1. HAND Hygiene, gloves & gowns

2. Prepared by: Neonatal Nurse RANIA QUMSIEH January, 31, 2008

3. Fundamentals of Isolation Precautions A variety of infection control measures are used for decreasing the risk of transmission of microorganisms in hospitals. These measures make up the fundamentals of isolation precautions.

4. Improving Hand Hygiene Many barriers and lots of excuses, but there is a solution! Yes We Can Do Better?! Alcohol-Based Hand Rub!

5. Alcohol gel hand rubs These are an accepted alternative to soap and water when: hand washing facilities are not available. there is a frequent need for hands to be decontaminated.

6. Alcohol gel hand rubs Hygienic treatment: 3 ml for 30 seconds. Surgical disinfection: 2 times x 4.5 ml for 3 minutes. Do not rinse. Let dry.

7. Alcohol-Based Hand Rub Gentle on the hands Contains moisturizers

8. Alcohol-Based Hand Rub saves time Twice as fast as hand washing Proven to be less drying & irritating than antibacterial soap.

9. Alcohol-Based Hand Rub If used appropriately alcohol gel preparations can reduce the carriage of transient microorganisms. Fast acting, kills bugs dead (i.e., VRE, MRSA, RSV, etc.) In 15 seconds, it decreases the bacteria on your hands by 10,000 fold.

10. Different Techniques Hydro- alcoholic gel Antiseptic solution Soap & water 99,999%99,99%90 % Elimination of transitory flora 90 %50 %No effect Elimination of resident flora 15 – 25 seconds 1 minute30 seconds Time

11. Alcohol-Based Hand Rub A study by Pittet et al on the impact of hand hygiene programs emphasizing use of bedside alcohol- based hand disinfection showed that compliance improved from 48% to 66% and was associated with a significant fall in the nosocomial infection rate from 16.9% to 9.9%.

12. Alcohol-Based Hand Rub The MRSA transmission rate also decreased from 2.16 to 0.93 incidents / 10,000 patient. Brown et al showed that a switch from soap and water to alcohol for hand hygiene in the NICU improved hand hygiene compliance and was associated with decreased cross-transmission of Klebsiella.

13. advantages of alcohol rubs (1) they have an immediate and delayed antimicrobial performance, (2) no wash basin is necessary. (3) alcohol rubs can be conveniently available near every patient/client and are more practical when there is insufficient time to wash hands.

14. A major disadvantage Alcohol gel should not replace hand washing and should not be used if hands are visibly dirty or in the presence of organic matter e.g: blood, feces, urine, sputum etc. The chemical activity will be inactivated by organic matter

15. When to use alcohol gel? Before and after minimal patient contact If performing multiple tasks on the same patient Within the same bay after minimal contact – ie: taking observations In an emergency situation; moving to another patient

16. When to use alcohol gel? During ward rounds providing dressings/wounds are not handled In the community setting where handwashing facilities may not be available. After a hand wash with liquid soap to provide a higher level of disinfection prior to performing clinical procedures.

17. GLOVES: Indications & Procedure Why to wear gloves? 1)To provide a protective barrier against pathogenic transmission.

18. Why to wear gloves? 2)To prevent cross contamination of the hands when dealing with the neonatal blood, body fluids, mucous membranes, and non-intact skin.

19. Why to wear gloves? 3)To reduce the possibility of transmitting the micro- organisms that present on the hands of personnel to the patients during invasive or other patient-care procedures that involve touching the neonate mucous membranes and non-intact skin.

20. Gloves Use Between care activities and procedures on the same patient in which the health care worker deals with body fluids and secretions.

21. Gloves Use After contact with materials that may contain high concentrations of microorganisms (e.g., after manipulating an indwelling urinary catheter and before suctioning an endotracheal tube).

22. Gloves Use Gloves should be used as an adjunct but not a substitute for hand washing

23. Selection of gloves should be based on: 1. Risk analysis of the type of setting, type of procedure, likelihood of exposure to blood or fluid capable of transmitting pathogens. 2. Factors such as personal comfort and fit. 3. Cost 4. Latex allergy.

24. Gloves Use Sterile Gloves must be used for invasive procedures only.

25. Gloves Use Clean non-sterile gloves should be worn if exposure is anticipated to blood and body fluids capable of transmitting blood borne infection. infectious material such as pus, feces, respiratory secretions or exudate of skin lesions.

26. Policies of Using Gloves 1.Gloves must be worn by all staff prior to contact with blood & body fluids. 2.One pair of gloves for one patient. 3.Do not touch anything during wearing gloves “e.g., telephone, door, etc…”.

27. Policies of Using Gloves 4.Gloves must be worn when there is an open cut in the hands. 5.Gloves don’t give 100% protection

28. Gowns ► Various types of gowns are worn to provide barrier protection and to reduce opportunities for transmission of microorganisms in hospitals. ► Gown should be fluid- resistant and non-sterile.

29. Gown Use Gowns are used to protect soiling of clothing during activities that may generate splashes or sprays of blood, body fluids, secretions and excretions. Gowns are especially treated to make them impermeable to liquids.

30. Gown Use The value of a gown in controlling infection is highly questionable, but before discarding our gowns, many scientific aspects of its benefits and limitations could be studied.

31. Gown Use Further, those who handle the infant must keep in mind that gowns do not prevent sepsis- but hand washing does. If the latter is not practiced, gown will be a piece of decoration.

32. THANK YOU!

33. References 1)Infection Control Today Magazine PPE’s Role in Standard & Contact Precautions. Jennifer Schraag; 02/01/07. 2) Guidelines for Isolation Precautions in Hospitals Hospital Infection Control Advisory Committee. Julia S. Garner,RN,MN; 01-01-1996 3) Improving Hand Hygiene, Dr. Hania Al-Jouzy 4) Manugel 85,http://www.ouriel-medical.com 5) MOH Guidelines of Infection control.