improving hand hygiene practices in healthcare settings

Mazen Kherallah, MD, FCCPCritical Care Medicine and Infectious Disease

• Why should we clean our hands?• Barriers to frequent handwashing • How do hands become contaminated?• Advantages of alcohol-based hand rubs• New Hand Hygiene Recommendations

To remove visible soiling from hands

To prevent transfer of bacteria from the home to the hospital

To prevent transfer of bacteria from the hospital to the home

To prevent infections that patients acquire in the hospital

The Iceberg Effect

Infected

Colonized

Many studies have shown that the bacteria that cause hospital-acquired infections are most frequently spread from one patient to another on the hands of healthcare workers

The Centers for Disease Control and Prevention (CDC) and other healthcare-related organizations believe that cleaning your hands before and after having contact with patients is one of the most important measures for preventing the spread of bacteria in healthcare settings

Yes! A scientific study performed in a hospital

nursery found that when nurses did not wash their hands between patient contacts, babies acquired Staph bacteria much more frequently than babies cared for by nurses who washed their hands with an antimicrobial soap.

Several other studies also show that washing hands between patient contacts reduces the spread of bacteria in healthcare

Average

Although handwashing has been proven to reduce the spread of microorganisms in healthcare facilities, healthcare workers often do not wash their hands when recommended. In 34 studies of handwashing, workers washed their hands only 40% of the time.

Average Compliance of Personnel in 34 Studies of Handwashing

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Study

Perc

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• Heavy workloads (too busy) • Sinks are poorly located • Skin irritation caused by frequent

exposure to soap and water • Hands don’t look dirty• Handwashing takes too long

Increasing WorkloadH

andw

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A recent study showed that the busier healthcare workers are, the less likely they are to wash their hands when recommended

Nursing shortages have caused nurses to be busier than ever before

Sinks used for handwashing are often installed in inconvenient locations.

Personnel may fail to wash their hands when indicated because it is too much trouble to get to the sinks provided.

Frequent handwashing with soap and water often causes skin irritation and dryness.

In the winter months, some personnel may even develop cracks in their skin that cause bleeding, as seen in the adjacent figure.

Culture plate showing growth of bacteria 24 hours after a nurse placed her hand on

the plate

Nurses, doctors and other healthcare workers can get 100s or 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 ◦ rolling patients over in bed ◦ touching the patient’s gown or

bed sheets ◦ touching equipment like bedside

rails, over-bed tables, IV pumps How can this happen?

13-25%

40%

30-39%

Percent of Patients with MRSA Who Carry the Organism on Their Skin

Patients with resistant bacteria like methicillin-resistant S. aureus (MRSA) or vancomycin-resistant enterococci (VRE) often carry the organism on many areas of their skin, even when they don’t have any wounds or broken skin.

Percent of Surfaces Contaminated

Frequency of Environmental Contaminationof Surfaces in the Rooms of Patients withMethicillin-Resistant S. aureus (MRSA)

Healthcare workers can contaminate their hands by touching environmental surfaces near affected patients.

Alcohol-based (hand)rub : An alcohol-containing preparation (liquid, gel or foam).

Antimicrobial (medicated) soap : Soap (detergent) containing an antiseptic agent at a concentration

Plain soap : Detergents that do not contain antimicrobial agents, or that contain very low concentrations of antimicrobial agents effective solely as preservatives.

0.0

1.0

2.0

3.0 0 60 180 minutes

0.0

90.0

99.0

99.9log%

Bac

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Alcohol-based handrub(70% Isopropanol)

Antimicrobial soap(4% Chlorhexidine)

Plain soap

Time After Disinfection

Baseline

Good Better Best

Plain Soap Antimicrobial soap

Alcohol-based handrub

Since washing hands frequently with soap and water is • inconvenient • time-consuming • often causes skin irritation and dryness

We need to make it easier for you to clean your hands quickly, with a minimum efforts and skin irritation.

One way to accomplish these goals is to clean your hands with an alcohol-based handrub (a gel, rinse or foam).

More than 20 published studies have shown that alcohol-based handrubs are more effective than either plain soap or antibacterial soaps in reducing the number of live bacteria on the hands

When hospitals placed alcohol handrub dispensers near each patient’s bed, healthcare workers cleaned their hands significantly more often than they did when only sinks were available for handwashing.

When compared to traditional soap and water handwashing, alcohol handrubs have the following advantages: • take less time to use • can be made more accessible than sinks • cause less skin irritation and dryness • are more effective in reducing the number of

bacteria on hands • makes alcohol-based handrubs readily

available to personnel • has led to improved hand hygiene practices

New guideline developed by the Centers for Disease Control and Prevention (CDC) and infection control organizations recommends that healthcare workers use an alcohol-based handrub (a gel, rinse or foam) to routinely clean their hands between patient contacts, as long as hands are not dirty.

Wash your hands with plain soap and water, or with antimicrobial soap and water if:•Your hands are visibly soiled

(dirty) •Hands are visibly

contaminated with blood or body fluids

•Before eating •After using the restroom

• Wet hands first with water

• Apply 3 to 5 ml of soap to hands

• Rub hands together for at least 15 seconds

• Cover all surfaces of the hands and fingers

• Rinse hands with water• Dry your hands with a

clean or disposable towel

• Use paper towel to turn off water faucet

Vijay Pratap Raghuvanshi M.Phil & MHA

( Hospital & Health Administration)

If hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based handrub for routinely cleaning your hands:• Before having direct contact with patients• After having direct contact with a patient’s

skin• After having contact with body fluids, wounds

or broken skin• After touching equipment or furniture near the

patient• After removing gloves

• Apply 1.5 to 3 ml of an alcohol gel or rinse to the palm of one hand, and rub hands together

• Cover all surfaces of your hands and fingers • Include areas around/under fingernails • Continue rubbing hands together until

alcohol dries If you have applied a sufficient amount of

alcohol hand rub, it should take at least 10 -15 seconds of rubbing before your hands feel dry.

Vijay Pratap Raghuvanshi M.Phil & MHA

( Hospital & Health Administration)

Although it's impossible to keep your hands germ-free, times exist when it's critical to wash your hands to limit the transfer of bacteria, viruses and other microbes.

1. Always2. Often3. Sometimes4. Never

1. 15 minutes

2. 30 minutes

3. 1 hour

4. 2.5 hours

1. Always

2. Often

3. Sometime

4. Never

1. Strongly agree

2. Agree

3. Don’t know

4. Disagree

5. Strongly disagree

1. Strongly agree

2. Agree

3. Don’t know

4. Disagree

5. Strongly disagree

PREVENTIONIS PRIMARY!

Protect patients…protect healthcare personnel…

promote quality healthcare!

يتقنه أن عمال عمل اذا العبد يحب الله ان

Wash our hands before and after we touch you

Use alcohol-based hand rub Make sure that physicians and all health

care workers do the same before and after touching you

Will use glove use to reduce risk of transmission of organisms