Handwashing Techniques - Research Paper Example

www.academia-research.com Sumanta Sanyal d: 01/05/07 Investigation: Efficiency of Normal and NHS (UK) Handwashing Techniques Abstract This paper reports an experiment conducted on six volunteers to determine the relative efficacies of normal and NHS (UK) handwashing techniques. It is estimated at current figures that there are 5000 deaths per annum in the UK from Healthcare associated infections (HAI). These can be avoided in large part if healthcare staff take care to disinfect their hands after coming into contact with possible contagion carriers. The best technique for such disinfecting, as numerous studies in recent years have shown, is handwashing. In this experiment, the participants’ hands were artificially infected with harmless K-12 strain E. coli and samples taken of the bacteria count on their fingers. Both hands were involved in the experiment. Next, half the participants (three in number) were asked to disinfect their hands using only soap and water while the other half were asked to do so with the NHS standard handwash – alcohol and chlorhexidine in 1:10 dilution. Samples were taken of the fingers after disinfecting. Samples were sustained for 24 hours after which the bacteria counts were taken. It was found that for all participants, both for normal and NHS standard handwash, there was reduction in the bacteria counts post-disinfect over pre-disinfect but the normal handwash – only soap and water – porved more efficacious than the NHS standard one. It is construed that since there is no established literature on the matter there is need to further investigate if the NHS recommended handwashing technique is superior to normal ones. As this report shows, it does seem like the normal handwashing techniques proves superior to the NHS standard. Introduction This paper investigates the efficiencies of normal handwashing techniques against that recommended by the National Health Service (NHS) UK. It should be known that handwashing is a very essential part of not only the healthcare profession but also all other professionals that somehow deal with toxic and virulent substances and organisms whenever there is possibility of such malignant materials coming into contact with the hands. Since it is the hands that humans primarily use to connect with outside materials it is these appendages that have to be thoroughly cleansed to negate the possibility of the toxicity or virulence being transmitted to other human individuals who may later come into contact with the concerned individual. This is not only for the safety of the human community within which the individual coming into initial contact with such toxicity or virulence but also of the individual him- or herself. In this particular context the investigation is made in special context of the healthcare profession. It is often taken as a surprise that a large national organization like the NHS, UK, should be concerned about something minor as handwashing techniques but it should be known that as many as 1 in 10 British patients admitted to a NHS facility in the UK contact infection there that is technically known as healthcare associated infections (HAI) (Hughes and Armitage, 2007). Bacterial strains like the Staphylococcus aureus have become increasingly resistant to common antibiotics and, as a result, infections from the healthcare facility atmosphere, which is ubiquitous with bacterial, viral and other malignant organisms, tend to jeopardise the health conditions of patients. These patients, who may have been admitted for treatment of other ailments, often contact infections that directly originate from the vitiated healthcare facility environment. Officially, the British Isles record about 5,000 deaths from HAI annually and it is sobering to know that only half that amount is accounted for by road accidents (Hughes and Armitage, 2007). Also, the NHS spends a billion pounds sterling yearly on hygiene in its associated healthcare facilities and a large part of this large amount would be saved if only all healthcare staff would take care to wash their hands thoroughly after contact with patients who are likely to carry infectious pathogens (Hughes and Armitage, 2007). Thus, it is as no surprise that the NHS places great importance upon handwashing, one of the primary techniques for combating the incidence of HAI in any healthcare facility. Several well-designed studies have shown that healthcare staff dressing wounds with methicillin-resistant S aureus has an 80% chance of carrying the organism for up to three hours on their hands (Editorial, BMJ, 2001). Another study showed that nurses in intensive care units, after initial contact with patients, even so much touching a shoulder, got Klebsiella on their hands (Editorial, BMJ, 2001). The organisms remained on hands for up to 150 minutes. Similar data is available for Clostridium difficile (Editorial, BMJ, 2001). These studies also demonstrated that handwashing invariably removed these organisms and greatly reduced the risk of other patients getting infected from these organisms on staff hands (Editorial, BMJ, 2001). In the NHS, as per research recommendations, it has been officially regarded as normal to use plain soap and water to wash hands if there is soiling (Editorial, BMJ, 2001). For more quick solutions, especially when there is possibility of infections, 70% alcohol solutions have been recommended for such cleansing (Editorial, BMJ, 2001). Innumerable studies have shown that a wide range of virulent organisms usually evident in healthcare facilities in the UK can be got rid of by alcohol rub or other antiseptic washes (Editorial, BMJ, 2001). This view is held by other studies such as that of Stone (2001) and Awofeso (2004). Thus, it been established that the rationale for this particular study is perfectly logical and that it is being conducted to specifically ascertain whether the currently NHS, UK, recommended handwash technique is comparably effective as a normal hand wash. Hypothesis: The hypothesis developed as per the previous review of existing literature on the subject assumes that, after the efforts exerted by the NHS, UK, to minimise HAI, the NHS handwashing technique will prove superior to the normal handwashing one. Methodology The methodology adopted to test the hypothesis is simple. Six participants have been nominated. Three will use normal handwashing techniques while three others will use the NHS recommended technique. Experiment Method: A harmless strain (k-12) of E. coli solution was taken. All six participants were made to wash both hands with soft soap for a minute and, thereafter, dry them with a paper towel. Next, they were made to immerse fingers of both hands up to the middle knuckles in the E. coli solution for 5 seconds. The fingers were held out horizontally and gently turning and air dried for 3 minutes. Next, the finger-tips (of all the participants) were rubbed gently with TSB (Tryptic soya broth) for 1 minute. This is the sampling for the pre-disinfectant bacteria count. In the next part, participants using the normal wash technique used soap and rubbed normally for 30 seconds while participants using the NHS standard used soap and rubbed with the ethanol rub solution with chlorhexidine gluconate in 1:10 dilution (NHS standard) for 30 seconds. Next, both set of participants rubbed fingertips with the TSB for 1 minute. This is the post-disinfectant sample taking. They next washed hands with soap and dried them with a paper towel. Sampling procedure was as per EN1500 standards and the pre- and post-disinfectant counts were taken. EN1500 is based on Iso-propanol (60%, v/v) 2 x 3 ml for a total of 60 seconds. Samples were left for 24 hours before counting was done. Results The pre- and post-disinfectant bacteria counts and their Log10 values have been posted in Table 1 (normal handwash) and Table 2 (NHS standard handwash). Table1: Normal Hand Wash Table 2: NHS Hand Wash Since the reduction values (Log10) for the pre-and post-disinfectant counts are distinct no elaborate statistical method other than simple graphs plotted for the Log10 reduction values (y-axis) against the participant numbers (x-axis) has been prepared. It is notable that each participant hand is accounted along the x-axes. Thus, for each type of handwash, there are six entries along the x-axis. Graph 1: Discussion It is obvious from the plotted graphs that the reduction factors for the normal handwash are much higher, proving higher efficiency, than those of the NHS standard handwash. It is thought that it is merely fortuitous that the values increase/decrease as the graph progresses to the right. The values for the normal handwash continue to increase while those of the NHS standard wash continue to decrease. Thus the initial hypothesis that the NHS standard handwash could stand superior to the normal one is annulled. This may be because the basis of the hypothesis was that there seems to have been a lot of effort put in by the NHS to improve health conditions in its facilities by introducing a superior handwashing technique. The studies reviewed had demonstrated only that handwashing after work by healthcare staff definitely reduces the incidence of HAIs. They do not in any way reveal that the NHS has introduced a handwash that is superior to any other. Thus, the results of this experiment and the subsequent annulment of the hypothesis does not in any manner negate previous findings. There is no known explanation for this strange result other than to state that the NHS standard wash using alcohol (ethanol) with neutralizing chlorhexidine (Kampf et al, 2005) is not proving as effective as normal wash with soap and water. It has been demonstrated before that the neutralizing agent like chlorhexidine with its bacteriostatic/bacteriocidal effects often has a pseudo-positive effect on experiments like these. The bacteriostatic/bacteriocidal effect does not allow the bacteria to grow in the sample culture media and the net effect is one of apparently greater reduction than is actual (Kampf et al, 2005). There is no cause to include this effect in this paper since, strangely, the NHS standard wash seems to be doing its job much less efficiently than the normal one and any pseudo-positive effect is unlikely. Conclusion The paper has proved that the simple normal handwash with only soap and water has proved more effective in removing bacteria from hands of those working in infection-prone environments than the NHS one. Though there seems to be no corroboration from existing literature for these results there is still a great need to accurately ascertain that the NHS standard handwash does do its work as efficiently as is presently advocated by that institution. There is also a need to develop more efficient washes that can be appropriately, in a timely and efficient manner, disinfect healthcare workers’ hands to minimize infections such as HAI. References Awofeso, Niyi, What’s New about the “New Public Health”? American Journal of Public Health, May 2004, Vol. 94, No. 5, pp. 705-709. Handwashing, Editorial, BMJ, 1999, 318: 686-686. Hughes, John, and Armitage, Tracey, The Reformation of a National Institution, Combating the Burden of HAIs: A British Perspective, 2007. Extracted on 29th April, 2007, from: http://www.infectioncontroltoday.com/articles/398/398_521perspectives.html# Kampf, Gunter, et al, Insufficient neutralization in testing a chlorhexidine-containing ethanol-based hand rub can result in a false positive efficacy assessment, BMC Infectious Diseases, 2005, 5:48. Stone, S.P., Hand hygiene – the case for evidence-based education, J R Soc Med, 2001, 94: 278-281. Read More