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8 Executive Briefing: Infection Prevention A ccording to the U.S. Centers for Disease Control and Pre- vention, it is estimated that one in every 25 hospitalized patients will contract a healthcare-associated infection. These infections can stem from resistant pathogens that can be spread through the hands of healthcare providers and patients as well as environmental surfaces. Infection prevention and control experts recognize hand hygiene as the single most important intervention in decreasing the spread of infection in both healthcare and community settings. Surface disinfection is also critical for high-touch items — items used daily that become a reservoir for bacterial and viral growth — that are frequently used during and between patient visits. Hand hygiene guidance and considerations The 2009 World Health Guidelines for Hand Hygiene for Health- care Settings indicates five instances for the nosocomial trans- mission of pathogens from one patient to another via the health- care worker's hands. They are as follows: • Microorganisms are present on the patient's skin or are shed into the patient's environment. • Microorganisms are transferred to the hands of the health- care worker. • Microorganisms are able to survive on the hands of the healthcare worker. • The healthcare worker omits hand hygiene or inadequately performs it. • The healthcare worker's contaminated hands come into di- rect contact with a patient or an item that will come into con- tact with a patient. The goal of hand hygiene is to remove as much of the micro- organisms on the hand as possible to avoid transmission. Soap and water is usually preferable, but CDC and WHO do endorse the use of alcohol-based hand rubs with alcohol concentration between 60 and 90 percent for healthcare worker hand hygiene. Several factors must also be considered when selecting a hand hygiene agent in order to ensure compliance, efficacy and safety. They are: • Cost of the agent • Ease of product use for healthcare workers • Potential for dermal irritation, skin reactions • Efficacy of the agent • Product availability and accessibility • Drying time after application • Staff support for the product selected Improving Hand Hygiene at Kirklin Clinic Janet Pate, JD, MHA, BSN, RN, director of infection prevention and employee health at Kirklin Clinic of University of Alabama Hospital in Birmingham, successfully improved hand and envi- ronmental hygiene at her facility through an improvement proj- ect that resulted in a 50 percent improvement in hand hygiene compliance. In 2007, the Kirklin Clinic of UAB Hospital implemented a compre- hensive hand and environmental hygiene program. The clinic's goal was to improve overall hand and environmental hygiene compliance among all patients and staff. Ms. Pate oversaw the program. Emphasizing the importance of never becoming "complacent," Ms. Pate says the goal for the hygiene program was and is always "zero healthcare-associated How One Facility Improved Hand Hygiene Compliance 50% Sponsored by: Infection prevention and control experts recognize hand hygiene as the single most important intervention in decreasing the spread of infection in both healthcare and community settings.