1. Page 1 Session 3: Infection Control Basics
Hand Hygiene
Session 3: Infection Control Basics

2. Learning Objectives: By the end of this session, participants will:
Page 2
By the end of this session, participants will:
Wash their hands more often on the job
Remove germs when they do wash their hands
The objective of this class is to encourage you to:
Wash your hands more often on the job
Remove more germs each time you do wash your hands
3: Hand Hygiene

3. Vocabulary Disinfectant - a germ killing substance
Page 3
Disinfectant - a germ killing substance
Antiseptic - a disinfectant for use on skin
Microbes or germs - organisms too small to see including viruses, bacteria, and fungi etc.
Hand hygiene - all types of hand cleansing with and without water
HCW - health care worker, this includes contract workers, cleaners and aides
Invasive - entering the blood stream or the organs inside of the body
Mucous membranes - skin inside the mouth, nose, rectum, vagina, etc.
3: Hand Hygiene

4. Part I: Hand Washing Basics
Page 4
Part I: Hand Washing Basics

5. The Goal of Handwashing:
Page 5
To prevent the transfer of germs from your hands to patients
We care about hand washing in a hospital because the microbes are often more dangerous than those in the home, and more common.
Also patients are weaker and more vulnerable so it is easier for microbes to make them sick.
In a hospital, patients can get sick from germs on their own bodies, and when health care workers and family carry germs to them on their hands.
Handwashing has to be done more often, and with a different technique than we use at home. The goal is to to protect both your patients and your self.
3: Hand Hygiene

6. 1. Protect the Patients
Page 6
Handwashing helps stop the spread of germs between patients and between staff and patients
It protects both the patients and the caregivers
3: Hand Hygiene

7. An important matter is to wash your hands more often
The Expectation
Page 7
ACTION
An important matter is to wash your hands more often
ACTION
It doesn’t matter if you can recite information about hand hygiene after this presentation
It only matters is you wash your hands more.
3: Hand Hygiene

8. Can I Make my Patients Sicker?
Page 8
Every time you touch people or objects, your fingers leave germs on the skin and pick up new germs
Wet hands transfer more germs than dry hands. Always dry your hands after washing them
Sometimes we are motivated more to act if we understand why it is important. So we do want to review why hand washing can prevent disease to patients and to ourselves.
Why does hand washing matter?
Since we have said the goal of hand washing is to prevent hand transfer of germs that may infect patients. Lets look at how germs infect patients to understand when hand washing is most important. And what other measures with help as well.
3: Hand Hygiene

9. Hand Washing is Important for Patients and Family Too
Page 9
If patients wash their hands, they can remove hospital germs before the germs enter the body
Your supervisor should provide water, soap or ash, and towels for the patient and family members at convenient places for hand washing
3: Hand Hygiene

10. Doesn’t Skin Protect People from Germs?
Page 10
Yes and No
Yes!
Skin is a good barrier and germs can be washed off when a patent bathes or washes hands
No!
Skin is a good thick barrier BUT germs on the skin can get inside the body where skin is thin or broken
Eyes, the inside of the nose, the mouth, vagina, and rectum have thin skin
Germs can pass through thin skin more easily than through than the thick skin on our feet and hands
3: Hand Hygiene

11. What Tasks Touch these Parts of the Body?

12. Germs can Get Inside through Broken Skin
Page 12
Germs get inside when we cut, or pierce the skin or touch open wounds:
Examples: surgery, injections, incisions to drain abscesses, biopsies, injections, changing dressings, childbirth
We mentioned that gerns can get through breaks in the skin, and can enter through the mucous membranes. Germs can also enter through invasive procedures that cut or pierce the skin or enter normally sterile parts of the body.
Examples: surgery, incisions to drain abscesses, biopsies, injections, childbirth.
Germs get carried inside by tubes
Example: urinary catheters, IV lines, intra-thoracic drains, suction catheters
3: Hand Hygiene

13. Tubes can also Carry Germs into the Body
Page 13
Germs get carried inside by tubes that go through the skin:
Example: urinary catheters, IV lines, intra-thoracic drains, suction catheters
Tubes are a like a metro system for easy transport through the body!
3: Hand Hygiene

14. When do you Need to Wash your Hands?
Page 14
When do you Need to Wash your Hands?
Note to Facilitator: ask for comments form participants and then show examples.
Before and after patient contact
Before preparing food or serving food
After removing gloves
When hands are visibly dirty for any reason
After using the toilet
Before and after eating
After contact with blood or body fluids
Taking specimens to the lab, but also after sneezing, coughing or blowing one’s nose.
After finishing work in the lab or ward before going home.
Before handling sterile items
3: Hand Hygiene

15. Important Wash your hands before and after you:
Page 15
Wash your hands before and after you:
Touch the eyes, give eye drops
Touch the inside of the nose (NG tubes)
Assist with pelvic exams
Do colonoscopies or give enemas
Touch any item that touches thin skin (mucous membranes)
3: Hand Hygiene

16. Wash Hands and Wear Gloves when Opening Tubes that Enter the Body
Page 16
Even a few germs deposited inside the body can cause an infection
It is important to have as few germs on the hands and tools as possible
Opening a urinary catheter or intra-thoracic drain puts the patient at risk
Staff must do hand hygiene - WEAR GLOVES!
Even a few germs on HCW’s clean hands can infect patient during an invasive procedure, because germs are being deposited inside the body.
Opening a urinary catheter or intra-thoracic drain put the patient at risk; handwashing and glove use between each patient is imperative
Because this task very commonly spreads disease, it may be too important to leave to untrained workers. Responsible registered nurses or closely supervised staff may be necessary to handle draining tubes, dressing changes, IVs to reduce infections.
3: Hand Hygiene

17. Remember… Always wash hands after removing gloves
Page 17
Always wash hands after removing gloves
Gloves are not a substitute for hand washing and need to be removed between patients
A common mistake is to use gloves rather than take the time to wash hands.
Always wash and dry your hands after removing gloves. The germs on the hands grow well in a hot moist environment under the gloves and numbers will increase while you wear gloves.
Secondly, gloves often develop tears so germs can enter and contaminate the hands.
Thirdly, used gloves such as utility gloves should be considered heavily contaminated inside and out, and hands should be washed after wearing them
3: Hand Hygiene

18. Part II: Hand Washing Techniques
Page 18
Part II: Hand Washing Techniques

19. Let’s Talk about Three Common Techniques for Hand Hygiene:
Page 19
Hand wash with soap and water
Alcohol hand rub without water
Surgical hand scrub
One objective was to wash hands more effectively.
We will talk about the ways that people working in hospitals wash their hands, and how those ways are different from the ways that our grandmothers or mothers taught us for use at home.
First, washing hands with soap and water. This is sometimes called “routine” or “social handwashing”. But washing with soap and water and drying is only technique one can use if you have visible dirt on your hands.
An alcohol hand rub is a relatively new option and is the most effective way to reduce the number of germs on the hands. While your hospital should have policies and procedures explaining when each type should be done, if nurses carry a small bottle in their pocket they will be able to cleanse their hands between patients without having to walk to a distant sink. They can use the solution after assisting a patient in bed or having other patient contact when they would be unwilling to walk to a sink.
Because the alcohol kills germs, it is an antiseptic that can be used before short invasive procedures such as putting in an IV, suctioning a patient, changing a dressing, or putting in a urinary catheter.
Before I discuss the thee types, I will talk about some basic procedures common to all three.
3: Hand Hygiene

20. For all Types of Hand Hygiene
Page 20
Staff should:
Keep nails short (1-2mm)
Wear no nail polish
Remove jewelry, bracelets, wrist watches
All staff including cooks should keep their nails short, and clean under the nails.
Nail polish is never allowed in hospitals because small cracks and invisible chips are common and germs or microbes collect in the cracks
Each hospitals makes its own policy on jewelry.Germs on jewelry are not removed during hand washing and jewelry tends to be heavily contaminated; policies banning the wearing of wedding rings or requiring staff to take it off may lead to social problems and the loss of jewelry.
3: Hand Hygiene

21. Routine Hand Wash
Page 21
Use poured or running water; never dip hands in a bowl of water
Use hand soap, ash, or sand (none kill germs, all are equally effective)
Rub all surfaces on both hands and both wrists - front, back and between - for at least 15 seconds
Rinse under running water
Dry hands with a clean towel or air dry
Wet both hands under running water. Even if the water has to be poured from a pitcher, it is important the water be discarded after a single use. If you stick hand in a pan of water, the germs will stay in the water and multiply.
Dipping hands in water may put even more germs on your hands.
It takes approximately 2 liters to wash hands and rinse away germs.
Both hands must be washed, even after using the toilet. Research has shown that if people clean only one hand, both the left and the right hand rapidly develop a high number of organisms.
Research has shown that many rubbing agents will help. This includes hand soap, ash or sand or dirt (as long as it doesn’t have animal feces). The important part is the rubbing and then rinsing. Do not use bar soap made for doing laundry as this soap may dry the hands and cause chapping. Chapped hands, harbour germs and maintain high numbers of germs despite washing.
Ash works as well as soap. Soap does not kill germs, it merely helps remove attached soil, dirt and organic material like blood of body fluids. Ash is equally as effective, and less expensive. Ash from incinerators may contain toxic metals should not be used. But ash from cooking fires may be a practical alternative both for families and workers.
Finally dry the hands. This is a commonly neglected step. But wet hands pick up more germs than dry hands. That is why when doctors and nurses take culture samples of skin, they wet the swab first to be able to pick up more microbes. You must dry your hands before patient contact. Do not share towels.
Notice that while it is your responsibility to wash your hands when caring for patients; it is your supervisor’s responsibility to make sure you have water, soap or ash, towels, enough staffing and the facilities near enough to be able to wash hands.
3: Hand Hygiene

22. Soap Bars can be Contaminated
Page 22
Soap doesn’t kill germs, so hands can easily contaminate it
Use very small bars of soap,or put soap on a string or rack to keep it dry
Refill containers with soap or antiseptics only after washing and drying
Soap doesn’t kill germs, so hands can easily contaminate it.
To prevent this, use very small bars of soap, and place the soap on a string or rack to keep it dry.
If liquid soap is used in a refillable container, the container should be washed and dried and preferably sterilised before it is filled up again.
Disinfectants and antiseptics can also be contaminated because none of them kill all germs. They should be washed to remove all visible dirt and then sterilised before refilling. Never just keep topping up the level.
3: Hand Hygiene

23. Antiseptics
Page 23
Remember, an antiseptic is a germ killing substance that is safe for use on human skin. The most common antiseptic is alcohol or chlorhexidine
To repeat, The term antiseptic just means a germ killing solution that is safe to use on skin.
While alcohol is the most cost effective antiseptic, and has the advantage that it can be used without water. There are other antiseptics as well.
Other substances that are antiseptics that are used with water are chlorhexicdine, hexachlorophene, iodine, iodophors, para-chloro meta-xelenol. While most health care workers may just know the company name, name this is dangerous as many different products fall under that name.
A very common mistake is to use disinfectant in place of an antiseptics. Few are safe for skin for the skin. Look around your ward to see what products you have, what the active ingredients are and if they are for killing germs on surfaces and objects (surface disinfectants) or are safe for killing germs on skin (antiseptics).
3: Hand Hygiene

24. Antiseptics (cont’d)
Page 24
There are other antiseptics that are used with water:
hexachloraphene
iodine
iodophors
para-chloro meta-xelenol
3: Hand Hygiene

25. Alcohol Hand Rub Without Water
Page 25
Antiseptics kills germs
Alcohol hand rub can be used without water, and is practical for a busy ward
If hands have visible dirt, handwashing with soap/ash and water is necessary first
3: Hand Hygiene

26. Alcohol Hand Rub
Page 26
Can replace routine handwashing, unless the hands are dirty
In addition, alcohol or other antiseptics should be used before placing IV, urinary catheters, doing dressing changes or other procedures requiring aseptic technique
3: Hand Hygiene

27. Danger! Danger! Many other disinfectants are UNSAFE for for human skin
Page 27
Many other disinfectants are UNSAFE for for human skin
Methanol is dangerous: Methylated spirits (i.e. a small amount of methanol in ethyl alcohol or isopropyl alcohol) is safe
The label of FAMISOL says it is an antiseptic. This is not true. FAMISOL should not be used on skin
3: Hand Hygiene

28. How to Clean Hands with Alcohol if Visible Dirt is not Present
Page 28
Place a 2 rupee size spot (3-5 ml) in the palm of one hand
Rub hands together, all sides, fingers, wrist until dry
You do an antiseptic hand wash nearly the same as for a routine hand wash. The most important difference is that you use an antiseptic instead of soap. However if the hands have soil, you have to wash with soap or detergent first to remove all visible dirt. Some antiseptics do not work in the presence of organic materials such as blood and body fluids. The hands will end up with fewer living microbes if the visible dirt is removed before the antispetic is put on the hands.
Alcohol hand rubs should contain at least 60% ethyl or isopropyl alcohol can be used without water. They will not work if the hands are dirty. But if hands have no visible dirt, a rupee size portion can be poured into the palm on dry hands and then rubbed in until the hands are dry. The advantage is that neither water nor drying towels are needed.
3: Hand Hygiene

29. How is the Surgical Hand Scrub Different ?
Page 29
The hands are wet and washed up to the elbow
A nail file is used to clean under the nails under running water
A long acting antiseptic is used, often (chlorhexidine, isodophors, sometimes with alcohol)
Hands are rubbed for 2-6 minutes and then washed under running water
Hands are dried on a sterile towel
A surgical hand scrub is done before surgery and other procedures requiring sterile technique.
As for the other hand hygiene procedures, jewelry should be removed. Staff should be wearing a short sleeved surgical scrubs.
Washing the hands before surgery is different in several ways:
The sink allows for water to be turned on and off without touching the taps
1) The hands are wet and washed up to the elbow
2) A nail file is used to clean under the nails. A stiff brush is no longer used because they caused small tears in the cuticles. A sterile sponge may be used.
3) A long acting antiseptic is used. The most effective is 2-4% chlorhexidine.
4) The hands are washed under running water for several minutes instead of for 15 seconds. In the past hands were washed for 10 minutes. This is no longer necessary. But ht e duration of washing is generally 2-6 minutes, and is timed with a clock. Other means are discussed in the attached reference at the end of this presentation.
5) Hands are dried on a sterile towel.
3: Hand Hygiene

30. Compare Hand Hygiene Methods
Page 30
Routine hand wash with soap and water
Only technique when hands have visible dirt
Soap (or ash) and water to remove germs
Wet hands to wrist
Use soap or ash
Rub for at least 15 seconds
Rinse with running water
Dry by air or single use towel
Alcohol hand rub
Can replace routine hand wash if no visible dirt on hands
Alcohol kills germs
Also done before procedures needing aseptic technique
Place 3-5 ml on dry hands
Rub until dry
No water or towels needed
Pre-Surgery/Surgical scrub
Done before surgery or procedures needing sterile technique
Antiseptic used to kill germs
Clean under nails with stick
Wet up to elbow
Use antiseptic, long acting and rub all surfaces for 2-6 minutes
Dry with sterile towel
Read the slide
Note that the type of handwashing doesn’t depend on who you are; it depends on what you are doing. Person who empty urinary catheters or intra-thoracic drains must wash his/her hands with an antiseptic between patients when emptying intra-thoracic drains.
Exercise: have each of the checked points written on a card. After going through this slide, go to the next slide.
Put three headers up on the wall “handwash with soap and water”, alcohol hand rub, and surgical scrub.
Pass out the cards and give participants 4 minutes to place the paper under the correct heading.
Note that several elements can be placed in several headings
Return to slide 32 and ask if any items are out of place.
3: Hand Hygiene

31. Hospital Hand Hygiene is Different from Cultural or Social Practises
Page 31
A hospital has more dangerous germs and more vulnerable people that settings at home
Teach the hospital cleaners, aides, support staff, servants and other kind souls who help us everyday to:
Wash both hands
Use soap or ash
Rub until both hands are clean
Rinse hands under running water
Dry their hands
3: Hand Hygiene

32. The Objective
Page 32
To encourage you to wash your hands more often, and to remove more germs when you do so
This is only possible if the hospital provides soap, water, alcohol rubs, towels, towels and other facilities that make it possible
The IC committee pledges to work to make it easier for you to protect your patients and yourself
Your responsibility is to wash your hands more often, and to remove more germs when you do so.
The hospital’s responsibility is to provide soap, water, alcohol rubs, towels, towels and other facilities that make it possible. The IC committee will work to make it easier for you to do hand hygiene protect your patients and yourself. Please contact them if or your supervisor if you have ideas or issues.
3: Hand Hygiene

33. Thank You!