Evidence-based model for hand transmission during patient care and the role of improved practices - 18/08/11

Doi : 10.1016/S1473-3099(06)70600-4

Didier Pittet, ProfMD ^a,^b,^⁎ , Benedetta Allegranzi, MD ^d,^e, Hugo Sax, MD ^a,^b, Sasi Dharan, Dip HIC ^a,^b, Carmem Lúcia Pessoa-Silva, MD ^f, Liam Donaldson, MD ^c, John M Boyce, MD ^g

on behalf of the WHO Global Patient Safety Challenge, World Alliance for Patient Safety

^a Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland

^b WHO Global Patient Safety Challenge, Geneva

^c World Alliance for Patient Safety, Geneva

^d Department of Infectious Diseases, University of Verona, Verona, Italy

^e Epidemic and Pandemic Alert and Response, WHO, Lyon, France

^f Healthcare-Associated Infections Programme, Department of Epidemic and Pandemic Alert and Response, WHO, Geneva, Switzerland

^g Infectious Diseases Section, Hospital of Saint Raphael, New Haven, CT, USA

^* Correspondence to: Prof D Pittet, Infection Control Programme, University of Geneva Hospitals, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. Tel: +41-22-372-9828; fax: +41-22-372-3987

Summary

Hand cleansing is the primary action to reduce health-care-associated infection and cross-transmission of antimicrobial-resistant pathogens. Patient-to-patient transmission of pathogens via health-care workers’ hands requires five sequential steps: (1) organisms are present on the patient’s skin or have been shed onto fomites in the patient’s immediate environment; (2) organisms must be transferred to health-care workers’ hands; (3) organisms must be capable of surviving on health-care workers’ hands for at least several minutes; (4) handwashing or hand antisepsis by the health-care worker must be inadequate or omitted entirely, or the agent used for hand hygiene inappropriate; and (5) the caregiver’s contaminated hand(s) must come into direct contact with another patient or with a fomite in direct contact with the patient. We review the evidence supporting each of these steps and propose a dynamic model for hand hygiene research and education strategies, together with corresponding indications for hand hygiene during patient care.

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