Hand Hygiene in Healthcare Settings

Hospital Acquired Infections

7-10% of patients acquire an infection

7,000 death per year

The federal government spend > $950 million annually

Source:Australian Council for Quality and Safety in Healthcare July 2003

Paediatric Nosocomial Infections

MORE Viral respiratory infections MORE Gastrointestinal infections MORE BACTEREMIAS All children are exposed to maternal

infections/siblings HIGH RISK PATIENT GROUPS:

Newborns and premature infants Children with congenital abnormalities

Obstetric Nosocomial Infections

Minimal invasive diagnostic procedures Surgery not prolonged Short hospital stay Intact host defenses Not subject to as many hospital pathogens Not exposed to prolonged antibiotic courses

Obstetric Nosocomial Infections- Risks Increase With:

Urinary catheterisation Intravenous therapy Intra-uterine and foetal monitoring PV examinations

“Hand Hygiene is the SINGLE most important practice to

preventing nosocomial infections”

Rotter ML 1997

Benefits of Hand Hygiene

Reduced number of deaths

Reduced number of infections: Decreased antibiotic usage Decreased patient length of stay Decreased use of resources

Compliance with hand hygiene?

Table 1. Compliance with hand hygiene

in different hospital settings before intervention

Table 2. Distribution of factors associated with non-compliance with hand hygiene

Source: Pittet D, Boyce JM LANCET Infect Dis 2001

An overview

Definitions

Guidelines for hand hygiene

Soap versus Alcohol solution

Healthy Hands

Definition of Terms

Hand Hygienea general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis.

Handwashingwashing hands with plain ( ie. non-antimicrobial) soap and water.

Decontaminationto reduce bacterial counts on the hands by performing antiseptic hand rub or antiseptic handwash.

Guide for Hand Hygiene in Healthcare Settings: MMWR 2002; vol.51, no. RR-16

When To Perform Hand Hygiene?

“High Risk” for Contamination Activities

“Low Risk” for Contamination Activities

“High Risk” for Contamination

Immediately before and after patient contact

Immediately before and after a procedure

“High Risk” for Contamination

Before and after touching any devices/equipment directly connected to the patient e.g.

Indwelling catheter External Ventricular Drains Redivacs Ventilation Equipment

“High Risk” for Contamination

Moving from contaminated to a clean body site

After contact with body fluids

“Low Risk” for Contamination

After contact with equipmente.g.patients charts, monitors

After removing gloves

After contact with own nose/mouth/hair

A quick and easy solution

An alcohol gel!

Alcohol at EVERY bed helps increase compliance

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Baseline 1 Dispenser per4 Beds

1 Dispenser forEvery Bed

Biscoff WE et al 1998: Abstract K132

Bed / cot

Trolley

Entrance to room

Place gel/rinse at each:

Alcohol is more effective in reducing the number of bacteria

Pittet D, Boyce JM. Lancet Infect Dis 2001

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Soap Iofophor 4% CHG 70% alcohol

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Reduction in resident flora

Alcohol has persistent activity

Rotter ML. Chapter 87 in Mayhall CG 1999

Less drying than soap and water

A quick and easy solution :An alcohol gel!

In all clinical situations EXCEPT:

When your hands are visibly soiled When a surgical scrub is required

When can you use an alcohol-based hand gel?

Ensure that hands have no visible contamination

Apply product to palm of one hand and rub hands together covering all surfaces and fingers

Allow to air dry

The process takes about 15 seconds

How to use an alcohol hand gel?

Continue rubbing hands together until alcohol is dry (should take 10-15 sec).

After using an alcohol based product, you will feel a “build up” on your hands. To remove this, wash your hands with soap and water as often as necessary.

A few tips when using the gel…

when hands are visibly contaminated with blood/body fluids

to remove “build-up” from the alcohol gel/rinse

before eating

after using the restroom

When should you handwash?

How to wash your hands?

Wet your hands1 2 Apply solution and scrub for at least 15 seconds

How to wash your hands?

3 Scrub back of hands,wrists, between fingersand under fingernails

4 Rinse your hands

How to wash your hands?

5 Turn off water leverusing your elbows

6 Dry with paper towel

Instruct them to EITHER wash their hands or apply the gel:

Before holding the baby/child

Before feeding the baby/child

After nappy change

Visitors and Relatives

Hands visibly soiled Soap and water or antimicrobial soap

Hands not soiled Alcohol hand rub for all routine hand hygiene

Summary of Recommendations

Use warm water, not hot

Wet hands before applying soap

Rinse hands well and pat dry

Moisturise 3-4 times daily

Healthy Hands:

Select a moisturiser compatible with Chlorhexidine gluconate

Nails should be kept short (< ¼ inch)

Artificial nails should not be worn in high risk areas e.g. ICU, NICU

Healthy Hands:

For more information visit

www.washup.org.au

Any Questions?