How to do it... Choosing hand sanitizers

1. Know the guidelines. Sanitizers come in various forms such as rinses, gels, foams and wipes but you should use only products with proper antimicrobial concentrations containing 60% to 95% alcohol, explains Gina Pugliese, RN, vice president at the Premier Safety Institute. 

Lower concentrations won't kill resistant germs like norovirus and cryptosporidium, warns Hudson Garrett, Ph.D., vice president of clinical affairs at PDI.

“Most often, opportunities for performing hand hygiene are missed within the clinical care activities of the resident, such as starting an IV and then removing a dirty dressing,” Garrett adds. 

Cheryl Carver, a product specialist for Gentell Corp., urges caregivers to sanitize hands immediately prior to dressing wounds. Other instances requiring immediate hand hygiene include contact with equipment and/or residents' surroundings, including hallways and common areas frequented by staff, residents and visitors, says Elaine McGowan, vice president of clinical affairs for DermaRite.

2. Know your vulnerabilities. In most facilities, they're literally right under your nose. 

Flu season is a time for constant hand sanitizing, says Barb Connell, vice president of clinical services at Medline. Vulnerability is even higher, however, in the off-season, “when there is nothing to see, but dangerous microbes still lurk and can be generously transmitted.”

Other daily vulnerabilities happen as nurses simply move from one resident to another, says Mary Madison, clinical consultant for long-term care/senior care assisted living at Briggs Healthcare. 

3. Fight misconceptions about hand hygiene. A major one: Personal protective equipment such as gloves — instead of hand hygiene — is the best and last line of defense, says Garrett. Missed hand washing between glove changes is a frequent citation during state surveys, adds Eula Reynolds, clinical education manager for DermaRite.

Contrary to popular opinion, hand dryers are worse than paper towels and can shoot bacteria up to six feet, adds Connell. 

Forget the notion that sanitizers and soaps are equally efficacious, experts say. As Carver points out, ordinary soap is most effective in cleaning visibly soiled hands. 

Another mistaken belief: Sanitizer use creates “super germs.” Not true, says Carver, adding “bacteria have not developed a resistance to alcohol, which breaks apart their cell walls.” 

Many nurses might think alcohol rubs dry out the hands. In fact, improperly formulated soaps do most of the damage, according to Chad Wyman, senior product manager for Direct Supply, and John Timmons, marketing director, alternate care, at GOJO Industries.

4. Understand, too, the barriers to effective hand hygiene. Compliance rates are low in long-term care. Skin stickiness, irritation and dryness, difficulty gloving and smell are among the potential pitfalls, says Garrett. The No. 1 barrier is lack of access to hand hygiene products, says McGowan. 

Another problem is under-staffing, which can fuel a chaotic environment where hand washing is overlooked, add Connell and Holly Korzendorfer, Ph.D., vice president of clinical business development, DermaRite.

5. Hand sanitizers won't get used if you don't make them ubiquitous and convenient — for staff, residents and visitors alike — in large gathering areas, hallways, dining rooms, private rooms, treatment rooms and nursing stations, Garrett urges. 

Give emphasis to point-of-care solutions, including bracket-mountable dispensers on devices such as wheelchairs and medication carts, and small bottles for individual healthcare workers, which can be carried in their pockets, add Wyman and Timmons. 

But think twice about placing them in obvious places near bathroom sinks or door entrances, where staff can easily contaminate their hands between the dispenser and the resident, Madison advises.