Hand hygiene

Hand hygiene

2. 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

3. 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)
Infection Control Dep.
KKUH

4. 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.

5. 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
Infection Control Dep.
KKUH

6. ?lHuabhlemltaoslucaoyi yy eo 5 Stage of hand transmissionWhy
One so Two ulyy Threedowl Fourdecy Fiveaylnr?
Hlyryhb ? oh?
Hmbeyhb?rtehW
mhi?
ennyiemby?
yhcelohnyhb?
rwlImfyr
Germs
present on
patient skin
and
immediate
environment
surfacesayln?
blmhrIyl?
ohbo?uymCbuD
fmly?soltylpr?
umhir
Germ
transfer
onto health-
care worker’s
handsaylnr?
rwlcecy ? oh?
umhir?Iol?
rycylmC?
nehwbyr
Germs
survive on
hands for
several
minutes.wKoHbenmC?
umhi?
fCymhrehU?
lyrwCbr?eh?
umhir?
lynmehehU?
fohbmnehmbyi
Suboptimal
hand
cleansing
results in
hands
remaining
contaminatedAohbmnehmbyi?
umhir? bl mhrneb ?
Uylnr?cem?ielyfb?
fohbmfb?sebu?
Hmbeyhb?ol?
Hmbeyhbpr?
yhcelohnyhb
Contaminated
hands transmit
germs via direct
contact with
patient or
patient’s
environment

7. 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.
Infection Control Dep.
KKUH
13-25%
40%
30-39%

8. Hand Hygiene: Not a New Concept
Infection Control Dep.
KKUH
•Since 1840, Semmelweis noticed the
great effect HH of in decreasing rate
of infection.

9. Hand Hygiene: Not a New Concept
Maternal Mortality due to Postpartum Infection
General Hospital, Vienna, Austria, 1841-1850
0
2
4
6
8
10
12
14
16
18
1841 1842 1843 1844 1845 1946 1847 1848 1849 1850
M
a
t
e
r
n
a
l
M
o
r
t
a
lit
y

(
%
)


MDsWhyyh shouldwecad
wnrohchd?cHhbmhcHotcd
Semmelweis’ Hand
Hygiene Intervention The Intervention:The Intervention:
was Hand scrub with was Hand scrub with
chlorinated lime solutionchlorinated lime solution
Infection Control Dep.
KKUH
Semmelweis IP, 1861

10. 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)
Infection Control Dep.
KKUH

11. What are types of
Hand Hygiene?
• Hand washing.
• Use of alcohol rubs/gels.
• Surgical hand ‘scrub
Infection Control Dep.
KKUH

12. “Types of Hand Hygiene”

13. WHO “My five (KEY) moments for
hand hygiene”
Infection Control Dep.
KKUH
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.

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

15. 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

16. 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.

17. 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)

18. 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

19. 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

20. 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
Infection Control Dep.
KKUH

21. VARIOUS HAND
DECONTAMINANTS

 SOAP SOLUTION.
 AQUEOUS ANTISEPTIC SOLUTION.
 CHLOROHEXIDINE.
POVIDINE IODINE.
 TRI CLOSAN.
ALCOHOL HAND-RUBS, GEL & WIPES.

21

22. 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.
Infection Control Dep.
KKUH
(Boyce JM, Pittet D et al. MMWR 2002;51 (RR-16):1-45)

23. Promoting Alcohol-Based Hand Rubs
Improve Hand Hygiene Habits
0
5
10
15
20
25
30
35
40
45
50
P
e
r
c
e
n
t

C
o
m
p
l
i
a
n
c
e
Baseline1 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)

24. Steps for perfect
Hand hygiene
Infection Control Dep.
KKUH

25. 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).

26. 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

27. ban?sr.K hdndsan?sK cuUdsD d Hand hygiene and glove useWhy soulhdo
wecauwnWrscs
Why souhloudw
GLOVES PLUS
HAND HYGIENE
= CLEAN HANDS
GLOVES WITHOUT
HAND HYGIENE
= GERM
TRANSMISSION

28. Infection Control Dep.
KKUH
Finally……..

30. Infection Control Dep.
KKUH
So now let`s check