The attendant

There is no doubt that the most important factor in the transfer of infection is the attendant's hands. Thus adherence to a strict policy of hand hygiene becomes the cheapest and most effective measure in the control of nosocomial infection. However, it remains the most difficult measure to enforce ( Jarvis 1994; Sproat and Inglis

Handwashing is crucial for the protection not only of the patient but also of the attendant. A clinical handwash (lower forearm downward), using a proprietary skin disinfectant, must be performed at the beginning and end of each clinical session (,DoebbeJiingiiiietial 1992). Between patients, either an alcohol rub (e.g. Hibisol™)

should be used or the hands should be washed briefly but thoroughly in a surgical scrub detergent. Where a sterile procedure is being performed, a full surgical handwash (elbows to finger tips), together with the use of surgical-quality sterile gloves, is mandatory. Personnel must ensure that special attention is paid to the tips of fingers, particularly when using an alcohol rub. It is impossible to carry out a clinical handwash while wearing a wrist watch. Staff should not wear wrist watches, bracelets, rings other than plain bands, or ear or nose ornaments other than studs while carrying out clinical duties.

There is much confusion concerning latex gloves, which are used for two overlapping purposes: sterile gloves protect patients from contamination, and clean non-sterile examination gloves are used to protect the attendant from possible contamination with micro-organisms from the patient. Before commencing a procedure, it is important to assess whether sterility is required so that the correct gloves are used. Examination gloves are presented in such a way that removal from the box involves contaminating the outer surface, underlining the non-sterile nature of this product. Therefore these gloves should be regarded as an extension of the operator's own skin. Thus they must be removed after contact with the patient and before writing notes or answering the telephone. Sterile gloves should be worn for aseptic procedures and discarded immediately on conclusion. Watches must not be worn under gloves (this suggests that a proper clinical handwash has not been performed). Under no circumstances should staff leave an isolation room wearing gloves of either sort. Suggestions that the use of examination gloves obviates the need for antiseptic handwashing seems to be a concession to slack practice, rather than an improvement.

A handwashing standard for ICU use is shown in Fig 1, and an example of an over-basin display is shown in Fig 2.

Fig. 1 A handwashing standard poster for ICUs. NB This poster should be on a yellow background, indicating infection.

- W-r -.-.-—1.H — JJ^i mC^.-vJ'.-r JT" i -T^""»»^» ■ J<- iu ■ ■■«-■-■ JW w^ v L-wu

: gzsjfcasr"

"V —1. -J--J- . . J _L --- i ^ 1U-J ■— .■

- —- 7.!...'... ..Ï.

Fig. 2 A handwashing poster. NB This poster should be on a yellow background, indicating infection.

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