1. HAND HYGIENE PRESENTER: CATHERINE W NGUGI 1

2. Objectives n Identify the single most effective way to reduce the spread of hospital associated infections n List the two main methods of doing hand hygiene n List the steps in proper hand washing n Identify when hand hygiene should be performed n Recognize incorrect and/ or unsafe hand hygiene practices n Identify some of the challenges to hand hygiene compliance 2

3. When to Perform Hand Hygiene  Before &After caring for patients  Before & After placement of an invasive device  Before &After preparing or handling food  When in- contact with a patient or potentially contaminated surfaces / objects  After touching blood or body fluids  Before & After removing gloves  Before &After toileting  Between tasks on the same patient when hands are visibly soiled 3

4. Normal microbial flora of skin n Resident;- survive & multiply in the superficial skin layers n Transient;- recent contaminants that survive briefly. E.g klebsiella from patients or the environment 4

5. Hand hygiene n Least expensive n Single most effective method to prevent the spread of many communicable diseases n Includes;  Hand washing: use of plain soap & water to mechanically remove bacteria/ viruses and debris  Hand sanitizer: use of waterless hand gel to kill bacteria & viruses on the hands 5

6. Levels of hand washing n Social hand washing n Hygienic hand washing n Surgical hand washing 6

7. Hygienic hand washing Before & after –Invasive procedures –Handling wounds, drains, catheters –Susceptible patients 7

8. Surgical hand washing n Before all surgical procedures n For 2-3 minutes including the wrists& fore- arms n Sterile disposable nailbrushes may be used to clean fingernails n Sterile towels are used to dry the hands thoroughly 8

9. How to wash your hands n Turn the water on and wet hands n Apply soap (plain or antimicrobial) and water to entire surface of hands n Rub fingers back and forth, and wash around the fingernail beds (~15-30 seconds) n Rinse hands until all soap is gone n Dry hands with a clean towel (preferably a disposable paper towel) n Use towel to turn water off, if possible 9

10. TECHNIQUE 10 Palm to palm. Right palm over left dorsum and left palm over right dorsum. Palm to palm fingers interlaced. Backs of fingers to opposing palms with fingers interlocked.

11. Problems of hand contamination n Human hands have both transient & resident microbial flora n staff hand transmission is one of the most important methods of spread of hospital infection from patient to patient n Hand hygiene is the most effective method for preventing this spread 11

12. Benefits of hand hygiene Practicing good hand hygiene has been shown to: – Terminate outbreaks of diseases spread by person to person contact – Reduce the spread of multi-drug resistant organisms – Reduce overall infection rates – Reduce staff illness and absenteeism It is the single most effective way to reduce the risk of spreading or acquiring infection 12

13. Before hand washing n Keep nails short n Remove jacket and roll sleeves back n Remove watches & rings 13

14. Limited resources n No running water. Use a clean bowl of water changed between each use n A drum with a drain spout (tap) can be elevated to serve as running water n Frequent disruption of water. Store water in large receptacles whenever available n No paper towels. Small clean towels can be used discarded after each use into a bag designated for laundering before reuse 14

15. Hand Sanitizer Gel Alternative to hand washing. Alcohol-based gel Kills 99% of microorganisms Takes 20-30 sec. to dry Do not use the gel when the hands are visibly soiled. 15

16. How to Use Hand Sanitizer Gel n Apply a small amount of hand sanitizer on your hands. (about 2 ml) n Rub hands together, covering all surfaces of the hands and fingers. Keep rubbing until hands are dry 16

17. How Not to Use Hand Sanitizer Gel n Hand sanitizer is not soap! It should not be washed off with water. n Hand sanitizer should not be used on top of gloves. n Do not use when hands are visibly soiled. n Do not use hand sanitizer and wash your hands. n Soap and water should always be your first choice! 17

18. Unsafe Hand Hygiene n Using a pair of gloves for a long time instead of practicing hand hygiene. n The use of spirit to decontaminate your hands. n The use of bleach to decontaminate your hands. n Reusing emptied hand sanitizer bottles without relabeling them. 18

19. Compliance with Hand Hygiene Reasons for not washing hands: 1.Inconvenient or no sinks 2.Lack of soap or paper towels 3.Too busy / No time 4.Soap causing skin irritation or dryness 5.Thinking the risk of transmitting disease is low 6.Understaffed / Overcrowded 7.Lack of knowledge about the value of hand hygiene 19

20. Guidelines for hand washing n Soap and sinks should be accessible. n Alcohol based hand gel should be available at the entrance to the neonate’s room or at each bedside. n Written procedures that encourage routine hand washing should exist. 20

21. Take home message n Always wash hands before and after every direct patient contact. n Gloves are not an alternative to hand hygiene. n The greatest challenge to hand hygiene is attitude. It is the single most effective way to reduce the risk of spreading or acquiring infection 21

22. The end. THANK YOU 22