Hand Hygiene Overview

1. Hand Hygiene Overview

2. Hand Hygiene History

3. Hand Hygiene History The 3 fathers of handwashing: • Dr. Oliver Wendell Holmes • Dr. Ignaz Semmelweis • Louis Pasteur

4. Hand Hygiene History • Dr. Oliver Wendell Holmes advocated hand washing to prevent childbed fever. He was horrified by the prevalence in American hospitals of this fever which he believed to be an infectious disease passed to pregnant women by the hands of doctors. His ideas were met with disdain.

5. Hand Hygiene History • In Vienna in 1846, Dr. Ignaz Semmelweis was working in maternity wards where he observed the mortality rate in the wards cared for by physicians and medical students were as much as three times greater than those wards where care was provided by midwives.

6. Hand Hygiene History • Semmelweis found that the students were coming straight from the pathology lab without washing their hands. He believed that they were carrying infections from the lab to their patients. When he implemented a handwashing protocol, his mortality rate dropped to less than 1%.

7. Hand Hygiene History • Louis Pasteur – contributed to the germ theory of disease, developed pasteurization, and in 1879 debated his ideas at the Academy of Medicine in Paris.

8. Hand Hygiene Today • According to the United States Centers of Disease Control and Prevention (CDC): “Handwashing is the single most important means of preventing the spread of infection.”

9. Microbiology 101

10. Terms & Definitions • Infection - An infection is the detrimental colonization of a host organism by a foreign species. In infection, the infecting organism seeks to utilize the host’s resources in order to multiply (usually at the expense of the host). The infecting organism, or pathogen, interferes with the normal functioning of the host

11. Terms & Definitions Infections can be caused by: • A bacteria • A virus • A fungus • A parasite

12. Terms & Definitions • Microbe – A microorganism that causes disease. This term is no longer in technical use. • Antimicrobial – Capable of destroying or inhibiting the growth of microorganisms, e.g., antimicrobial solutions or antimicrobial drugs

13. Terms & Definitions • Pathogen – A pathogen or infectious agent is a biological agent that causes disease or illness to its host. The term is most often used for agents that disrupt the normal physiology of a multi-cellular animal or plant.

14. Terms & Definitions Bacteria: • Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life). • Were the only life form on earth for 2 billion years • May be beneficial or harmful

15. Bacteria

16. Terms & Definitions • Virus – A virus is a microscopic particle that can infect the cells of a biological organism. Viruses can only replicate themselves by infecting a host cell and therefore cannot reproduce on their own. • It has been argued extensively whether viruses are living organisms. Most virologists consider them non-living, as they do not meet all the criteria of the generally accepted definition of life

17. Viruses

18. Terms & Definitions • Fungi (singular fungus) - are a kingdom of eukaryotic organisms. They are heterotrophic (live off others) and digest their food externally, absorbing nutrient molecules into their cells. Yeasts, molds, and mushrooms are examples of fungi. The branch of biology involving the study of fungi is known as mycology.

19. Fungi

20. Terms & Definitions • Parasite - Parasitism is one version of symbiosis ("living together"), a phenomenon in which two organisms which are phylogenetically unrelated co-exist over a prolonged period of time, usually the lifetime of one of the individuals.

21. Parasites

22. Measuring Antimicrobial Efficacy • Antimicrobial properties are measured in their ability to kill or eliminate pathogens • Testing protocols consist of sampling the hands before and after a “treatment” of an antimicrobial • The labs count the number of “Colony Forming Units” (CFU’s) before and after a treatment by an antimicrobial

23. Colony Forming Units

24. Units of Measurement • The two most common “units of measurement” for the reduction of CFU’s are: • A percent reduction, e.g., “kills 99.9% of bacteria” • A log10 reduction

25. Log Reductions • As mnemonic for converting log reductions into percent reductions is the number of the log, e.g., 1, 2, 3, 4 etc. equates to the number of “nines” (9’s) in the percent reduction: • 1-log = 90% reduction • 2-logs = 99% reduction • 3-logs = 99.9% reduction • 4 logs = 99.99% reduction

26. Healthcare Associated Infections and Food Borne Illness

27. HAIs Cost of Health Care Associated Infections • Approximately 1 in 10 patients acquire a HAI after admission, totaling more than 2 million cases each year. At least one-third of these infections are preventable, and hand washing is the single most important procedure for prevention. (CDC) • Nearly 100,000 deaths a year result from HAI’s, and this number continues to grow. (APIC) • In the United States, HAIs add an estimated $30.5 billion in annual costs to the nation’s health care system. (Committee to Reduce Infection Deaths)

28. HAIs Cost of Health Care Associated Infections • The average stay for patients with HAIs diagnosed in the hospital is 23 days; the average stay for patients without infections is 5 days. (American Journal of Medical Quality) • Patients who acquire infections average healthcare costs of approximately $185,000, compared with less than $32,000 for those who do not acquire infections. (Pennsylvania Health Care Cost Containment Council) • HAIs are among the top five causes of death in the United States. (HealthNews Digest)

29. HAIs Cost of Health Care Associated Infections • Approximately 3 million cases of Clostridium difficile are reported each year in the US, costing more than $1.3 billion. (Washington University School of Medicine, CDC) • In 2005, there were about 368,600 cases of MRSA infection in US hospitals. In 1993, there were fewer than 2,000 MRSA infections recorded in US hospitals. (Agency for Healthcare Research and Quality)

30. Food Borne Illness • The CDC estimates that 76 million Food Borne illness, or food poisoning, cases occur in the United States every year, which means that one in four Americans contracts a Food Borne illness annually after eating foods contaminated with such pathogens. • Approximately 325,000 people are hospitalized with a diagnosis of food poisoning, and 5,000 die. The estimated costs in terms of medical expenses and lost wages or productivity are between $6.5 and $34.9 billion

31. Food Borne Illness While most Food Borne illness cases go unreported to health departments, nearly 13.8 million cases are reported and diagnosed by their cause: • Viruses cause 67% of cases • Bacteria cause 30% of cases • Parasites cause 3% of cases

32. Common Bugs

33. Top Bugs Clostridium Difficile • This organism is a growing problem in healthcare settings. C. diff causes serious diarrheal disease and colitis and most often affects patients that are seriously ill or undergoing antibiotic treatment. In its spore form, Clostridium difficile must be removed from the hands with soap and water.

34. Top Bugs MRSA • Methicillin-resistant Staphylococcus aureus, both healthcare associated and community associated, is a type of bacteria that is resistant to certain antibiotics. Typically starting as a skin infection, MRSA now accounts for nearly 70% of staph infections.

35. Top Bugs Norovirus • This virus is the leading cause of gastroenteritis in the United States. Noroviruses are relatively resistant to environmental challenge, are often food borne, and can be spread through contaminated surfaces and hands. This bug must be removed from the hands through mechanical action during handwashing.

36. Top Bugs VRE • Enterococci are bacteria normally found in the intestinal track and in the environment. These bacteria can sometimes cause infections of the urinary track, skin wounds or bloodstream, and can be spread through skin to skin contact. Enterococci can become resistant to antibiotics, including Vancomycin, resulting in VRE.

37. Top Bugs Influenza • Influenza Type A and Type B viruses are responsible for seasonal flu epidemics. Influenza viruses are constantly changing through antigenic drift. Each year, 5 to 20% of the population will come down with the flu.

38. Top Bugs Acinetobacter • Acinetobacter bacteria can be found in soil, water and the skin of healthy people. It can cause a variety of diseases, from pneumonia to serious blood or wound infections. Acinetobactor outbreaks most often occur in intensive care units or healthcare settings with seriously ill patients.

39. Top Bugs Campylobacter • Common bacterial cause of diarrhea in the United States; Sources: raw and undercooked meat and poultry, raw milk and untreated water. Campylobacter infections cause also be caused by contact with sickened animals, including household pets.

40. Top Bugs Escherichia coli O157:H7 • A common food borne bacterium that can produce a deadly toxin and causes approximately 73,000 cases of Food Borne illness each year in the U.S.; Sources: meat, especially undercooked or raw hamburger, produce and raw milk.

41. Top Bugs Listeria monocytogenes • Causes listeriosis, a serious disease for pregnant women, newborns and adults with a weakened immune system. Symptoms include nausea, fever and gastroenteritis. Sources: soil and water. Listeria is often found in drains.

42. Top Bugs Pseudomonas • Pseudomonas is a bacterium with many dangerous strains, including Pseudomonas fluorescens and Pseudomonas aeruginosa. Sources: soil and water. Listeria is often found in drains due to biofilm buildup.

43. Top Bugs Salmonella • Most common cause of Food Borne deaths. Responsible for millions of cases of Food Borne illness a year; Sources: raw and undercooked eggs, undercooked poultry and meat, dairy products, seafood, fruits and vegetables.

44. Top Bugs Shigella • Causes an estimated 300,000 cases of diarrheal illnesses. Poor hygiene causes Shigella to be easily passed from person to person.

45. Top Bugs Toxoplasma gondii • A parasite that causes toxoplasmosis, a very severe disease that can produce central nervous system disorders particularly mental retardation and visual impairment in children. Pregnant women and people with weakened immune systems are at higher risk.

46. Top Bugs Vibrio vulnificus • This gram-negative bacterium causes gastroenteritis or a syndrome known as primary septicemia. People with liver diseases are especially at high risk.

47. Top Bugs Hepatitis A • Food contaminated with the virus is the most common vehicle transmitting Hepatitis A. The food preparer or cook is the individual most often contaminating the food.

48. Clinical Background

49. Quiz Time • What is the body’s largest organ? • How much skin does the average person have? • What are some of the main functions of skin? • How often does our skin replace itself? • How are skin health and hygiene related?

50. Skin Fun Facts