Basic Hygiene Hand Hygiene

Hand hygiene – It’s in your hands

A handshake when greeting someone, the opening of a door, the grabbing of a bill from your wallet – we spread germs and expose ourselves to them every day as a matter of course. On our hands alone, there are approximately 10 million potentially pathogenic microorganisms – an impressive number that makes hands a significant risk factor. In addition to normal skin flora, there are also multi-resistant germs including S. aureus, S. pseudintermedius, Pseudomonas spp., and Enterobacteriaceae present on the hands of veterinary staff. ^​[1]

Hand hygiene poses major challenges for every veterinary practice, every veterinary clinic, and every other veterinary institution – while at the same time offering enormous potential for improvement in hygiene management. By specifically improving hand hygiene, a significant 40 percent reduction in hospital-associated or hospital-acquired infections (HAI/NI) can be achieved. ^{​[2, 3]}

Hand hygiene compliance (ensured according to the 5 moments for hand hygiene) in veterinary medicine is well below the average value compared to human medicine at 14-36 percent. ^{​[4, 5]} It can therefore be assumed that there is even greater potential for reducing hospital-acquired infections in veterinary medicine. The average contact time is also often too short for surgical and hygienic hand disinfection. ^{​[4, 5]}

When life is in our hands – Hygiene in veterinary medicine

This means that hand hygiene is one of the most important measures for counteracting HAI/NI. ^​[6]

It should therefore be an integral part of everyday routine in veterinary practices and clinics.

These points show us how much life truly is in our hands at times. 
 
Our desire is to help veterinary health care facilities to truly take advantage of this prevention potential. Here, the goal is to work on staff compliance with regard to hand hygiene.

Hygienic hand disinfection

The hands are the most important tools for staff in veterinary practices and clinics. This is precisely why they are also the most common route of transmission for hospital-acquired infections. Effective and simple protection against nosocomial infections is provided by correctly performed hand disinfection. You can find all the necessary steps in detail in our step-by-step guide on hygienic hand disinfection.

Prerequisites for successful hand hygiene

• Do not wear rings (including wedding rings), bracelets, watches or piercings on your hands and forearms.
• Fingernails should be cut short and rounded and should finish at the fingertips.
• Artificial and gelled fingernails should be disallowed.
• Hands should be free from nail bed injuries, inflammatory lesions or other injuries, especially cuts, etc.
• Hand disinfectant should be applied to dry hands.
• In the event of possible contamination with viruses, it must be ensured that the product to be used has a wide spectrum of effects and is effective against the corresponding viruses.
  

Hygienic hand disinfection is required ^{​[6, 17]​}

• Before entering the clean side of the personnel airlock of operating departments/compartments, sterilization departments/compartments, and other clean room areas 
• Before entering various animal wards, e.g., intensive care unit
• Before patient contact 
• Before aseptic activities (e.g., injections, dressing changes, preparation of medication)
• After contact with potentially infectious material (urine, saliva, blood, wound secretions, etc.)
• After patient contact
• After contact with the patient’s immediate environment
• After removing protective gloves in the event of contact with or probable contact with a pathogen or severe contamination

Surgical hand disinfection

Whether preparing for surgery or during surgery: Minimizing risks is always one of the top priorities in all hygiene measures. Correct hand disinfection – that of the operating surgeon, as well as that of all other persons involved in the operation – is essential in order to avoid possible infection of the patient during a procedure. Therefore, surgical hand disinfection must aim to reduce transient and, above all, resistant skin flora as far as possible and for as long as possible. All necessary steps are described in detail in our surgical hand disinfection step-by-step guide.

Background information resident germs^​

A pH value of 5.5 and a relatively low moisture content – healthy skin has good growth conditions for the predominantly gram-positive bacterial flora. This flora is referred to as resident flora. Resident germs are characterized by their special adhesive properties. They mainly colonize the upper layers of the stratum corneum (horny skin layer) as well as the upper parts of the hair follicles and sebaceous ducts. Approximately 20 percent of microorganisms can still be detected in layers deeper than 0.3 mm. This microbial flora does not normally harm a healthy person; however, it does pose a risk to wounds and thus to patients and can only be reduced by surgical hand disinfection. Compared to hygienic hand disinfection, surgical hand disinfection therefore requires a longer contact time for it to reach the deeper layers.

Conditions for surgical hand disinfection^​

• Fingernails must be short and round.
• There may be no nail bed injuries or inflammatory conditions present.
• Only nails and nail folds should be cleaned with a soft (!), (thermally) disinfected plastic brush and hygienic hand washing detergent wherever necessary.
• Brushing hands and forearms is not permitted due to the fact that it causes skin irritation and greater germ release.
• Fittings and dispensers may not be operated via hand contact.
     

Preparation and implementation ^{​[6, 17, 18]​}

• Before the first surgery of the day, wash your hands and forearms up to your elbow with your fingertips facing upwards and your elbows low down. Use a hand wash for 30-60 seconds.
• Only nails and nail folds should be cleaned with a soft plastic brush and a hygienic hand wash wherever necessary.
• Brushing hands and forearms should be avoided due to the fact that brushing causes skin irritation and higher germ release (brushing should only be done in the event of stubborn dirt).
• After the washing phase, dry the hands and forearms with a low-germ towel or a sterile cloth.
• A gap of >10 minutes should be maintained between hand washing and surgical hand disinfection wherever possible.
• Subsequent surgical hand disinfections do not require soap washing unless the hands are visibly soiled.
• During hand disinfection, the hands and forearms are first wetted for the contact time specified by the manufacturer. The hand disinfectant is then rubbed into both hands in the same way as it is for hygienic hand disinfection. The main focus is on the fingertips, the nail folds, and the gaps between the fingers. It is important that the hands remain well moistened during the entire contact time.
• Do not put gloves on with wet hands.

Cleaning the hands

Frequent hand cleansing removes protective lipids from the skin and impairs the skin’s natural barrier function. For this reason, unnecessary hand washing should be avoided. Hand washing should be carried out in accordance with the AWMF Hand Hygiene guidelines:

Hand washing ^{[6, 17]​}

• Before starting work
  
• If necessary, after finishing work
• After visiting the restroom
• In case of visible soiling
• After hand disinfection in the event of contact with bacterial spores or parasites
  

 
Hands are washed under running water. The elbow is used to dispense the skin-gentle hand wash from the dispenser. The agent is rubbed into the hands, the hands then get rinsed under under running water and are then carefully dried with a disposable towel.

The following are also recommended

• Dispenser for disposable towels
• Liquid soap instead of solid soap
• Dispensers with an extended lever fitting (for the hand wash)
  

Hand and skin care

Frequent washing and disinfection, constant contact with different substances, or frequent wearing of latex gloves – professional activities and increasing external aggravations can lead to high levels of strain on hands and skin. Skin problems are increasingly common as a consequence. Occupational skin diseases have increased significantly in recent years and now occupy the top position on the list of reported occupational diseases. One thing is clear: injuries, eczema, and other skin diseases are not just a purely esthetic problem. They are of high hygienic relevance. For this reason, skin protection, skin cleansing and skin care are considered an essential part of occupational health and safety and are described in the General Prevention Guidelines for Skin Protection of the DGUV (German Social Accident Insurance).

Skin protection

The use of preparations for skin protection is particularly important for wet work and particularly for skin-stressing activities. Protective measures strengthen the skin’s resilience. The employers’ liability insurance association recommends using skin protection products:

• Before starting work
• Before any respective activities with contact to moisture
• Before wearing gloves
• During breaks
  

 
And to use liquid product from a dispenser whenever possible.

Skin care products

In order to minimize hand washing and disinfection effects on the skin from, it is important to ensure sufficient skin care. However, this does not just concern employees wishing to avoid burdensome skin irritation and diseases: damaged hands can no longer be sufficiently disinfected because germs nest in the damaged areas of the skin and are therefore no longer accessible for the disinfectant. Even the smallest cracks and microtrauma are sufficient to allow the risk of transmission of pathogens to increase.

To minimize this risk, skin care should be performed:

• After washing hands
  
• During breaks
• After finishing work
• During free time
• As needed
  

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[​20] German Statutory Accident Insurance (DGUV). DGUV Information 212-017 "Auswahl, Bereitstellung und Benutzung von beruflichen Hautmitteln (Selection, provision and use of occupational skincare products)".​}