title: Evidence-based model for hand transmission during patient care and the role of improved practices.
abstract: 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.
authors.affiliation: Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland. didier.pittet@hcuge.ch
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
authors.forename: Benedetta
authors.initials: B
authors.lastname: Allegranzi
authors.forename: Hugo
authors.initials: H
authors.lastname: Sax
authors.forename: Sasi
authors.initials: S
authors.lastname: Dharan
authors.forename: Carmem Lúcia
authors.initials: CL
authors.lastname: Pessoa-Silva
authors.forename: Liam
authors.initials: L
authors.lastname: Donaldson
authors.forename: John M
authors.initials: JM
authors.lastname: Boyce
mesh_terms: D004493:Education; D050456:Fomites / Q000382:microbiology; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection; D006282:Health Personnel / Q000193:education; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D050296:Microbial Viability; D008954:Models, Biological; D012867:Skin / Q000382:microbiology