Proper Hand-washing & Use of Personal Protective Equipment

(PPE) in Infection ControlBy Jennifer Amponsah & Abina Luitel

ObjectivesBy the end of this presentation students will; Demonstrate proper hand-washing and

proper use of PPE.Verbalize at least three the importance of

hand-washing and PPE in infection control.Verbalize when to wash hands and use PPE.Describe the history of hand hygiene and

PPE.Describe the impact of hand washing and

PPE on human health

PICO questionPopulation: Health care workers and patientsInterventions: Proper hand washing and PPEComparison: No proper hand washing and

use of PPEOutcome: Decrease spread of nosocomial

infections PICO question: For Patients, does the use of

proper hand washing and PPE by health care workers reduce the risk of nosocomial infection compared with improper hand washing and use of PPE?

Background Questions??How often do you see nurses on your unit wash their

hands?What is effective handwashing?What is the purpose of personal protective equipment

(PPE)? How do Healthcare workers get

contaminated with Bacteria ?

Videohttp://www.youtube.com/watch?

v=NHHrCZkcFXk&feature=related

Introduction Hand-washing is a first break of infection, and

the most effective and inexpensive ways to prevent infection including nosomical infections

The majority of HAI cases are preventable through a combination of strategies including environmental control and cleaning, use of isolation precautions, and use of personal protective equipment (PPE) when appropriate

(Landers, McWalters, Behta, Bufe, Ross, Vawdrey & Larson, 2010)

History of Hand-washingConcept of using antiseptic agent for hand-

washing begin in 19th centuryIn 1961, the U. S. Public Health Service

produced a training film that demonstrated hand-washing techniques recommended for use by health-care workers (HCWs)

In 1975 and 1985, formal written guidelines on hand-washing practices in hospitals were published by CDC

(Hand hygiene for health care workers, 2009)

History of PPEIn 1970, the US CDC recommended the use

of seven isolation categories , later in 1983, tuberculosis isolation, drainage/secretion precautions, and blood and body fluid precautions were also included

In 2007, CDC extended the level of standard precautions to incorporate safe injection practices, respiratory/cough etiquette and use of masks for invasive measures

(Landers et al., 2010)

Statistics & Facts1 in 10 person may experience nosocomial

infection (Biddle, 2009)At any one time, an estimated 1.4 million

people suffer from (Healthcare-associated infections) HAIs (Landers et al., 2010)

Global Hand-washing Day is in October 15th of each year

Hospital acquired infections account for 1.7 million infections and 99,000 deaths each year (CDC.gov)

When to Wash HandsBefore and after direct contact with patientBefore and after invasive procedures and

sterile proceduresAfter contact with body fluids or secretions,

mucus membrane, non-intact skin, and wound dressing

After contact with inanimate objectsBefore and after gloving

(Kampf, Löffler, & Gastmeier, 2009).

Proper Hand-washing TechniquePalm to palm Right palm over left dorsum and leftpalm over right dorsum Palm to palm, fingers interlaced Fingers to opposing palms Rotational rubbing of right thumb clasped

over left and vice versa Rotational rubbing backwards and forwards

(Pirie, 2010).

Components of PPEGloves GownsApronsMasksGogglesVisorsCapsTheatre footwear(Hinkin, Jayne & Cutter, 2008)

Selecting Appropriate PPEAnticipated exposure such as touch, splashes,

sprays, blood or body fluidsCategories of isolation precautions a patientDurability and appropriateness of PPE for the

task PPE Fit the categories of exposure(Akridge, 2011)

Sequence for Donning PPE Gown: Fully cover torso from neck to knees,

arms to end of wrists, and wrap around the back, fasten in back of neck and waist

Mask or respirator: Secure ties or elastic bands at middle of head and neck, fit flexible band to nose bridge, snug to face and below chin

Goggles or face shield: Place over face and eyes to adjust

Gloves: Extend to cover wrist of isolation gown(Transferring More than Patients, 2011)

Sequence of Removing PPEGloves: Grasp outside of glove with opposite gloved

hand to peel off, hold removed glove in gloved hand and slide fingers of ungloved hand under remaining glove at wrist. Peel and discard

Goggles or face shield: handle by head band or ear pieces. Place in designated receptacle

Gown: Unfasten ties. Pull away from neck and shoulders, touching inside of gown only. Turn gown inside out, fold or roll into a bundle and discard.

Mask or respirator: Grasp bottom, then top ties or elastics and remove and discard

(Transferring More than Patients, 2011)

Video for PPEhttp://www.youtube.com/watch?v=_IYrqiQjvy

Q

Impact on Health Care WorkersExcessive hand-washing and wearing occlusive gloves

can cause Sore and damaged skinSkin irritation and drynessIn winter months some personnel may develop cracks

in their skin that cause bleeding Darker skin has less skin irritation than darker skinDermatitis (hand washing with soap before or after

alcohol based product) (Bissett, 2007)

Impact on Patients

Nosomocial infections causes Increase morbidity and mortality rate in

patients Prolonged hospital stayIncrease health care costs(Chen & Chiang, 2007)

Impact on CostEstimated 1.4 million people suffer from HAIs

which increased direct and indirect costs, prolonged hospitalizationhigh rates of disability and death. In the US, estimated that HAIs account for

direct hospital costs of $28.4–$45 billion per year

(Landers et al. 2010)

Challenge and BarriersSkin irritation Time consuming (15-30 sec)Work load stress (too busy)Shortage of staff Availability of PPELack of knowledge Interfere in ability to provide care(Hinkin, Jayne & Cutter, 2008)

ResearchRelevant Databases

EBSCO MegaFILECINAHL

Key WordsHand-washing“PPE”Nosocomial infectionsNursing implicaitons

StreamlineDates: 2007 to PresentPublication Type: Research, Journal

Research Article OneIn 206 hospital healthcare workers, observed episodes for hand hygiene and glove use . 74.7% for hand hygiene and 72.4% glove use . two-third of episodes, participants washed their hands after

each patient contact. 78.5% failed to rub their hands together vigorously for at

least 15 seconds. major break in compliance with glove use was failure to

change gloves between procedures on the same patient. In 28.6% of observed glove use episodes, participants did not

wear gloves during procedures that exposed them to blood, body fluids, excretion, non-intact skin or mucous membranes.

(Chau, Thompson, Twinn, Lee, & Pang,2011).

Research Article Two123 families in 15-bed PICU of a medical centre in central

TaiwanA video-centered teaching program based on social

learning principlesThe video-based teaching program was effective in

increasing compliance and accuracy with a hand-washing policy among families with children in intensive care units.

Study period indicate that compliance with hand washing in families in experimental group was higher than the comparison group at a statistically significant level.

(Chen, & Chiang, 2007).

Research Article Three500 patients in Division of General Surgery,

King Khalid University Hospital, Riyadh, Saudi Arabia.

Preoperative alcohol hand-rub preparations are as effective as traditional surgical scrub in reducing SSI.

The alcohol hand-rub easier to use and preferred by surgeons.

(Al-Naami, Anjum, Afzal, Al-Yami, Al-Qahtani, Al-Dohayan, & ... Al-Saif, 2009)

Research Article Four211 Registered Nurses from Trakya

University Training and Research Hospital, Turkey participate in four curricula on infection control and to identify sources of information.

There was significant increase in the quality of hand washing by the nurses after training. compliance with hand-washing recommendations was 70% before training and increased to 84% after training

(Erkan, Findik, & Tokuc, 2011)

Research Article Five317 Registered Nurses from three different

hospital at campus in East-cost, US participate in describing isolation precautions correct identification of required personal protective equipment.

Correct identification of hand hygiene recommendations across all scenarios was 94.6%,

Identifying proper placement of patients in a private room when transmission-based precautions are required was 62.9%

(Landers, McWalters, Behta, Bufe, Ross, Vawdrey, & Larson, 2010)

Research Article SixCross-sectional studies done in 350 students

studying medical, nursing, physiotherapist and assistant radiologist at Rouen University, France

To evaluate the knowledge of healthcare students after four curricula on infection control and to identify sources of information

The mean overall score (±SD) was 21.5 ± 2.84. Nursing students had a better mean overall score (23.2 ± 2.35)

(Tavolacci, Ladner, Bailly, Merle, Pitrou, & Czernichow, 2008)

Does proper hand-washing and use of PPE helps to prevent the spread of infections???

Answer to PICO QuestionSix research studies analyzed support the

use of proper hand washing and PPE by health care workers reduce the risk of nosocomial infection in patients compared with improper hand washing and use of PPE

ConclusionStudies show the bacteria that

cause hospital acquired infections are frequently spread from patient to patient by health care workers hand

CDC and many research support that proper hand-washing before and after having contacts with patients is the one most important measure for preventing the spread of infection in health care settings

Foreground QuestionsWhat are the importance of hand washing

and PPE in infection control?When should healthcare workers wash their

hands and use PPE?When did the concept of using antiseptic

agent for hand washing begin? What are the impact of hand washing and

PPE on human health?

Any Question???

References Akridge, J. (2011). Clinicians armor up with PPE to battle infections. Healthcare

Purchasing News, 35(2), 20-26.Al-Naami, M., Anjum, M., Afzal, M., Al-Yami, M., Al-Qahtani, S., Al-Dohayan, A., & ... Al-Saif, F. (2009). Alcohol-

based hand-rubversus traditional surgical scrub and the risk of surgical site infection: a randomized controlled equivalent trial. EWMA Journal,9(3), 5.

Biddle, C. (2009). Semmelweis revisited: Hand hygiene and nosocomial disease transmission in the anesthesia workstation. AANA Journal, 77(3), 229-237.

Bissett, L. (2007). Skin care: An essential component of hand hygiene and infection control. British Journal Of Nursing (BJN), 16(16), 976

Chen, Y., & Chiang, L. (2007). Effectiveness of hand-washing teaching programs for families of children in pediatric intensive care units. Journal Of Clinical Nursing, 16(6), 1173-1179 doi: 10.1111/j.1365-2702.2006.01665.x

Chau, J., Thompson, D., Twinn, S., Lee, D., & Pang, S. (2011). An evaluation of hospital hand hygiene practice and glove use in Hong Kong. Journal Of Clinical Nursing, 20(9/10), 1319-1328.

Erkan, T., Fındık, U., & Tokuc, B. (2011). Hand-washing behaviour and nurses' knowledge after a training programme. International Journal Of Nursing Practice, 17(5), 464-469. doi:10.1111/j.1440-172X.2011.01957.x

ReferencesHand hygiene for health care workers. (2009). http://www.learnwell.org/handhygiene.htm

Hinkin, J., Gammon, J., & Cutter, J. (2008). Review of personal protection equipment used in practice. British Journal Of Community Nursing, 13(1), 14-19.

Kampf, G., Löffler, H., & Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial infections. Deutsches Aerzteblatt International, 106(40), 649-655. doi:10.3238/arztebl.2009.0649

Landers, T., McWalters, J., Behta, M., Bufe, G., Ross, B., Vawdrey, D., & Larson, E. (2010). Terms used for isolation practices by nurses at an academic medical center. Journal Of Advanced Nursing, 66(10), 2309-2319. doi:10.1111/j.1365-2648.2010.05398.x

Pirie, S. (2010). Hand washing and surgical hand antisepsis. Journal Of Perioperative Practice, 20(5), 169-172.

Tavolacci, M., Ladner, J., Bailly, L., Merle, V., Pitrou, I., & Czernichow, P. (2008). Prevention of nosocomial infection and standard precautions: Knowledge and source of information among healthcare students. Infection Control & Hospital Epidemiology, 29(7), 642-647.

Transferring more than patients. (2011). Hospital Infection Control & Prevention, 38(11), 129-130.