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HAND HYGIENE … THE EASY WAY!

HAND HYGIENE … THE EASY WAY!. Maria Rhona M. G. Bergantin, MD. PSEUDOMONAS Normally lives in soil and in water storage tank. but, once he gets into the hospital, is notoriously difficult to remove. The Hospital Gang. ESCHERICHIA COLI generally lives a blameless life in the gut

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HAND HYGIENE … THE EASY WAY!

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  1. HAND HYGIENE … THE EASY WAY! Maria Rhona M. G. Bergantin, MD

  2. PSEUDOMONAS Normally lives in soil and in water storage tank. but, once he gets into the hospital, is notoriously difficult to remove The Hospital Gang ESCHERICHIA COLI generally lives a blameless life in the gut but assumes a life of crime once he is allowed to roam in the hospital KLEBSIELLA. Lesser known resident of the intestine, fond of hitchhiking on the hands of doctors and nurses. Known to take over entire wards. STAPHYLOCOCCUS AUREUS Alias Goldie the Grape, found in the nose and on the hands of hospital staff but survives for days in dusty places STREPTOCOCCUS Still a common cause of throat infection but also involved in more serious offenses against the rest of the person PROTEUS A motile young bacterium, anxious to swim into the wrong places. Generally follows up the dirty work of other bacteria

  3. Normal Bacterial Skin Flora • Scalp 1 x 106 CFU/cm2 • Axilla 5 x 105 CFU/cm2 • Abdomen 4 x 104 CFU/cm2 • Forearm 1 x 104 CFU/cm2 • Total bacterial count on the hands = 3.9 x 104 to 4.6 x 106

  4. ORGANISMS PRESENT ON THE HANDS RESIDENT ORGANISMS • normal flora of the skin • deeply seated in the epidermis • not easily removed by single hand washing • rarely cause infection • cause infection during implant surgery and IV sites

  5. ORGANISMS PRESENT ON THE HANDS RESIDENT ORGANISMS • normal flora of the skin • coagulase negative staphylococci • Staphylococcus epidermidis • Corynebacterium or Diphtheroids • Propionibacterium species

  6. ORGANISMS PRESENT ON THE HANDS TRANSIENT ORGANISMS • microorganisms NOT part of the normal flora • represent recent contamination • usually survive for a limited period of time • acquired during contact with the infected/colonized patient or environment • easily removed by good hand washing technique

  7. ORGANISMS PRESENT ON THE HANDS TRANSIENT ORGANISMS • gram negative bacilli (E. coli, Klebsiella and Pseudomonas) • Salmonella sp. • Staphylococcus aureus • Viruses (Rotavirus)

  8. HEALTH CARE WORKER’S HANDS Probably the MOST common means by which spread of infection by direct contact can occur

  9. How the Hands act as a VECTOR of Nosocomial Infection

  10. The Hand Takes Germs from : - the skin, dirty wounds, pus excretions of the sick - the body, the hands, the clothes of the physicians and hospital personnel

  11. The Hand Infects - newly operated - the child, the chronically ill - the old patient - ALL sick people - ALL hospital personnel The Hand Takes Germs from : - the skin, dirty wounds, pus excretions of the sick - the body, the hands, the clothes of the physicians and hospital personnel

  12. The Hand Infects - newly operated - the child, the chronically ill - the old patient - ALL sick people - ALL hospital personnel The Hand Takes Germs from : - the skin, dirty wounds, pus excretions of the sick - the body, the hands, the clothes of the physicians and hospital personnel The Hand contaminates - the physicians’ instruments - clean laundry - toiletries - sanitary equipments - dishes and silver etc.

  13. The Hand Infects - newly operated - the child, the chronically ill - the old patient - ALL sick people - ALL hospital personnel The Hand Takes Germs from : - the skin, dirty wounds, pus excretions of the sick - the body, the hands, the clothes of the physicians and hospital personnel The Hand contaminates - the healthcare worker’s instruments - clean laundry - toiletries - sanitary equipments - dishes and silver etc. The Hand transfer Germs from: bed sheets, dirty underwear, moist towels, sinks and bathtubs, toiletries

  14. HANDWASHING • Considered to be one of the MOST important procedures in the prevention of hospital-acquired infection

  15. Defined Technique for Hand Washing The Hands are moistened and 3-5 ml formulation is applied to cupped hands. The hands are then rubbed together 5 times as follows : 1. PALM to PALM 2. Right Palm over 3. PALM to PALM dorsum and vice versa fingers interlaced 4. Back of fingers 5. Rotational rubbing of 6. Rotational rubbing, to opposing palms, right thumb clasped in backwards and forwards fingers interlocked left palm and vice versa with clasped fingers of right hand in left palm and vice versa

  16. Factors Influencing Adherence to Hand-Hygiene Practices • Observed risk factors for poor adherence to recommended hand-hygiene practices • Physician status (rather than nurses) • Nursing assistant status (rather than a nurse) • Male sex • Working in an intensive-care unit • Working during the week (versus weekends) • Wearing gloves/gowns • Automated sink • Activities with high risk of co-transmission • High number of opportunities for hand hygiene per hours of patient care Pitter D, 2000

  17. Factors Influencing Adherence to Hand-Hygiene Practices • Additional perceived barriers to appropriate hand hygiene • Lack of active participation in hand-hygiene promotion at individual or institutional level • Lack of role model for hand hygiene • Lack of institutional priority for hand hygiene • Lack of administrative sanction of noncompliers/rewarding compliers • Lack of institutional safety climate Pitter D, 2000

  18. Factors Influencing Adherence to Hand-Hygiene Practices • Self-reported factors for poor adherence with hand hygiene • Hand washing agents cause irritation and dryness • Sinks are inconveniently located/shortage of sinks • Lack of soap and paper towels • Often too busy/insufficient time • Understaffing/overcrowding • Patients needs take priority • Hand hygiene interferes with health-care worker relationships with patients • Low risk of acquiring infection from patients • Wearing of gloves/beliefs that glove use obviates the need for hand hygiene Pitter D, 2000

  19. Factors Influencing Adherence to Hand-Hygiene Practices • Self-reported factors for poor adherence with hand hygiene • Lack of knowledge of guidelines/protocols • Not thinking about it/forgetfulness • No role model from colleagues or superiors • Skepticism regarding the value of hand hygiene • Disagreement with the recommendations • Lack of scientific information of definitive impact of improved hand hygieneon health-care associated infection rates Pitter D, 2000

  20. Decontaminate hands before having direct contact with patients Indications for hand washing and hand antisepsis

  21. Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter Indications for hand washing and hand antisepsis

  22. Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure Indications for hand washing and hand antisepsis

  23. Decontaminate hand AFTER contact with patient’s intact skin Indications for hand washing and hand antisepsis

  24. Decontaminate hands AFTER contact with body fluids or excretions, mucous membranes, non-intact skin and wound dressings if hands are not visibly soiled Indications for hand washing and hand antisepsis

  25. Decontaminate hands if moving from a contaminated body- site to a clean-body site during patient care Indications for hand washing and hand antisepsis

  26. Decontaminate hands AFTER contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient Indications for hand washing and hand antisepsis

  27. Decontaminate hands AFTER removing gloves Indications for hand washing and hand antisepsis

  28. Before eating and after using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water Indications for hand washing and hand antisepsis

  29. Antimicrobial impregnated wipes (i.e. towelletes) may be considered as an alternative to hand washing with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of HCWs, they are not substitute for using an alcohol-based hand rub or antimicrobial soap Indications for hand washing and hand antisepsis

  30. Liquid bar, leaflet or powdered form of plain soap are acceptable when washing hands with a non-antimicrobial soap and water. When bar soap is used, soap rack that facilitate drainage and small bars of soap should be used Hand hygiene technique

  31. Multiple-use cloth towels of the hanging or roll-type are not recommended for use in the health care setting Hand hygiene technique

  32. Do not wear artificial finger nails or extenders when having direct contact with patients at high risk Other aspects of hand hygiene

  33. Other aspects of hand hygiene • Keep natural nails tips less than ¼ inch long

  34. Other aspects of hand hygiene • No recommendation can be made regarding wearing rings in health-care settings. Unresolved issue

  35. HYGIENIC HAND DISINFECTION IT SHOULD BE USED during outbreaks of infection where contact with blood and body fluids or in situations where microbial contamination is likely to occur

  36. HYGIENIC HAND DISINFECTION IT SHOULD BE USED In high risk areas, e.g. patients in isolation, intensive care and special care baby unit Before performing an invasive procedure

  37. HYGIENIC HAND DISINFECTION IT SHOULD BE USED Before and after touching wounds, urethral or iv catheters before wearing and after removing gowns

  38. HYGIENIC HAND RUB • An alternative method of hand disinfection • a rapid and effective alternative to hand washing e.g. ward rounds with no water and no wash basin

  39. ALCHOLIC HAND RUBS DO NOT CLEANSE, therefore hands should be cleaned with soap and water in the presence of visible contamination… HYGIENIC HAND RUB

  40. HYGIENIC HAND RUB PROCEDURE: • Apply 3-5 ml of fast acting antiseptic (e.g. alcohol hand rub) containing glycerol as an emollient to prevent excessive drying of hands • Hands are rubbed according to defined technique until dried

  41. before after Results of culture pre and post-application of hand rub

  42. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB

  43. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB Requires the removal and killing of transient microorganisms and substantial reduction and suppuration of the resident flora of the surgical team for the duration of operation in case the surgical glove is punctured or torn

  44. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB • ensure that fingernails are kept SHORT and CLEAN all the time • Wrist watches and jewelries should be removed before surgical hand disinfection

  45. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB PROCEDURE Turn the taps ON using the elbows and adjust the flow of water and temperature of the water

  46. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB PROCEDURE Wet hands and forearms Apply antiseptic detergent preparation from an elbow-operated pump dispenser (e.g. Chlorhexidine Povidone Iodine)

  47. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB PROCEDURE Lather hands, wrists and forearms for ONE MINUTE Keep them above elbow level then rinse thoroughly under running water

  48. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB PROCEDURE Clean fingernails and removed ingrained dirt with a manicure stick held under running water or use a sterile nail brush to clean nails and subungal spaces

  49. SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING / SURGICAL SCRUB PROCEDURE The Hand Washing procedure is then repeated for 2 MORE MINUTES

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