질병 예방 가장 과학적인 손씻기 방법 Effective hand hygiene key to reducing hospital-based infections
Effective hand hygiene key to reducing hospital-based infections
By Ananya Mandal, MDApr 15 2019
Reviewed by Kate Anderton, B.Sc.
The World Health Organization (WHO) recommends a 30 second application of a six-step hand washing and hand rub regimen that could keep infections away. New research titled, 'Simplifying the WHO protocol for hand hygiene, three steps and 15 seconds: a randomized crossover trial' and presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands held between 13th and 16th of April suggests hand rubs could achieve the same in a three step procedure for 15 seconds.
Image Credit: Santypan / Shutterstock
Related Article:
Why patients need to be advised about washing hands?
https://www.siasat.com/news/why-patients-need-be-advised-about-washing-hands-2-1487678/
질병 예방 가장 과학적인 손씻기 방법 스위스 연구팀 공개 WHO 제안 보다 훨씬 간단 독감과 메르스, A형간염, 장티푸스와 같은 전염병을 예방하는 가장 좋은 방법으로 전문가들은 '손씻기'를 강조한다. 세균과 바이러스가 손을 통해 전염될 위험이 가장 높으므로 손을 자주 씻으면 그만큼 감염율을 낮출 수 있기 때문이다. 세계보건기구(WHO)는 손을 잘 씻으면 감염률을 60% 이상 줄일 수 있다고 권고하고 있다.
스위스 바젤대병원 연구팀은 WHO가 제안한 것보다 훨씬 간단하게 손을 씻는 방법을 제안했다. 알코올 세정제를 이용해 15초간 3단계로 손을 닦는 것이다. 바젤대 제공 WHO는 물과 비누를 이용해 60초간 6단계로, 알코올세정제를 이용해 30초간 6단계로 손을 씻는 방법을 권장해왔다. 하지만 이 방법은 너무 번거롭다는 단점이 있었다. 과학자들이 최근 훨씬 간편하고 세정 효과가 높은 손 씻는 방법을 새롭게 내놨다. 스위스바젤대병원 감염내과 교수팀 이달 14일 네덜란드 암스테르담에서 열린 유럽미생물학및감염성질병학회에서 WHO 권장 방법보다 훨씬 세정 효과가 뛰어난 손씻기 권고안을 공개했다.
WHO가 제시한 손 씻기 방법. 알코올 세정제를 이용해 30초간, 물과 비누를 이용해 60초간 그림처럼 6단계를 거쳐 손을 씻으라고 제안했다. WHO 제공 세균 감염의 경로는 '손' 미국 미시간대 연구팀은 병원에 입원한 환자 399명과 병실 4269개를 조사한 결과 약 10%가 손에 슈퍼박테리아(항생제에 내성을 가진 균)를 지니고 있으며, 침대의 손잡이나 호출버튼 등 환자의 손이 자주 닿는 물건까지 합하면 슈퍼박테리아에 감염될 확률이 13.3%에 이른다는 사실을 알아냈다. 연구를 이끈 로나 모디 미시건대병원 노인병학과장은 "환자와 직접 닿지 않고 환자가 만진 물건만으로도 슈퍼박테리아가 전염될 수 있다는 뜻"이라면서 손 씻기를 강조했다. WHO는 알코올이 든 세정제를 이용해 30초간 6단계, 또는 물과 비누를 이용해 60초간 6단계에 거쳐 손과 발을 씻도록 권장하고 있다. 자체 연구 결과 이 방법대로 손을 씻으면 감염율이 60% 이상 감소하는 것으로 나타났다. 그러나 이달 14일 유럽미생물학및감염성질병학회에서 로린 허월트 미국 아이오와대 로이제이앤 루실에이카버의대 내과 교수는 2005년부터 2006년까지 미국 전역 18개 병원 중환자실에서 3246시간 동안 관찰한 결과, 의료진의 약 3분의 1만이 WHO에서 권장한대로 손을 씻었다고 발표했다. 손 씻는 시간보다 '마찰'이 중요 새라 추딘서터 스위스바젤대병원 감염내과 교수팀은 같은 날 학회에서 "WHO가 제안한 방법은 비교적 긴 시간 동안 여러 단계를 거쳐야 해 시간 압박과 과도한 업무 부담을 느끼는 의료진에게는 자주 손 씻기마저 부담이 될 수 있다"며 훨씬 간단하면서도 비슷한 청결효과를 내는 손 씻기 방법을 제안했다. 스위스 과학자들이 제안한 '15초-3단계' 손 씻기 방법. 양손을 15초씩 마찰력을 이용해 닦는다. 바젤대병원 제공 연구진이 제안한 새로운 손씻기 방식은 알코올 세정제를 이용해 단 15초간 3단계에 걸쳐 손을 닦는 것이다. 먼저 양손 전체에 세정제를 흠뻑 묻히고 손바닥과 손등을 문질러 닦은 다음, 한 손의 손가락을 모아 다른 손의 손바닥을 긁듯이 문지른다. 그리고 엄지손가락을 돌리듯이 닦는다. 양손 모두 같은 순서대로 15초씩 닦는다. 이때 중요한 것은 손가락과 손바닥을 마찰하는 것이다.
그 결과 손 닦는 단계를 연구팀이 제안한 대로 3단계로 줄여도 항균 효과가 있는 것으로 나타났다. 손을 씻은 뒤 세균이 줄어든 수치를 쟀더니 30초간 6단계로 씻을 때 3.7, 15초간 6단계로 씻을 때 4.3, 30초간 3단계로 씻을 때 3.4, 15초간 3단계로 씻을 때 4.2로 나타났다. 추딘서터 교수는 "손을 씻는 데 걸리는 시간보다 마찰을 이용한 기술이 훨씬 중요하다"며 "물과 비누를 이용해 손을 씻을 때도 3단계로 닦으면 효과적"이라고 설명했다. 이정아 기자 zzunga@donga.com 동아사이언스 |
edited by kcontents
Alcohol based hand rubs are widely used in hospitals and other set ups for infection control. This hand hygiene could be a crucial measure to prevent and reduce the spread of infections. There are no studies evaluating the best practice that could reduce infections. The WHO recommended six-step hand rub technique is effective in killing bacteria. This study shows that a simple 15 second three step hand rub could be just as effective in killing bacteria as well as improved user adherence.
Dr Sarah Tschudin-Sutter and colleagues from University Hospital Basel, Switzerland, tried their 15 second three step hand rub regimen in a randomised cross-over trial. They recruited 20 healthy participants between ages 18 and 51 years. They were randomly assigned to four different techniques of hand rubs including;
Six-step hand hygiene for 30 seconds
Six-step hand hygiene for 15 seconds
Three-step hand hygiene for 30 seconds and
Three-step hand hygiene for 15 seconds
All participants were in turn assigned to each of the groups.
Results revealed that three step technique for 15 seconds was as effective as reducing bacteria counts on the hands of the volunteers as 30 second three or six step regimen.
Professor Tschudin-Sutter in a statement said, “The time pressure and heavy workload experienced by healthcare workers reduces compliance with hand hygiene standards. Our findings suggest that shortening hand rubbing time and simplifying the technique for use of hand rub could be a safe alternative that is easier to fit into their busy routine, could enhance the overall quality of hand hygiene performance, and have a positive effect on adherence. Further studies are needed to validate the performance of the shorter application time in everyday clinical practice.”
The team agrees that the study could not make blanket statements about the three step regimen’s ability to stop transmission of microbes unless studied in actual clinical settings.
Hand hygiene and reduction in Staph infections
In 2009 the National Australian Hand Hygiene Initiative (NHHI) was implemented and since then there has been a significant improvement in reduction of Staph infections in healthcare facilities. The results of this new study titled, 'Improved hand hygiene compliance (HHC) is associated with a significant reduction in rates of healthcare-associated Staphylococcus aureus bacteraemia (HA Sab) in Australia's 132 largest hospitals: outcomes of the Australian National Hand Hygiene Initiative (NHHI)', were presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands held between 13th and 16th of April.
The report suggests that there have been a significant improvement in hand hygiene and its adherence among Australian health care workers. This has reduced the risk of transmission of often fatal healthcare-associated Staphylococcus aureus infection. The researchers noted that for each 10 percent rise in adherence to hand hygiene guidelines, there was a 15 percent reduction in the incidence of S. aureus bloodstream infection among the 132 largest public hospitals of Australia as was seen from the study. These hospitals cater to over 15 million patients-days across the nation in 2016-17, they add. This translates to more than three quarters of inpatient care for the Australian population.
The team was following up the WHO campaign called “5 Moments for Hand Hygiene” that would reduce the risk of healthcare associated infections.
These five moments include;
Before touching a patient
After touching a patient
After touching a patent's surroundings
Before a clean procedure
After exposure to body fluids/wounds
CDC
edited by kcontents
Professor Lindsay Grayson from Hand Hygiene Australia, and study leader said, “Hospital-acquired infections are a major concern for hospitals around the world and S. aureus is among the most dangerous. The risks to patients are enormous, as are the associated hospital costs. Despite robust evidence supporting improved practices for hand hygiene, securing compliance is notoriously difficult, and few national programmes have been sustained in the long-term.” The researchers and experts say that S. aureus is the main Gram positive bacterium that leads to hospital-acquired infections. Some of these such as endocarditis, acute pneumonia, and sepsis might become fatal and good hand hygiene could keep them at bay.
The team for this study looked at outcomes of the NHHI for eight years since it started. The timeline for the study was from January 2009 to June 2017. Three times a year hand hygiene moments were observed and recorded. The impact of this programme was assessed using linking of the data on hospital based S. aureus infections.
Results showed that hand hygiene compliance moments (observed) was 64 percent (36,213 of 56,978 potential opportunities of hand washing or hygeine) in 2009. The numbers came to 84 percent (494,673 of 586,559 potential opportunities of hand washing or hygiene) in 2017. The team looked at adherence to the hand hygiene moments among doctors, nurses and allied staff. They found that compliance to hand hygiene was 10 to 15 percent lower among medical staff compared to nursing staff over the 8 years of the study. Further every 10 percent increase in hand hygiene compliance reduced the S. aureus infection by 15 percent they found. Cases of S. aureus infection declined from 1.27 new cases per 10,000 bed-days in 2010-11 to 0.87 per 10,000 bed-days in 2016-17.
Professor Grayson said in a statement, “The National Australian Hand Hygiene Initiative has achieved impressive results, both in terms of improving healthcare worker hand hygiene compliance and its association with reduced rates of healthcare-associated staphylococcal bacteraemia. Few national programmes have become successfully integrated into national health-care structures.”
kcontents
