Hand hygiene is the most important measure to avoid transmission of microbes and prevent health care-associated infections

Semmelweis is recognised as the first person to introduce hand hygiene into healthcare by using a bowl, jug containing a solution of calcium hypochlorite and a towel. The modern-day equivalent - hand wash stations (HWS) is essentially a basin connected to the drainage system, above which is an outlet connected to the building water supply.  HWS are usually used together with soap and hand towels.

Outlets may be hand, knee or sensor operated. Concerns exist over the risk of biofilm formation in sensor operated outlets due to the increased complexity (also a risk of contaminating the end of the outlet with hands when learning how to activate the sensor).

Elbow operated outlets are therefore often seen as the gold standard in clinical areas even though liable to biofilm formation from thermostatic cartridges (often unnecessary if a scalding risk assessment had been performed). Knee operated outlets never gained widespread acceptance in healthcare.

Using a video camera mounted above hand wash stations, we decided to see how staff interacted with elbow operated outlets. Our findings show 92% of staff turn on elbow operated outlets with their hands and 68% use either their hands (21 people) or wrist (4 people) to turn the outlet off (use of wrists is deemed incorrect as it contravenes ‘bare below the elbows’ which advocates wrist washing). Thus, a high percentage of staff risk immediately re-contaminating their hands/wrists due to incorrect operation of the HWS.

Hand wash training/assessment using ultra violet light with fluorescent powders/creams, and hand washing instructions placed at HWS, tend to emphasise technique with little attention on correct use of HWS.

Re-contamination of hands at clinical hand wash stations, at the frequency observed, is cause for concern.

Watch the video below:

Dr Mike Weinbren