Infection Control: New York State Mandatory Training

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As previously stated, HAIs are a serious problem in healthcare. Every year an estimated 2 million patients acquire HAIs; 99,000 die from their infection. Many infections are transmitted on the hands of healthcare providers and personnel. One of the most important methods for breaking the chain of infection is hand hygiene and hand washing. Despite the sophistication healthcare and the science behind that care, the simple and low-tech intervention of hand hygiene is a significant factor in reducing the spread of infection.

According to the CDC (2002), healthcare personnel only practice hand hygiene about half the time. In the CDC Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in the Healthcare Setting (2007), multiple research regarding healthcare professionals and hand hygiene were summarized:

Differences in observed adherence to proper handwashing and hand hygiene were reported among occupational groups in the same healthcare facility and between experienced and nonexperienced professionals. The self-reports of healthcare providers indicated higher adherence than those reported in observational studies. Among nurses and physicians, the number of years of experience was a negative predictor of adherence. Education was used as the primary intervention to improve adherence in most studies. While positive changes in knowledge and attitude were demonstrated, accompanying behavioral changes were limited or did not occur. Use of engineering controls and facility design concepts for improving adherence is gaining interest.

The hand hygiene guidelines presented here were developed by the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC), in collaboration with the Society for Healthcare Epidemiology of America (SHEA), the Association of Professionals in Infection Control and Epidemiology (APIC), the Infectious Disease Society of America (IDSA) (2003).

Handwashing should occur (CDC, 2002):

  • Whenever hands are visibly dirty or contaminated.
  • Before:
    • having contact with patients
    • putting on gloves before inserting any invasive device
    • manipulating an invasive device
  • After:
    • having contact with a patient's skin
    • having contact with bodily fluids or excretions, non-intact skin, wound dressings, contaminated items
    • having contact with inanimate objects near a patient
    • removing gloves

It is important to remember that even if the healthcare provider did not touch the patient, bacteria can survive for days on patient care equipment and other surfaces in the patient care environment, including bed rails, IV pumps, computer keyboards, etc. Practicing hand hygiene after leaving the patient's room, even when the patient was not touched, is imperative to prevent the transmission of pathogens (CDC, 2003).

Persistence of Bacteria and Viruses on Dry/Inanimate Surfaces
(Kramer, Schwebke & Kampf, 2006)

Acinetobacter species —› 3 days - 5 months

C. difficile (spores) —› 5 months

E. coli —› 1.5 hours - 16 months

Enterococci —› 5 days - 4 months

Klebsiella species —› 2 hours to >30 months

Pseudomonas —› 6 hours - 16 months

Staphylococcus aureus —› 7 days - 7 months

Influenza —› 1-2 days

Rotavirus —› 6 -60 days

Alcohol-based hand rubs, either foam or gel, kill more effectively and more quickly than handwashing with soap and water. They are also less damaging to the skin, resulting in less dryness and irritation, leading to fewer breaks in the skin. Hand rubs require less time than handwashing with soap and water and bottles/dispensers can be conveniently placed at the point of care, to be more accessible (CDC, 2003).




An alcohol-based hand rub is the preferred method for hand hygiene in all situations, except for when your hands are visibly dirty or contaminated.

HAND RUB (foam and gel)

  • Apply to palm of one hand (the amount used depends on specific hand rub product).
  • Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 15 seconds to dry.


  • Wet hands with water.
  • Apply soap.
  • Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails.
  • Rinse under running water and dry with disposable towel.
  • Use the towel to turn off the faucet.

Colleagues, trainees, and other staff watch one another (CDC, 2003):

  • Research has shown that the actions of clinicians influence the behavior of others.
  • Show your colleagues that hand hygiene is an important part of quality care. Patients also watch what healthcare providers do:
  • As a healthcare provider, your actions send a powerful message.
  • Show your patients that you are serious about their health.

Hand lotions are important to prevent skin dryness and irritation. You should use only hospital-approved hand lotions. Other lotions may (CDC, 2002):

  • Make hand hygiene less effective.
  • Cause breakdown of latex gloves.
  • Become contaminated with bacteria if dispensers are refilled.

Artificial Nails (CDC, 2002):

  • Healthcare workers who have direct contact with high-risk patients (e.g., ICU, OR) should not wear artificial nails, tips, wraps, etc.
  • Natural fingernails should be kept to a length of approximately inch past the tip of the finger.
  • Nail polish is acceptable, but should not be chipped.

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