Hand hygiene (i.e. hand washing or use of alcohol-based hand rubs) is the most important practice to reduce the transmission of infectious agents in healthcare settings. Accordingly, compliance with hand hygiene on room entry and room exit is a high priority for Emory Healthcare and all affiliated facilities. Patients can carry resistant bacteria such as MRSA or Clostridioides difficile on their skin and other parts of their body without showing signs of infection (e.g. they are colonized). Colonized patients as well as infected patients can be the source of pathogens that spread from person to person, typically by transient carriage on the hands of healthcare workers. Colonized patients as well as infected patients can be the source of pathogens that spread from person to person, either via direct contact with the hands of healthcare workers, or indirectly via contaminated objects in their environment. Improved adherence to hand hygiene can reduce the transmission of antimicrobial resistant organisms, reduce overall hospital-acquired infection rates, and save lives.

Alcohol-based hand rubs are currently recommended as the primary method of hand hygiene in most situations because: 1) it takes less time and is easier to do than hand washing, 2) it is more convenient, 3) it results in a greater reduction in bacteria on the skin compared to washing with soap and water, and 4) it is less drying because of the emollients in the hand rubs. However, soap and water is recommended when:

• hands are visibly soiled (dirty) or are visibly contaminated with blood or body fluids
• before eating
• after using the restroom
• after caring (on room exit) for a patient with Clostridioides difficile, norovirus, or other pathogens that are not inactivated by alcohol as indicated on the Contact Enteric Precautions signage

The use of gloves does NOT eliminate the need for hand hygiene. When gloves are used as part of Standard or Contact Precautions, it is important to perform hand hygiene both before and after glove use. Gloves should also be changed if you go from a dirty area to a clean area on the same patient or if the gloves become soiled, contaminated or perforated while caring for a single patient.

To improve compliance with hand hygiene, Emory Healthcare

• makes alcohol based hand-rubs widely available
• monitors hand hygiene compliance on room entry and exit and feeds-back compliance rates using an electronic hand hygiene monitoring system with voice reminders. For more information on Clean Hands Emory, see https://ourehc.org/departments/quality/clean-hands-emory/index.html
• creates an environment where all patients, staff and physicians are empowered to remind each other to practice hand hygiene and are receptive to being reminded
• has low tolerance for those who willfully disregard reminders to clean their hands

The Centers for Disease Control and Prevention recommends against, and EHC policy prohibits, the wearing of artificial nails, acrylics, overlays and tips by healthcare workers with direct or indirect patient contact. Additionally, natural nails must be short, clean and not extend over the fingertip. Regular nail polish must not be chipped or flaking. Long nails, chipped nails and artificial nails of healthcare workers have been associated with increased risk of patient infections.