The Unseen: Why Clean Hands Matter In Aged Care

Do you ever consider what microscopic entities reside on our hands, in those creases and under fingernails? Our hands are constantly interacting with the environment and tell a silent story of millions of microorganisms, some harmless, others not so much. The average human hand can become home to thousands of different types of bacteria, with estimates ranging from 150 to as many as 3,200 distinct species. This remarkable diversity emphasises the extensive interaction of our hands with the environment and their ability to act as a vector for microbial transmission to a non-infected surface. The bacterial load on hands can range from approximately 10,000 to 10 million bacteria per hand. The hands encounter around 10 million organisms per day, and humans have approximately 1,500 bacteria living on each square centimetre of skin on their hands, with even more underneath fingernails and between fingers. Consider also the crevices made available to this microbial population by wearing false nails and chipped nail polish. This blog post will uncover the fascinating science behind hand hygiene, revealing why this simple action is so powerful in safeguarding the health of our older adults and preventing the spread of infections within aged care settings. See your hands in a whole new light and discover practical steps to ensure their bacterial passengers are not passed onto unwanted surfaces. When it comes to stopping the spread of about 80% of infectious diseases transmitted by unclean hands touching contaminated surfaces, it’s always hand hygiene.

In aged care settings, maintaining a clean environment and practising diligent hand hygiene are critical. Older adults are often more vulnerable to infections due to weakened immune systems and underlying health issues. The close living conditions of facility residents and the frequent hands-on care provided by healthcare workers create an environment where pathogens can spread easily from the environment and from each other. Our hands serve as a primary conduit for the transmission of a vast array of microorganisms, playing a pivotal role in the spread of both resident and transient bacteria. Transient flora, which are microorganisms acquired temporarily on superficial layers of the skin, are more easily removed by routine hand hygiene. These are the organisms most frequently associated with healthcare-associated infections (HAIs).

About 80% of infectious diseases are transmitted by unclean hands touching contaminated surfaces. Organisms left on surfaces can survive for a few minutes to weeks. Disturbingly, a single bacterium can multiply into more than 16 million in 8 hours. Considering that hands encounter around 10 million organisms per day, the potential for transmission of a pathogenic organism within an aged care facility is very significant. Furthermore, humans touch their faces on average 23 times an hour, risking infection transmission to the eyes, nose, and mouth. 

Consider the multitude of points of contact in an aged care facility:

• Assisting residents with personal care, including toileting and personal hygiene.
• Handling medications.
• Preparing and serving food.
• Touching the resident or another individual.
• Touching the resident’s or another individual's surroundings.
• Using portable medical equipment and computer keyboards, which can harbour millions of organisms.
• Even mobile phones are hazardous microbial collection points.

It’s crucial to remember the adage: "It might be gloves. It’s always hand hygiene". (See our next post for more on this subject). Gloves provide a barrier but do not replace the fundamental requirement to have clean hands before donning gloves and after removing them.

Effective hand hygiene is a cornerstone of infection prevention practices. Both handwashing with soap and water and the use of alcohol-based hand rub (ABHR) are vital practices.

When should you clean your hands in aged care?

“The 5 Moments for Hand Hygiene” (WHO) makes this clear:  

Klebsiella bacteria are increasingly recognised as significant contributors to HAIs, including urinary tract infections, pneumonia, and bloodstream infections, which are more prevalent in aged care facilities and more concerning in older adults. These opportunistic pathogens can be readily transmitted through person-to-person contact, often via the contaminated hands of healthcare workers. The emergence of antibiotic-resistant Klebsiella strains further emphasises the vital need for stringent infection control measures, with hand hygiene being dominant in preventing their spread. Healthcare workers must consistently and effectively clean their hands between each resident contact and after touching any potentially contaminated surfaces or equipment to minimise the risk of Klebsiella transmission.

Successful hand hygiene requires a collaborative effort. As health professionals in aged care, you are role models. Encourage and support a culture where hand hygiene is a priority for all staff, residents (where able), and visitors. Ensure that:

• Hand hygiene facilities (sinks with soap and paper towels, and ABHR dispensers) are readily accessible in all care areas and common spaces, and solely for hand hygiene.

• Regular training and education on proper hand hygiene techniques and the importance of compliance are provided to all staff.
• Visual reminders, such as posters, are displayed to reinforce key moments for hand hygiene.
• Residents and their families are educated about the importance of hand hygiene in preventing infections.

Understanding the unseen story of the microbial world on our hands highlights the critical importance of hand hygiene in our daily lives within aged care. As we've explored, effective hand hygiene practices are not just about a quick wash; they are evidence-based techniques crucial for preventing the transmission of a vast array of microorganisms, including potentially harmful bacteria like Klebsiella, which significantly contributes to healthcare-associated infections. By diligently adhering to the guidelines and recommendations outlined in this post, you can equip yourself with the knowledge and practical steps to significantly reduce the risk of infection and contribute to a healthier and safer environment for our vulnerable residents.

Looking ahead, we want to remind you that May 5, is World Hand Hygiene Day. This annual event serves as a global reminder of the critical role hand hygiene plays in preventing the spread of infections. We encourage you to continue reflecting on your practices and championing hand hygiene excellence within our aged care community. Do this to protect yourself and, most importantly, those in your care.

Take advantage of our expertise in IPC. See the HUB for policies, resources and courses relating to this very important subject. Ask EVE for a quick answer to your question

Be sure to check out more blogs over the next couple of weeks, delving deeper into the vital subject of Hand Hygiene.