Hand Hygiene in NICUDr Manan Parikh

• Bacteria that cause hospital-acquired infections most commonly transmitted via HCW’s hands

• Studies have shown that washing hands between patients reduces spread of bacteria in health care

• HCW handwashing compliance rate 40%

Improving Hand Hygiene PracticeWhy?

Minor Action _ Major Outcome

• Simple tasks can contaminate hands:

– Taking a patient’s vital signs– Touching the patient’s clothing or linens– Touching equipment and furniture nearby

“Hand Hygiene

is the SINGLE

most important practice

to prevent

nosocomial infections”

Benefits of Hand Hygiene

Reduced number of deaths Reduced number of infections:

Decreased antibiotic usage Decreased patient length of stay Decreased use of resources

Definitions Hand Hygiene

a general term that applies to either handwashing, antiseptic hand wash, antiseptic hand rub or surgical hand antisepsis.

Handwashingwashing hands with plain soap and water.

• Antiseptic Hand Washwashing hands with water and soap or other detergents containing an antiseptic agent.

• Alcohol-based Hand Rub the alcohol-containing preparation applied to the hands to reduce the number of viable microorganisms.

When To Perform Hand Hygiene?

“High Risk” for Contamination Activities

“Low Risk” for Contamination Activities

Immediately before and after patient contact Immediately before and after a procedure Before and after touching any devices/equipment

directly connected to the patient e.g. IV Lines, Umbilical Lines, PICC Lines, Central Lines External Ventricular Drains Urinary Catheters Ventilation Equipment

“High Risk” for Contamination

Moving from contaminated to a clean body site

After contact with body fluids

After coming from washroom

After taking food

“High Risk” for Contamination

“Low Risk” for Contamination

After contact with equipmente.g. patients charts, monitors

After removing gloves

After contact with own nose/mouth/hair

BEFORE Hand Wash

• Nails should be kept short / No Nail Polish

• Artificial nails should not be worn• Remove your footwear, take NICU slippers• Remove all your ornaments (rings, bracelet, bangles etc),

wristwatch before entering NICU• Roll over your sleeves up to elbow• Wear ICU Gown, Apron (even if you are not touching the

baby)• Use antiseptic solution for Hand rub (even if you are not

touching the baby)• Wear face mask, if you have common cold, cough, URTI

How to do Hand Wash?

Alcohol at EVERY bed helps increase compliance

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Baseline 1 Dispenser per4 Beds

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Biscoff WE et al 1998: Abstract K132

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 do Hand Rub ?

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 hand rub

Before & After EVERY ACT

related to patient care

When to follow Hand Hygiene?

Before Entering NICU

When Hands are Visibly Soiled

Before examining the Patient

Before Touching the Patient

In between 2 Patients

Before VF Insertion

Before Procedure

Before - After IV Injections

After Waste Disposal

Before – After touching Infusion Pump

Before – After touching Monitor

Before – After touching Trolley

Before – After Nappy Change

After Handling Body Fluids / Secretions

After Touching Files / Papers

After removing gloves

After touching the Mobile

WHO should follow Hand Hygiene?• Consultants• Outside consultants visiting NICU

(Superspecialist, Radiologist, Neurologist, Physiotherapist etc)• In-House Paediatrician• Resident Doctors• Nurses• Health care assistant• Support staff• X-ray Technician• Lab Assistant• Mothers / Relatives / Visitors• Cleaning Staff• Hospital Management Staff• Maintenance people of different NICU instruments • WHO SO EVER ENTERS THE NICU ---- MUST FOLLOW HAND HYGIENE

Nurse’s Role

• Follow the Hand Hygiene Guidelines– For every patient– For every act– In every shift

• Observe others…. If somebody is not following Hand Hygiene… Even if CONSULTANTS… You have right to tell them to follow Hand Hygiene Guidelines

Single Step to Prevent Infection

Hand washing

Hand washing

Hand washingHand washing

Hand washing

Hand washing

Questions ?