INFECTION CONTROL

INTRODUCTIONHand hygiene is the easiest way to prevent

infection. The rate of infection is steadily increasing in hospitals and communities. Therefore, the purpose of this learning module is to provide infection control practices and proper hand washing techniques.

DIRECTIONSAfter viewing the information provided, the

healthcare professional will be able to establish and effectively develop hand washing techniques.

BACTERIAL FLORA ON HANDSBacterial flora resides on hands. The

bacteria can be transient or resident. According to Smeltzer and Bare (2000), transient bacteria are usually due to activities of daily living and can be found under one’s fingernails and on the surface of one’s hands. This type of bacteria can be removed by thorough hand-washing. Staphylococcus is normal flora of the skin.

BACTERIAL FLORA ON HANDSTransient flora: Transient flora colonizes the

superficial layers of the skin and may be removed by practicing good hand antisepsis. Healthcare workers often acquire transient floras during direct contact with patients or contact with contaminated environmental surfaces within close proximity of a patient. Transient flora are the organisms most frequently associated with healthcare-associated infections.

BACTERIAL FLORA ON HANDSResident flora: Resident flora are attached to

deeper layers of the skin and are more resistant to removal.

HAND CLEANSERSAntimicrobial SoapAntiseptic Hand Rub/Foam

FACTSAccording to RN journal (2001), hand

sanitizers work for up to six hours. It kills 99.9% of bacteria in fifteen seconds. In addition, Purell contains sixty-two percent ethyl alcohol and kills 99.9% of bacteria. However, the duration of effectiveness is unknown. Dial instant sanitizer also kills 99.9% of bacteria and duration is unknown (Schiff, 2001).

PROCESSEach employee must begin and end the shift

with a three to five minute scrub of the hands.

The employee must clean under the fingernails and in the creases of the hands.

The employee must remove jewelry and watches to perform an appropriate scrub.

PROCESS CONT.For hand washing, lathered hands should be

rubbed together for ten to fifteen seconds then rinse under the stream of water before and after patient care, glove removal, and any invasive procedures.

In addition to hand washing, employees should sanitize their hands at the patient’s doorway and/or bed and before patient contact.

Hand sanitizers can be used up to 10 times before washing hands.

POLICYHand washing is required when:

• hands are visibly dirty or soiled with any body substance

• after removing gloves that are visibly dirty or soiled with any body substance

• after contact with body fluids, secretions or excretions, mucous membranes, non-intact skin and wound dressings

• Before eating and after using a restroom

POLICY CONT.Fingernails

All health care workers including non-supervisory an supervisory personnel who regularly or occasionally provide direct, hands-on care to patients will not wear artificial nails or extenders

Natural nails are to be less than ¼ inch in length from the tip of the finger. this length will allow a healthcare worker to thoroughly clean beneath nails and will not cause glove tears

POLICY CONT.Fingernails Cont.

Nail polish, if worn, must be in good repair without cracks or chips

POLICYEducation:

Annual education on Hand Hygiene will be provided by Infection Control

Infection Control Representative will provide consultation and educational services as needed and review and enforce policy

POST TEST 1. The hand washing process should last 3-5 seconds. T or F 2. The most common bacteria found on the hands are resident

bacteria. T or F 3. Jewelry and watches should be left on while washing hands. T

or F 4. An appropriate scrub lasts about 3-5 minutes. T or F 5. Cleaning under the fingernails is not necessary for the hand

washing process. T or F 6. Hand sanitizers replace hand washing. T or F 7. All nurses practice good hand washing techniques. T or F

REFERENCESO’Boyle, C. A., Henly, S. J., & Duckett, L. J. (2001).

Nurses’ Motivation to Wash Their Hands: A Standardized Measurement Approach. Applied Nursing Research, 14, 136-145.

Schiff, L. (2001). Hand Cleansers. RN 64, 65-66, 68-70.

Smeltzer, S. C., & Bare, B.G. (2000). Management of patients with infectious diseases. Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 9th ed. (p. 1878). Lippincott Williams & Wilkins.

Taylor, C., Lillis, C., & LeMone, P. (2001). Asepsis. Fundamentals of Nursing 4th ed. (p. 541). Lippincott Williams & Wilkins.

REFERENCES CONT.Department of Veterans Affairs (2013). Hand Hygiene policy.James Emery, “Washing hands (before shot)” March, 7 2008

via Flickr, Creative Commons Attribution http://www.flickr.com/photos/emeryjl/2327539982/

Jar, “Wash your hands” September 5, 2010 via Flickr, Creative Commons Attribution http://www.flickr.com/photos/jariceiii/4960522015/

Carl Glover, “Nursing” August 23, 2011 via Flickr, Creative Commons Attribution http://www.flickr.com/photos/34239598@N00/6420116185/

Niaid_Flickr, “Methicillin-Resistant staphyloc0ccus (MRSA) Bacteria” February 6 2012 via Flickr, Creative Commons Attribution http://www.flickr.com/photos/niaid/6830393029/

REFERENCES CONT.Derrick Coetzee, “Purell hand sanitizer gel in bottle”

February 18, 2013 via Flickr, Creative Commons Attribution http://www.flickr.com/photos/dcoetzee/8487014501/

Horia Varlan, “Colorful bars of soap on white towel” November 6, 2008 via Flickr, Creative Commons Attribution http://www.flickr.com/photos/horiavarlan/4263958356/

Niaid_Flickr, “Staphylococcus epidermis Bacteria” April 12, 2011 via Flickr, Creative Commons Attribution http://www.flickr.com/photos/niaid/5613984108/

Mark Turnauckas, “Hand Washing Howto” April 19, 2011 via Flickr, Creative Commons Attribution http://www.flickr.com/photos/marktee/5647531215/

REFERENCESKatie Brady, “Nails” February 21, 2010 via

Flickr, Creative Commons Attribution http://www.flickr.com/photos/cliche/4468016400/