Hand hygiene rkch new

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HAND HYGIENE

Dr. Sabah Javed (Consultant Microbiologist)Ramkrishna Care Hospital

• Most common mode of transmission of pathogens is via hands!

Infections acquired in healthcare Spread of antimicrobial resistance

So Why All the Fuss About Hand Hygiene?

MICROBIAL FLORA OF HANDS

The microbial flora of the skin consists of • resident (colonizing) • transient (contaminating) microorganisms.Resident flora includes the coagulase-negative staphylococci, members of the genus Corynebacterium

(diphtheroids or coryneforms), Acinetobacter species, and occasionally members of the Enterobacteriaceae

group.

• Resident skin microorganisms can cause infections after invasive procedures.

• The transient microbial flora • -represents recent contaminants of the hands

acquired from colonized or infected patients/ clients or contaminated environment or equipment.

• The most common transient flora - the gram negative coliforms and Staphylococcus aureus.

• more frequently implicated as the source of nosocomial infections.

Nosocomial infections –When numbers matter

• ~ 5 to 10% of hospitalized patients

acquire nosocomial infections.

• Hospital Infection Society (HIS), India,

“About 10 to 30% hospitalized patients in

India acquire nosocomial infection”.

• Healthcare workers’ hands represent the

principal route of transmission of

pathogens.

Sax H, Allegranzi B, kay UC.‘My five moments for hand hygiene’: a user-centred design approach to understand,train, monitor and report hand hygiene.Journal of Hospital Infection. 2007;67:9-21.

Hand hygiene – The easiest way to prevent transmission

• Hand hygiene is a critical to the prevention of these infections.

• Compliance among healthcare workers is at an average 50%.

Spread the word not the germ

Kampf G, Löffler H, Gastmeier P.Hand hygiene for the prevention of nosocomial infections.Dtsch Arztebl Int 2009; 106(40): 649–55.

Self-Reported Factors for Poor Adherence with Hand Hygiene

Handwashing agents cause irritation and dryness

Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients

Hand hygiene – What purpose does it serve

• Prevents nosocomial infections in patients.

• Prevents cross transmission of microorganisms between patient.

• Prevents contamination of hospital environment with potential pathogens.

• Protect health care workers from occupational infectious diseases e.g., HIV, hepatitis C virus.

Longtin Y, Sax H, Allegranzi B, et al.Hand hygiene. N Engl J Med. 2011;364;13: e24.

Relationship between hand hygiene and healthcare-associated pathogens

• Hand cleansing with an antiseptic agent between patient contacts reduces transmission of health care associated pathogens.

• Reduced transmission of S. Aureus, Klebsiella spp. among patients.

Kampf G, Löffler H, Gastmeier P.Hand hygiene for the prevention of nosocomial infections.Dtsch Arztebl Int 2009; 106(40): 649–55.

How does cross transmission occur?

• Skin and mucous membranes of humans are colonized by various microbial species.

• Hospitalized, patients gradually shed these microorganisms onto patient zone (e.g., bed linens and bedside furniture).

If the healthcare worker does not follow hand hygiene, he/she is most likely to contaminate other areas with potential pathogens.

How does cross transmission occur? Contd..

• Corridors and public area are contaminated by healthcare works and visitors.

• Cross contamination from one area to another take place by healthcare workers.

Definitions• Hand hygiene

– Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis

• Handwashing– Washing hands with plain soap and water

• Antiseptic handwash– Washing hands with water and soap or other detergents containing

an antiseptic agent• Alcohol-based handrub

– Rubbing hands with an alcohol-containing preparation• Surgical hand hygiene/antisepsis

– Handwashing or using an alcohol-based handrub before operations by surgical personnel

My five moments for hand hygiene

WHO Guidelines on Hand Hygiene in Health care. WHO 2009. WHO Library Cataloguing-in-Publication Data.

Indications for Hand Hygiene

When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.

If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands.

Specific Indications for Hand Hygiene

• Before:– Patient contact – Donning gloves when inserting a CVC– Inserting urinary catheters, peripheral vascular

catheters, or other invasive devices that don’t require surgery

• After:– Contact with a patient’s skin – Contact with body fluids or excretions, non-intact

skin, wound dressings– Removing gloves

Equipment required for hand washing

Alcohol based hand rub formulation.

Soap, water and towel.

Drying agent.

Alcohol-based hand-rub formulation

• Contain 60 to 80% ethanol as isopropanol or n-propanol.

• Emollients to protect the skin.

• Available as – Liquid solutions Gels Sprays Foams

These equipment should be available with in reach, preferably closer to the point of care with in 3 feet or should be carried by healthcare professional for personal use.

Hand rubbing with an alcohol-based formulation

Apply a palm full of hand rub formulation and rub your hands together as seen in the image.

Hand washing with soap and water

• Soaps and detergents remove lipids and dirt.

• The antibacterial effects of soaps results from the ability of soap to dislodge bacteria from skin when combined with the rinsing effect.

The entire process will take no more than 40 to 60 seconds!

Efficacy of Hand Hygiene Preparations in Killing Bacteria

Good BetterBest

Plain Soap Antimicrobial soap Alcohol-based handrub

3.0 0 60 180 minutes

99.9log%

rial R

Alcohol-based handrub(70% Isopropanol)

Antimicrobial soap(4% Chlorhexidine)

Plain soap

Time After Disinfection

Baseline

Ability of Hand Hygiene Agents to Reduce Bacteria on Hands

SummaryAlcohol-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

Gloves

Purpose• Prevent transmission of

microorganisms from healthcare worker to patients.

• Reduce the healthcare workers risk of acquiring diseases from the patients.

Type• Non sterile gloves to be

worn when patient care activities result in exposure to blood , body fluids and open wounds.

Limit the use of glove, do not use them when taking temperature etc.

Gloving

• Wear gloves when contact with blood or other potentially infectious materials is possible

• Remove gloves after caring for a patient• Do not wear the same pair of gloves for the

care of more than one patient• Do not wash gloves

• Do not disinfect or reuse glove.

• Gloves use does not replace hand hygiene.

• Remove gloves perform hand hygiene and if required again wear fresh pair if required.

Jewellery and finger nails• Wearing rings and bracelets can

increase the bacterial load of the skin, avoid them.

• Long finger nails have been associated with infectious outbreaks of resistant pathogens.

• Keep you nails short (less than 0.2 inches or ½ cm in length.

• Avoid artificial nails• Finger nail infections have to be

treated immediately as it may reduce the efficacy of hand hygiene

Key Points

• Hand hygiene is not optional.• Every health care worker should

master hand hygiene.• Hand hygiene should be used

diligently to improve patient safety.• Due to growing knowledge patients

expect you to follow hand hygiene

HAND WASHING REDUCE HAI

PREVENTION

IS PRIMARY!

Protect patients…protect healthcare personnel…

promote quality healthcare!

Hand hygiene rkch new

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