"For most, it's a question of competing priorities. Quick-drying hand gels that kill bacteria without need of soap and water are now standard fare in 95 percent of US hospitals. But still, at 30 seconds per hand wash, busy hospital workers who constantly jump from patient to patient could spend 10 minutes per hour washing their hands, leaving them less time to do other important tasks, like examining patients and double-checking drug doses."

• When hands are visibly dirty or soiled
  
• Before having direct contact with a patient
  
• Before putting on gloves
  
• After taking gloves off
  
• Before inserting catheters
  
• After taking a pulse or blood pressure
  
• After lifting a patient
  
• After contact with bodily fluids, mucous membranes, nonintact skin, and wound dressings
  
• If moving from a contaminated-body site to a clean-body site
  
• After contact with inanimate objects in the vicinity of a patient
  
• Before eating and after using a restroom

Last week, the Annals of Internal Medicine (AIM) published an article about physicians and their handwashing habits.

"Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions" - abstract from AIM

April 29, 2004 - The standards council of the National Fire Protection Association, which sets fire safety standards used in 38 states, on April 28 announced amendments to the NFPA Life Safety Code effective May 5 that will permit hospitals and other health care facilities to install alcohol-based hand-rub dispensers in their corridors. News item from AHANews.com.

March 2, 2004 - Anti-bacterial soaps do not deliver the type of protection from common health ailments that consumers expect, according to a study published in the latest issue of the Annals of Internal Medicine (AnnIM). Story from AP/Yahoo. (link is no longer available)

"Effect of Antibacterial Home Cleaning and Handwashing Products on Infectious Disease Symptoms" - full-text article from AnnIM

September 22, 2003 - SARS, West Nile virus, HIV/AIDS, and Norwalk virus were some of the buzzwords this week as thousands of the world's top infectious disease experts converged upon Chicago for the 43rd annual Interscience Conference on Antimicrobial Agents and Chemotherapy. Article from WebMD.

June 10, 2003 - The Centers for Disease Control and Prevention (CDC) has released a new document that addresses water quality in hemodialysis settings:

"Guideline for Environmental Infection Control in Health-Care Facilities, 2003" - Web page or 48-page pdf format

February 22, 2003 - If the doctor doesn't wash his hands, the nurses, residents and medical students under his supervision probably won't wash up either, a U.S. study found. Story from nurses.com. (link is no longer available)

November 11, 2002 - National Hand Washing Awareness Week is Dec. 8 to Dec. 14. The push is towards alcohol-based hand rubs, which are considered easier to use and more efficient at killing germs that often cause serious infections. Story from American Medical News.

The Centers for Disease Control and Prevention (CDC) is now offering materials (posters and buttons) to promote hand hygiene in your healthcare facility.

The four principles of hand awareness are:

• Wash you hands when they are dirty and before eating.
  
• Do not cough into your hands.
  
• Do not sneeze into your hands.
  
• Above all, do not put your fingers into your eyes, nose or mouth.

On November 1, the CDC announced a campaign aimed at nephrologists to prevent antimicrobial resistance in dialysis patients. Press release from the CDC.

The CDC has set up a web page with Tools for Clinicians who treat dialysis patients. Among the available resources:

• 12 Step Fact Sheet
  
• 3" x 2" Laminated Badge Card
  
• 20" x 30" Poster

October 25, 2002 - The Centers for Disease Control and Prevention (CDC) issued new hand hygiene guidelines today that recommend that healthcare facilities across the nation begin to use alcohol-based hand rubs to cut the risk of spreading germs to patients. Story from Reuters Health/Yahoo. (link is no longer available)

The CDC is urging healthcare facilities to adopt alcohol-based hand rubs, otherwise known as instant sanitizers, in place of soap and water, except when hands are visibly soiled. The CDC guideline on hand hygiene has not been revised since 1985, and it replaces 1995 guidelines developed by the Association of Professionals in Infection Control and Epidemiology. Here is the CDC press release on these new guidelines.

The new document, "Guideline for Hand Hygiene in Health-Care Settings", is available in two formats:

• Web version (html)

  Guideline without appendix - "Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force"

  Appendix - "Antimicrobial Spectrum and Characteristics of Hand-Hygiene Antiseptic Agents"

• PDF Version (for download and printing)

  Guideline with Appendix (56 pages)

August 16, 2002 - Researchers are reporting that when used in routine practice, handrubbing with an alcohol based solution after contact with patients achieved a greater reduction in bacterial contamination of hands than conventional handwashing with medicated soap. Full-text article from BMJ (British Medical Journal).

Here is a search result from Infection Control Today showing 200 recent articles on handwashing and infection control.

January 17, 2002 - Australian researchers found that male healthcare workers washed their hands one-third less often than female workers did after contact with an invasive instrument or a patient's skin, blood or "excretions." Story from Reuters Health/Yahoo. (link is no longer available)

November 9, 2001 - The CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) "Draft Guideline for Hand Hygiene in Healthcare Settings" can now be downloaded or ordered and is available for public comment until December 24, 2001.

The Draft Guideline for Hand Hygiene in Healthcare Settings is designed to provide healthcare practitioners with:

• a thorough review of evidence dealing with handwashing and hand antisepsis in healthcare settings and
• specific recommendations to promote improved hand hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings.

October 18, 2001 - As part of efforts to reduce hospital-related infections, patients at one of Britain's largest hospital trusts are given information leaflets highlighting the dangers of poor hand hygiene. The patients are then also encouraged to ask medical staff if they had washed their hands before examining them. Here is the story from Reuters/Medical Economics. (link is no longer available)

The first phase of this study was carried out at the University of Pennsylvania and resulted in an average 40% increase in hand washing by medical staff on one medical ward and one surgical ward.

August 1, 2001 - Frustrated by the lack of a vaccine, the US Navy found it was able to reduce respiratory illnesses by 45% by ordering recruits to wash their hands five times a day. Here is a summary from EurekAlert (link no longer available).

May 22, 2001 - The Centers for Disease Control and Prevention (CDC) has released a draft of new hand hygiene guidelines for healthcare workers.

The draft hand-hygiene guidelines recommend that healthcare workers not wear artificial nails and advocate the use of waterless, alcohol-based agents for routine hand antisepsis. Soap and water should be used when hands are visibly soiled.

Nosocomial is the adjective for describing infections or injuries acquired in a hospital or resulting from the actions of healthcare workers - as in "nosocomial infection" or "nosocomial injury". It is pronounced - NOSE oh COE me ol - (approximately)

Here is a search result of the MEDLINE database at the National Library of Medicine for handwashing and nosocomial infections.

The Centers for Disease Control and Prevention (CDC) has The National Nosocomial Infections Surveillance (NNIS) System.

Here are Eight Guidelines for Preventing Healthcare-Related Infections from the CDC.

Here the Universal Precautions guidelines from the National Institute of Health.