Hand Hygiene

1. Hand Hygiene

2. Outline • Importance of Hand Hygiene • Types of Hand Hygiene • Steps of Hand Hygiene • General Rules

3. Why hand hygiene? Most common modes of transmission of pathogens in the hospitals are via hands of health care workers! Patient ObjectHCW HandsPatient

4. Goal of hand hygiene Decrease the portion of nosocomial infections spread by hand contact

5. Is there evidence that handwashing matters? 1846- Semmelweis observed patients of doctors who delivered babies of women after doing autopsies had higher mortality rates.

6. Is there evidence that handwashing matters? • 1847- He insisted that physicians clean hands with chlorine between each patient. Maternal mortality dropped and stayed low. • Forty years later the practice was not widely used despite good evidence.

7. Contaminating sources • Patients skin • Inguinal areas are the most heavily colonized • Objects and environmental surfaces around the patient • Blood secretions and body fluids during procedures Remember: The patient may be colonized but not infected , so NO SIGNS OF INFECTION , but still can be a source !!!

8. The Inanimate Environment Can Be a Source!! Xrepresents VRE culture positive sites ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

9. What is living on our hands? • Total bacterial counts on the hands of HCW ranges from 40000 to 4 millions CFU! • Two categories of micro-organisms: • Transient flora (on the skin surface) • Resident flora (on the surface and deep in the skin layers) Electron Micrograph of skin bacteria www.sghms.ac.uk/.../ pathogens_sknbac.html

11. Indications for hand hygiene • Before and after direct contact with patients • After removing gloves • Before invasive techniques (regardless of whether or not gloves are used) • After contact with body fluids or excretions • After contact with inanimate objects (including medical equipment) in patient surroundings • Before handling medication and preparing food

12. Types of hand hygiene • Routine hand washing • Antiseptic hand hygiene • Alcohol-based hand rub • Surgical hand hygiene

13. Routine hand washing • Product used : plain soap and water • Influence on hand flora: - Mechanical removal of most of transient flora – No effect on resident flora • Time : 30 seconds (longer timing is more effective) • Speed of action: - Slow, tends to remove surfaces germs so rubbing and rinsing under water are important • Residual effect on microbes: short period

14. Routine hand washingSoap • Effect: Removes lipid and adherent dirt soil, and loosely adherent transient flora • No antimicrobial action • Advantages: - Cleansing action • Disadvantages: • Skin irritation • Needs water supply and drying material • Time factor

15. Antiseptic hand washing • Product used: • Chlorhexidine, iodophors • Influence on hand flora: - Kills transient flora; reduces resident colonies • Time: • Varies with the product but not less than 2 minutes • Residual activity: • chlorhexidine greater than iodophors.

16. Antiseptic hand washingAntiseptics • Chlorhexidine, hexachloraphene, iodine, iodophors, para-chloro meta-xylenol • Advantages : - more antimicrobial action - more sustained effect • Disadvantages: - Needs water supply and drying material - Time factor - Skin irritation

17. Alcohol-based hand rub • Types suitable for hand hygiene: - Ethanol , isopropanol, n-propanol or combination of two of them (methyl alcohol is toxic and can’t be used for medical purposes) • Effect : - Kills transient flora and decrease resident flora (broad range spectrum) • Time : 30 seconds is enough

18. Alcohol- based hand rub • Speed: • Very rapid action • Residual activity: • Short duration

19. Alcohol-based hand rubAlcohol • Advantages: • Rapid action • No need for water supply nor drying material • More antimicrobial effect • Disadvantages: • Can not be used when hands are visibly soiled (no cleansing action) • Has drying effect • Short duration • flammable

20. Alcohol-based hand rub • When hands are visibly dirty, contaminated, or soiled, wash with soap and water. • If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands.

21. 7 Steps to ensure optimum hand hygiene palm over opposite dorsum with interlaced fingers palm to palm with fingers interlaced Palm to palm backs of fingers to opposing palms with fingers interlocked rotational rubbing of thumb Rubbing of the wrist rotational rubbing of finger tips and nails in opposite palm

22. Frequently missed areas

23. General rules Hand hygiene • Remove all jewelry (except wedding ring) and watches and move sleeves up • All surfaces of the hand should be reached • If water is used it should be running water, hands must be rinsed thoroughly and dried. • Do not re-contaminate hands after hand hygiene, close faucet using drying towel

24. General rules Hand hygiene • Keep nails short • Do not use polish • Use soft hard nail brushes as hard bristles can cause minor abrasions. • Avoid artificial nails- the adhesive can easily be colonized with pathogens

25. General rulesHand hygiene • Adding glycerol to alcohol reduces its irritating effect • Brushing during hand washing is prohibited . Minor scratches favors colonization. • Do not use gloves before hand drying

26. General rulesWhy hand drying is important? • Wet hands provide better conditions for the transmission of microorganisms • Use of gloves on wet hands increases the risk of irritation • The effect of alcohol on wet hands is less (dilution effect)

27. General rules Hand hygiene • Hand washing is needed after removing gloves - warmth and humidity favor microorganism growth • Hands can be contaminated even with the use of the gloves Pessoa-Silva, C.L .,etal., Dynamics of bacterial h and contamination during routine neonatal care. Infect. Control Hosp. Epidemiol,, 2004. 25(3): p. 192-7.