Hand Hygiene

ObjectivesObjectives KEY CONCEPTS you will learn: Why hand hygiene is important? When and how to wash your hands Hand hygiene practices Barriers to appropriate hand hygiene How to improve hand hygiene practices

Why is hand hygiene important?

CriteriaCriteria Intensity of contact with patients and/or blood and body fluids Likelihood of microbial transmission Patient’s susceptibility to infections Procedures being performed N.B. THE LEVEL OF HANND HYGIENE WILL BE DETERMINED BY THE ACTIVITY OR AREA OF PRACTICE

Hand Hygiene Practices  Handwashing  Hand antisepsis  Antiseptic handrub  Surgical scrub

Hand Washing  Hands are the principle route of cross infection.  Hand washing is THE SINGLE most important measure in reducing the spread of infection!

Hand washing Objective: Mechanically remove soil and debris from the skin and reduce the number of transient microorganisms

When Do We Wash Our Hands?  Wash hands: After arriving at work Before and after examining any client After touching contaminated instruments/items After exposure to blood or any body fluids Before putting on gloves and after removing them Whenever our hands become visibly soiled After blowing your nose, covering a sneeze After visiting the toilet Before leaving work

Hand washing Steps:  Thoroughly wet hands.  Apply plain soap (antiseptic agent is not necessary).  Vigorously rub all areas of hands and fingers for 10–15 seconds, paying close attention to fingernails and between fingers.  Rinse hands thoroughly with clean water.  Dry hands with a paper towel or a clean, dry personal towel.  Use a paper towel when turning off water if there is no foot control or automatic shut-off.

Handwashing Technique WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft): A Summary. WHO: Geneva

Hand Antisepsis  Similar to that for plain hand washing. The soap or detergent contains an antiseptic agent (often clorhexidine, iodophors, or triclosan) instead of plain soap or detergent.  When to use hand antisepsis?  Before: Examining or caring for highly susceptible patients (e.g., premature infants, elderly patients, or those with advanced AIDS) Performing an invasive procedure (e.g., intravascular device) Leaving the room of patients on Contact Precautions (e.g. hepatitis A or E) Objective: Remove soil and debris as well as to reduce both transient and resident flora

Antiseptic Hand rub  Purpose : Is to inhibit or kill transient and resident flora.  Considered to be more effective than antimicrobial hand washing agents or plain soap and water,  It is quicker and easier to perform,  but it should not be used when the hands are visibly soiled.  Do not rinse hands after applying hand rub

Antiseptic Handrub Steps:  Apply enough alcohol-based handrub to cover the entire surface of hands and fingers (about a teaspoonful).  Rub the solution vigorously into hands, especially between fingers and under the nails, until dry. Alcohol-based solution for handrub:  Add glycerine or sorbitol to alcohol (2 ml. in 100 ml. of 60–90% ethyl or isopropyl alcohol solution)  Use 5 ml. for each application and continue rubbing the solution over hands until they are dry (15-30 seconds).

Summary Alcohol-Based Handrubs: What benefits do they provide? Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition

Efficacy of Hand Hygiene Preparations in Killing Bacteria GoodBetterBest Plain Soap Antimicrobial soap Alcohol-based handrub

Surgical Handscrub

Purpose To mechanically remove soil, debris and transient organisms and to reduce resident flora for the duration of the surgery

Surgical Hand-scrub Steps:  Remove rings, watches, and bracelets.  Thoroughly wash hands and forearms to the elbow with soap and water.  Clean nails with a nail cleaner.  Rinse hands and forearms with water.  Apply an antiseptic agent.  Vigorously wash all surfaces of hands, fingers, and forearms for at least 2 minutes.

Surgical Hand-scrub….Cont’d  Rinse hands and arms thoroughly with clean water, holding hands higher than elbows.  Keep hands up and away from the body, do not touch any surface or article. and dry hands with a clean, dry towel.  Put on sterile or HLD gloves.

Why Health Care Workers Don’t Wash Their Hands See reference manual page 3-10, table 3-2.

Why Healthcare Workers Don’t Wash Their Hands?  Hand washing between every patient encounter is unnecessary,  Hand washing doesn’t affect clinical outcome,  Hand washing is unnecessary when gloves are worn,  Frequent hand washing damages skin and causes cracking, dryness, irritation and dermatitis,  Hand washing damages nails and nail polish  Hand washing facilities are not conveniently placed or well designed,  Hand washing takes too much time….etc.,

How to Improve Handwashing  Have supplies available and at “point of use.”  Disseminate and promote guidelines.  Reinforce guidelines.  Involve everybody.  Give positive feedback.  Reward role modeling.  Benchmark best practices.

Issues Related to Hand Hygiene  Hand lotions and creams  Lesions and skin breaks  Fingernails  Artificial nails  Nail polish  Jewelry

FingernailsFingernails  The region under fingernails harbors many microbes,  Long nails can: tear gloves easier, cause potential patient injury, and require additional time to properly wash,  Artificial or long nails may prevent effective hand washing,  Keep nails clean and short