principles of hand washing
TRANSCRIPT
Abdullah A. Idrees
Presented by :
Definitions• 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
Why is Hand washing Important?
Routine Hand washing prevents the spread of
disease!Abdullah A. Idrees
How disease spreads
Infectious diseases can spread in a variety of ways .
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Common Microbes
Microbes found on a cutting board.
© Dennis Kunkel
E Coli.
©Dennis Kunkel Staphylococcus aureus
©Dennis Kunkel
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Proper hand washing with
soap and waterFollow these instructions for washing with soap and
water:
• Wet your hands with warm, running water and apply liquid or clean bar soap. Lather well.
• Rub your hands vigorously together for at least 15 seconds.
• Scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
• Rinse well. • Dry your hands with a clean or disposable towel. • Use a towel to turn off the tap.
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Recommended Hand 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
To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps.
This takes only 20–30 seconds!
How to handrub
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How to handwash
To effectively reduce the growth of germs on hands, handwashing
must last 40–60 secs
and should be performed by following all of the illustrated steps
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Hand hygiene and glove use
GLOVES PLUSHAND HYGIENE
=CLEAN HANDS
GLOVES WITHOUTHAND HYGIENE
=GERM TRANSMISSION
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Hand hygiene and glove use
–The use of gloves does not replace the need for cleaning your hands!
–You should remove gloves to perform hand hygiene, when an indication occurs while wearing gloves
–You should wear gloves only when indicated otherwise they become a major risk for germ transmission
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Examples of hand hygiene products easily accessible at the point-of-care
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Alcohol-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
When should you wash your hands?
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.
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Barriers to hand washing
Can you find the sink in this picture ?
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Barriers to hand washing
The sink mentioned in the previous
slide is located behind the
patient’s bed and behind several IV
pumps.
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Self-Reported Factors for Poor 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.
Health care workers
Nurses, doctors and other healthcare
workers can get 100s or 1000s of bacteria on their hands by doing
simple tasksCulture plate showing growth of bacteria 24 hours after a nurse placed her hand on
the plate
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How clean are you???
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Why should you clean your hands?
Any health-care worker, caregiver or person involved in patient care needs to be
concerned about hand hygieneTherefore hand hygiene does concern you!
You must perform hand hygiene to:protect the patient against harmful germs
carried on your hands or present on his/her own skin
protect yourself and the health-care environment from harmful germs
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Hand hygiene must be performed exactly where you are delivering health care to patients (at the point-of-care)
During health care delivery, there are 5 moments when it is essential that you perform hand hygiene ("My 5 Moments for Hand Hygiene" approach)
The golden rules for hand hygiene
To clean your hands, you should prefer handrubbing with an alcohol-based formulation, if available. Why? Because it makes hand hygiene possible right at the point-of-care, it is faster, more effective, and better tolerated.
You should wash your hands with soap and water when visibly soiled
You must perform hand hygiene using the appropriate technique and time duration
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HEALTH-CARE ZONE
PATIENT ZONE
The geographical conceptualization of the transmission risk
Critical site with infectious risk for the patient
Critical site with body fluid
exposure risk
Abdullah A. IdreesH Sax, University Hospitals, Geneva 2006
1
23
5
Another way of visualizing the patient zone and the contacts occurring within it
5 Moments for
Hand Hygiene
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PatientRefers to any part of the patient, their clothes, or any medical device that is connected to the patient
If the patient were to get out of bed and walk off – what would still be attached to them?
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Immediate Patient Surroundings
A space temporarily dedicated to an individual patient for that patient’s stay Includes:
• Patient furniture and personal belongings • Medical equipment – BP machine, monitor• Medical chart • Anything touched by HCW while caring for that patient
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Patient Surroundings
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Moment 1Before Touching a Patient
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Mom
ent 1
When:Examples:
Touching a patient in any wayShaking hands, Assisting a patient to move, most Allied health interventions, Touching any invasive medical device connected to the patient (eg. IV pump, IDC)
Any personal care activitiesBathing, Dressing, Brushing hair, Putting on personal eg. Glasses
Any non-invasive observationsTaking a pulse, Blood pressure, Oxygen saturation, Temperature, Chest auscultation, Abdominal palpation, Applying ECG electrodes, CTG
Any non-invasive treatmentApplying an oxygen mask or nasal cannula, Fitting slings/braces, Application of incontinence aids (including condom drainage)
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Moment 2Before a Procedure
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Procedure
Is an act of care for a patient where there is a risk of direct introduction of a pathogen into the patient’s body.
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Moment 2When:Examples:
Insertion of a needle into a patient’s skin, or into an invasive medical device
Venipuncture, Blood glucose level, Arterial blood gas, Subcutaneous or Intramuscular injections, IV flush
Preparation and administration of any medications given via an invasive medical device, or preparation of a sterile field
IV medication, NGT feeds, PEG feeds, Baby feeds, Dressing trolley
Administration of medications where there is direct contact with mucous membranes
Eye drop installation, Suppository insertion, Vaginal pessary
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Moment 2When:Examples:
Insertion of, or disruption to, the circuit of an invasive medical device
Procedures involving the following: ETT, Tracheostomy, Nasopharyngeal airways, Suctioning of airways, Urinary catheter, Colostomy/ileostomy, Vascular access systems, Invasive monitoring devices, Wound drains, PEG tube, NGT, Secretion aspiration
Any assessment, treatment and patient care where contact is made with non-intact skin or mucous membranes
Wound dressings, Burns dressings, Surgical procedures, Digital rectal examination, Invasive obstetric and gynaecological examinations and procedures, Digital assessment of newborns palate
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Moment 3After a Procedure or Body Fluid
Exposure Risk
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Any situation where contact with body fluids may occur. Such contact may pose a contamination risk to either the HCW or the environment
Body Fluid Exposure Risk
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Actual or potential contact with:
• Blood, Lochia• Saliva or tears• Mucous, wax, or pus• Breast milk, Colostrum• Vomitus • Urine, faeces, semen, or meconium• Pleural fluid, ascitic fluid or CSF
• Tissue samples, including biopsy specimens, organs, bone marrow, cell samples
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Moment 3When:Examples:After any Moment 2See Moment 2
After any potential body fluid exposure
Contact with a used urinary bottle / bedpan, Contact with sputum either directly or indirectly via a cup or tissue, Contact with used specimen jars / pathology samples, Cleaning dentures, Cleaning spills of body fluid from patient surroundings, After touching the outside of a drain
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Moment 4After Touching a Patient
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Moment 5After touching a patient’s immediate surroundings
when the patient has not been touched
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Moment 5When:Examples:
After touching the patient’s immediate surroundings when the patient has not been touched
Patient surroundings include: Bed, Bedrails, Linen, Table, Bedside chart, Bedside locker, Call bell/TV remote control, Light switches, Personal belongings, Chair, Foot stool, Monkey bar
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