CDC Issues New Hand Hygiene Guidelines

CHICAGO (Reuters Health) - The US Centers for Disease Control and Prevention (CDC) issued new hand hygiene guidelines here Friday that recommend that healthcare facilities across the nation begin to use alcohol-based hand rubs to cut the risk of spreading germs to patients.

The guidelines come as US hospitals, nursing homes and long-term care facilities are besieged by increasing numbers of antibiotic-resistant bacteria. A University of Iowa study of 670 hospitals showed that Staphylococcus aureus, a type of bacteria often found on the skin, has become the most common antibiotic-resistant germ in US hospitals.

The Infectious Disease Society of America (IDSA) estimates that hospital-acquired infections kill 20,000 patients a year in the US.

"There's a growing need to take actions within the healthcare system that promote patient safety and protect patients, and we know that hand hygiene is a critical part of good health care," said Dr. Julie Gerberding, director of the CDC.

Speaking at a news conference at the annual meeting of the IDSA, Gerberding said a number of studies show that the availability of alcohol-based hand rubs increases hygiene, primarily by making hand cleansing more convenient.

"This is not to be interpreted that alcohol preps alone are the important issue," said Gerberding.

"What we're advocating is a comprehensive approach to hand hygiene. Certainly if the hands of healthcare workers are soiled, they need to wash with soap and water, and gloves are still recommended for situations where people have contact with blood or other body fluids or when they're conducting sterile procedures," she said. "The addition of alcohol preps is an expansion of hygiene, not a substitution for practices that we've known for a long time are important."

Dr. John M. Boyce, professor of medicine at Yale University, said at least 20 studies have shown that in addition to being fast and convenient, alcohol-based products are more effective than soap at removing bacteria from the hands.

Dr. Elaine Larson of the Columbia University School of Public Health in New York emphasized that many hospitals have already adopted the use of alcohol-based hand cleansers. She added that the previous guidelines for hand hygiene often weren't followed in busy emergency departments and intensive care units where it can be difficult to stop and wash with soap and water every few minutes.

"What's advantageous about these new guidelines is that it will be possible, in emergency and high-risk situations, to not have to line up at a sink and make a choice between doing hand hygiene and doing a high-risk procedure" that could threaten a patient with an infection that may be resistant to the antibiotics, said Larson.

Gerberding said the voluntary guidelines, published in the October 25th issue of the CDC's Morbidity and Mortality Weekly Report, should now be "de facto standard of care." The guidelines do not cover surgery, where a more rigorous regimen of hand scrubbing is necessary.

The most immediate impact of the guidelines will be in intensive care units (ICUs) and regular hospital ward practice, said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University in Nashville.

"Today, hospitals are full of very, very sick patients and are (virtually) quasi intensive care units, so implementing these guidelines in the wards and ICUs ought to have a substantial impact" on healthcare acquired infections, said Schaffner.

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