Handwashing in the intensive care unit: a big measure with modest effects

• Published in: Journal of Hospital Infection Vol. 59; no. 3; pp. 172 - 179
• Main Authors: Silvestri, L., Petros, A.J., Sarginson, R.E., de la Cal, M.A., Murray, A.E., van Saene, H.K.F.
• Format: Journal Article Book Review
• Language: English
• Published: Kent Elsevier Ltd 01.03.2005; Elsevier
• Subjects: Biological and medical sciences; Clinical Trials as Topic; Cross Infection - prevention & control; Cross Infection - transmission; Epidemiology. Vaccinations; General aspects; Guideline Adherence; Hand Disinfection; Handwashing; Human infectious diseases. Experimental studies and models; Humans; Infection; Infection Control - methods; Infectious Disease Transmission, Professional-to-Patient; Infectious diseases; Intensive care unit; Intensive Care Units - standards; Medical sciences; Handwashing; Infection; Intensive care unit; Nosocomial infection; Compliance; Transmission; Check; Health care staff; Disinfection; Washing; Oropharynx; Hand; Indicator; Prevention; Surveillance; Rectum; Bacteriosis; Clinical trial; Failure; Hygiene; Bibliographic review
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2004.11.005

Handwashing is widely accepted as the cornerstone of infection control in the intensive care unit. Nosocomial infections are frequently viewed as an indicator of poor compliance of handwashing. The aim of this review is to evaluate the effectiveness of handwashing on infection rates in the intensive care unit, and to analyse the failure of handwashing. A literature search identified nine studies that evaluated the impact of handwashing or hand hygiene on infection rates, and demonstrated a low level of evidence for the efforts to control infection with handwashing. Poor compliance cannot be blamed as the only reason for the failure of handwashing to control infection. Handwashing on its own does not abolish, but only reduces transmission, as it is dependent on the bacterial load on the hand of healthcare workers. Finally, recent studies, using surveillance cultures of throat and rectum, have shown that, under ideal circumstances, handwashing can only influence 40% of all intensive care unit infections. A randomised clinical trial with the intensive care as randomisation unit is required to support handwashing as the cornerstone of infection control.