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HAND HYGIENE … THE EASY WAY!
HAND HYGIENE … THE EASY WAY!
Maria Rhona M. G. Bergantin, MDMaria Rhona M. G. Bergantin, MD
The
Hospital Gang
The
Hospital Gang
ESCHERICHIA COLIgenerally lives a blameless life in the gut
but assumes a life of crime once he is allowed to roam in the hospital
PSEUDOMONAS Normally lives in soil and in water
storage tank. but, once he gets into the hospital, is notoriously difficult to remove
KLEBSIELLA. Lesser known resident of the intestine,
fond of hitchhiking on the hands of doctors and nurses. Known to take over entire wards.
STREPTOCOCCUS Still a common cause of throat infection
but also involved in more seriousoffenses against the rest of the person
PROTEUSA motile young bacterium, anxious to swim into the wrong places. Generally follows up the dirty
work of other bacteria
STAPHYLOCOCCUS AUREUSAlias Goldie the Grape, found
in the nose and on the hands of hospital staff but survives
for days in dusty places
Normal Bacterial Skin FloraNormal Bacterial Skin Flora
• Scalp 1 x 106 CFU/cm2
• Axilla 5 x 105 CFU/cm2
• Abdomen 4 x 104 CFU/cm2
• Forearm 1 x 104 CFU/cm2
• Total bacterial count on the hands =3.9 x 104 to 4.6 x 106
• Scalp 1 x 106 CFU/cm2
• Axilla 5 x 105 CFU/cm2
• Abdomen 4 x 104 CFU/cm2
• Forearm 1 x 104 CFU/cm2
• Total bacterial count on the hands =3.9 x 104 to 4.6 x 106
ORGANISMS PRESENT ON THE HANDS
ORGANISMS PRESENT ON THE HANDS
RESIDENT ORGANISMS• normal flora of the skin• deeply seated in the epidermis• not easily removed by single hand
washing• rarely cause infection• cause infection during implant
surgery and IV sites
RESIDENT ORGANISMS• normal flora of the skin• deeply seated in the epidermis• not easily removed by single hand
washing• rarely cause infection• cause infection during implant
surgery and IV sites
ORGANISMS PRESENT ON THE HANDS
ORGANISMS PRESENT ON THE HANDS
RESIDENT ORGANISMS• normal flora of the skin• coagulase negative staphylococci• Staphylococcus epidermidis• Corynebacterium or Diphtheroids• Propionibacterium species
RESIDENT ORGANISMS• normal flora of the skin• coagulase negative staphylococci• Staphylococcus epidermidis• Corynebacterium or Diphtheroids• Propionibacterium species
ORGANISMS PRESENT ON THE HANDS
ORGANISMS PRESENT ON THE HANDS
TRANSIENT ORGANISMS• microorganisms NOT part of the normal
flora• represent recent contamination• usually survive for a limited period of time• acquired during contact with the
infected/colonized patient or environment• easily removed by good hand washing
technique
TRANSIENT ORGANISMS• microorganisms NOT part of the normal
flora• represent recent contamination• usually survive for a limited period of time• acquired during contact with the
infected/colonized patient or environment• easily removed by good hand washing
technique
ORGANISMS PRESENT ON THE HANDS
ORGANISMS PRESENT ON THE HANDS
TRANSIENT ORGANISMS• gram negative bacilli (E. coli,
Klebsiella and Pseudomonas)• Salmonella sp.• Staphylococcus aureus• Viruses (Rotavirus)
TRANSIENT ORGANISMS• gram negative bacilli (E. coli,
Klebsiella and Pseudomonas)• Salmonella sp.• Staphylococcus aureus• Viruses (Rotavirus)
HEALTH CARE WORKER’S HANDS
HEALTH CARE WORKER’S HANDS
Probably the MOST common means by which spread of
infection by direct contact can occur
Probably the MOST common means by which spread of
infection by direct contact can occur
The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel
The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel
The Hand Infects- newly operated
- the child, the chronically ill- the old patient
- ALL sick people- ALL hospital personnel
The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel
The Hand Infects- newly operated
- the child, the chronically ill- the old patient
- ALL sick people- ALL hospital personnel
The Hand contaminates- the physicians’ instruments
- clean laundry- toiletries
- sanitary equipments- dishes and silver etc.
The Hand Takes Germs from :- the skin, dirty wounds, pus excretions of the sick- the body, the hands, the clothes of the physicians and hospital personnel
The Hand Infects- newly operated
- the child, the chronically ill- the old patient
- ALL sick people- ALL hospital personnel
The Hand contaminates- the healthcare worker’s
instruments- clean laundry
- toiletries- sanitary equipments- dishes and silver etc.
The Hand transfer Germs from:
bed sheets, dirty underwear, moist towels, sinks and
bathtubs, toiletries
HANDWASHINGHANDWASHING
• Considered to be one of the MOST important procedures in the prevention of hospital-acquired infection
• Considered to be one of the MOST important procedures in the prevention of hospital-acquired infection
The Hands are moistened and 3-5 ml formulation is applied to cupped hands. The hands are then rubbed together 5 times as follows :
Defined Technique for Hand WashingDefined Technique for Hand Washing
1. PALM to PALM 2. Right Palm over 3. PALM to PALM dorsum and vice versa fingers interlaced
4. Back of fingers 5. Rotational rubbing of 6. Rotational rubbing, to opposing palms, right thumb clasped in backwards and forwards fingers interlocked left palm and vice versa with clasped fingers of
right hand in left palm and vice versa
Factors Influencing Adherence to Hand-Hygiene Practices
Factors Influencing Adherence to Hand-Hygiene Practices
• Observed risk factors for poor adherence to recommended hand-hygiene practices– Physician status (rather than nurses)– Nursing assistant status (rather than a nurse)– Male sex– Working in an intensive-care unit– Working during the week (versus weekends)– Wearing gloves/gowns– Automated sink– Activities with high risk of co-transmission– High number of opportunities for hand hygiene per
hours of patient carePitter D, 2000
• Observed risk factors for poor adherence to recommended hand-hygiene practices– Physician status (rather than nurses)– Nursing assistant status (rather than a nurse)– Male sex– Working in an intensive-care unit– Working during the week (versus weekends)– Wearing gloves/gowns– Automated sink– Activities with high risk of co-transmission– High number of opportunities for hand hygiene per
hours of patient carePitter D, 2000
Factors Influencing Adherence to Hand-Hygiene Practices
Factors Influencing Adherence to Hand-Hygiene Practices
• Additional perceived barriers to appropriate hand hygiene
– Lack of active participation in hand-hygiene promotion at individual or institutional level
– Lack of role model for hand hygiene– Lack of institutional priority for hand hygiene– Lack of administrative sanction of
noncompliers/rewarding compliers– Lack of institutional safety climate
Pitter D, 2000
• Additional perceived barriers to appropriate hand hygiene
– Lack of active participation in hand-hygiene promotion at individual or institutional level
– Lack of role model for hand hygiene– Lack of institutional priority for hand hygiene– Lack of administrative sanction of
noncompliers/rewarding compliers– Lack of institutional safety climate
Pitter D, 2000
Factors Influencing Adherence to Hand-Hygiene Practices
Factors Influencing Adherence to Hand-Hygiene Practices
• Self-reported factors for poor adherence with hand hygiene– Hand washing agents cause irritation and dryness– Sinks are inconveniently located/shortage of sinks– Lack of soap and paper towels– Often too busy/insufficient time– Understaffing/overcrowding– Patients needs take priority– Hand hygiene interferes with health-care worker
relationships with patients– Low risk of acquiring infection from patients– Wearing of gloves/beliefs that glove use obviates the
need for hand hygiene
Pitter D, 2000
• Self-reported factors for poor adherence with hand hygiene– Hand washing agents cause irritation and dryness– Sinks are inconveniently located/shortage of sinks– Lack of soap and paper towels– Often too busy/insufficient time– Understaffing/overcrowding– Patients needs take priority– Hand hygiene interferes with health-care worker
relationships with patients– Low risk of acquiring infection from patients– Wearing of gloves/beliefs that glove use obviates the
need for hand hygiene
Pitter D, 2000
Factors Influencing Adherence to Hand-Hygiene Practices
Factors Influencing Adherence to Hand-Hygiene Practices
• Self-reported factors for poor adherence with hand hygiene– Lack of knowledge of guidelines/protocols– Not thinking about it/forgetfulness– No role model from colleagues or superiors– Skepticism regarding the value of hand hygiene– Disagreement with the recommendations– Lack of scientific information of definitive impact of
improved hand hygiene on health-care associated infection rates
Pitter D, 2000
• Self-reported factors for poor adherence with hand hygiene– Lack of knowledge of guidelines/protocols– Not thinking about it/forgetfulness– No role model from colleagues or superiors– Skepticism regarding the value of hand hygiene– Disagreement with the recommendations– Lack of scientific information of definitive impact of
improved hand hygiene on health-care associated infection rates
Pitter D, 2000
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hands before having direct contact with patients
• Decontaminate hands before having direct contact with patients
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter
• Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure
• Decontaminate hands before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hand AFTER contact with patient’s intact skin
• Decontaminate hand AFTER contact with patient’s intact skin
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hands AFTER contact with body fluids or excretions, mucous membranes, non-intact skin and wound dressings if hands are not visibly soiled
• Decontaminate hands AFTER contact with body fluids or excretions, mucous membranes, non-intact skin and wound dressings if hands are not visibly soiled
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hands if moving from a contaminated body- site to a clean-body site during patient care
• Decontaminate hands if moving from a contaminated body- site to a clean-body site during patient care
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hands AFTER contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient
• Decontaminate hands AFTER contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Decontaminate hands AFTER removing gloves
• Decontaminate hands AFTER removing gloves
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Before eating and after using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water
• Before eating and after using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water
Indications for hand washing and hand antisepsis
Indications for hand washing and hand antisepsis
• Antimicrobial impregnated wipes (i.e. towelletes) may be considered as an alternative to hand washing with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of HCWs, they are not substitute for using an alcohol-based hand rub or antimicrobial soap
• Antimicrobial impregnated wipes (i.e. towelletes) may be considered as an alternative to hand washing with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of HCWs, they are not substitute for using an alcohol-based hand rub or antimicrobial soap
Hand hygiene techniqueHand hygiene technique
• Liquid bar, leaflet or powdered form of plain soap are acceptable when washing hands with a non-antimicrobial soap and water. When bar soap is used, soap rack that facilitate drainage and small bars of soap should be used
• Liquid bar, leaflet or powdered form of plain soap are acceptable when washing hands with a non-antimicrobial soap and water. When bar soap is used, soap rack that facilitate drainage and small bars of soap should be used
Hand hygiene techniqueHand hygiene technique
• Multiple-use cloth towels of the hanging or roll-type are not recommended for use in the health care setting
• Multiple-use cloth towels of the hanging or roll-type are not recommended for use in the health care setting
Other aspects of hand hygieneOther aspects of hand hygiene
• Do not wear artificial finger nails or extenders when having direct contact with patients at high risk
• Do not wear artificial finger nails or extenders when having direct contact with patients at high risk
Other aspects of hand hygieneOther aspects of hand hygiene
• Keep natural nails tips less than ¼ inch long
• Keep natural nails tips less than ¼ inch long
Other aspects of hand hygieneOther aspects of hand hygiene
• No recommendation can be made regarding wearing rings in health-care settings. Unresolved issue
• No recommendation can be made regarding wearing rings in health-care settings. Unresolved issue
HYGIENIC HAND DISINFECTIONHYGIENIC HAND DISINFECTIONIT SHOULD BE
USED during outbreaks
of infection where contact with blood and body fluids or in situations where microbial contamination is likely to occur
IT SHOULD BE USED
during outbreaks of infection where contact with blood and body fluids or in situations where microbial contamination is likely to occur
HYGIENIC HAND DISINFECTIONHYGIENIC HAND DISINFECTIONIT SHOULD BE
USED In high risk areas,
e.g. patients in isolation, intensive care and special care baby unit
Before performing an invasive procedure
IT SHOULD BE USED
In high risk areas, e.g. patients in isolation, intensive care and special care baby unit
Before performing an invasive procedure
HYGIENIC HAND DISINFECTIONHYGIENIC HAND DISINFECTIONIT SHOULD BE
USEDBefore and after
touching wounds, urethral or iv catheters
before wearing and after removing gowns
IT SHOULD BE USED
Before and after touching wounds, urethral or iv catheters
before wearing and after removing gowns
HYGIENIC HAND RUBHYGIENIC HAND RUB
• An alternative method of hand disinfection
• a rapid and effective alternative to hand washing e.g. ward rounds with no water and no wash basin
• An alternative method of hand disinfection
• a rapid and effective alternative to hand washing e.g. ward rounds with no water and no wash basin
HYGIENIC HAND RUBHYGIENIC HAND RUB
ALCHOLIC HAND RUBS DO NOT CLEANSE, therefore hands
should be cleaned with soap and water in the presence of visible
contamination…
ALCHOLIC HAND RUBS DO NOT CLEANSE, therefore hands
should be cleaned with soap and water in the presence of visible
contamination…
HYGIENIC HAND RUBHYGIENIC HAND RUB
PROCEDURE: • Apply 3-5 ml of fast
acting antiseptic (e.g. alcohol hand rub) containing glycerol as an emollient to prevent excessive drying of hands
• Hands are rubbed according to defined technique until dried
PROCEDURE: • Apply 3-5 ml of fast
acting antiseptic (e.g. alcohol hand rub) containing glycerol as an emollient to prevent excessive drying of hands
• Hands are rubbed according to defined technique until dried
Results of culture pre and post-application of hand rub
before after
SURGICAL HAND DISINFECTION/ SURGICAL
HANDWASHING / SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL
HANDWASHING / SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
Requires the removal and killing of transient
microorganisms and substantial reduction
and suppuration of the resident flora of the surgical team for the
duration of operation in case the surgical glove
is punctured or torn
Requires the removal and killing of transient
microorganisms and substantial reduction
and suppuration of the resident flora of the surgical team for the
duration of operation in case the surgical glove
is punctured or torn
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
• ensure that fingernails are kept
SHORT and CLEAN all the time
• Wrist watches and jewelries should be
removed before surgical hand disinfection
• ensure that fingernails are kept
SHORT and CLEAN all the time
• Wrist watches and jewelries should be
removed before surgical hand disinfection
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUBPROCEDURETurn the taps
ON using the elbows and adjust the flow of water and temperature of the water
PROCEDURETurn the taps
ON using the elbows and adjust the flow of water and temperature of the water
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUBPROCEDUREWet hands and
forearmsApply antiseptic
detergent preparation from an elbow-operated pump dispenser (e.g. Chlorhexidine Povidone Iodine)
PROCEDUREWet hands and
forearmsApply antiseptic
detergent preparation from an elbow-operated pump dispenser (e.g. Chlorhexidine Povidone Iodine)
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUBPROCEDURELather hands,
wrists and forearms for ONE MINUTE
Keep them above elbow level then rinse thoroughly under running water
PROCEDURELather hands,
wrists and forearms for ONE MINUTE
Keep them above elbow level then rinse thoroughly under running water
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUBPROCEDUREClean fingernails
and removed ingrained dirt with a manicure stick held under running water or use a sterile nail brush to clean nails and subungal spaces
PROCEDUREClean fingernails
and removed ingrained dirt with a manicure stick held under running water or use a sterile nail brush to clean nails and subungal spaces
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUBPROCEDUREThe Hand Washing
procedure is then repeated for 2 MORE MINUTES
PROCEDUREThe Hand Washing
procedure is then repeated for 2 MORE MINUTES
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
The hands, wrists and forearms are then rinsed thoroughly under running water making sure that fingertips should always point upward and elbows down to avoid recontamination of clean fingers and hands by water running down from contaminated proximal areas
The hands, wrists and forearms are then rinsed thoroughly under running water making sure that fingertips should always point upward and elbows down to avoid recontamination of clean fingers and hands by water running down from contaminated proximal areas
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
The technique of drying is VERY IMPORTANT . A separate , sterile towel is used for each arm moving from fingertips to elbow using a dabbing action
The technique of drying is VERY IMPORTANT . A separate , sterile towel is used for each arm moving from fingertips to elbow using a dabbing action
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUB
SURGICAL HAND DISINFECTION/ SURGICAL HANDWASHING /
SURGICAL SCRUBThe towel is
DISCARDED and the procedure is repeated for the other arm
When both hands, wrists and forearms are thoroughly dry, the individual is READY to gown and glove
The towel is DISCARDED and the procedure is repeated for the other arm
When both hands, wrists and forearms are thoroughly dry, the individual is READY to gown and glove
ANTIBIOTICSDO NOTRENDER HAND WASHING UNNECESSARY
ANTIBIOTICSDO NOTRENDER HAND WASHING UNNECESSARY
ReferencesReferences
• Guidelines for Hand Hygiene in Health-care Settings (CDC,2002)
• Philippine Hospital Infection Control Society (PHICS) News, July-December 2004
• Guidelines for Hand Hygiene in Health-care Settings (CDC,2002)
• Philippine Hospital Infection Control Society (PHICS) News, July-December 2004
“Little things are indeed little,
but to be faithful in little things is a great thing”
Mother Teresa
“Little things are indeed little,
but to be faithful in little things is a great thing”
Mother Teresa