Long-Term Care Survey Alert

If your facility staff associates clean hands with lots of water and lather, that may be changing in the future.

According to revised hand hygiene guidelines expected to be released this year by the Centers for Disease Control and Prevention, alcohol-based handrubs reduce bacterial counts more effectively than antimicrobial or plain soap. The handrubs are also faster and less drying to the skin then soap and water, the CDC says.

"If the hands are heavily soiled, however, the caregiver would definitely use soap and water to remove any solid debris," says Sandra Fitzler, director of clinical services for the American Health Care Association.

The CDC guidelines also advise against caregivers wearing artificial nails and nail extenders in health care settings. Use of these nails has been linked to fungal infections in nurseries and surgical settings, according to James Marx, an infection control expert in San Diego, CA. Marx says hes unaware of studies linking infections to the nails in nursing homes, however.

In comments submitted to the CDC on the guidelines, AHCA raises a number of concerns unique to long-term care facilities, including the impact of routinely placing alcohol-based handrubs around cognitively impaired residents, who could be injured by putting them in their mouths or eyes, for example.

AHCA also notes that federal regulations require facilities to maintain a home-like environment and the alcohol rubs connote more of a medical type setting.

Another concern cited by AHCA and the CDC is the need for training to address caregiver perception that the alcohol-based handrubs wont really get their hands clean, even though the evidence says otherwise. "The CDC recommends training in this area to help ensure caregiver compliance," Fitzler tells Eli.