by HCAI every year in Europe, and 1.7 million in the USA. The European estimates indicate that HCAI cause 16 million extra days of hospital stay and 37,000 attributable deaths annually, but also contribute to an additional 110,000 deaths. This gives a guide of associated costs of approximately €7 billion annually. In the USA, around 910,000 deaths were attributed to HCAI in 2002. In 2004 the associated costs of HCAI were approximately US$6.5 billion.

NHS Outcomes Framework 2014/15

The 2014/15 NHS Outcomes Framework’s fifth outcome is ‘Treating and caring for people in a safe environment and protecting them from avoidable harm’. The section on improvement areas for reducing the incidence of avoidable harm is divided into four areas. One of these relates to the incidence of the healthcare associated infections Methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium Difficile. Improvements can be made in different ways to protect people from harm. One of the ways of decreasing the transmission of HCAI is good hand hygiene within all areas of the healthcare environment.

Definition of hand washing and hand hygiene

The WHO definition of hand hygiene is a general term referring to any action of hand cleansing, and the definition of hand washing is the washing of hands with plain or antimicrobial soap and water. Hand hygiene is the simplest and most effective way of reducing both the spread of infection and multi-resistant pathogenic microorganisms. The WHO report states that one of the key ways to reduce the transmission of HCAI is ‘implementing standard precautions, particularly best hand hygiene practices’. Hand hygiene can be actioned by everyone.

In 2005 the WHO launched the First Global Patient Safety Challenge, ‘Clean Care is Safer Care’, extending it to the campaign ‘SAVE LIVES: Clean Your Hands’ which reinforces the ‘My 5 Moments for Hand Hygiene’ approach as key to reducing the spread of pathogenic microorganisms.

My 5 Moments for Hand Hygiene

The WHO approach encourages healthcare workers to clean their hands:

  1. Before touching a patient
  2. Before clean/aseptic procedures
  3. After body fluid exposure/risk
  4. After touching a patient
  5. After touching patient surroundings

The aim of the WHO campaign was to focus on protecting the service user, the healthcare worker and the healthcare environment against the spread of pathogens, thus reducing HCAI. Reducing environmental spread is part of the strategy in preventing HCAI transmission, for example, people touching a door handle that has previously being contaminated. Any strategy taken to reduce the spread of pathogenic microorganisms needs to consider every aspect of potential transmission before a person even enters a building.

Duty of care and responsibility

Good hand hygiene is not solely required whilst undertaking medical care, but from the moment a person enters a building. Service users of healthcare facilities, regardless of the type of service, play a role in preventing the transmission of pathogenic microorganisms. All visitors entering the building have responsibility in supporting the reduction and prevention of transmission of pathogenic microorganisms. Workers within all healthcare establishments, regardless of the type of work they are doing, have a duty of care to protect people from avoidable harm. These workers include contractors working on any project in the building.

Reminders through signage

The provision of hand hygiene facilities, whether this is a mixture of hand washing facilities and alcohol-based hand rub, needs to be available at the entrances and exits of a building. Alerts through signage to remind a person to clean their hands before progressing further into a building will have greater impact. Further reminders on hand hygiene as a person walks through a building will continually increase awareness and highlight its importance.

Hand washing and hand rubbing

Hand washing is required to remove surface dirt that can be visually seen before applying an antiseptic hand rub to reduce or inhibit the growth of microorganisms. Hand rubbing with an alcohol-based solution does not require a source of water or drying with towels or other devices. Alcohol hand rub can only be used if hands are free from soling. The alcohol-based hand rub needs to be thoroughly rubbed into all hand surfaces until the hands are completely dry.

Hand washing technique

The following steps should be used to ensure you wash your hands effectively:

  1. Wet hands with water
  2. Apply enough soap to cover all surfaces of hand
  3. Rub hands palm to palm
  4. Right palm over back of left hand with interlaced fingers and vice versa
  5. Palm to palm with fingers interlaced
  6. Back of fingers to opposing palms with fingers interlocked
  7. Rotational rubbing of left thumb clasped in right palm and vice versa
  8. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa
  9. Rinse hands with water
  10. Dry hands thoroughly with a non-touch dryer or single use disposable towel
  11. Use disposable towel to turn off tap or elbow depending on the type of tap

Raising awareness

The hand washing technique is simple yet effective. A poster demonstrating the technique will help to guide the person to wash their hands in an effective way and will play its part in increasing awareness of its importance.

An automatic soap dispensing system and automatic non-touch air-dryer will be better at reducing the spread of pathogenic microorganisms than picking up a bar of touch soap or touching a dryer to turn it on.

QCS Infection Control Policy

QCS provides policies on infection control and hand hygiene. It is recommended that you carry out an audit of the hand hygiene facilities on your premises in order to ensure there are no potential gaps. Provide posters and other forms of information to raise awareness in both personnel and the general public.


World Health Organisation
Report on the Burden of Endemic Health Care-Associated Infection Worldwide
Clean Care is Safer Care

World Health Organisation
A Guide to the Implementation of the WHO
Multimodal Hand Hygiene Improvement Strategy
Save Lives Clean your Hands

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


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