Hand Hygiene AT TRAVANCORE MEDICAL COLLEGE KOLLAM
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Transcript of Hand Hygiene AT TRAVANCORE MEDICAL COLLEGE KOLLAM
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HAND HYGIENEPRINCIPLES AND IMPLEMENTATION AT
TRAVANCORE MEDICAL COLLEGE, KOLLAM, KERALA. INDIA
DR.T.V.RAO MD
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THE WORK OF IGNAZ SEMMELWEISS Hungarian doctor who worked in a maternity ward in
Austria in the 1840s.
There were two wards in the maternity building:One contained women due to give birth and wasrun by midwives. The other was used as ateaching hospital for medical students, who mayhave come straight from dissecting dead bodies.
The wards were cleaned no more than once a
month. The doctors rarely washed their hands and often
wore dirty coats.
Semmelweiss was horrified by the number ofwomen who died after births that were troublefree. The women developed a very high
temperature and died within a few days from anillness called childbed fever.
No-one had any idea what caused this disease.No-one knew about bacteria or viruses then.
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THE WORK OF IGNAZ SEMMELWEISS
Semmelweiss realised that more than three times as manywomen died from fever in the teaching ward than in themidwives ward. He was determined to try to reduce thenumber of deaths.
He looked into at each factor that was different betweenthe two wards, but nothing that he thought of seemed tomake a difference. Then a professor was accidentally cut
with a knife that was getting used to study the body of awoman who had died. The professor himself died, from adisease whose symptoms were like childbed fever.
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THE WORK OF IGNAZ SEMMELWEISS
Semmelweiss thought that there must havebeen something on the knife that had causedthe disease.
He made all the doctors wash their hands inchlorine water before examining the women
Within a very short time, the death rate hadfallen
Semmelweiss presented his findings to otherdoctors. His ideas were mocked.
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Evidence of Relationship Between Hand Hygiene andHealthcare-Associated Infections
Substantial evidence that handhygiene reduces the incidence ofinfections
Historical study: Semmelweis
More recent studies: rates lower when
antiseptic hand washing wasperformed
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Hand Hygiene Definitions
Hand washingThe application of non-antimicrobial soap and water to thesurface of the hands
Antiseptic hand wash
Washing hands with water and soap or other detergentscontaining an antiseptic agent
Alcohol-based hand rub
an alcohol-containing preparation designed for application to
the hands in order to reduce the number of viable organisms withmaximum efficacy and speed
Surgical hand hygiene/antisepsis
Hand washing or using an alcohol-based hand rub beforeoperations by surgical personnel
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INDICATIONS FOR HAND WASHING
Hand hygiene should be performed before and
after every patient contact
Hand hygiene should be performed after contactwith patients environment
Hand hygiene should be performed after using a
restroom, after removing gloves, prior to andfollowing meals
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Indications for Hand HygieneWhen hands are visibly dirty,
contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap andwater.
If hands are visibly clean, use an alcohol-
based hand rub for routinelydecontaminating hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR2002; vol. 51, no. RR-16.
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Wethands.
Get soap. Washhands.
Dryhands.
Throwaway.
1 2 3 4 5
Washing Hands Follow
the Steps
Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children
with Challenging Behavior. Tampa, Florida: University of South Florida,
Early Intervention Positive Behavior Support.
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A CASUAL HAND WASH MAY MISS
SEVERAL AREAS FROM DISINFECTION
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PRACTICE A LITTLE OF SCIENTIFIC
STEPS IN HAND WASHING
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MAKE THE BEST USE OF SCIENTIFIC
METHODS IN CRITICAL CARE OF PATIENTS
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Why we dont wash our hands
Too busy/insufficient time
Patient needs take priority
Understaffing/overcrowding
Adapted from Pittet D, Infect Control Hosp Epidemiol2000;21:381-386.
HCW are not badjust busy!
Poor design
Poor product
More education
Sinks are inconveniently located or lack ofsinks
Lack of soap and paper towels
Hand washing agents cause irritationand dryness
Low risk of acquiring infection frompatients
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What can we do to help change thisProvide easy access to hand hygiene
materials
Handrub solution
Conveniently located:at the patients bedside
at the patients room entrance
in convenient / appropriate locations
in high traffic public areas
Working appropriately
Full of product
Within use by dateDR.T.V.RAO MD 14
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Glove UseHand hygine is required regardless of whether
gloves are used or changed
Failure to remove gloves after patient contact or
between dirty and clean body site care in the samepatient has to be regarded as noncompliance withrecommandations
Gloves should not be washed or reused
Gloved HCWs can cause cross infections
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DR.T.V.RAO MD 16
C C
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ACCORDING TO THE CDC
Wet hands with running water; place soap inpalms; rub together to make a lather; scrub
hands vigorously for 20 seconds; rinse soap off
hands.
If possible, turn off the faucet by using a
disposable paper towel.
Dry hands with a disposable paper towel. Do notdry hands on clothing.
Assist young children with washing their hands.
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SPECIFIC INDICATIONS FOR HAND HYGIENE
Before: Patient contact
Donning gloves when inserting a CVC
Inserting urinary catheters, peripheral vascular catheters, or other invasivedevices that dont require surgery
After: Contact with a patients skin
Contact with body fluids or excretions, non-intact skin, wounddressings
Removing gloves
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.DR.T.V.RAO MD 18
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WHAT TO USE AND WHEN
When hands are visibly soiled use soap and water to
wash
If your hands are visibly CLEAN use Alcohol based handrubes
Before and after touching a patient
Before and after a procedure
After touching a patients surroundings
Before and after glove use
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RUBapply to palm
ROLLrub hands together coveringall aspects of your fingers &
hands until dry
SQUIRTone squirt (1-3 ml) to
your hands
Easy Message
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. Recommendations for Hand Washing Facility:
Clean at all times;
Strategically located as per regulations, near
bathrooms and entrances to the processing area;
Dedicated to hand washing only;
Liquid soap in dispenser;
Hot water (43 C or 110 F);
Use of disposable paper towels or air blowers; and
Adjacent hand sanitizing facilities.
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Basic message always the
same
Clean you hands before and
after every patient touchInstructions always the same
Squirt
Rub
Roll
EASY MESSAGE
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SELF-REPORTED FACTORS FOR POOR
ADHERENCE WITH HAND HYGIENE Hand washing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks
Lack of soap and paper towels
Too busy/insufficient time
Understaffing/overcrowding
Patient needs take priority
Low risk of acquiring infection from patients
Adapted from Pittet D, Infect Control Hosp Epidemiol2000;21:381-386.DR.T.V.RAO MD 23
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EDUCATION/MOTIVATIONPROGRAMS
Monitor healthcare workers (HCWs)adherence with recommended handhygiene practices and give feedback
Implement a multidisciplinary program toimprove adherence to recommendedpractices
Encourage patients and their families toremind HCWs to practice hand hygiene
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51,no. RR-16.DR.T.V.RAO MD 24
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Healthcare workers in a room with a
senior staff member or peer who DID NOTwash their hands were significantly lesslikely to wash their own hands
EMERGING INFECTIOUS DISEASES FEB 2003
Failed Role Models
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- is an important barrier to compliance- is more frquent with soap and
water than with handrubs-
is reduced and can be treated byemollient-containing solutions
Skin irritation A Limitation toHand Washing
Boyce et al. Inf Contr Hosp Epi 2000;21:442
Kramer et al. J Hosp Infect 2002; 51:114Larson et al. Heart Lung 2000; 29:139Pittet. Emerging Inf Dis 2001; 2:234
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CLEAN HANDS SAVES MANY LIVES
HAVE ONE OURSELVES
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HOSPITAL ADMINISTRATION THANKS
EVERYONE FOR WASHING HANDS
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REFERENCES
WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) April
2006
Guideline for Hand Hygiene in Health-Care Settings.MMWR 2002:vol,51,no
RR-16
HHA 5 Moments for Hand Hygiene ,Advanced draft, August 2008
Pittet D,Inf .Control Hospital Epidemiology200:21:381-386
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Programme Created by Dr.T.V.Rao
MD for Medical and ParamedicalProfessionals Email
DR.T.V.RAO MD 30