Effective hand washing is the basis of good hygiene practice and is the first line of defence against infection. Hands can easily be contaminated with pathogens. We can not only infect ourselves, we can also spread infections to co-workers and patients by touching them or shared objects. Transmission of pathogens via staff has been reported as the most common form of disease transmission (Tambuwal et al, 2009).
Hand washing significantly reduces the number of potential pathogens on your hands and decreases incidences of patient sickness and death due to hospital acquired infections (HAIs). It is also an important part of keeping yourself safe and reduce the risk of contracting an infection.
In situations that may pose a risk of infection, gloves should be worn; however, wearing gloves is not a substitute for effective hand washing as they can have microscopic holes or tears. Also, when gloves are being removed hands may come into contact with contaminated areas.
To minimise the spread of pathogens, you should also:
- Keep your nails short and clean.
- Remove all rings when working and avoid artificial nails. For non-invasive procedures, wedding rings or similar may be kept on but must be moved so that the skin underneath can be washed properly.
- Cover cuts, abrasions and dermatitis with water-resistant dressings and change them regularly.
When Should You Wash Your Hands?
Wash your hands whenever there is a chance that your hands may have become contaminated and whenever you are at risk of transmitting infections to yourself or others. Always wash your hands:
- Immediately when you arrive at work.
- At all 5 points of contact with patients (5 Moments for Hand Hygiene)
- After touching any instrument or object that might be contaminated with blood or other bodily fluids, or after touching mucous membranes.
- After you handle blood, urine or other specimens.
- After removal of gloves.
- Before and after using the toilet.
- Before eating or drinking.
- Before leaving work.
It may even be necessary to wash hands during contact with a patient, for example between changing a wound dressing and checking a peripheral IV catheter or if you become contaminated yourself with a bodily fluid.
Scarily, international studies have found that only 48 – 67% of vets washed their hands between patients, 53% of veterinary staff consumed food or drinks in animal-handling areas, and that 52% of vets washed their hands prior to eating (Lipton et al, 2008; Wright, 2008).
These same studies discovered that around one third of vets were not aware of the proper protocols for hygiene related to infection control.
Other studies found even lower compliance, reporting 21-48% in veterinary support staff (Nakamura, 2012; Shea & Shaw, 2012). Attard et al (2014) have stated that we have minimal Australian data to refer to, however we can presume the levels of complacency are similar in Australia.
Liquid Soap or Bars of Soap?
Liquid soaps are preferable to bar soaps. Bar soaps have been found to harbour micro-organisms.
Used liquid soap containers, whether they are antibacterial or not, should be replaced rather than refilled to help minimise contamination and potential contribution to biocidal resistance.
If you do choose to refill to save plastics going into landfill, then the container must be thoroughly cleaned and dried prior to being refilled. This reduces the risk of bacteria breeding in your hand soaps.
HAND WASHING TECHNIQUES
There are three main methods of hand washing used by veterinary staff:
- Routine/Social hand wash
- Aseptic hand wash
- Surgical hand wash.
As a general rule, you should remove jewellery and watches as they can carry bacteria. Minimal jewellery should be worn at work, with various infection control recommendations being nothing below the elbow.
Check hands for cuts or abrasions and cover with a water proof dressing. If you have a break in the skin, it is a portal for pathogens to enter your body.
Routine/social hand washing
The routine/social hand wash is the hand wash you’ll perform most often. This is the hand wash you’ll be performing between patients etc. This hand wash takes around 15 to 30 seconds to complete. This will be completed with soap and water OR with an alcohol hand rub – depending on your clinic policies and the level of contamination on your hands.
- Wet hands with running water.
- Rub hands together with soap and lather well, covering all surfaces on both sides of your hands.
- Weave fingers and thumbs together and slide them back and forth.
- Rinse hands under a stream of clean, running water until all soap is gone.
- Blot hands dry with a clean disposable paper towel. (Shared towels can become contaminated quickly.
Alcohol hand rub/gel
Alcohol hand gels kill or inhibit the growth of transient and resident micro-organisms but do not remove micro-organisms or soil. This method can be used when hand washing is not possible or practical (such as between patients in high-volume settings), but only if your hands are not visibly soiled with dirt, blood, or other matter. The technique is the same as for the routine/social above but with the alcohol hand rub in place of the soap and water.
Aseptic hand wash
Aseptic hand washes are done before you perform a non-surgical procedure that requires good infection control, such as IV catheter placement. Chlorhexidine or Iodine based scrubs are generally used and the complete procedure lasts around 1 minute.
- Wet hands and forearms with running water.
- Dispense antiseptic (approx. 5mLs) onto hands.
- Vigorously rub to obtain a lather on all sides of your hands and your forearms, rotating around for at least 30 seconds, including webbing, backs of hands, fingers and fingernails.
- Rinse hands thoroughly. Do not use hands to touch the tap to turn off. Use elbows or paper towel to cover it.
- Pat dry hands on paper towel.
Constant hand washing can damage your hands if they are not properly cared for. You’ve probably noticed that your skin is prone to drying out and cracking, the more you wash your hands.
Skin that is completely intact and free of cuts and abrasions has a natural defence against infection.
To prevent skin from drying and cracking:
- Wash hands with warm water.
- Make sure your hands are wet prior to applying detergent to your hands.
- Rinse off the detergent fully after rubbing your hands together for the required period.
- Pat (not rub) hands dry with single-use paper towel.
- Regularly use a water-based moisturiser.
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Infection Control Practices for Veterinary Clinics
Infection control in the veterinary clinic is vital not only for patient health, but also for veterinary staff, clients and the general public.Check it out
Attard, K., Burrows, E., Kotiranta-Harris, K., Hedlefs, R., Ketheesan N., and Govan, B. (2012) Veterinary infection control in Australia: is there control? Australian Veterinary Journal, 90(11), 438-441.
Lipton, B., Hopkins, S., Koehler, J., & DiGiacomo, R.A. (2008). Survey of veterinarian involvement in zoonotic disease prevention practices. Journal of American Veterinary Medicine Association, 233, 1242–1249.
Nakamura RK, Tompkins E, Braasch EL, Martinez JG, Bianco D. (2012). Hand hygiene practices of veterinary support staff in small animal private practice. Journal of Small Animal Practice, 53, 155–160.
Shea A, Shaw S: Evaluation of an educational campaign to increase hand hygiene at a small animal veterinary teaching hospital. J Journal of American Veterinary Medicine Association, 240, 61–64.
Tambuwal, F., Shittu, A., Abubakar, M. et al. (2009). A survey of veterinary hospitals in Nigeria for the presence of some bacterial organisms of nosocomial and zoonotic potential. Veterinaria Italiana, 45(2), 235–241.
Wright, J., Jung, S., Holman, R., Marano, N., & McQuiston, J. (2008). Infection control practices and zoonotic disease risks among veterinarians in the United States. Journal of American Veterinary Medicine Association, 232, 1863–1872.