NEW TRENDS INHAND HYGIENE

FromInfection control department

Dr Fatima Noman (HOD )Ms shaheen Asif (ICN)

Why all the fuss abouthand washing?

PROPER HAND HYGIENE

To prevent health care associated infections And spread of antimicrobial resistant organisms

Most effective

SimplestLeast

expensive

Most common mode of transmission ofpathogens is via hands!

Infections acquired in healthcare Spread of antimicrobial resistance

PREVENTION ISPRIMARY!

Protect patients

protect healthcare personnel

promote quality healthcare

Hands are used in all healthcareactivities

Hands spread germs

Handsspreadgerms

Microbial skin flora

RESIDENT SKIN FLORA

TRANSIENT SKIN FLORA

RESIDENT FLORA:

Colonizes deeper skin layers. It is more resistant to mechanical removal. Organisms multiply in hair follicles and remain stable. They are of lower pathogenic potential. They are imp for colonization resistance, and prevent

colonization with other organisms.

transient flora:

Colonizes the superficial skin layers for shortperiods.

Acquired by contact with a patient or contaminatedenvironment.

They are easily removed by mechanical means. Most responsible for health care associated

infections and spread of antimicrobial resistance.

Evidence of RelationshipBetween Hand Hygiene and

Healthcare-AssociatedInfections

Substantial evidence that hand hygienereduces the incidence of infections

Historical study: Semmelweis More recent studies: rates lower when

antiseptic handwashing was performed

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

The Intervention:Hand scrub with chlorinated lime solution

Hand hygiene basin at the Lying-In Womens Hospital in Vienna, 1847.

Definitions Hand hygiene

Performing handwashing, antiseptic handwash, alcohol-basedhandrub, 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 beforeoperations by surgical personnel

Personal Hygiene

1. All staff must maintain good personalhygiene.

2. Nails must be clean and kept short.3. False nails should not be worn.4. Hair must be worn short or pinned up.5. Beard and moustaches must be kept trimmed

short and clean.

Self-Reported Factors forPoor Adherence with Hand

Hygiene Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

Hand decontamination.

1. There must be written policies and procedures for handwashing.

2. Jewellery must be removed before washing.3. Simple hygiene procedures may be limited to hands and

wrists.4. Surgical procedures include the hand and forearm.5. Equipment and products are not equally accessible in all

countries or health care facilities. Flexibility in productsand procedures and sensitivity to local needs willimprove compliance.

Indications for HandHygiene

When hands are visibly dirty,contaminated, or soiled, wash withnon-antimicrobial or antimicrobialsoap and water.

If hands are not visibly soiled, use analcohol-based handrub for routinelydecontaminating hands.

Specific Indications forHand Hygiene

Before: Patient contact Donning gloves when inserting a CVC or Inserting urinary catheters, peripheral vascular catheters,

or other invasive devices that dont require surgery

After: Contact with a patients skin Contact with body fluids or excretions, non-intact skin,

wound dressings Removing gloves

Selection of Hand HygieneAgents: Factors to Consider

Efficacy of antiseptic agent Acceptance of product by healthcare

personnel Characteristics of product Skin irritation and dryness

Accessibility of product Dispenser systemsGuideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.

Efficacy of Preparations used

Good Better Best

Plain Soap Antimicrobialsoap Alcohol-basedhandrub

Time Spent CleansingHands:

one nurse per 8 hour shift Hand washing with soap and water: 56

minutes Based on seven (60 second) handwashing episodes per hour

Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour

Voss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.

~ Alcohol-based handrubs reduce timeneeded for hand disinfection ~

Recommendations forHand Hygiene Technique

Handrubs Apply to palm of one hand, rub hands together covering

all surfaces until dry Volume: based on manufacturer

Handwashing Wet hands with water, apply soap, rub hands together

for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucet

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

Surgical HandHygiene/Antisepsis

Use either an antimicrobial soap or alcohol-basedhandrub

Antimicrobial soap: scrub hands and forearms forlength of time recommended by manufacturer

Alcohol-based handrub: follow manufacturersrecommendations. Before applying, pre-washhands and forearms with non-antimicrobial soap

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

Do not confuse!Both procedures should not be used at thesame time.

Use of alcohol immediately before or after handwashing may cause dermatitis.

Skin Care

Provide healthcare workers with hand lotionsor creams to minimize contact dermatitis

Get information from manufacturersregarding effects that hand lotions, creams, oralcohol-based handrubs may have on theeffectiveness of antimicrobial soaps

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

Fingernails and ArtificialNails

Natural nail tips should be kept to inch in length

Artificial nails should not be worn whenhaving direct contact with high-riskpatients (e.g., ICU, OR)

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

Unresolved Issues

Routine use of nonalcohol-basedhandrubs

Wearing rings in healthcare settings

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

Gloving

Wear gloves when contact with blood or otherpotentially infectious materials is possible

Remove gloves after caring for a patient Do not wear the same pair of gloves for the

care of more than one patient Do not wash gloves

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

Education/MotivationPrograms

Monitor healthcare workers (HCWs)adherence with recommended hand hygienepractices and give feedback

Implement a multidisciplinary program toimprove adherence to recommendedpractices

Encourage patients and their families toremind HCWs to practice hand hygieneGuideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.

Administrative Measuresto Improve Hand Hygiene

Make improved hand hygiene aninstitutional priority

Place alcohol-based handrubs at entranceto patient room, or at bedside

Provide HCWs with pocket-sizedcontainers

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

Performance Indicators

Monitor and record adherence to handhygiene by ward or service

Provide feedback to healthcare workersabout their performance

Monitor the volume of alcohol-basedhandrub used per 1,000 patient days

Monitor adherence to policies on wearingartificial nailsGuideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.

SummaryAlcohol-Based Handrubs:What benefits do they provide?

Require less time More effective for standard

handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition

SQUIRT: once onto the palm ofyour hand

ROLL: over all surfaces of yourHands until dry

RUB: hands together

HAND RUB

Dont forget your finger tips andaround your nails

Areas Most Frequently Missed

HAHS 1999

Hands spread germs

With hand hygiene theyre dead

GERMS

Take care

Thats all Folks!

Practice hand hygienePromote quality healthcare!