Hand hygiene principles and practice

1. Hand hygieneprinciples and practice Dr.T.V.Rao MD Dr.T.V.Rao MD

2. Hungarian doctor who worked in a maternity ward in Austria in the 1840’s. There were two wards in the maternity building: One contained women due to give birth and was run by midwives. The other was used as a teaching hospital for medical students, who may have come straight from dissecting dead bodies. The wards were cleaned no more than once a month. The doctors rarely washed their hands and often wore dirty coats. Semmelweiss was horrified by the number of women who died after births that were trouble free. The women developed a very high temperature and died within a few days from an illness called childbed fever. No-one had any idea what caused this disease. No-one knew about bacteria or viruses then. The work of Ignaz Semmelweiss Dr.T.V.Rao MD

3. Semmelweiss realised that more than three times as many women died from fever in the teaching ward than in the midwives’ ward. He was determined to try to reduce the number of deaths. He looked into at each factor that was different between the two wards, but nothing that he thought of seemed to make a difference. Then a professor was accidentally cut with a knife that was getting used to study the body of a woman who had died. The professor himself died, from a disease whose symptoms were like childbed fever. The work of Ignaz Semmelweiss Dr.T.V.Rao MD

4. Semmelweiss thought that there must have been something on the knife that had caused the disease. He made all the doctors wash their hands in chlorine water before examining the women Within a very short time, the death rate had fallen Semmelweiss presented his findings to other doctors. His ideas were mocked. The work of Ignaz Semmelweiss Dr.T.V.Rao MD

5. Evidence of Relationship Between Hand Hygiene and Healthcare-Associated Infections • Substantial evidence that hand hygiene reduces the incidence of infections • Historical study: Semmelweis • More recent studies: rates lower when antiseptic hand washing was performed Dr.T.V.Rao MD

6. Hand Hygiene Definitions • Hand washing • The application of non-antimicrobial soap and water to the surface of the hands Antiseptic hand wash • Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based hand rub • an alcohol-containing preparation designed for application to the hands in order to reduce the number of viable organisms with maximum efficacy and speed Surgical hand hygiene/antisepsis • Hand washing or using an alcohol-based hand rub before operations by surgical personnel Dr.T.V.Rao MD

7. Why we don’t wash our hands • Too busy/insufficient time • Patient needs take priority • Understaffing/overcrowding HCW are not bad just busy! • Sinks are inconveniently located or lack of sinks • Lack of soap and paper towels Poor design Poor product • Hand washing agents cause irritation and dryness • Low risk of acquiring infection from patients More education Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386. Dr.T.V.Rao MD

8. Indications for hand washing • Hand hygiene should be performed before and after every patient contact • Hand hygiene should be performed after contact with patient’s environment • Hand hygiene should be performed after using a restroom, after removing gloves, prior to and following meals Dr.T.V.Rao MD

9. Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children with Challenging Behavior. Tampa, Florida: University of South Florida, Early Intervention Positive Behavior Support. Washing Hands 2 3 4 5 1 Wet hands. Throw away. Get soap. Wash hands. Dry hands.

10. A casual hand wash may miss several areas from disinfection Dr.T.V.Rao MD

11. Practice a little of scientific steps in hand washing Dr.T.V.Rao MD

12. Make the best use of scientific methods in critical care of patients Dr.T.V.Rao MD

13. Indications for Hand Hygiene • When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. • If hands are visibly clean, use an alcohol-based hand rub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Dr.T.V.Rao MD

14. What can we do to help change this • Provide easy access to hand hygiene materials • Handrub solution • Conveniently located: • at the patient’s bedside • at the patient’s room entrance • in convenient / appropriate locations • in high traffic public areas • Working appropriately • Full of product • Within use by date Dr.T.V.Rao MD

15. Glove use • Hand hygiène is required regardless of whether gloves are used or changed • Failure to remove gloves after patient contact or between dirty and clean body site care in the same patient has to be regarded as noncompliance with recommendations • Gloves should not be washed or reused • Gloved HCWs can cause cross infections Dr.T.V.Rao MD

16. Dr.T.V.Rao MD

17. According to the CDC • Wet hands with running water; place soap in palms; rub together to make a lather; scrub hands vigorously for 20 seconds; rinse soap off hands. • If possible, turn off the faucet by using a disposable paper towel. • Dry hands with a disposable paper towel. Do not dry hands on clothing. • Assist young children with washing their hands. Dr.T.V.Rao MD

18. Before: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery After: Contact with a patient’s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves Specific Indications for Hand Hygiene Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Dr.T.V.Rao MD

19. What to use and When When hands are visibly soiled use soap and water to wash If your hands are visibly CLEAN use ABHR Before and after touching a patient Before and after a procedure After touching a patient’s surroundings Before and after glove use Dr.T.V.Rao MD

20. Easy Message ROLL rub hands together covering all aspects of your fingers & hands until dry SQUIRT one squirt (1-3 ml) to your hands RUB apply to palm Dr.T.V.Rao MD

21. . Recommendations for Hand Washing Facility: •  Clean at all times; • Strategically located as per regulations, near bathrooms and entrances to the processing area; • Dedicated to hand washing only; • Liquid soap in dispenser; • Hot water (43º C or 110º F); • Use of disposable paper towels or air blowers; and • Adjacent hand sanitizing facilities.

22. Easy Message Basic message always the same “Clean you hands before and after every patient touch” Instructions always the same • Squirt • Rub • Roll Dr.T.V.Rao MD

23. Hand washing 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 Self-Reported Factors for Poor Adherence with Hand Hygiene Dr.T.V.Rao MD Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

24. Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene Education/Motivation Programs Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Dr.T.V.Rao MD

25. Failed Role Models “Healthcare workers in a room with a senior staff member or peer who DID NOT wash their hands were significantly less likely to wash their own hands” EMERGING INFECTIOUS DISEASES FEB 2003 Dr.T.V.Rao MD

26. Skin irritation A Limitation to Hand Washing • - is an important barrier to compliance • is more fréquent with soap and water than with handrubs • is reduced and can be treated by emollient-containing solutions Boyce et al. Inf Contr Hosp Epi 2000;21:442 Kramer et al. J Hosp Infect 2002; 51:114 Larson et al. Heart Lung 2000; 29:139 Pittet. Emerging Inf Dis 2001; 2:234 Dr.T.V.Rao MD

27. Clean hands saves many live have one ourselves Dr.T.V.Rao MD

28. Hospital administration thanks everyone for washing hands Dr.T.V.Rao MD

29. References • WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) April 2006 • Guideline for Hand Hygiene in Health-Care Settings.MMWR 2002:vol,51,no RR-16 • HHA 5 Moments for Hand Hygiene,Advanced draft, August 2008 • Pittet D,Inf .Control Hospital Epidemiology 200:21:381-386 Dr.T.V.Rao MD

30. Programme created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World • Email • doctortvrao@gmail.com Dr.T.V.Rao MD