Drying is an essential part of the hand hygiene process. In November 2008, a non-peer-reviewed study was presented to the European Tissue Symposium by the University of Westminster

University of Westminster

The University of Westminster is a public research university located in London, United Kingdom. Its origins go back to the foundation of the Royal Polytechnic Institution in 1838, and it was awarded university status in 1992.The university's headquarters and original campus are based on Regent...

, London, comparing the bacteria levels present after the use of paper towel

Paper towel

A paper towel is an absorbent textile made from paper instead of cloth. Unlike cloth towels, paper towels are disposable and intended to be used only once. Paper towels soak up water because they are loosely woven which enables water to travel between them, even against gravity...

s, warm air hand dryers, and modern jet-air hand dryers. Of those three methods, only paper towels reduced the total number of bacteria on hands, with "through-air dried" towels the most effective.

The presenters also carried out tests to establish whether there was the potential for cross-contamination of other washroom users and the washroom environment as a result of each type of drying method. They found that:

• the jet air dryer, which blows air out of the unit at claimed speeds of 400 mph, was capable of blowing micro-organisms from the hands and the unit and potentially contaminating other washroom users and the washroom environment up to 2 metres away
• use of a warm air hand dryer spread micro-organisms up to 0.25 metres from the dryer
• paper towels showed no significant spread of micro-organisms.

In 2005, in a study conducted by TUV Produkt und Umwelt, different hand drying methods were evaluated. The following changes in the bacterial count after drying the hands were observed:

Drying method	Effect on bacterial count
Paper towels and roll	Decrease of 24%
Hot-air drier	Increase of 117%

Cleaning, disinfection and sterilization
Sterilization is a process intended to kill all microorganisms and is the highest level of microbial kill that is possible. Sterilizers may be heat only, steam, or liquid chemical.
Effectivness of the sterilizer (e.g., a steam autoclave) is determined in three ways.
First, mechanical indicators and gauges on the machine itself indicate proper operation of the machine. Second heat sensitive indicators or tape on the sterilizing bags change color which indicate proper levels of heat or steam. And, third (most importantly) is biological testing in which a highly heat and chemical resistant microorganism (often the bacterial endospore) is selected as the standard challenge. If the process kills this microorganism, the sterilizer is considered to be effective. It should be noted that in order to be effective, instruments must be cleaned, otherwise the debris may form a protective barrier, shielding the microbes from the lethal process. Similarly care must be taken after sterilization to ensure sterile instruments do not become contaminated prior to use.

Disinfection refers to the use of liquid chemicals on surfaces and at room temperature to kill disease causing microorganisms. Disinfection is a less effective process than sterilization because it does not kill bacterial endospores.

Sterilization, if performed properly, is an effective way of preventing bacteria

Bacteria

Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

 from spreading. It should be used for the cleaning of the medical instruments or gloves, and basically any type of medical item that comes into contact with the blood stream and sterile tissues.

There are four main ways in which such items can be sterilized: autoclave

Autoclave

An autoclave is an instrument used to sterilize equipment and supplies by subjecting them to high pressure saturated steam at 121 °C for around 15–20 minutes depending on the size of the load and the contents. It was invented by Charles Chamberland in 1879, although a precursor known as the...

 (by using high-pressure steam

Steam

Steam is the technical term for water vapor, the gaseous phase of water, which is formed when water boils. In common language it is often used to refer to the visible mist of water droplets formed as this water vapor condenses in the presence of cooler air...

), dry heat

Heat

In physics and thermodynamics, heat is energy transferred from one body, region, or thermodynamic system to another due to thermal contact or thermal radiation when the systems are at different temperatures. It is often described as one of the fundamental processes of energy transfer between...

 (in an oven), by using chemical sterilants such as glutaraldehydes or formaldehyde

Formaldehyde

Formaldehyde is an organic compound with the formula CH2O. It is the simplest aldehyde, hence its systematic name methanal.Formaldehyde is a colorless gas with a characteristic pungent odor. It is an important precursor to many other chemical compounds, especially for polymers...

 solutions or by radiation

Radiation

In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...

 (with the help of physical agents). The first two are the most used methods of sterilizations mainly because of their accessibility and availability. Steam sterilization is one of the most effective types of sterilizations, if done correctly which is often hard to achieve. Instruments that are used in health care facilities are usually sterilized with this method. The general rule in this case is that in order to perform an effective sterilization, the steam must get into contact with all the surfaces that are meant to be disinfected. On the other hand, dry heat sterilization, which is performed with the help of an oven, is also an accessible type of sterilization, although it can only be used to disinfect instruments that are made of metal

Metal

A metal , is an element, compound, or alloy that is a good conductor of both electricity and heat. Metals are usually malleable and shiny, that is they reflect most of incident light...

 or glass

Glass

Glass is an amorphous solid material. Glasses are typically brittle and optically transparent.The most familiar type of glass, used for centuries in windows and drinking vessels, is soda-lime glass, composed of about 75% silica plus Na2O, CaO, and several minor additives...

. The very high temperatures needed to perform sterilization in this way are able to melt the instruments that are not made of glass or metal.

Steam sterilization is done at a temperature of 121 C (250 F) with a pressure of 106 kPa (15 lbs/in2). In these conditions, unwrapped items must be sterilized for 20 minutes, and wrapped items for 30 minutes. The time is counted once the temperature that is needed has been reached. Steam sterilization requires four conditions in order to be efficient: adequate contact, sufficiently high temperature, correct time and sufficient moisture

Moisture

Humidity is the amount of moisture the air can hold before it rains. Moisture refers to the presence of a liquid, especially water, often in trace amounts...

. Sterilization using steam can also be done at a temperature of 132 C (270 F), at a double pressure. Dry heat sterilization is performed at 170 C (340 F) for one hour or two hours at a temperature of 160 C (320 F). Dry heat sterilization can also be performed at 121 C, for at least 16 hours.

Chemical sterilization, also referred to as cold sterilization, can be used to sterilize instruments that cannot normally be disinfected through the other two processes described above. The items sterilized with cold sterilization are usually those that can be damaged by regular sterilization. Commonly, glutaraldehydes and formaldehyde are used in this process, but in different ways. When using the first type of disinfectant, the instruments are soaked in a 2-4% solution for at least 10 hours while a solution of 8% formaldehyde will sterilize the items in 24 hours or more. Chemical sterilization is generally more expensive than steam sterilization and therefore it is used for instruments that cannot be disinfected otherwise. After the instruments have been soaked in the chemical solutions, they are mandatory to be rinsed with sterile water which will remove the residues from the disinfectants. This is the reason why needles

Hypodermic needle

A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...

 and syringes are not sterilized in this way, as the residues left by the chemical solution that has been used to disinfect them cannot be washed off with water

Water

Water is a chemical substance with the chemical formula H2O. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. Water is a liquid at ambient conditions, but it often co-exists on Earth with its solid state, ice, and gaseous state . Water also exists in a...

 and they may interfere with the administered treatment. Although formaldehyde is less expensive than glutaraldehydes, it is also more irritating to the eyes, skin

Human skin

The human skin is the outer covering of the body. In humans, it is the largest organ of the integumentary system. The skin has multiple layers of ectodermal tissue and guards the underlying muscles, bones, ligaments and internal organs. Human skin is similar to that of most other mammals,...

 and respiratory tract

Respiratory tract

In humans the respiratory tract is the part of the anatomy involved with the process of respiration.The respiratory tract is divided into 3 segments:*Upper respiratory tract: nose and nasal passages, paranasal sinuses, and throat or pharynx...

 and is classified as a potential carcinogen

Carcinogen

A carcinogen is any substance, radionuclide, or radiation that is an agent directly involved in causing cancer. This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes...

.

Other sterilization methods exist, though their efficiency is still controversial. These methods include gas

Gas

Gas is one of the three classical states of matter . Near absolute zero, a substance exists as a solid. As heat is added to this substance it melts into a liquid at its melting point , boils into a gas at its boiling point, and if heated high enough would enter a plasma state in which the electrons...

 sterilization, UV sterilization, and sterilization with other chemical agents such as peroxyacetic acid

Peroxyacetic acid

Peracetic acid , is an organic compound with the formula CH3CO3H. This organic peroxide is a colorless liquid with a characteristic acrid odor reminiscent of acetic acid...

, paraformaldehyde

Paraformaldehyde

Paraformaldehyde is the smallest polyoxymethylene, it is the condensation reaction product of formaldehyde with a typical degree of polymerization of 8–100 units. Paraformaldehyde commonly has a slight odor of formaldehyde due to decomposition...

 and gas plasma sterilization.

Infections can be prevented from occurring in homes as well. In order to reduce their chances to contract an infection, individuals are recommended to maintain a good hygiene by washing their hands after every contact with questionable areas or bodily fluids and by disposing the garbage

Waste

Waste is unwanted or useless materials. In biology, waste is any of the many unwanted substances or toxins that are expelled from living organisms, metabolic waste; such as urea, sweat or feces. Litter is waste which has been disposed of improperly...

 at regular intervals to prevent germs

Microorganism

A microorganism or microbe is a microscopic organism that comprises either a single cell , cell clusters, or no cell at all...

 from growing.
Personal protective equipment
Personal protective equipment (PPE)

Personal protective equipment

Personal protective equipment refers to protective clothing, helmets, goggles, or other garment or equipment designed to protect the wearer's body from injury by blunt impacts, electrical hazards, heat, chemicals, and infection, for job-related occupational safety and health purposes, and in...

 is specialized clothing or equipment worn by a worker for protection against a hazard. The hazard in a health care setting is exposure to blood, saliva, or other bodily fluids or aerosols that may carry infectious materials such as Hepatitis C

Hepatitis C

Hepatitis C is an infectious disease primarily affecting the liver, caused by the hepatitis C virus . The infection is often asymptomatic, but chronic infection can lead to scarring of the liver and ultimately to cirrhosis, which is generally apparent after many years...

, HIV

HIV

Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

, or other blood borne or bodily fluid pathogen

Pathogen

A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...

. PPE prevents contact with a potentially infectious material by creating a physical barrier between the potential infectious material and the healthcare worker.

In the United States, the Occupational Safety and Health Administration (OSHA)

Occupational Safety and Health Administration

The United States Occupational Safety and Health Administration is an agency of the United States Department of Labor. It was created by Congress of the United States under the Occupational Safety and Health Act, signed by President Richard M. Nixon, on December 29, 1970...

 requires the use of Personal protective equipment (PPE)

Personal protective equipment

Personal protective equipment refers to protective clothing, helmets, goggles, or other garment or equipment designed to protect the wearer's body from injury by blunt impacts, electrical hazards, heat, chemicals, and infection, for job-related occupational safety and health purposes, and in...

 by workers to guard against blood borne pathogens if there is a reasonably anticipated exposure to blood or other potentially infectious materials.

Components of Personal protective equipment (PPE)

Personal protective equipment

Personal protective equipment refers to protective clothing, helmets, goggles, or other garment or equipment designed to protect the wearer's body from injury by blunt impacts, electrical hazards, heat, chemicals, and infection, for job-related occupational safety and health purposes, and in...

 include gloves

Medical gloves

Medical gloves are disposable gloves used during medical examinations and procedures that help prevent contamination between caregivers and patients. Medical gloves are made of different polymers including latex, nitrile rubber, vinyl and neoprene; they come unpowdered, or powdered with cornstarch...

, gowns

Hospital gown

A hospital gown, also known as a patient gown, exam gown, johnny shirt or johnny gown, is a short-sleeved, thigh-length garment worn by patients in hospitals and other medical facilities.-Utility:...

, bonnets, shoe covers, face shield

Face shield

A face shield is a device used to protect wearer's entire face from impact hazard such as flying objects and road debris, chemical splashes , or potentially infectious fluid .-Industry:...

s, CPR masks, goggles

Goggles

Goggles or safety glasses are forms of protective eyewear that usually enclose or protect the area surrounding the eye in order to prevent particulates, water or chemicals from striking the eyes. They are used in chemistry laboratories and in woodworking. They are often used in snow sports as well,...

, surgical mask

Surgical mask

A surgical mask also known as a procedure mask is intended to be worn by health professionals during surgery and at other times to catch the bacteria shed in liquid droplets and aerosols from the wearer's mouth and nose....

s, and respirators. How many components are used and how the components are used is often determined by regulations or the infection control protocol of the facility in question. Many or most of these items are disposable

Disposable

A disposable is a product designed for cheapness and short-term convenience rather than medium to long-term durability, with most products only intended for single use. The term is also sometimes used for products that may last several months to distinguish from similar products that last...

 to avoid carrying infectious materials from one patient to another patient and to avoid difficult or costly disinfection

Disinfection

Disinfectants are substances that are applied to non-living objects to destroy microorganisms that are living on the objects. Disinfection does not necessarily kill all microorganisms, especially nonresistant bacterial spores; it is less effective than sterilisation, which is an extreme physical...

. In the United States, OSHA

Occupational Safety and Health Administration

The United States Occupational Safety and Health Administration is an agency of the United States Department of Labor. It was created by Congress of the United States under the Occupational Safety and Health Act, signed by President Richard M. Nixon, on December 29, 1970...

 requires the immediate removal and disinfection or disposal of worker's PPE prior to leaving the work area where exposure to infectious material took place.
Antimicrobial surfaces
Microorganisms are known to survive on non-antimicrobial inanimate ‘touch’ surfaces (e.g., bedrails, over-the-bed trays, call buttons, bathroom hardware, etc.) for extended periods of time. This can be especially troublesome in hospital environments where patients with immunodeficiencies are at enhanced risk for contracting nosocomial infections.
Products made with antimicrobial copper alloy (brass

Brass

Brass is an alloy of copper and zinc; the proportions of zinc and copper can be varied to create a range of brasses with varying properties.In comparison, bronze is principally an alloy of copper and tin...

es, bronze

Bronze

Bronze is a metal alloy consisting primarily of copper, usually with tin as the main additive. It is hard and brittle, and it was particularly significant in antiquity, so much so that the Bronze Age was named after the metal...

s, cupronickel

Cupronickel

Cupronickel or copper-nickel or "cupernickel" is an alloy of copper that contains nickel and strengthening elements, such as iron and manganese. Cupronickel is highly resistant to corrosion in seawater, because its electrode potential is adjusted to be neutral with regard to seawater...

, copper-nickel-zinc, and others) surfaces destroy a wide range of microorganisms in a short period of time.
The United States Environmental Protection Agency

United States Environmental Protection Agency

The U.S. Environmental Protection Agency is an agency of the federal government of the United States charged with protecting human health and the environment, by writing and enforcing regulations based on laws passed by Congress...

 has approved the registration of 355 different antimicrobial copper alloys that kill E. coli

Escherichia coli

Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls...

 O157:H7, methicillin

Methicillin

Meticillin or methicillin is a narrow-spectrum beta-lactam antibiotic of the penicillin class. It should not be confused with the antibiotic metacycline.-History:Methicillin was developed by Beecham in 1959...

-resistant Staphylococcus aureus

Staphylococcus aureus

Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...

 (MRSA), Staphylococcus

Staphylococcus

Staphylococcus is a genus of Gram-positive bacteria. Under the microscope they appear round , and form in grape-like clusters....

, Enterobacter aerogenes, and Pseudomonas aeruginosa in less than 2 hours of contact. Other investigations have demonstrated the efficacy of antimicrobial copper alloys to destroy
Clostridium difficile

Clostridium difficile

Clostridium difficile , also known as "CDF/cdf", or "C...

, influenza A virus, adenovirus

Adenoviridae

Adenoviruses are medium-sized , nonenveloped icosahedral viruses composed of a nucleocapsid and a double-stranded linear DNA genome...

, and fungi

Fungus

A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...

. As a public hygienic measure in addition to regular cleaning, antimicrobial copper alloys are being installed in healthcare facilities in the U.K., Ireland, Japan, Korea, France, Denmark, and Brazil.

Vaccination of health care workers

Health care workers may be exposed to certain infections in the course of their work. Vaccine

Vaccine

A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...

s are available to provide some protection to workers in a healthcare setting. Depending on regulation, recommendation, the specific work function, or personal preference, healthcare workers or first responders may receive vaccinations for hepatitis B; influenza; measles, mumps and rubella

MMR vaccine

The MMR vaccine is an immunization shot against measles, mumps, and rubella . It was first developed by Maurice Hilleman while at Merck in the late 1960s....

; Tetanus, diphtheria, pertussis; N. meningitidis; and varicella

Varicella vaccine

The varicella vaccine is a live virus that protects against the viral disease commonly known as chickenpox caused by Varicella Zoster Virus . Varicella vaccine is marketed as Varivax in the U.S. by Merck...

. In general, vaccine

Vaccine

A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...

s do not guarantee complete protection from disease, and there is potential for adverse effects from receiving the vaccine.

Post exposure prophylaxis

In some cases where vaccines do not exist Post Exposure prophylaxis is another method of protecting the health care worker exposed to a life threatening infectious disease. For example, the viral particles for HIV-AIDS can be precipitated out of the blood through the use of an antibody injection if given within 4 hours of a significant exposure.

Surveillance for emerging infections

Surveillance is the act of infection investigation using the CDC definitions. Determining an infection requires an Infection Control Practitioner (ICP) to review a patient's chart and see if the patient had the signs and symptom of an infection. Surveillance definition cover infections of the bloodstream, urinary tract, pneumonia, and surgical sites.

Surveillance traditionally involved significant manual data assessment and entry in order to assess preventative actions such as isolation of patients with an infectious disease. Increasingly, integrated computerised software solutions, such as Formic Fusion are becoming available that assess incoming risk messages from microbiology and other online sources. By reducing the need for data entry, this software significantly reduces the data workload of ICPs, freeing them to concentrate on clinical surveillance.

As approximately one third of healthcare acquired infections are preventable, surveillance and preventative activities are increasingly a priority for hospital staff. In the United States, a study on the Efficacy of Nosocomial Infection Control Project (SENIC) by the CDC found that hospitals reduced their nosocomial infection rates by approximately 32 per cent by focusing on surveillance activities and prevention efforts.

Isolation

In the health care context, isolation refers to various physical measures taken to interrupt nosocomial spread of contagious diseases. Various forms of isolation exist, and are applied depending on the type of infection and agent involved, to address the likelihood of spread via airborn particles or droplets, by direct skin contact, or via contact with body fluid

Outbreak investigation

When an unusual cluster of illness is noted, infection control teams undertake an investigation to determine whether there is a true outbreak, a pseudo-outbreak (a result of contamination within the diagnostic testing process), or just random fluctuation in the frequency of illness. If a true outbreak is discovered, infection control practitioners try to determine what permitted the outbreak to occur, and to rearrange the conditions to prevent ongoing propagation of the infection. Often, breaches in good practice are responsible, although sometimes other factors (such as construction) may be the source of the problem.

Outbreaks investigations have more than a single purpose. These investigations are carried out in order to prevent additional cases in the current outbreak, prevent future outbreaks, learn about a new disease or learn something new about an old disease. Reassuring the public, minimizing the economic and social disruption as well as teaching epidemiology

Epidemiology

Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...

 are some other obvious objectives of outbreak investigations.

According to the WHO

Who

Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...

, outbreak investigations are meant to detect what is causing the outbreak, how the pathogenic agent is transmitted, where it all started from, what is the carrier, what is the population at risk of getting infected and what are the risk factors.

The results of outbreak investigations are always made public in the means of a report in which the findings are communicated to the authorities, media, scientific community and so on. These reports are commonly used as pedagogical tools.

Training in infection control and health care epidemiology

Practitioners can come from several different educational streams. Many begin as nurses, some as medical technologists (particularly in clinical microbiology), and some as physicians (typically infectious disease specialists). Specialized training in infection control and health care epidemiology are offered by the professional organizations described below. Physicians who desire to become infection control practitioners often are trained in the context of an infectious disease fellowship.

In the United States, Certification Board of Infection Control and Epidemiology is a private company that certifies infection control practitioners based on their educational background and professional experience, in conjunction with testing their knowledge base with standardized exams. The credential awarded is CIC, Certification in Infection Control and Epidemiology. One must have 2 years of Infection Control experience in order to sit for the boards. Certification must be renewed every five years.

A course in hospital epidemiology (infection control in the hospital setting) is offered jointly each year by the Centers for Disease Control and Prevention (CDC) and the Society for Healthcare Epidemiology of America.

The Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) offers training and courses in infection control.

Australia

In 2002, the Royal Australian College of General Practitioners

Royal Australian College of General Practitioners

The Royal Australian College Of General Practitioners is the professional body for General Practitioners in Australia.The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian...

 published a revised standard for office-based infection control which covers the sections of managing immunisation, sterilisation and disease surveillance. However, the document on the personal hygiene of health workers is only limited to hand hygiene, waste and linen management, which may not be sufficient since some of the pathogens are air-born and could be spread through air flow.

United States

Currently, the federal regulation that describes infection control standards is found at 29 CFR Part 1910.1030 Bloodborne pathogens.

See also

• Infectious disease
  Infectious disease
  Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
  
  
• Nosocomial infection
  Nosocomial infection
  A nosocomial infection , also known as a hospital-acquired infection or HAI, is an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff...
  
  
• Royal Australian College of General Practitioners
  Royal Australian College of General Practitioners
  The Royal Australian College Of General Practitioners is the professional body for General Practitioners in Australia.The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian...
  
  

Footnotes

1. 22 Devnani M, Kumar R, Sharma RK, Gupta AK. A survey of hand-washing facilities in the outpatient department of a tertiary care teaching hospital in India. J Infect Dev Ctries 2011;5(2):114-118.

External links

• Association for Professionals in Infection Control and Epidemiology is primarily composed of infection prevention and control professionals with nursing or medical technology backgrounds
• The Society for Healthcare Epidemiology of America is more heavily weighted towards practitioners who are physicians or doctoral-level epidemiologists.
• Website about hospital infections
• The Provincial Infection Control Network of British Columbia
• Regional Infection Control Networks