Hand hygiene

Is generally poorly adhered to across the board by all levels of Health Care Worker’s

Hands: the most common way transporting microorganisms, & subsequently causing infection in patients seeking medical advice/care in health care facilities.

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HCWs can get 100 or 1000 of Germs on their hands by doing simple tasks, such as:

◦ Putting patients up in bed ◦ Taking blood pressure or pulse◦ Touching a patient's hand ◦ Rolling patients over in bed◦ Touching the patient's gown or bed

sheets◦ Touching equipment like bed side

rails, over bed tables, IV pumps

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• Following contact with patients and/or contaminated environment, germs can survive on hands for differing lengths of time (2-60 minutes)

• In the absence of hand hygiene action, the longer the duration of care, the higher the degree of hand contamination

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Contaminated HCWs hands have been associated with endemic Health Care Associated Infections and also with several HCAI outbreaks

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Prevention of spread of microorganisms in such situations necessitates hand hygiene to be adequately and properly performed.

HH is considered to be the single most important practice in reducing transmission of infectious agents, and thus HCAI, during delivery of medical care.

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HH is the simplest, most effective measure for preventing nosocomial infections.

Adherence of HCW’s to recommended HH practices is unacceptably low.

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Average compliance of HH recommendations varies between hospitals wards & among professional categories of HCWs according to working conditions.

Compliance is usually estimated as < 50%

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Defective hand cleansing ◦ (e.g. using insufficient amount of product and /

or insufficient duration of HH action) leads to poor hand decontamination

Obviously , when HCWs fail to clean their hands during the sequence of care of a single patient and / or between patients contact microbial transfer is likely to occur

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Risk factors for noncompliance with HH have been determined objectively in several observational studies or interventions to improve compliance included:

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Being a physician or a nursing assistant rather than a nurse

Being a male Working in an intensive care unit (ICU) Working during weekdays rather than the

weekend Wearing gown and gloves Using an automated sink Performing activities with high risk for cross –

transmission Many opportunities for HH per hour of patient

care

Being a physician or a nursing assistant rather than a nurse

Being a male Working in an intensive care unit (ICU) Working during weekdays rather than the

weekend Wearing gown and gloves Using an automated sink Performing activities with high risk for cross –

transmission Many opportunities for HH per hour of patient

care

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RESIDENT HAND FLORA (commensals)

Low virulence, survive & multiply on skin Protective function

Not easily removed by mechanical washinge.g. Coag. Neg. staph., Diphtheroids, anaerobic cocci,

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TRANSIENT MICRO-ORGANISMS

Easily acquired and transferred by

direct contact.

Loosely attached to skin surface.

Most abundant around finger tips.

Important source of cross-infection eg, Staph. aureus, Streptococci, Gram-ve bacilli (E. coli, pseudomonas aeruginosa, klebsiella, acinetobacter, etc)

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Handwashing Washing hands with plain soap and water

Remove soil/dirt

Antiseptic handwash Washing hands with water and an antiseptic

soap or detergents Remove soil/dirt and transient micro-organisms

Alcohol-based handrub Rubbing hands with an alcohol-containing

preparation Remove transient microorganisms

Handwashing Washing hands with plain soap and water

Remove soil/dirt

Antiseptic handwash Washing hands with water and an antiseptic

soap or detergents Remove soil/dirt and transient micro-organisms

Alcohol-based handrub Rubbing hands with an alcohol-containing

preparation Remove transient microorganisms

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WHY IS HAND HYGIENE

IMPORTANT ????

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Most common mode of transmission

Most important factor in preventing spread of organisms

Reduce number of infections

Decrease patient length of stay

Decrease use of resources

Reduce number of deaths

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USA: Up to 2 million HAI/yr, 80,000 of them may contribute to death, and generate 4.5 to 5.7 billion USD additional

expenses/yr (WHO figures, 2005).

UK: 320,000 HAI/yr, 5,000 of them may contribute to death, andgenerate £1 billion additional expenses /year

(WHO figures, 2005).

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Why don’t we wash our hands?

Too busy/insufficient time

Patient needs take priority

Understaffing/overcrowding

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

HCW are not bad just busy!

Poor design

Poor product

More education

Sinks are inconveniently located or lack of sinks

Lack of soap and paper towels

Hand washing agents cause irritation and dryness

Low risk of acquiring infection from patients

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Sinks are inconvenie

ntly located

Poor design

Interventions aimed at improving compliance with HH must be based on the various levels of behaviour interaction

Thus, the interdependence of: Individual factors, Environmental constrains, and Institutional climate

Should be considered in strategic planning and Should be considered in strategic planning and development of HH promotion campaignsdevelopment of HH promotion campaigns

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How can we overcome problems associated with hand washing?

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A quick and easy solution

An Alcohol Based Hand Rub

(ABHR)

!

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Bac

teria

l Red

uctio

n

Alcohol-based handrub

0.0

1.0

2.0

3.0 0 60 180 minutes

0.0

90.0

99.0

99.9log%

Antimicrobial soap

Plain soap

Time After Disinfection

Baseline

Ability of Hand Hygiene Agents to Reduce Bacteria on Hands

More EffectiveIn Reducing The Number Of Bacteria On Hands

Reduces bacterial count on hands

More effective for standard hand wash

Reduces adverse outcomes/costs associated with HAI’s

Requires less time

Less irritating

Can be readily accessible/portable

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◦At every bed (ICU, Burn, ER)

◦At every ward entrance

◦Ward trolley

◦Entrance to every room

◦On every incubator

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◦ABHR (gel , rinse or foam) should be used routinely to clean staff hands between patient contacts, as long as hands are not visibly dirty

◦After having contact with body fluids, wounds or broken skin.

◦After touching equipment or furniture near the patient

◦After removing gloves30

◦An amount of 1.5 to 3 ml of an alcohol

product should be used

◦All hand surfaces including fingers and

under finger nails should be covered until

alcohol dries

◦The procedure should take 20 – 30 seconds

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◦ABHR should be completely dried before putting gloves

◦After removing gloves, hands should be decontaminated

◦Allow patients to remained you to decontaminate your hand

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◦Chlorhexidine gluconate 1% solution & Ethyl Alcohol 61 % has:

Proved its excellent effect Less time in application Made to lastProvides persistent kill (up to six hours) after application.

Kills up to 99% of the germs on hands

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My 5 Moments for HH approach definesdefines the key moments when health-care workers should perform hand hygiene.

This evidence-basedevidence-based, field-testedfield-tested, user-user-centeredcentered approach is designed to be:easy to learn, logical and applicable in a wide range of

settings.

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1 BEFORE TOUCHINGA PATIENT

WHEN?WHY?

Clean your hands before touching a patient when approaching him/her.To protect the patient against harmful germs carried on your hands.

2BEFORE CLEAN/ ASEPTIC PROCEDURE

WHEN?WHY?

Clean your hands immediately before performing a clean/aseptic procedure.To protect the patient against harmful germs, including the patient's own, from entering his/her body.

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AFTER BODY FLUID EXPOSURE RISK

WHEN?

WHY?

Clean your hands immediately after an exposure risk To body fluids (And after glove removal). To protect yourself and the health-care environment from harmful patient germs.

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AFTER TOUCHING A PATIENT

WHEN?

WHY?

Clean your hands after touching a patient and her/his.Immediate surroundings, when leaving the patient's side.To protect yourself and the health-care environment from harmful patient germs.

5AFTERTOUCHING PATIENT SURROUNDINGS

WHEN?

WHY?

Clean your hands after touching any object or furniture in the patient's immediate surrounding, when leaving even if the patient has not been touched. To protect yourself and the health-care environment from harmful patient germs.

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Can you identify the main examples of this indication during your everyday practice of health care?

Some examples may be:

• shaking hands, stroking an arm

• helping a patient to move around, get washed, giving a massage

• taking pulse, blood pressure, chest auscultation, abdominal palpation


• secretion aspiration

• skin lesion care, wound dressing

• catheter insertion, opening a vascular access system or a draining system

• preparation of medication, dressing sets



• oral/dental care, giving eye drops, secretion aspiration

• skin lesion care, wound dressing, subcutaneous injection

• drawing and manipulating any fluid sample, opening a draining system, endotracheal tube insertion and removal

• clearing up urines, faeces, vomit, handling waste (bandages, napkin, incontinence pads), cleaning of contaminated and visibly soiled material or areas (lavatories, medical instruments)



• shaking hands, stroking an arm

• helping a patient to move around, get washed, giving a massage

• taking pulse, blood pressure, chest auscultation, abdominal palpation



• changing bed linen

• perfusion speed adjustment

• monitoring alarm

• holding a bed rail

• clearing the bedside table


We should not forget the moments where hand hygiene is indicated and falls under hygienic or social practices i.e.: after using the toilet, preparing food and eating, after coughing etc…

AREAS FREQUENTLY MISSED DURING HANDWASHING

AREAS FREQUENTLY MISSED DURING HANDWASHING

Keep natural nail tips short. Avoid nail polish, artificial nails and

extenders. Avoid wearing rings or other hand jewelry. Avoid hot or cold water. Use papers towel to dry hands properly. Use papers towel to turn off tap/faucet. Do not use papers towel to dry hands after

using ABHR. Use hand lotions to prevent skin dryness Do not follow this by washing hands with

water Do not use antimicrobial soap

concomitantly

Important HH ConsiderationsImportant HH Considerations

Pseudomonas

nail infection

Education is a cornerstone for improvement of hand hygiene practices.

Easy access to hand hygiene supplies, whether sink, soap, medicated detergent. Monitor HCWs adherence to

recommended hand hygiene practices. Encourage patients and their families to remind HCWs to decontaminate their hand.

Make improved hand hygiene adherence an institutional priority

Provide appropriate administrative support and financial resources.

To improve hand hygiene adherence among personnel who work in areas with high work-loads ◦ ABHR should be available in convenient locations

and pocket sized to be carried by HCWs.

Make improved hand hygiene adherence an institutional priority

Provide appropriate administrative support and financial resources.

To improve hand hygiene adherence among personnel who work in areas with high work-loads ◦ ABHR should be available in convenient locations

and pocket sized to be carried by HCWs.

Hand hygiene

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