Hand Hygiene: The Single Most Critical IPC Practice for Anaesthetists
Hand hygiene is the one infection prevention and control practice I am most vigilant about, as hand-mediated transmission is the major contributing factor to healthcare-associated infections, and effective hand decontamination immediately before every episode of direct patient contact results in significant reduction in pathogen transfer and preventable infections. 1
Why Hand Hygiene Takes Priority
The Association of Anaesthetists of Great Britain and Ireland explicitly states that anaesthetists must ensure that good hand hygiene becomes an indispensable part of their clinical culture 1. This is not merely a recommendation—it is identified as the foundational practice upon which all other infection control measures depend 1.
The Evidence Base
- Hand-mediated transmission is the single most important vector for healthcare-associated infections in anaesthetic practice 1
- Approximately two-thirds of patients receiving parenteral antibiotics also undergo an anaesthetic, making the anaesthesia workspace a critical control point for hospital-wide infection prevention 2
- Even with near-perfect antibiotic prophylaxis compliance, over 5% of surgical patients develop surgical site infections, some directly traceable to contamination from the anaesthesia workspace 2
- 98% of anaesthetists' contact with patients' blood could be prevented by routine use of gloves, but gloves themselves become vectors without proper hand hygiene 1
The Practical Algorithm for Hand Hygiene
When to Perform Hand Hygiene
- At the start of every clinical session - wash with liquid soap and water 1
- Immediately before every episode of direct patient contact - use antimicrobial hand rub if hands not visibly soiled 1
- Between patients or activities - antimicrobial hand rub is effective and quicker than washing 1
- When hands are visibly soiled or potentially contaminated - must wash with soap and water 1
- After removing gloves - hands must be washed or decontaminated even after glove use 1
Critical Technique Points
- Ensure the whole hand and fingers, particularly the tips, are exposed to the hand rub 1
- Remove all watches and jewellery (including dress rings and wrist adornments) at the beginning of each clinical session before regular hand decontamination begins 1
- Cover cuts and abrasions with waterproof dressings, changed as appropriate 1
Important Caveat
Antimicrobial hand rub is NOT effective in preventing cross-infection with Clostridium difficile - soap and water washing is mandatory in these cases 1
Why Hand Hygiene Supersedes Other Measures
While other IPC practices are essential, hand hygiene is the gateway practice:
- Gloves can actually spread infection between patients if used incorrectly without proper hand hygiene 1
- Gloves must be removed before touching fomites (curtains, pens, clinical notes, keyboards, telephones), and hands must be decontaminated afterward 1
- Standard precautions, maximal barrier precautions for central lines, and equipment decontamination all depend on proper hand hygiene as their foundation 1
The Compliance Problem
Despite consistent advice and overwhelming evidence, staff often neglect hand hygiene when caring for patients 1. This makes personal vigilance even more critical. The anesthesia workspace has been directly implicated in transmission of multidrug-resistant organisms including MRSA 2, making this not just a personal practice issue but a patient safety imperative.
Practical Implementation
- Ensure sinks, soap, and antimicrobial hand rubs are conveniently placed 1
- Make hand hygiene an automatic reflex before every patient contact 3
- Recognize that maintenance of workspace cleanliness along with hand hygiene forms the cornerstone of preventing microbial transmission 3
Hand hygiene is the single most cost-effective, evidence-based intervention under direct control of the anaesthetist that impacts morbidity and mortality across the entire hospital patient population 4, 5, 3.