Hand hygiene products such as soaps, brushless and water-aided scrubs and waterless alcohol-based rubs are both key to preventing patient infections and a disposable supply cost. The expense adds up: How many employees clean their hands before, during and after procedures and how many times do they do it during the day, month and year?

Unless we're talking about smaller facilities, I'm not sure how closely hand hygiene costs are examined. In a larger organization like our regional hospital, it's a sliver of the budget, but it can still greatly affect the bottom line. Here are a few ways to make sure the products you have on hand (and on hands) work for their money.

Use as directed
First, remember why we wash and sanitize our hands: to decrease the number of microorganisms on our skin, even if we're putting on gloves. In the big picture, then, it's entirely possible that the most economical use of hand hygiene products would be to make sure that we "do no harm" and that healthcare-acquired infections remain at an absolute minimum, since infections can cost your facility thousands in treatment costs.

This requires proper product use. Infection control practitioners and surgical educators rely on the CDC's hand hygiene guidelines and AORN's standards. Since each product may call for slightly different techniques, though - how much to use or how it is applied - be sure to refer to the manufacturers' recommendations, since they've conducted clinical research to determine the most efficient use.

If you really want to get value out of your hand hygiene purchases, find out whether the company offers clinical support. It may sound silly, inviting a rep to show how to scrub or sanitize hands, but a demonstration of proper technique may help to set a good example for surgical personnel and increase compliance. Most suppliers want you to use their products correctly.

Getting with the program
"Compliance" is the catchword of the times. Whether it's for government authorities or accreditation agencies, you've got to measure aspects of patient care in the name of quality improvement, so you've got to make sure that everyone follows the rules.

Hand hygiene is no exception, but this can prove challenging. After you've provided a demonstration and posted signage on protocols, how can you monitor compliance? Noting how many bottles of scrub your facility goes through may not show the whole picture, but direct observation will cost you in staff time, unless you set a volunteer to the task.

If you can collaborate on monitoring with the department's director, though, it can reap insights on staff's use of the product while offering an opportunity for instruction and potential economizing. You'll see who uses three or four pumps of sanitizer or soap when only two are necessary, who wastes water, time and towels by washing hands when sanitizer could have been used and who uses waterless products improperly.

Remember, too, that sometimes it's not so much the scrub technique that's an issue, but basic hand hygiene protocol that surgical staff may have lost focus on. Basics such as washing or sanitizing hands after any contact with a patient, and before making contact with another, may be erroneously overlooked. I refer again to the CDC guidelines in making sure staff members understand the basics of hand hygiene.

Available and accessible
Given the number of times busy staff members must cleanse their hands, it's easy to see the time-saving benefits of waterless hand rubs. You can't put sinks everywhere, and hand sanitizer is a great tool to increase compliance, getting the job done in less time with the same outcome.

But can staff readily access the product on the go? Compliance may depend on how far you have to go to get it done. You may be well served by keeping an eye on your facility's traffic flow to assess the places staff members pass most often. Then install waterless sanitizer dispensers in those areas. (Waterless scrub should remain outside the surgical suites, near the sinks.) I've found that sanitizer is most handy at our nurses' station, in the circulators' area and on the anesthesia cart.

Saving your skin
Frequent scrubbing and washing are hard on your hands, can make them more susceptible to colonization and can increase the shedding of potentially infectious microorganisms. We've been trying to minimize brush usage because broken skin negates your first line of defense against infection and affects the scrub's integrity.

You must consider skin condition and how your staff's hands look and feel if you're considering changing hand hygiene products. It's fine to be open to possibilities that another product has economic or efficacy benefits, but every time you change a product, it's possible it could irritate some hands.

While many current products have been formulated to maintain skin integrity, it can still take time to get used to a new product due to chemical additives or lack of conditioners. Perhaps you've had the experience of one soap feeling better than another, or of changing facilities and noticing an accompanying dryness or dermatitis on the skin of your hands. It's because your skin has to adjust to the pH difference or missing protective additives in the new product.

If you've consulted with your infection control experts and materials managers and found no reported problems with your current products, I wouldn't change them. Monitor for compliance and keep skin healthy - soft, pliable and hydrated - by using facility-approved hand lotions after washing to maintain your natural barrier protection.