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The Lancet Infectious Diseases 2006; 6:641-652
DOI:10.1016/S1473-3099(06)70600-4
Evidence-based model for hand transmission during patient care and the role of improved practices
Prof Didier PittetMD
a b 
, Benedetta AllegranziMD d e, Hugo SaxMD a b, Sasi DharanDip HIC a b, Carmem L?cia Pessoa-SilvaMD f, Liam DonaldsonMD c and John M BoyceMD g, on behalf of the WHO Global Patient Safety Challenge, World Alliance for Patient Safety
Summary
Hand cleansing is the primary action to reduce health-care-associated infection and cross-transmission of antimicrobial-resistant pathogens. Patient-to-patient transmission of pathogens via health-care workers' hands requires five sequential steps: (1) organisms are present on the patient's skin or have been shed onto fomites in the patient's immediate environment; (2) organisms must be transferred to health-care workers' hands; (3) organisms must be capable of surviving on health-care workers' hands for at least several minutes; (4) handwashing or hand antisepsis by the health-care worker must be inadequate or omitted entirely, or the agent used for hand hygiene inappropriate; and (5) the caregiver's contaminated hand(s) must come into direct contact with another patient or with a fomite in direct contact with the patient. We review the evidence supporting each of these steps and propose a dynamic model for hand hygiene research and education strategies, together with corresponding indications for hand hygiene during patient care.
Affiliations
a. Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
b. WHO Global Patient Safety Challenge, Geneva
c. World Alliance for Patient Safety, Geneva
d. Department of Infectious Diseases, University of Verona, Verona, Italy
e. Epidemic and Pandemic Alert and Response, WHO, Lyon, France
f. Healthcare-Associated Infections Programme, Department of Epidemic and Pandemic Alert and Response, WHO, Geneva, Switzerland
g. Infectious Diseases Section, Hospital of Saint Raphael, New Haven, CT, USA
DOI:10.1016/S1473-3099(06)70600-4
Evidence-based model for hand transmission during patient care and the role of improved practices
Prof Didier PittetMD
a b , Benedetta AllegranziMD d e, Hugo SaxMD a b, Sasi DharanDip HIC a b, Carmem L?cia Pessoa-SilvaMD f, Liam DonaldsonMD c and John M BoyceMD g, on behalf of the WHO Global Patient Safety Challenge, World Alliance for Patient SafetySummary
Hand cleansing is the primary action to reduce health-care-associated infection and cross-transmission of antimicrobial-resistant pathogens. Patient-to-patient transmission of pathogens via health-care workers' hands requires five sequential steps: (1) organisms are present on the patient's skin or have been shed onto fomites in the patient's immediate environment; (2) organisms must be transferred to health-care workers' hands; (3) organisms must be capable of surviving on health-care workers' hands for at least several minutes; (4) handwashing or hand antisepsis by the health-care worker must be inadequate or omitted entirely, or the agent used for hand hygiene inappropriate; and (5) the caregiver's contaminated hand(s) must come into direct contact with another patient or with a fomite in direct contact with the patient. We review the evidence supporting each of these steps and propose a dynamic model for hand hygiene research and education strategies, together with corresponding indications for hand hygiene during patient care.
Affiliations
a. Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
b. WHO Global Patient Safety Challenge, Geneva
c. World Alliance for Patient Safety, Geneva
d. Department of Infectious Diseases, University of Verona, Verona, Italy
e. Epidemic and Pandemic Alert and Response, WHO, Lyon, France
f. Healthcare-Associated Infections Programme, Department of Epidemic and Pandemic Alert and Response, WHO, Geneva, Switzerland
g. Infectious Diseases Section, Hospital of Saint Raphael, New Haven, CT, USA