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. Improved adherence to hand hygiene can reduce the transmission of antimicrobial resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile, reduce overall hospital-acquired infection rates, and save lives.

Patients can carry resistant bacteria such as MRSA or C. 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. Infected or colonized patients can also contaminate the objects in their environment, leading to the subsequent contamination of the hands of healthcare workers who touch these items. Cleaning hands on room entry and exit can minimize the risk of pathogen transmission.

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
• promotes a "foam-in/foam-out" message to encourage all healthcare workers to clean their hands on room entry and exit.
• monitors hand hygiene compliance on room entry and exit and feeds-back compliance rates using an electronic hand hygiene monitoring system with voice reminders. It is expected that all eligible healthcare providers will participate in the "Cleans Hand Emory" monitoring effort. 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 and feel comfortable reminding each other to practice hand hygiene
• creates an environment where all staff and physicians are receptive to being reminded
• recognizes that busy healthcare workers can sometimes forget to clean their hands and thus benefit from reminders, but have low tolerance for those who disregard reminders to clean their hands

The Centers for Disease Control and Prevention recommends against, and Emory Healthcare policy prohibits, the wearing of artificial nails, inlays or gel nails by healthcare workers with direct patient contact. Additionally, natural nails may be no longer than one quarter of an inch past the fingertips. Long nails and artificial nails of healthcare workers have been associated with increased risk of patient infections.