preventing infections · •keep natural nails short (tips less than 0.5 cm long) preventing...
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IntroductionWHO Guidelines on Hand Hygiene in Health CareFirst Global Patient Safety Challenge Clean Care is Safer Care
Health care-associated infections: 10% 1 in 10 patients get an infection while receiving care.
Surgical site infections: 50% More than 50% of surgical site infections can be antibiotic-resistant.
Impact of infection prevention and control: 30% Effective infection prevention and control reduces health care-associated infections by at least 30%.
Normal bacterial flora on hands
• 1938 Price: bacteria recovered from the hands could be divided into two categories, namely resident or transient.
• Resident flora - protective functions: microbial antagonism and the competition for nutrients in the ecosystem.
• Resident flora is less likely to be associated with infections, but may cause infections in sterile body cavities, the eyes, or on non-intact skin.
Health care-associated infections (HAIs)
Globally, hundreds of millions of people are affected every year by health care-associated infections (HAIs)
01many are avoidable and a large proportion are caused by antibiotic resistant organisms.
02No country or health system, even the most developed, can claim to be free of these infections
03Infection prevention and control (IPC) is a practical, evidence-based approach preventing patients and health workers from being harmed by avoidable infections.
04
Health care-associated infections (HAI) results
prolonged hospital stays
01long-term disability
02increased resistance to antibiotics
03massive additional costs for health systems
04high costs for patients and their family
05unnecessary deaths.
06
What are the solutions to
the problem of HCAI?
• Identifying local determinants of the HAI burden.
• Improving reporting and surveillance systems at the national level.
• HAI surveillance at the hospital level, including microbiology laboratories' capacity.
• Hand hygiene practices at the bedside.
• Improving staff education.
• Involvement of patients and their families.
WHO's global annual call to
action for health workers
Health workers: “Take 5 Moments to clean your hands to prevent sepsis in health care."
Ranking system for
evidence
The consensus recommendations listed below, adapted as follows:
• Category IA: Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiological studies
• Category IB: Strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and a strong theoretical rationale.
• Category IC: Required for implementation, as mandated by federal and/or state regulation or standard.
• Category II: Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or a consensus by a panel of experts
Indications for hand hygiene
Wash hands with soap and water
when visibly dirty or visibly soiled with blood or
other body fluids (IB) or after using
the toilet (II).
If exposure to potential spore-
forming pathogens is
strongly suspected or
proven, including Clostridium
difficile, hand washing with
soap and water is the preferred
means (IB)
Indications for hand hygiene
• Use an alcohol-based handrubas the preferred means for routine hand antisepsis in all other clinical situations, if hands are not visibly soiled (IA).If alcohol-based handrub is not obtainable, wash hands with soap and water (IB).
Recommendations for surgical hand preparation
Remove rings, wrist-watch, and bracelets before beginning surgical hand preparation (II).
Artificial nails are prohibited (IB).
If hands are visibly soiled, wash hands with plain soap before surgical hand preparation (II).
Remove debris from underneath fingernails using a nail cleaner, preferably under running water (II).
Brushes are not recommended for surgical hand preparation (IB).
Recommentations for surgical hand preparation
• Surgical hand antisepsis should be performed using either a suitable antimicrobial soap or suitable alcohol-based handrub, before donning sterile gloves (IB).
• If quality of water is not assured, in the operating theatre, surgical hand antisepsis using an alcohol-based handrub is recommended before donning sterile gloves when performing surgical procedures (II).
Iodine and iodophors
• Iodine has been recognized as an effective antiseptic since the 1800s, though iodophors have largely replaced iodine as the active ingredient in antiseptics because iodine often causes irritation and discolouring of skin.
• Povidone-iodine 5–10% has been classified as a safe and effective active agent for use as an antiseptic handwash and HCW handwash.
• As the amount of free iodine increases, however, the degree of skin irritation also may increase.
Alcohol-based handrubs
• At present, alcohol-based handrubs are the only known means for rapidly and effectively inactivating a wide array of potentially harmful microorganisms on hands
Suggested composition
of alcohol-based
handrub formulations
for local production
• Formulation I
To produce final concentrations of ethanol 80% v/v, glycerol 1.45% v/v, hydrogen peroxide (H2O2) 0.125% v/v
Pour into a 1000 ml graduated flask: a) ethanol 96% v/v, 833.3 ml b) H2O2 3%, 41.7 ml c) glycerol 98% ,14.5 ml
Top up the flask to 1000 ml with distilled water or water that has been boiled and cooled; shake the flask gently to mix the content.
http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf?ua=1
Other aspects of hand hygiene
• Do not wear artificial fingernails or extenders when having direct contact with patients (IA)
• Keep natural nails short (tips less than 0.5 cm long)
Preventing infection during delivery
• it is one of the most common causes of death after childbirth
• most of our actions during labour and delivery can be safe only if you are able to follow the basic rules to prevent infection.
• hand washing and alcoholic hand sanitizer
• protective clothing
• gloves, face mask, eye protection and gown, feet protection
• after delivery tools must be cleaned and disinfected
These rules as the ‘three cleans’
• clean hands
• clean surface (for the delivery) and
• clean equipment
➢you must thoroughly clean the place where the baby will be born. in addition, you should follow other standard hygiene measures
Summary: Perform hand hygiene:
before and after touching the patient (IB);
before handling an invasive device for
patient care, regardless of whether or not gloves
are used (IB);
after contact with body fluids or excretions,
mucous membranes, non-intact skin, or
wound dressings (IA);
if moving from a contaminated body site
to another body site during care of the same
patient (IB);
after contact with medical equipment and then taking care of the
patient (IB);
after removing sterile (II) or non-sterile gloves (IB)