Session 6& 7 - Just Clean Your Hands

7/25/2019 Session 6& 7 - Just Clean Your Hands

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JUST CLEAN

YOUR HANDSHAND HYGIENE

Katia Saliba

INFECTIONCONTROL:LECTURE 2


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2

Strategies for infection prevention and control

General measures Surveillance Routine practices Transmission-based

precautions

Specific measures

Specifically targeted against:

Surgical site infections Respiratory infections Bloodstream infections Urinary tract infections

Prudent antibiotic control


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3

Role Health Care ProvidersHads Pla! i "#readi$

I%e&tios


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Hand Hygiene

Good had h!$iee 'a! (e thesi$le 'ost i'#ortat thi$health&are )or*ers &a do to#rote&t the lives o% their#atiets+


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HISTORY

For generations, handwashing with soapand water has been considered a measureof personal hygiene. Only in the last two

centuries has the lin betweenhandwashing and the spread of diseasebeen clearly established.

!s early as "#$$, a French pharmacist

demonstrated that solutions containingchloride of lime or soda could eradicatethe foul odor associated with humancorpses and be used as disinfectants andantiseptics. with a li%uid chloride solution


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HISTORY

In "#+, Igna- Semmelweisobsered that women whosebabies were deliered byphysicians in the First 'linic atthe /eneral Hospital of 0iennaconsistently had a highermortality rate than thosedeliered by midwies in theSecond 'linic.

!s a result, in 1ay "#+2,

Semmelweis insisted thatphysicians cleanse their handswith chlorine solution betweenpatients. Thereafter, thematernal mortality rate in the

First 'linic droppeddramaticall &'(', $))$*.


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Sin

The primary function of thesin is to reduce water loss,proide protection to thebody against abrasie action

and microorganisms, and actas a permeable barrier to theenironment.

In addition, it seres a barrier

function for the body bysecreting glycerolipids andsterols to protect and nourishsin cells.


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Trasiet ,ora adResidet ,ora

There are two categories of 3ora on the sin4 Trasiet ,oracoloni-e the super5cial

layers of the sin and are more amenableto remoal by routine handwashing. Theyare the organisms most fre%uently found

in healthcare6associated infections. Residet ,oraare attached to deeper

layers of the sin and are more resistantto remoal.

The hands of some caregiers may becomepersistently coloni-ed with residentpathogenic 3ora such as yeast andStaphylococcus aureus, a gram6negatiebacilli.

Inestigators hae found that although the


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Sin

Sin irritation caused by

chemicals, remoal of tape, and other physicaldisruptions leads to a decrease in the sin7sbarrier function proided by glycerolipids andsterols in the sin.

(etergents and acetones remoe these protectiesecretions. 8hen they are remoed, it taes thesin about hours for 9ust half of the normal

barrier function of these protectie secretions toreturn and : to days for their barrier function tocompletely return.

Thus, caregiers need to nourish the sin of their

own hands with protectie creams or lotions.


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Had tras'issio

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Hands are the mostcommon ehicle totransmit health careassociated organisms

Transmission of healthcare associatedorganisms from one

patient to another iahealth care proiderhands re%uires 5ese%uential steps


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Organisms (S. aureus, P. mirabilis,

Klebsiella spp andAcinetobacter spp.)

present on intact areas of some patients

sin: !""-! million colony forming units

(#$U%&cm'

early ! million sin s)uames containing

viable organisms are s*ed daily from

normal sin

+atient environment (bed linen, furniture,

obects% becomes contaminated

(especially by stap*ylococci and

enterococci% by patient organisms

Hand transmission: Step 1(The Lancet Infectious Diseases 2006)

Organisms present on patient skin and environment surfaces


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urses could contaminate t*eir *ands .it*

!""-!,""" #$U of Klebsiella spp.during

/clean0 activities (lifting patients, taing t*e

patient1s pulse, blood pressure, or oral

temperature%

!2 per cent of nurses .oring in an isolation

unit carried a median of !",""" #$U of S.

aureuson t*eir *ands

3n a general *ospital, '4per cent nurses

carried S. aureuson t*eir *ands (median

count, 5,6"" #$U% and !7-5" per centcarried

8ram- negative bacilli (median counts:

5,9""-56,""" #$U%


Organisms transfer on health care providers hands examples:


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Organisms survival on hands

$ollo.ing contact .it* patients and&or contaminated environment, organisms

can survive on *ands for differing lengt*s of time ('-" minutes%

3n t*e absence of *and *ygiene, t*e longer t*e duration of care, t*e *ig*er

t*e degree of *and contamination



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Insufficient amount of product,

and/or insufficient technique

and duration of hand hygiene

action lead to poor handcleaning

Transient organisms may still

be recovered on hands

following handwashing with

soap and water, whereas

handrubbing with an alcohol-based hand rub has been

proven significantly more

effective


Defective hand cleansing results in hands remaining contaminated


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In many outbreas, organismtransmission betweenpatients and from theenironment &both the healthcare setting and patientenironment* to patientsthrough health careproiders7 hands has beendemonstrated


Contaminated hands crosstransmit organisms


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Eviro'etal "o-r&es o%Patho$es

Co''o &ota'iats in the healthcare setting aregram6negatie bacilli, Staphylococcus aureus, Enterococci,and Clostridium difcile.

'aregiers may contaminate their hands or gloes merelyby touching iai'ate o(.e&ts. ;atient gowns, bed linen,bedside furniture, and other ob9ects in the patient7simmediate enironment can easily become contaminatedwith pathogenic organisms. Other ob9ects in patient rooms


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Nails ad i%e&tios!rti5cial nails, enhancements, long nails linedto >I'? outbrea and surgical site infections

>I'? Outbrea of P. aerunginosa$)))

+ &") per cent* neonates a@ectedA B: per cent

died

'ared for by nurses with same strain C one with

long natural nails and one with arti5cial nails

>I'? Outbrea of K. pneumonia$))+

"D &+: per cent* neonates a@ected

'ared for by nurse with arti5cial nails with

same strain

Health care proiders who bite their nailssigni5cantly are more liely to hae fecalcarriage of resistant Enterococci

1olenar ICHE$)))A /upta ICHE$))+A ;assaroJID"2:4DD$6:A ;arry CID$))"A

Reproduced .it* permission from ;r< =< Rot*, T*e Otta.a >ospital


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Lo$ ails ad .e)eller!iter%ere )ith e/e&tive had

h!$iee

Rings increase the number ofmicroorganisms present on

hands and increase the risk

of tears in gloves

!cema often starts under a

ring as irritants may be

trapped under ring causingirritation"

#rm $ewellery interferes with

the action of hand hygiene

%ong nails are&

difficult to clean

can pierce gloves

harbour more micro-

organisms than short nails

#rtificial nails and nailenhancements have been

implicated in the transfer of

microorganisms

NAILS JEWELLERY


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!ntiseptics

!ppendi= 1any chemicals %ualify as antiseptics. The following

antiseptics are generally aailable in many parts of theworld4

)CD)G alcohols &ethyl, isopropyl or methylated spirit* $C+G chlorhe=idine gluconate &HibiclensJ, HibiscrubJ,

HibitaneJ*

'hlorhe=idine gluconate and cetrimide, ariousconcentrations &SalonJ*

BG iodineA a%ueous iodine and alcohol6containing &tinctureof iodine*products

2.:C")G iodophors, arious concentrations &etadineJ or8escodyneJ*

).:C+G chloro=ylenol &;ara6chloro6meta=ylenol or ;'1K*arious concentrations &(ettolJ*


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!echni"ues for performing hand h#giene

$eep nails short and clean

%emove rings and bracelets

Do not &ear artificial nails

%emove chipped nail polish 'ake sure that sleeves are

rolled up and do not get &et

Clean hands for at least

() seconds

Dr# hands thoroughl#

*ppl# lotion to hands fre"uentl#

!o clean hands properl#:

rub all parts of t*e *ands .it* an alco*ol-based *and rub or soap and

running .ater

pay special attention to fingertips, bet.een fingers, bacs of *ands and

base of t*e t*umbs


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Handrubbin !it" a#$o"o#%based so#utions

and Hand!as"in

+and&ashing

Lather 15 secondsup to 1.5 min for

entire procedure

Alcohol-based

Handrubbing

15 sec


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23Pittet and Boyce, The Lancet Infectious Diseases 2001

App#i$ation time o& "and "'iene ("and!as"in and

"andrubbin) and redu$tion o& ba$teria# $ontamination

'and hygiene with&

'andwashing'andrubbing

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Had &are is i'#ortat

Intact sin is the 5rstline of defence againstorganisms.

Organisms can entersin that is craced orbroen.

Fre%uent hand hygienecan dry hands.

!o reduce skin dr#ness and irritation: use .arm running .ater instead of *ot .ater

.*en .as*ing *ands rinse t*oroug*ly and pat *ands dry .it* a

paper to.el instead of rubbing t*em $re)uently use t*e lotion t*at is provided by

t*e facility< protect *ands '9&7 from c*emicals and

e?treme conditions at *ome and .or (e


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Ta*i$ &are o% health

&are #rovider hads


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De0itio o%Patiets

Eviro'et


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1he ad ho) to

&lea hads

Documents

Session 6& 7 - Just Clean Your Hands