Principles of Hand Washing

Abdullah A. Idrees

Presented by :

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

Why is Hand washing Important?

Routine Hand washing prevents the spread of

disease!Abdullah A. Idrees

How disease spreads

Infectious diseases can spread in a variety of ways .

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Common Microbes

Microbes found on a cutting board.

© Dennis Kunkel

E Coli.

©Dennis Kunkel Staphylococcus aureus

©Dennis Kunkel

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Proper hand washing with

soap and waterFollow these instructions for washing with soap and

water:

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

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

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

• Rinse well. • Dry your hands with a clean or disposable towel. • Use a towel to turn off the tap.

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Recommended Hand Hygiene Technique

• Handrubs– Apply to palm of one hand, rub hands

together covering all surfaces until dry

– Volume: based on manufacturer

• Handwashing – Wet hands with water, apply soap, rub hands

together for at least 15 seconds

– Rinse and dry with disposable towel

– Use towel to turn off faucet

To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps.

This takes only 20–30 seconds!

How to handrub

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How to handwash

To effectively reduce the growth of germs on hands, handwashing

must last 40–60 secs

and should be performed by following all of the illustrated steps

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Hand hygiene and glove use

GLOVES PLUSHAND HYGIENE

=CLEAN HANDS

GLOVES WITHOUTHAND HYGIENE

=GERM TRANSMISSION

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Hand hygiene and glove use

–The use of gloves does not replace the need for cleaning your hands!

–You should remove gloves to perform hand hygiene, when an indication occurs while wearing gloves

–You should wear gloves only when indicated otherwise they become a major risk for germ transmission

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Examples of hand hygiene products easily accessible at the point-of-care

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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

When should you wash your hands?

Although it's impossible to keep your hands germ-free, times exist when it's critical to wash your

hands to limit the transfer of bacteria, viruses and other microbes.

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Barriers to hand washing

Can you find the sink in this picture ?

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Barriers to hand washing

The sink mentioned in the previous

slide is located behind the

patient’s bed and behind several IV

pumps.

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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

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

Health care workers

Nurses, doctors and other healthcare

workers can get 100s or 1000s of bacteria on their hands by doing

simple tasksCulture plate showing growth of bacteria 24 hours after a nurse placed her hand on

the plate

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How clean are you???

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Why should you clean your hands?

Any health-care worker, caregiver or person involved in patient care needs to be

concerned about hand hygieneTherefore hand hygiene does concern you!

You must perform hand hygiene to:protect the patient against harmful germs

carried on your hands or present on his/her own skin

protect yourself and the health-care environment from harmful germs

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Hand hygiene must be performed exactly where you are delivering health care to patients (at the point-of-care)

During health care delivery, there are 5 moments when it is essential that you perform hand hygiene ("My 5 Moments for Hand Hygiene" approach)

The golden rules for hand hygiene

To clean your hands, you should prefer handrubbing with an alcohol-based formulation, if available. Why? Because it makes hand hygiene possible right at the point-of-care, it is faster, more effective, and better tolerated.

You should wash your hands with soap and water when visibly soiled

You must perform hand hygiene using the appropriate technique and time duration

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HEALTH-CARE ZONE

PATIENT ZONE

The geographical conceptualization of the transmission risk

Critical site with infectious risk for the patient

Critical site with body fluid

exposure risk

Abdullah A. IdreesH Sax, University Hospitals, Geneva 2006

1

23

5

Another way of visualizing the patient zone and the contacts occurring within it

5 Moments for

Hand Hygiene

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PatientRefers to any part of the patient, their clothes, or any medical device that is connected to the patient

If the patient were to get out of bed and walk off – what would still be attached to them?

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Immediate Patient Surroundings

A space temporarily dedicated to an individual patient for that patient’s stay Includes:

• Patient furniture and personal belongings • Medical equipment – BP machine, monitor• Medical chart • Anything touched by HCW while caring for that patient

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Patient Surroundings

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Moment 1Before Touching a Patient

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Mom

ent 1

When:Examples:

Touching a patient in any wayShaking hands, Assisting a patient to move, most Allied health interventions, Touching any invasive medical device connected to the patient (eg. IV pump, IDC)

Any personal care activitiesBathing, Dressing, Brushing hair, Putting on personal eg. Glasses

Any non-invasive observationsTaking a pulse, Blood pressure, Oxygen saturation, Temperature, Chest auscultation, Abdominal palpation, Applying ECG electrodes, CTG

Any non-invasive treatmentApplying an oxygen mask or nasal cannula, Fitting slings/braces, Application of incontinence aids (including condom drainage)

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Moment 2Before a Procedure

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Procedure

Is an act of care for a patient where there is a risk of direct introduction of a pathogen into the patient’s body.

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Moment 2When:Examples:

Insertion of a needle into a patient’s skin, or into an invasive medical device

Venipuncture, Blood glucose level, Arterial blood gas, Subcutaneous or Intramuscular injections, IV flush

Preparation and administration of any medications given via an invasive medical device, or preparation of a sterile field

IV medication, NGT feeds, PEG feeds, Baby feeds, Dressing trolley

Administration of medications where there is direct contact with mucous membranes

Eye drop installation, Suppository insertion, Vaginal pessary

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Moment 2When:Examples:

Insertion of, or disruption to, the circuit of an invasive medical device

Procedures involving the following: ETT, Tracheostomy, Nasopharyngeal airways, Suctioning of airways, Urinary catheter, Colostomy/ileostomy, Vascular access systems, Invasive monitoring devices, Wound drains, PEG tube, NGT, Secretion aspiration

Any assessment, treatment and patient care where contact is made with non-intact skin or mucous membranes

Wound dressings, Burns dressings, Surgical procedures, Digital rectal examination, Invasive obstetric and gynaecological examinations and procedures, Digital assessment of newborns palate

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Moment 3After a Procedure or Body Fluid

Exposure Risk

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Any situation where contact with body fluids may occur. Such contact may pose a contamination risk to either the HCW or the environment

Body Fluid Exposure Risk

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Actual or potential contact with:

• Blood, Lochia• Saliva or tears• Mucous, wax, or pus• Breast milk, Colostrum• Vomitus • Urine, faeces, semen, or meconium• Pleural fluid, ascitic fluid or CSF

• Tissue samples, including biopsy specimens, organs, bone marrow, cell samples

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Moment 3When:Examples:After any Moment 2See Moment 2

After any potential body fluid exposure

Contact with a used urinary bottle / bedpan, Contact with sputum either directly or indirectly via a cup or tissue, Contact with used specimen jars / pathology samples, Cleaning dentures, Cleaning spills of body fluid from patient surroundings, After touching the outside of a drain

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Moment 4After Touching a Patient

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Moment 5After touching a patient’s immediate surroundings

when the patient has not been touched

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Moment 5When:Examples:

After touching the patient’s immediate surroundings when the patient has not been touched

Patient surroundings include: Bed, Bedrails, Linen, Table, Bedside chart, Bedside locker, Call bell/TV remote control, Light switches, Personal belongings, Chair, Foot stool, Monkey bar

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