Presented by :

Abdullah A. Idrees

 Hand hygiene Handwashing

Definitions

Performing handwashing, antiseptic handwash, alcoholbased handrub, surgical hand hygiene/antisepsis 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!

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How disease spreads

Infectious diseases can spread in a variety of ways.

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Common Microbes

Microbes found on a cutting board.

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E Coli

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Staphylococcus aureus
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Proper hand washing with soap and water

Follow 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

How to handrub
To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps. This takes only 2030 seconds!

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How to handwash
To effectively reduce the growth of germs on hands, handwashing must last 4060 secs and should be performed by following all of the illustrated steps

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Hand hygiene and glove use

GLOVES PLUS HAND HYGIENE = CLEAN HANDS GLOVES WITHOUT HAND 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 patients 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 tasks

Culture 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 hygiene Therefore 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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The golden rules for hand hygiene

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)
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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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The geographical conceptualization of the transmission risk

HEALTH-CARE ZONE
PATIENT ZONE
Critical site with infectious risk for the patient

Critical site with body fluid exposure risk

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

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H Sax, University Hospitals, Geneva 2006

5 Moments for Hand Hygiene

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Patient
Refers 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 patients 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 1 Before Touching a Patient

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When:

Examples:

Touching a patient in any way

Moment 1

Shaking hands, Assisting a patient to move, most Allied health interventions, Touching any invasive medical device connected to the patient (eg. IV pump, IDC) Bathing, Dressing, Brushing hair, Putting on personal eg. Glasses Taking a pulse, Blood pressure, Oxygen saturation, Temperature, Chest auscultation, Abdominal palpation, Applying ECG electrodes, CTG

Any personal care activities

Any non-invasive observations

Any non-invasive treatment

Applying an oxygen mask or nasal cannula, Fitting slings/braces, Application of incontinence aids (including condom drainage)

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Moment 2 Before 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 patients body.
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Moment 2
When:
Insertion of a needle into a patients skin, or into an invasive medical device Preparation and administration of any medications given via an invasive medical device, or preparation of a sterile field

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

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

Administration of medications Eye drop installation, where there is direct contact with Suppository insertion, mucous membranes Vaginal pessary

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Moment 2
When: Insertion of, or disruption to, the circuit of an invasive medical device Examples:
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 nonintact 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 3 After a Procedure or Body Fluid Exposure Risk

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Body Fluid Exposure Risk

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

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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 3
When:
After any Moment 2

Examples:

See 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 4 After Touching a Patient

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Moment 5
After touching a patients immediate surroundings when the patient has not been touched

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Moment 5
When:
After touching the patients immediate surroundings when the patient has not been touched

Examples:
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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