2 Hand Hygiene

7/28/2019 2 Hand Hygiene

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Hand Hygiene in Health Care


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What is the role of hands in

health care?


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1) Clinical Examination

2) Assurance

3) Healing

and ..


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Carry and transmit

potentially harmful microorganisms!


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Unwashed Hand

Culture plate

showing growth

of bacteria 24

hours after a

nurse placed her

unwashed hand

on the plate.


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Most common mode of transmissionof pathogens in a health care

setting is

via hands!


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Nurses could contaminate their hands with100 - 1,000 CFU of Klebsiella spp. during

cleaning activities

Lifting patients

Taking the patient's pulse

Blood pressure, or

Oral temperature


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The Evidence

Hand hygiene reduces the incidence of infections
http://images.google.co.in/imgres?imgurl=http://onecoolsite.files.wordpress.com/2008/07/evidence.jpg&imgrefurl=http://onecoolsite.wordpress.com/2008/07/17/how-to-become-a-better-blogger-3-ethics-and-links/&usg=__AKu0DxLvfSVuGbdNHMtC3LIElWI=&h=500&w=500&sz=25&hl=en&start=1&um=1&tbnid=N_wJ_M87GKvokM:&tbnh=130&tbnw=130&prev=/images?q=Evidence&hl=en&safe=active&sa=G&um=1http://images.google.co.in/imgres?imgurl=http://onecoolsite.files.wordpress.com/2008/07/evidence.jpg&imgrefurl=http://onecoolsite.wordpress.com/2008/07/17/how-to-become-a-better-blogger-3-ethics-and-links/&usg=__AKu0DxLvfSVuGbdNHMtC3LIElWI=&h=500&w=500&sz=25&hl=en&start=1&um=1&tbnid=N_wJ_M87GKvokM:&tbnh=130&tbnw=130&prev=/images?q=Evidence&hl=en&safe=active&sa=G&um=1


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The Pioneer of hand hygiene

Ignaz Philipp Semmelweis:

Vienna,Austria

GeneralHospital,

1841-1850

Fighting puerpral fever


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Semmelweis IP, 1861

InterventionMay 15, 1847

Maternalmortality

0

2

4

6

8

10

12

14

16

18

1841 1842 1843 1844 1845 1846 1847 1848 1849 1850

First

Second

Maternal mortality rates, first & second

obstetrics clinics, General Hospital of

Vienna


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Improved adherence to hand hygiene

Hand washing or

Alcohol-based hand rubs

Terminate outbreaks in health care facilities

Reduce transmission of antimicrobial resistant

organisms

(e.g. methicillin resistant staphylococcus aureus)

And reduce overall infection rates


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How do organisms get onto the

hands?

Resident flora

(normally present)

Transient flora(acquired during health care delivery)

How do organisms on hands

get to the patients?


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Hand transmission5 step process

Organisms

present on

patients skin

/ external

devices /

environmenta

l surfaces

Transferre

d to HCW

hands

during

direct /

indirect

contact

Survive

and

persist

on hands

from few

minutes -

hours

Hands are notdecontaminated

/ inadequately

decontaminated

Contaminate

d hands

furtherspread the

organisms to

other

patients /

environment


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What happens

when organisms are

transmitted /transferred to

susceptible patients?


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Transmission between two patients viahealth care workers results in health careassociated infections (HAIs).

Adapted from the Swiss Hand Hygiene Campaign


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Getting acquainted with certain terms

Hand hygiene

Performing handwashing, antiseptic handwash, alcohol-based

handrub, surgical hand hygiene/antisepsis

Handwashing

Washing hands with plain soap and water

Antiseptic handwash

Washing hands with water and soap or other detergents

containing an antiseptic agent

Alcohol-based handrub

Rubbing hands with an alcohol-containing preparation

Surgical hand hygiene/antisepsis

Handwashing or using an alcohol-based handrub before

operations by surgical personnel

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16


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Hand hygiene refers to

Removing / killing microorganisms onhands

Maintaining good skin integrity


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What does hand hygiene achieve

?

Prevents the transfer of microorganismsfrom HCW hands to patients and self!

It protects both the patients and the HCW.


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Hand hygiene with alcohol-based hand rub

correctly appliedkills organisms inseconds.

Hand hygiene with soap and water

done correctlyremoves organisms.


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Hand hygiene When ?


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I. Before patient contact some

examples

Shakinghands,strokinganarm

Helpingpatientmovearound,getwashed,

givingamassage

Takingpulse,bloodpressure,chestauscultation,

abdominalpalpation

BeforeadjustinganIVline


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III. After body fluid exposure risk someexamples

Oral/dental care, giving eye drops, secretionaspiration

Skin lesion care, wound dressing, subcutaneous

injection

Drawing and manipulating any fluid sample, opening

a draining system, endotracheal tube insertion and

removal

Clearing up urine, faeces, vomit, handling waste

(bandages, napkin, incontinence pads), cleaning of

contaminated and visibly soiled material or areas

(bathroom, medical instruments)


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IV. After patient contact some examples

- Shaking hands, stroking an arm

- Helping a patient to move around, get washed,giving a massage

- Taking pulse, blood pressure, chest auscultation,

abdominal palpation- Changing bed linen

- Perfusion speed adjustment

- Monitoring alarm- Holding a bed rail

- Clearing the bedside table


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Hand hygiene How?


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Hand washing The process

1 Turn on taps or pour water(never dip hands in a mug of water)

2 Wet hands with warm water

3 Apply liquid soap4 Vigorously lather and rub hands together for 15 seconds

5 Thoroughly rinse soap from hands

6 Dry hands thoroughly

7 Turn off taps with paper towels

8 Discard paper towels


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6 Steps of effective hand washing

Step 1Wash palms and fingers

Step 2Wash back of hands

Step 3Wash fingers and knuckles

Step 4Wash thumbs

Step 5Wash finger tips

Step 6Wash wrists


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Areas frequently missed

during hand washing


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What is surgical hand scrub?

1) The hands are washed up to the elbow

2) A nail file is used to clean under the nails

3) A long acting antiseptic is used such aschlorhexidine or iodophor, sometimes with alcohol)

4) Hands are rubbed for 2-6 minutes and then

washed under running water

5) Hands are dried on a sterile towel


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The difference

Hand wash Hand rub Surgical Scrub

When visibly soiled or

dirty

No visible soil / dirt Done before all surgeries

and otherinvasive

procedures needing

strict asepsis

With soap and water with alcoholic hand rub With antiseptic soap and

water

upto wrist upto wrist Scrub vigorously with

upto elbows.

Also, clean under the

nail bed.

Rub for15 seconds Rub until dry 2-5 minutes

Dry with a clean single

use towel / paper napkin

No water or towel

needed.

Use sterile towel for

drying


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Hand Hygiene

with what?

1. Liquid soap

2. Anti-bacterial soap

3. Alcoholic hand rub


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Efficacy of Hand Hygiene

Preparations in Killing Bacteria

Good

Plain Soap

Better

Antimicrobial soap

Best

Alcohol-basedhand rub


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When hands are not visibly soiled

Hand rub (alcoholic)

When hands are visibly soiled

Liquid soap (plain) and WaterAnti-bacterial soap in high risk areas


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Hand wash

for how long?

Soap and water15 secs

Alcoholic hand rub till it

dries


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What are alcoholic hand rubs? Contain variety of alcohols

Concentrations ranging from 60 90%

Kill more effectively and more quickly

Cause less dryness and irritation of skin

(Contain emollients to reduce skin drying and

irritation)

Require less time

Should not be followed by water rinse


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Keep nails short and clean

Do not wear artificial nails

Remove rings and bracelets

Remove chipped nail polish

Make sure that sleeves are rolled up and do not

get wet

Hand washing - Prerequisites


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Benefits of hand hygiene in health care

Increase in hand hygiene adherence of only 20

percent results in a 40 percent reduction in the

rate of health care associated infections.(McGeer, A. Hand Hygiene by Habit. Infection prevention: practical tips for physicians to improve hand hygiene.

Ontario Medical Review, November 2007, 74 (10).)

Improvement in patient outcomes and decreasedcosts associated with HAIs


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Gloves are not a replacement for

hand hygiene !


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Hand hygiene

is the single

most

important

means of

preventing

infection.


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handhygiene

saves lives

2 Hand Hygiene

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