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Hand Washing & Infection Control

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Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health Administration) Administration) Washing hands reduces Washing hands reduces hospital-acquired hospital-acquired infection infection
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Page 1: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Washing hands reduces Washing hands reduces hospital-acquired hospital-acquired

infectioninfection

Page 2: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

How disease spreadsHow disease spreads

Infectious diseases can spread in Infectious diseases can spread in a variety of ways. a variety of ways.

Page 3: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Why is Hand washing Why is Hand washing Important?Important?

Routine Hand washing prevents the Routine Hand washing prevents the spread of disease!spread of disease!

Page 4: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Few Infectious PlacesFew Infectious Places

Page 5: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Hand hygiene productsHand hygiene products Alcohol-based (hand)rub :Alcohol-based (hand)rub : An alcohol-containing preparation An alcohol-containing preparation

(liquid, gel or foam). (liquid, gel or foam). Antimicrobial (medicated) soap :Antimicrobial (medicated) soap : Soap (detergent) containing Soap (detergent) containing

an antiseptic agent at a concentration an antiseptic agent at a concentration Antiseptic agent :Antiseptic agent : An antimicrobial substance which reduces or An antimicrobial substance which reduces or

inhibits the growth of microorganisms on living tissues. inhibits the growth of microorganisms on living tissues. Detergent (surfactant) :Detergent (surfactant) : They are composed of a hydrophilic They are composed of a hydrophilic

and a lipophilic part and can be divided into four groups: anionic, and a lipophilic part and can be divided into four groups: anionic, cationic, amphoteric, and non-ionic. cationic, amphoteric, and non-ionic.

Plain soap :Plain soap : Detergents that do not contain antimicrobial agents, Detergents that do not contain antimicrobial agents, or that contain very low concentrations of antimicrobial agents or that contain very low concentrations of antimicrobial agents effective solely as preservatives.effective solely as preservatives.

Waterless antiseptic agent :Waterless antiseptic agent : An antiseptic agent that does not An antiseptic agent that does not require the use of exogenous water. After application, the require the use of exogenous water. After application, the individual rubs the hands together until the agent has dried. The individual rubs the hands together until the agent has dried. The term includes different types of handrubs (liquid formulations, term includes different types of handrubs (liquid formulations, gels, foams).gels, foams).

Page 6: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Why is compliance with Why is compliance with recommended handwashing recommended handwashing

so poor?so poor?Here are some reasons why healthcare workers do not wash their hands as often as they should:

•Heavy workloads (too busy)

•Sinks are poorly located

•Skin irritation caused by frequent exposure to soap and water

•Hands don’t look dirty

•Handwashing takes too long

Page 7: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Proper hand washing with Proper hand washing with soap and watersoap and water

Follow these instructions for Follow these instructions for washing with soap and water:washing with soap and water:

Wet your hands with warm, running Wet your hands with warm, running water and apply liquid or clean bar soap. water and apply liquid or clean bar soap. Lather well. Lather well.

Rub your hands vigorously together for Rub your hands vigorously together for at least 15 seconds. at least 15 seconds.

Scrub all surfaces, including the backs Scrub all surfaces, including the backs of your hands, wrists, between your of your hands, wrists, between your fingers and under your fingernails. fingers and under your fingernails.

Rinse well. Rinse well. Dry your hands with a clean or Dry your hands with a clean or

disposable towel. disposable towel. Use a towel to turn off theUse a towel to turn off the tap. tap.

Page 8: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

When should you wash When should you wash your hands?your hands?

Although it's impossible to keep your hands germ-Although it's impossible to keep your hands germ-free, times exist when it's critical to wash your free, times exist when it's critical to wash your hands to limit the transfer of bacteria, viruses and hands to limit the transfer of bacteria, viruses and other microbes.other microbes.

Page 9: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Health care workersHealth care workers

Nurses, doctors Nurses, doctors and other and other healthcare healthcare workers can get workers can get 100s or 1000s 100s or 1000s of bacteria on of bacteria on their hands by their hands by doing simple doing simple taskstasks

Culture plate showing growth of bacteria 24 hours after a nurse

placed her hand on the plate

Page 10: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

What is the single most What is the single most important reason for important reason for healthcare workers to healthcare workers to

practice good hand practice good hand hygiene?hygiene? To remove visible soiling from handsTo remove visible soiling from hands

To prevent transfer of bacteria from the To prevent transfer of bacteria from the home to the hospitalhome to the hospital

To prevent transfer of bacteria from the To prevent transfer of bacteria from the hospital to the home hospital to the home

To prevent infections that patients To prevent infections that patients acquire in the hospitalacquire in the hospital

Page 11: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Colonized or Colonized or Infected:Infected:

What is the What is the Difference?Difference?

People who carry bacteria without People who carry bacteria without evidence of infection (fever, increased evidence of infection (fever, increased white blood cell count) are white blood cell count) are colonizedcolonized

If an infection develops, it is usually from If an infection develops, it is usually from bacteria that colonize patientsbacteria that colonize patients

Bacteria that colonize patients can be Bacteria that colonize patients can be transmitted from one patient to another by transmitted from one patient to another by the hands of healthcare workersthe hands of healthcare workers

~ Bacteria can be transmitted even if the patient is not infected ~

Page 12: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

The Iceberg Effect

Infected

Colonized

Page 13: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

How often do you clean your How often do you clean your hands after touching a hands after touching a

PATIENT’S INTACT SKINPATIENT’S INTACT SKIN

1.1. AlwaysAlways

2.2. OftenOften

3.3. SometimeSometimess

4.4. NeverNever

Page 14: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Which method do you use Which method do you use to clean your hands at to clean your hands at

work?work?1.1. Plain soap and waterPlain soap and water

2.2. Antimicrobial soap and waterAntimicrobial soap and water

3.3. Alcohol-based handrubAlcohol-based handrub

Page 15: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Efficacy of Hand Hygiene Efficacy of Hand Hygiene Preparations in Killing Preparations in Killing

BacteriaBacteria

Good Better Best

Plain Soap Antimicrobial soap

Alcohol-based handrub

Page 16: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Ability of Hand Hygiene Ability of Hand Hygiene Agents to Reduce Bacteria on Agents to Reduce Bacteria on

HandsHands

Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

0.0

1.0

2.0

3.0 0 60 180 minutes

0.0

90.0

99.0

99.9log%

Ba

cte

ria

l R

ed

uct

ion Alcohol-based handrub

(70% Isopropanol)

Antimicrobial soap(4% Chlorhexidine)

Plain soap

Time After Disinfection

Baseline

Page 17: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

How much time would an ICU How much time would an ICU nurse save during an 8 hour nurse save during an 8 hour

shift by using an alcohol-shift by using an alcohol-based handrub instead of based handrub instead of

soap and water?soap and water?1. 15 minutes

2. 30 minutes

3. 1 hour

4. 2.5 hours

Page 18: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

How often do you clean your hands after touching an

ENVIRONMENTAL SURFACE near a patient?

1. Always

2. Often

3. Sometime

4. Never

Page 19: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Use of artificial nails by Use of artificial nails by healthcare workers poses healthcare workers poses

no risk to patients.no risk to patients.

1. Strongly agree

2. Agree

3. Don’t know

4. Disagree

5. Strongly disagree

Page 20: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Glove use for all patient care contacts is a useful

strategy for reducing risk of transmission of

organisms.1. Strongly agree

2. Agree

3. Don’t know

4. Disagree

5. Strongly disagree

Page 21: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

The following list gives some The following list gives some examples when hands should be examples when hands should be

washedwashed Before preparing, handling or eating foodBefore preparing, handling or eating food After visiting the toiletAfter visiting the toilet Whenever hands are visibly dirtyWhenever hands are visibly dirty After bed makingAfter bed making After Removing GlovesAfter Removing Gloves Before wearing sterile gloves.Before wearing sterile gloves. Before and after administering medicationBefore and after administering medication After any possible microbial contaminationAfter any possible microbial contamination Any situation which involves direct patient/client contact e.g. Any situation which involves direct patient/client contact e.g.

bathing, assisting to movebathing, assisting to move Before and after handling wounds, urethral cathetersBefore and after handling wounds, urethral catheters After handling contaminated laundry and waste.After handling contaminated laundry and waste. Before and after emptying urine drainage bags for susceptible Before and after emptying urine drainage bags for susceptible

patientspatients

Page 22: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

How to wash How to wash HandsHands

Handwashing Handwashing Remove jewelry before hand wash procedureRemove jewelry before hand wash procedure Rinse hands under running water.Rinse hands under running water. Lather with soap and, using friction, cover all Lather with soap and, using friction, cover all

surfaces of the hands and fingers.surfaces of the hands and fingers. Rinse and dry with disposable towelRinse and dry with disposable towel Use towel to turn off taps (if not elbow)Use towel to turn off taps (if not elbow)

HandrubsHandrubs Apply to palm of one hand, rub hands together Apply to palm of one hand, rub hands together

covering all surfaces until dry covering all surfaces until dry Application is key: Let It Dry!Application is key: Let It Dry!

Page 23: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Page 24: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Page 25: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Education/Motivation Education/Motivation ProgramsPrograms

Monitor healthcare workers (HCWs) Monitor healthcare workers (HCWs) adherence with recommended hand adherence with recommended hand hygiene practices and give feedback hygiene practices and give feedback

Implement a multidisciplinary Implement a multidisciplinary program to improve adherence to program to improve adherence to recommended practices recommended practices

Encourage patients and their families Encourage patients and their families to remind HCWs to practice hand to remind HCWs to practice hand hygienehygiene

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Page 26: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

Proposed Strategies to Improve Hand Washing Proposed Strategies to Improve Hand Washing Technique and ComplianceTechnique and Compliance

ObstacleObstacle StrategyStrategy

Lack of Lack of knowledgeknowledge

Education with supportive literature, videotaped instructions, hand washing Education with supportive literature, videotaped instructions, hand washing demonstrations; frequent refreshers; involvement of personnel in education demonstrations; frequent refreshers; involvement of personnel in education and feedbackand feedback

Lack of Lack of motivationmotivation

Direct observation and feedback on regular basis; role models; involvement ofDirect observation and feedback on regular basis; role models; involvement of

staff in studies; application of new technologiesstaff in studies; application of new technologies

Programs on hand hygiene for patients and familiesPrograms on hand hygiene for patients and families

Availability of Availability of hand hand washing washing facilitiesfacilities

Hand washing facilities conveniently located throughout the health care settingHand washing facilities conveniently located throughout the health care setting

A sink accessible to personnel in or just outside every room; more than one A sink accessible to personnel in or just outside every room; more than one sink per room may be necessary if a large room is used for several individuals.sink per room may be necessary if a large room is used for several individuals.

Hand washing facilities in or adjacent to rooms where health care procedures Hand washing facilities in or adjacent to rooms where health care procedures are performedare performed

Accessible, adequately supplied and proper functioning soap and towel Accessible, adequately supplied and proper functioning soap and towel dispensers or hand dryersdispensers or hand dryers

Faucets with foot, wrist or knee operated handles; faucets with an electric eye Faucets with foot, wrist or knee operated handles; faucets with an electric eye arealso desirable.arealso desirable.

Waterless antiseptic agents readily available in wall mounted dispensers, or Waterless antiseptic agents readily available in wall mounted dispensers, or insmall containers for mobile care such as home care and for emergency insmall containers for mobile care such as home care and for emergency responders.responders.

Hand Hand washing washing productproduct

Hand washing products that have a high level of acceptability to staff, with Hand washing products that have a high level of acceptability to staff, with appropriateness, cost, supply, etc., being taken into considerationappropriateness, cost, supply, etc., being taken into consideration

DermatitisDermatitis Lotions to prevent skin drynessLotions to prevent skin dryness

Lotion supplied in small, non-refillable containersLotion supplied in small, non-refillable containers

Compatibility between lotion and antiseptic products and effect on glove Compatibility between lotion and antiseptic products and effect on glove integrityintegrity

Lotions approved by personnel in infection control and occupational healthLotions approved by personnel in infection control and occupational health

Page 27: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

PREVENTIONIS PRIMARY!

Protect patients…protect healthcare personnel…

promote quality healthcare!

Page 28: Hand Washing & Infection Control

Vijay Pratap Raghuvanshi Vijay Pratap Raghuvanshi

M.Phil & MHA M.Phil & MHA ( Hospital & Health ( Hospital & Health

Administration)Administration)

How clean are How clean are you???you???


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