Hygi ne des mains et pr cautions visant pr venir la transmission de microorganismes lors des soins

1. Hygiène des mains et précautions visant à prévenir la transmission de microorganismes lors des soins Pr. Hervé Richet Equipe Opérationnelle d’Hygiène Hospitalière Hôpital de la Timone

2. Pourquoi tout ce foin au sujet de l’hygiène des mains? Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings. Hand hygiene reduces the incidence of healthcare associated infections. CDC estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection. More widespread use of hand hygiene products that improve adherence to recommended hand hygiene practices will promote patient safety and prevent infections. Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings. Hand hygiene reduces the incidence of healthcare associated infections. CDC estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection. More widespread use of hand hygiene products that improve adherence to recommended hand hygiene practices will promote patient safety and prevent infections.

3. Hygiène hospitalière, quelques étapes historiques Louis-Bernard Guyton de Morveau (1737-1816): Précurseur de la désinfection en utilisant les émanations chlorhydriques provoquées par la réaction de l’acide sulfurique sur le sel marin dans les chaudières pour lutter contre les odeurs de putréfaction. Rôle des mains dans la transmission des infections Alexander Gordon (1795): perçoit le rôle des mains dans la transmission de la fièvre puerpérale. Oliver Wendell Holmes (Etats Unis, 1809-1894): soutient dans sa thèse à Harvard que même des mains apparemment propres peuvent transmettre le fièvre puerpérale. IGNAZ PHILIP SEMMELWEIS (1818-1865)

4. Ignaz Semmelweis, 1815-1865 1840: Hôpital de Vienne 2 maternités alternant les admissions toutes les 24 heures: Première clinique: étudiants en médecine Seconde: sages femmes In 1846 Ignaz Semmelweis observed that women whose babies were delivered by students and physicians in the First Clinic at the General Hospital of Vienna consistently had a higher mortality rate than those whose babies were delivered by midwives in the Second Clinic. He noted that physicians who went directly from the autopsy suite to the obstetrics ward had a disagreeable odor on their hands despite washing their hands with soap and water upon entering the obstetrics clinic. His theory: puerperal fever, which was causing the deaths, was caused by “cadaverous particles” transmitted from the autopsy suite to the obstetrics ward via the hands of students and physicians. In 1846 Ignaz Semmelweis observed that women whose babies were delivered by students and physicians in the First Clinic at the General Hospital of Vienna consistently had a higher mortality rate than those whose babies were delivered by midwives in the Second Clinic. He noted that physicians who went directly from the autopsy suite to the obstetrics ward had a disagreeable odor on their hands despite washing their hands with soap and water upon entering the obstetrics clinic. His theory: puerperal fever, which was causing the deaths, was caused by “cadaverous particles” transmitted from the autopsy suite to the obstetrics ward via the hands of students and physicians.

5. Intervention:Application sur les mains d’une solution chlorée In May 1847 Semmelweiss insisted that students and physicians clean their hands with a chlorine solution, similar to the one pictured here, between each patient in the clinic. In May 1847 Semmelweiss insisted that students and physicians clean their hands with a chlorine solution, similar to the one pictured here, between each patient in the clinic.

6. Hygiène des mains After Semmelweis insisted that students and physicians clean their hands with a chlorine solution between each patient, the maternal mortality rate in the First Clinic dropped. Maternal mortality rate in the First Clinic dropped dramatically and remained low for years. This is the first evidence indicating that cleansing heavily contaminated hands with an antiseptic agent between patient contacts may reduce healthcare-associated transmission of contagious diseases more effectively than handwashing with plain soap and water. After Semmelweis insisted that students and physicians clean their hands with a chlorine solution between each patient, the maternal mortality rate in the First Clinic dropped. Maternal mortality rate in the First Clinic dropped dramatically and remained low for years. This is the first evidence indicating that cleansing heavily contaminated hands with an antiseptic agent between patient contacts may reduce healthcare-associated transmission of contagious diseases more effectively than handwashing with plain soap and water.

7. Quelle technique utiliser pour l’hygiène des mains? Lavage ou friction avec une solution hydro-alcoolique (SHA)

8. Pouvoir Bactéricide des Différents Produits utilisables pour l’Hygiène des Mains Plain soap is good at reducing bacterial counts but antimicrobial soap is better, and alcohol-based handrubs are the best. Plain soap is good at reducing bacterial counts but antimicrobial soap is better, and alcohol-based handrubs are the best.

9. This graph shows that alcohol-based handrub is better than handwashing at killing bacteria. Shown across the top of this graph is the amount of time after disinfection with the hand hygiene agent. The left axis shows the percent reduction in bacterial counts. The three lines represent alcohol-based handrub, antimicrobial soap, and plain soap. This graph shows that alcohol-based handrub is better than handwashing at killing bacteria. Shown across the top of this graph is the amount of time after disinfection with the hand hygiene agent. The left axis shows the percent reduction in bacterial counts. The three lines represent alcohol-based handrub, antimicrobial soap, and plain soap.

10. Alcohol-based handrubs are less damaging to the skin than soap and water. In the graph on the left the blue bar shows self-reported skin health scores for persons using soap and water, and persons using alcohol-based handrubs are depicted by the orange bar. Self-reported studies indicate participants using soap and water reported a significant increase in dryness, cracking, and irritation after 2 weeks, whereas those that used the alcohol-based handrub reported improvement in skin dryness. Epidermal water content shows the same results as the self reported scores, after 2 weeks of use, the skin water content decreased for those that used soap and water (resulting in dryer skin) as compared with those who used an alcohol-based handrub. Alcohol-based handrubs are less damaging to the skin than soap and water. In the graph on the left the blue bar shows self-reported skin health scores for persons using soap and water, and persons using alcohol-based handrubs are depicted by the orange bar. Self-reported studies indicate participants using soap and water reported a significant increase in dryness, cracking, and irritation after 2 weeks, whereas those that used the alcohol-based handrub reported improvement in skin dryness. Epidermal water content shows the same results as the self reported scores, after 2 weeks of use, the skin water content decreased for those that used soap and water (resulting in dryer skin) as compared with those who used an alcohol-based handrub.

11. Temps passé par une infirmière à se laver les mains pendant 8 heures de travail Lavage des mains à l’eau et au savon: 56 minutes 7 lavages de mains de 60 secondes par heure Friction avec une SHA: 18 minutes 7 frictions de 20 secondes par heure The time required for nurses to leave a patient’s bedside, go to a sink, and wash and dry their hands before attending the next patient is a deterrent to frequent handwashing or hand antisepsis. More rapid access to hand hygiene materials could help improve adherence. Alcohol-based handrubs may be a better option than traditional handwashing with plain soap and water or antiseptic handwash because they require less time, act faster, and irritate hands less often. The time required for nurses to leave a patient’s bedside, go to a sink, and wash and dry their hands before attending the next patient is a deterrent to frequent handwashing or hand antisepsis. More rapid access to hand hygiene materials could help improve adherence. Alcohol-based handrubs may be a better option than traditional handwashing with plain soap and water or antiseptic handwash because they require less time, act faster, and irritate hands less often.

12. Solutions hydro-alcooliques: Bénéfices? Nécessite moins de temps Plus efficace que le lavage simple des mains Ne nécessite pas d’équipement (lavabos) Réduit le nombre des bactéries sur les mains Améliore l’état des mains In summary, alcohol-based handrubs provide several advantages compared with handwashing with soap and water, because they not only require less time, they also act faster. In addition, alcohol-based handrubs are more effective for standard handwashing than soap, are more accessible than sinks, are the most efficacious agents for reducing the number of bacteria on the hands of healthcare workers, and can even provide improved skin condition. In summary, alcohol-based handrubs provide several advantages compared with handwashing with soap and water, because they not only require less time, they also act faster. In addition, alcohol-based handrubs are more effective for standard handwashing than soap, are more accessible than sinks, are the most efficacious agents for reducing the number of bacteria on the hands of healthcare workers, and can even provide improved skin condition.

14. Indications Générales de l’Hygiene des Mains Quand les mains sont visiblement sales, souillées ou contaminées, il faut les laver à l’eau avec un savon antimicrobien ou non. Si les mains ne sont pas visiblement souillées, il faut effectuer une friction avec une SHA. Healthcare workers should wash hands with soap and water when hands are visibly dirty, contaminated or soiled and use an alcohol-based handrub when hands are not visibly soiled to reduce bacterial counts. Healthcare workers should wash hands with soap and water when hands are visibly dirty, contaminated or soiled and use an alcohol-based handrub when hands are not visibly soiled to reduce bacterial counts.

20. In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care. A mean of 56% of body sites and 17% of environmental sites were VRE positive. After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE. After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated. The inanimate environment plays a role in facilitating transmission of organisms. In one study, hands of 131 healthcare workers (HCWs) were cultured before, and hands and gloves after, routine care. A mean of 56% of body sites and 17% of environmental sites were VRE positive. After touching the patient and environment, 75% of ungloved HCWs hands and 9% of gloved HCWs hands were contaminated with VRE. After touching only the environment, 21% of ungloved and 0 gloved HCWs hands were contaminated. The inanimate environment plays a role in facilitating transmission of organisms.

23. Se protéger soi-même

25. Etudes de l’observance de l’hygiène des mains

26. In general, adherence of healthcare workers to recommended hand hygiene procedures has been poor. Studies shown here are representative of the overall adherence rates which averaged about 40%. Adherence rates do vary by occupation. In general, adherence of healthcare workers to recommended hand hygiene procedures has been poor. Studies shown here are representative of the overall adherence rates which averaged about 40%. Adherence rates do vary by occupation.

27. Observance de l’hygiène des mains par catégorie professionnelle

28. Observance selon les indications:Médecins

30. Observance selon les indications :Soins intensifs

31. Comment améliorer l’observance de l’hygiène des mains et effets de l’amélioration de l’observance

32. Mesures permettant d’améliorer l’hygiène des mains Faire de l’hygiène des mains une priorité institutionnelle Placer des distributeurs de SHA à l’entrée de la chambre ou à proximité du lit Fournir des flacons de poche de SHA au personnel soignant Make improved hand hygiene an institutional priority and provide appropriate administrative support and financial resources. Several administrative measures may help improve hand hygiene adherence among personnel who work in areas where high workloads and high intensity of patient care are anticipated. These include placing alcohol-based handrubs at the entrance to patients’ rooms, or at the bedside and providing healthcare workers with individual pocket-sized containers. Make improved hand hygiene an institutional priority and provide appropriate administrative support and financial resources. Several administrative measures may help improve hand hygiene adherence among personnel who work in areas where high workloads and high intensity of patient care are anticipated. These include placing alcohol-based handrubs at the entrance to patients’ rooms, or at the bedside and providing healthcare workers with individual pocket-sized containers.

36. Autres mesures de prévention de la transmission des microorganismes Précautions standard Précautions spécifiques

37. PROCEDURES Livre blanc des bonnes pratiques de l’Assistance Publique – Hôpitaux de Marseille Lavage/antisepsie des mains Mesures d’isolement septique Entretien des locaux Décontamination du matériel Traitement des excreta

38. PRECAUTIONS Précautions standard Pour tous les patients Précautions spécifique Pour certains patients

39. PRECAUTIONS STANDARD Tous les patients...! Tous les soignants! Tous les jours

40. Prévention des infections/Précautions standard Pour tout patient – Par tout soignant Désinfection des mains entre deux patients et entre deux activités Port de gants pour tout geste si risque de contact avec un liquide biologique Port de casaque/surblouse/tablier si risque de contact avec un liquide biologique 1 paire de gants pour 1 patient pour 1 soin Ne pas recapuchonner les aiguilles. Ne pas désadapter à la main aiguilles, lames… Utiliser les collecteurs pour objets piquant, coupant, tranchant

41. Gants Porter des gants lors de risque d’exposition à du sang ou à d’autres liquides biologiques ou à des tissus potentiellement infectant Enlever les gants immédiatement après avoir effectué un soin à un patient Ne pas porter la même paire de gants pour des soins à plusieurs patients Ne pas laver des gants Wearing gloves reduces the risk of healthcare workers acquiring infections from patients, prevents flora from being transmitted from healthcare workers to patients, and reduces contamination of the hands of healthcare workers by flora that can be transmitted from one patient to another. Gloves should be used when HCWs have contact with blood or other body fluids. Gloves should be removed after caring for a patient. The same pair of gloves should not be worn for the care of more than one patient. Gloves should not be washed or reused. Wearing gloves reduces the risk of healthcare workers acquiring infections from patients, prevents flora from being transmitted from healthcare workers to patients, and reduces contamination of the hands of healthcare workers by flora that can be transmitted from one patient to another. Gloves should be used when HCWs have contact with blood or other body fluids. Gloves should be removed after caring for a patient. The same pair of gloves should not be worn for the care of more than one patient. Gloves should not be washed or reused.

42. PRECAUTIONS SPECIFIQUES - Précautions « contact » : abcès suppurants, infections à BMR,... - Précautions « gouttelettes » : Pneumopathies à SARM, Aspergillus - Précautions « AIR » : Tuberculose pulmonaire active, VZV et HSV

43. EFFICACITE DES METHODES Rares études contrôlées

44. Conclusions Primum non nocere Droit du patient: Tout patient a le droit d’être touché par des mains propres