Hand hygiene , Standard Precautions , Nosocomial infections.

1. Dr . Hala Fekry

2. •Infections appearing
in conection with in
both:
in and out patients‘
stay in hospital.
•They are also known
as a hospital-
acquired infection.

3. • Infections that are acquired in hospital (48
hours or more after admission)
• Most of patients will suffer from an infection
whilst in hospital – risk increases with length
of stay
• Significant financial burden on NHS

4. •Both patients and health care personnel
(HCP) can be exposed to pathogens
•Contact with blood, oral and respiratory
secretions, and contaminated equipment
occurs
•Proper procedures can prevent transmission
of infections among patients and HCP

5. •Direct contact with blood or body fluids
•Indirect contact with a contaminated
instrument or surface
•Contact of mucosa of the eyes, nose, or mouth
with droplets or spatter
•Inhalation of airborne microorganisms

6. Pathogen
Source
ModeEntry
Susceptible Host

8. »Apply to all patients receiving care
in hospitals or health care setting,
regardless of their diagnosis or
presumed infection status

9. 1. Hand Hygiene.
2. Use of gloves, masks, eye protection, and
gowns-PPE.
3. Re-processing of equipment.
4. Aseptic techniques.
5. Environmental surfaces.
6. Waste management.
7. Injury prevention.

10.  Why Is Hand Hygiene Important?
o Hand are the most common mode of
pathogen transmission
o Reduce spread of antimicrobial
resistance
o Prevent health care-associated infections

11. o Visibly dirty
o After touching contaminated objects with
bare hands
o Before and after patient treatment (before
glove placement and after glove removal)

12. •Repeat each movement 5 times.
•Don’t forget the wrist

14. There are 3 Types of hand hygiene:
• Routine hand wash
• Antiseptic Hand Wash
• Surgical Hand wash

15. • Removal of dirt, organic material and
transient microorganisms.
• Plain soap is sufficient.
• Essential step before surgical scrub.
• Done before antiseptic hand wash or
alcohol rub if the hands are visibly
contaminated.

16. • Indications:
oBefore and after: Contact with patients.
oAfter: removing gloves.
o Before: serving meals or drinks-leaving
work.

17. • Jewelries should be removed.
• Nails should be kept short & rounded
• Hands should be dried either by using
paper or cloth towel/towels should be
placed near the sink .

18. • Plain Soap is sufficient/If bar soap is used,
small bars are preferred.
• Liquid soap containers should be cleaned
when empty & refilled with fresh soap with
an amount sufficient for only one day shift .
• Always use running water .
• Basin used for no other purpose.

19. • Inactivates transient microorganisms and
reduces concentration of resident flora.

20. • Technique:
oWet hands and forearms till 2.5cm below
the elbow.
oUse an antiseptic hand wash preparation
e.g. 70-90% ethyl alcohol +0.5% glycerin
(98+2ml).
oApply the selected product 2 min at least
(HAND WASHING TECHNIQUES)
oDry hands.

21. • Indications:
oBefore the performance of invasive
procedures.
oBefore dressing wounds.
oBefore patient care at high risk of
infection.
oBefore the preparation of intravenous
fluids and medication.

22. • The Guideline is designed to encourage
alcohol-based hand rub in order to :
make cleaning your hands faster, more
convenient and easier .
increase adherence of healthcare workers to
hand hygiene procedures
reduce the spread of microorganisms in
healthcare settings

23. • If hands are not visibly soiled or contaminated
with blood or body fluids, use it for routinely
cleaning your hands, otherwise you must
wash your hands routinely with soap and
water.
• Apply 3 to 5 ml of an alcohol gel or rinse to the palm of
one hand, and rub hands together.

24. • Cover all surfaces of your hands and fingers
including areas around/under fingernails.
• Continue rubbing hands together until alcohol
dries

25. • Remove all jewelry.
• Adjust water to warm
temp, wash thoroughly
hands & forearm to 5 cm
above the elbow to
remove dirt & transient
flora

26. • Clean under finger nail & around the nail
bed with a nail cleaner prior to performing
the first surgical scrub of the day (SOFT
BRUSH-SPONGE)
• Holding hand up above the level of elbow,
apply antimicrobial agent, using a circular
motion(3-5min)

27. • Rinse each arm separately,
fingertips first, holding hands
above the level of the elbow.
• Using a sterile towel , dry the
finger tips to 5 cm above the
elbow. Use one side of the
towel to dry the first hand &
the other side of the towel to
dry the second hand.

28. • Keep hands above the level of the waist &
do not touch anything before putting on
sterile gown & surgical gloves.

29. Good Better Best
Plain Soap Antimicrobial
soap
Alcohol-based
hand rub

31. • A major component of Standard Precautions
• Protects the skin and mucous membranes
from exposure to infectious materials in spray
or spatter
• Should be removed when leaving treatment
areas

32. • Gloves – protect hands
• Gowns/aprons – protect skin and/or clothing
• Goggles – protect eyes
• Face shields – protect face, mouth, nose,&
eyes
• Foot wear
PPE

33. • PPEs should be
used in appropriate
sizes
• Should be available
and easily
accessible

34. • Don before contact with the patient, generally
before starting an invasive procedure
• Use carefully – don’t spread contamination
• Remove gloves if they become torn
• Remove and discard carefully
• Immediately perform hand hygiene

35. • Wear a surgical mask and either eye
protection with solid side shields or a face
shield to protect mucous membranes of the
eyes, nose, and mouth
• Change masks between patients
• Clean reusable face protection between
patients; if visibly soiled, clean and disinfect

36. • Wear gowns, lab coats, or uniforms that cover
skin and personal clothing likely to become
soiled with blood, saliva, or infectious material
• Change if visibly soiled
• Remove all barriers before leaving the work
area

37. • Minimize the risk of health care personnel
acquiring infections from patients
• Prevent microbial flora from being transmitted
from health care personnel to patients
• Reduce contamination of the hands of health
care personnel by microbial flora that can be
transmitted from one patient to another
• Are not a substitute for handwashing!

38. •There are three types of gloves:
Sterile gloves
No sterile gloves
Heavy duty household gloves

39. •Single use disposable sterile
•Individually wrapped item
• Indications:
o Before surgery
o Before any invasive procedure that requires aseptic technique (urinary
catheter, central venous catheter, cannulas in immunocompromised &
newborn).
o Before putting the sterile wound dressing.
o Mixing IV fluids and using multidose vials.

40. •Single use (latex glove)
• Usually not individually wrapped
•Should discard after one use.

41. •Indications:
 Starting IV lines or performing phlebotomy.
 Changing dressing or handling soiled
dressing.
 Cleaning or handling soiled equipment,
instruments or other items that may be
contaminated with blood, urine, feces or
drainage.
 Handling specimens & their containers.
 Suction the respiratory tract of a patient.

42. •Indications:
Handling medical waste ( red bag trash)
Cleaning up spills of blood or body fluids.
Using chemicals such as cleaning products &
disinfectants.
Performing environmental cleaning.

43. •Wear gloves when contact
with blood, saliva, and
mucous membranes is
possible
•Remove gloves after patient
care
•Wear a new pair of gloves for
each patient

44. Remove gloves that
are torn, cut or punctured
Do not wash, disinfect
or sterilize gloves
for reuse

45. • Sequence for
Donning PPE
o Head cover
o Mask
o Goggles or face shield
o Gown
o Gloves
• Sequence for
Removing PPE
o Gloves
o Gown
o Face shield or goggles
o Mask
o Head cover