The importance of hand hygiene as a standard preventive measure against infection has been pointed out worldwide. In the field of medical care and long-term care, we are promoting compliance with hand hygiene, but there are also sites where it is not thoroughly enforced, and although awareness of infection control has changed rapidly due to the spread of infection with the new coronavirus, the outbreak of infection in the facility continues. .. Rethink the importance of hand hygiene.
The number of outbreaks of outbreaks (clusters) has not started to decrease while the convergence of the infection of the new coronavirus cannot be expected. Although the number of clusters of medical facilities and facilities for the elderly is declining, prevention of infection in the facilities is extremely important for ensuring the safety of patients, residents, and staff because contact with infected people is unavoidable. is important. Among them, hand hygiene is the most important means to prevent infection, and the World Health Organization (WHO) has developed guidelines.
It has been said that it is difficult for staff to thoroughly implement hand hygiene because it is not possible to visually confirm whether or not it has been performed. It was recognized that it was important to protect the disease, and diligent hand hygiene was established in the hospital "(Professor Hiroshige Mikamo, Department of Infectious Diseases, Aichi Medical University).
However, looking at the clusters that occurred in various places, for example, in the case where about 20 people were infected at a core hospital in Kanagawa prefecture, "hand hygiene was not thoroughly implemented when contacting patients", a special nursing home in Osaka prefecture. Even in cases where the infection spread in nursing homes, it was reported that "staff working in multiple units exchanged sheets without disinfecting their hands."
Let us reconsider the significance of hand hygiene. Keiji Kanemitsu, a professor of infection control at Fukushima Medical University, said, "There are three types of hand hygiene: daily hand washing, hygienic hand washing, and hand disinfection during surgery." Routine hand washing removes some of the dirt and passing bacteria (pathogenic microorganisms that temporarily get on your hands and are likely to be a source of infection) on your fingers with soap and running water before meals and after the toilet. Hygienic hand washing is performed by medical and long-term care staff before and after medical treatment and long-term care to remove all dirt and passing bacteria. The purpose of disinfection during surgery is for surgical staff to reduce the number of indigenous bacteria on the skin and suppress the growth of bacteria during surgery.
Medical and long-term care staff need hygienic hand washing, and if there is visible dirt, wash hands with soap and running water. Washing your hands with running water can cause rough hands, so if there are no visible stains, disinfect your hands with alcohol. However, since there may be invisible contamination such as alcohol-resistant microorganisms, it is recommended to wash hands with soap and running water in addition to alcohol.
Hand disinfection with alcohol disinfectant has the advantage that it can perform effective hand hygiene in a short time, and since the disinfectant can be placed and carried in various places, hand hygiene can be performed anytime and anywhere. In addition, it is said that rough hands are less likely to occur if a disinfectant containing a moisturizer is used.
Although hand hygiene needs to be done frequently, WHO guidelines provide five timings for hand hygiene when caring for a patient (Figure). The timing and purpose are as follows.
① Before touching the patient (to protect the patient from pathogenic microorganisms transmitted through the fingers)
②Before clean / sterile operation (to prevent microorganisms from invading the patient's body)
③ If you may have been exposed to body fluids (to protect yourself from the patient's pathogenic microorganisms)
④ After touching the patient (to protect yourself and the medical environment from the patient's pathogenic microorganisms)
⑤ After touching the environment and articles around the patient (to protect yourself and the medical environment from the patient's pathogenic microorganisms)
In order to ensure thorough hand hygiene, not only physical measures such as placing hand sanitizers in various places in the facility and holding portable containers, but also the significance of such hand hygiene and the timing of performing it on site are always enlightened. There is a need to. This is because even if the compliance rate for hand hygiene improves immediately after a cluster occurs, it often declines over time. The target should be not only regular employees but also temporary staff and outsourcing staff who have a limited employment period.
There are many reports that infections in medical and long-term care facilities have decreased due to the improved compliance rate of hand hygiene. Medical and long-term care facilities are required to ensure the safety of patients, residents, and staff by striving to prevent in-facility infections, including the new coronavirus.
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