Who are Healthcare workers?

A Health Care Worker (HCW) or Health Care Professional (HCP) is one who provides health care treatment and advice based on formal training and experience. They include Doctors, Nurses, Physiotherapists and Pharmacists who perform services related to Health Care

Why is Hand Hygiene critical for HCWs?

Hand Hygiene is especially important for HCWs because poor hand hygiene by HCW can lead to Health Care Associated Infection (HCAI), which is a major cause of death and disability worldwide. 

HCAI can lead to

1. Prolonged hospital stay
2. Long term disability
3. Increased resistance of microorganisms to antimicrobials
4. Additional financial burdens
5. More  deaths
6. High costs for the health systems
7. Emotional stress for patients and their families.

As per studies HCAI affects 5–15% of hospitalized patients and 9–37% patients admitted in ICUs.

Causes for HCAI

Transmission of HCAI takes place through direct and indirect contact, droplets, air and any common medium. However, the most common method of transmission of HCAI is by way of the hands of HCWs,

through the below process:

1. Organisms which are present on one patient’s skin or surroundings, can be transferred to the hands of HCWs thus contaminating their hand

2. Many of these organisms are capable of surviving for several minutes on HCWs’ hands

3. When the HCW touches other patients or even objects that can be touched by others (such as door handles) with contaminated hands, the germ can pass on to others.

Hand Hygiene for HCWs

Practicing hand hygiene is thus a simple yet effective way to prevent HCAI. Hand Hygiene means cleaning hands by using soap and water or antiseptic hand rub (i.e. alcohol-based hand sanitizer including foam or gel). Cleaning hands with appropriate antiseptic agent can prevent the spread of germs, including those that are resistant to antibiotics. This can drastically reduce the risk of HCAI.

Two Methods for Hand Hygiene

1. Alcohol-Based Hand Sanitizer

2. Washing with Soap and Water

Alcohol-Based Hand Sanitizer

Alcohol-based hand sanitizers are the most effective in reducing the number of germs on the hands of healthcare providers and are preferred in most clinical situations.

When to Use an Alcohol-Based Hand Sanitizer

1. Immediately before touching a patient
2. Before placing or handling invasive medical devices, e.g. urinary catheters
3. Before moving from work on a soiled body site to a clean body site on the same patient
4. After touching a patient 
5. After contact with blood, body fluids or contaminated surfaces
6. Immediately after glove removal

Washing with Soap and Water

Wash your hands with soap and water during Routine Patient Care, whenever they are visibly dirty, before eating, and after using the restroom.

When to Wash with Soap and Water

1. When hands are visibly soiled
2. After caring for a person with known or suspected infectious diarrhea
3. After known or suspected exposure to spores

Hand hygiene is the most effective measure for reducing the transmission of microorganisms and HCAI both in the society and in the healthcare setting. As the techniques involved in hand hygiene are simple, it is feasible to ensure a high degree of compliance.

Injuries and Infections lead to an increased nitrogen loss from the body. The net loss of nitrogen from the body is termed as Negative Nitrogen Balance. The net nitrogen lost reflects the balance between protein synthesis and protein breakdown, which are simultaneously occurring in all tissues of the body.

Body protein represents an indispensable structural and functional element of the body. Depletion of this lean body mass leads to immunosuppression, poor wound healing, weight loss, decreased strength and activity, and delayed recovery.

Infections and Injuries result in hypermetabolism and a negative nitrogen balance which is modulated by hormones, cytokines and other pro-inflammatory mediators, and is compounded by a reduced food intake. Higher the severity of the infection or injury, greater is the nitrogen loss.

Protein loss due to the catabolism induced by infection should be compensated through additional protein intake particularly during recovery. As the capacity to retain protein is enhanced in the recovery phase of infection, increased intake of protein during this time will reverse loss of lean body mass, build immunity and reduce recovery time.

Dietary proteins are broken down by proteolytic enzymes in the body into simpler molecules called amino acids which are then utilized by the body for various structural and functional roles. The body needs 20 different amino acids for normal functioning. Out of these, 9 are essential amino acids, named so as they cannot be synthesized by the body, and must necessarily be obtained through diet.

Each essential amino acid has a critical role to play in restoring nitrogen balance, building lean body mass, boosting immunity and accelerating recovery. Supplementation of essential amino acids during the recovery phase after infections, injuries and surgeries is recommended to restore nitrogen balance, reverse weight loss, build immunity and accelerate recovery.

Upper respiratory tract infections (URTIs) are one of the most common reasons for mild morbidity in adults and children. Common symptoms of RTI include throat pain, pain when swallowing, cold, cough, sneezing, pharyngitis and fever.

It is a known fact that most of the URTIs are caused by VIRUSES, such as adenovirus, rhinovirus, influenza, herpes simplex virus, coronavirus and respiratory simplex virus. In fact, less than 20% of URTIs are caused by bacterial infections that require treatment with antibiotics, while others are mostly of viral origin, wherein antibiotics are ineffective.

One of the main reasons why URTIs have to be addressed early is because they are associated with social costs arising on account of absenteeism from school & work, loss in productivity and use of medical resources. Further, as most of the URTIs are caused by viruses, they are highly contagious and can spread from person to person by inhaling respiratory droplets from coughing or sneezing. The transmission of respiratory infections can also occur by touching the nose or mouth by hand or other objects exposed to the virus.

The first step in the development of URTIs is the attachment and colonization of the respiratory pathogens to the oropharyngeal mucosa, and the first symptoms are typically throat pain or pain when swallowing

Considering the typical viral origins and early symptoms of URTI, gargling offers a practical solution to URTIs. The center for disease control (CDC), USA recommends antiseptic gargle as the best treatment for URTIs. Among various antiseptics, gargling with Povidone-Iodine carries unique merits such as:

1. Faster onset of action (within 10 seconds)
2. Wider spectrum of coverage, including strong anti-viral activity
3.  Multiple modes of action, and hence no resistance reported till date

4. No change in taste sensation or discoloration of teeth

A study conducted in Japan strongly recommends gargling with povidone-iodine for both prevention and treatment of URTIs, supported by the findings from various studies conducted to assess the role of gargling on both healthy individuals and those with frequent respiratory infections. In these studies, gargling with povidone-iodine solution (four times daily) resulted in 50% reduction in the episodes of chronic respiratory infections.

In another study conducted on children attending middle schools, it was observed that absenteeism because of colds or influenza was considerably reduced after PVPI gargling practice.

When we consider the etiological basis of URTIs & results of several studies, it is easy to narrow down GARGLING WITH POVIDONE-IODINE SOLUTION as an effective measure for the early treatment and reduction of upper respiratory tract infections.