Hand hygiene

Contents

Why should we clean our hands?1

How do hands become contaminated?2

Infection Control Dep.KKUH

3 Advantages of alcohol-based hand rubs

Hand Hygiene Recommendations4

Why should we clean our hands?

• Healthcare-associated pathogens are most often transmitted from patient to patient through the hands of healthcare workers.

• Hand Hygiene is the single most important measure for preventing the spread of microorganisms in healthcare settings.

(Pittet et al 2001)


What are our hands carrying?

Resident Flora:• Deep seated• Difficult to remove• Part of body’s

natural defence mechanism

• Associated with infection following surgery/invasive procedures.

Transient Flora:• Superficial• Transferred with

ease to and from hands

• Important cause of cross infection

• Easily removed with good hand hygiene.

Many Personnel Don’t Realize When They Have Germs on Their Hands

• Healthcare Personnel can get 100s to 1000s of bacteria on their hands by doing simple tasks like: • pulling patients up in bed

• taking a blood pressure or pulse

• touching a patient’s hand

• touching the patient’s gown or bed sheets

• touching equipment like bedside rails, over bed tables, IV pumps

Casewell MW et al. Br Med J 1977;2:1315

Ojajarvi J J Hyg 1980;85:193


5 Stage of hand transmission5 Stage of hand transmissionOneOne TwoTwo ThreeThree FourFour FiveFive

Germs present on patient skin

and immediate environmentsurfaces

Germs present on patient skin and immediate environment surfaces

Germ transfer onto health-care worker’s hands

Germ transfer onto health-care worker’s hands

Germs survive on hands for several minutes

Germs survive on hands for several minutes

Suboptimal hand cleansing results in hands remaining contaminated

Suboptimal hand cleansing results in hands remaining contaminated

Contaminated hands transmit germs via direct contact with patient or patient’s environment

Contaminated hands transmit germs via direct contact with patient or patient’s environment

Patients Often Carry Resistant Bacteria on Their Skin

• Patients often carry resistant bacteria on many areas of their skin, even without wounds or broken skin.

The Figure shows the percent of patients with (MRSA) who carry the organism on the skin under their arms, on their hands or wrists, or in the groin area.


13-25%

40%

30-39%

Hand Hygiene: Not a New Concept


• Since 1840, Semmelweis noticed the great effect HH of in decreasing rate of infection.

Hand Hygiene: Not a New Concept

Maternal Mortality due to Postpartum Infection General Hospital, Vienna, Austria, 1841-1850

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1841 1842 1843 1844 1845 1946 1847 1848 1849 1850

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MDs

Semmelweis’ Hand Hygiene Intervention Semmelweis’ Hand

Hygiene Intervention The Intervention:The Intervention:was Hand scrub with was Hand scrub with

chlorinated lime solutionchlorinated lime solution


Semmelweis IP, 1861

Does Hand Hygiene Reduce the Spread of Microorganisms in Healthcare Settings?

• In a scientific study performed in a hospital nursery, 1/2 of the nurses did not wash their hands between patient

contacts. 1/2 of the nurses washed their hands with an antimicrobial

soap between patient contacts• Babies cared for by nurses who did not wash their hands

acquired S. aureus significantly more often than babies cared for by nurses who washed their hands with an antimicrobial soap.

(Mortimer EA et al. Am J Dis Child 1962;104:289)


What are types of Hand Hygiene?

• Hand washing.

• Use of alcohol rubs/gels.

• Surgical hand ‘scrub


“Types of Hand Hygiene”

WHO “My five (KEY) moments for hand hygiene”


1. Before touching a patient.

2. Before clean/aseptic procedure.

3. After body fluid exposure risk.

4. After touching a patient.

5. After touching patient surroundings.

“The 5 Moments apply to any setting where health care involving direct contact with patients takes place”

WHY? WHY? To protect the patient against colonization and exogenous infection

Situations illustrating direct contact:

shaking hands, stroking a child’s forehead

helping a patient to move around, get washed

applying oxygen mask, giving physiotherapy

taking pulse, blood pressure, chest auscultation, abdominal palpation, recording ECG

WHY? WHY? To protect the patient against infection by his own germs

Situations illustrating clean/aseptic procedures:

brushing the patient's teeth, instilling eye drops

skin lesion care, wound dressing, subcutaneous injection

catheter insertion, opening a vascular access system or a draining system, secretion aspiration

preparation of food, medication, pharmaceutical products, sterile material.

WHY? WHY? To protect you and the environment from germ spread

Situations illustrating body fluid exposure risk:

brushing the patient's teeth, instilling 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 (soiled bed linen lavatories, urinal, bedpan, medical instruments)

WHY? WHY? To protect you and the To protect you and the environment from germ spreadenvironment from germ spread

Situations illustrating direct contact :

shaking hands, stroking a child forehead

helping a patient to move around, get washed

applying oxygen mask, giving physiotherapy

taking pulse, blood pressure, chest auscultation,

abdominal palpation, recording ECG

WHY? WHY? To protect you and the To protect you and the environment from germ spreadenvironment from germ spread

Situation illustrating contacts with patient surroundings:

changing bed linen, with the patient out of the bed

perfusion speed adjustment

monitoring alarm

holding a bed rail, leaning against a bed, a night table

clearing the bedside table

Routine hand washing.

• Wash your hands with antimicrobial soap and water if:• your hands are visibly soiled (dirty).

• hands are visibly contaminated with blood or body fluids.

• After contact with Cl. difficile diarrhea/infective diarrhea.

• before eating and after using the restroom

• Washing hands frequently with soap and water is:• inconvenient

• time-consuming

• often causes skin irritation and dryness


VARIOUS HAND DECONTAMINANTS

SOAP SOLUTION.

AQUEOUS ANTISEPTIC SOLUTION.

CHLOROHEXIDINE.

POVIDINE IODINE.

TRI CLOSAN.

ALCOHOL HAND-RUBS, GEL & WIPES.

21

Alcohol-Based Hand Rub

• Are Alcohol-Based Hand Rubs Really Effective?

Many published studies have shown that alcohol-based hand rubs remove bacteria from

hands more effectively than washing hands with plain or an antimicrobial soap and water.


(Boyce JM, Pittet D et al. MMWR 2002;51 (RR-16):1-45)

Promoting Alcohol-Based Hand Rubs Improve Hand Hygiene Habits

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Per

cen

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omp

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Baseline 1 Dispenser Per 4 Beds

1 Dispenser For Every

Bed

the figure shows: Increase hand hygiene compliance by ICU personnel after installation of alcohol dispensers next to every 4th bed and next to every bed.

(Bischoff WE et al. Arch Intern Med 2000;160:1017)

Steps for perfect Hand hygiene


Tips for perfect clean hands

• Fingernails:• Should be short, clean, and free from nail varnish as it

harbour micro organisms that are not easily removed during hand hygiene (Larson, 1989).

• Documented evidence of link between artificial nails and a Pseudomonas outbreak in a neonatal intensive care unit in the USA.

• Jewellery: No Jewellery are recommended to be worn on the hands &

wrists as it become contaminated during work activities and prevent proper hand hygiene procedures (Larson, 1985).

More Tips on How to Use an Alcohol-Based Hand Rub

• If you feel a “build-up” of emollients on your hands after cleaning your hands 5 to 10 times with an alcohol-based hand rub, wash your hands with soap and water.

• The use of gloves does not replace the need for cleaning your hands!

• Hand hygiene should be performed before donning and after removing gloves.

• If you clean your hands with an alcohol-based hand rub before putting on gloves, make sure the alcohol has dried completely before putting on gloves.

•Infection Control Dep.

KKUH

Hand hygiene and glove useHand hygiene and glove use

GLOVES PLUS

HAND HYGIENE

= CLEAN HANDS

GLOVES PLUS

HAND HYGIENE

= CLEAN HANDS

GLOVES WITHOUT

HAND HYGIENE

= GERM TRANSMISSION


Finally……..


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Hand hygiene

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