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Hand washing, Saving Lives

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Hand washing, Saving Lives

Hand washing, Saving Lives

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    Hand washing, Saving Lives Hand washing, Saving Lives Presentation Transcript

    • Dr.T.V.Rao MD
      Hand washing a solution to hospital infections
      Dr.T.V.Rao MD
      1
    • Most common mode of transmission of pathogens is via hands!
      So Why All the Fuss About Hand Hygiene?
      Dr.T.V.Rao MD
      2
    • Dr. Ignaz Semmelweis postulated
      He postulated that the students might be carrying the infection from their dissections to birthing mothers. He ordered doctors and medical students to wash their hands with a chlorinated solution before examining women in labour. The mortality rate in his maternity wards eventually dropped to less than one per cent.
      Dr.T.V.Rao MD
      3
    • Dr. Ignaz Semmelweis Proved the Hypothesis – Many ignored
      In the late 1840's, Dr. Ignaz Semmelweis was an assistant in the maternity wards of a Vienna hospital. There he observed that the mortality rate in a delivery room staffed by medical students was up to three times higher than in a second delivery room staffed by midwives. In fact, women were terrified of the room staffed by the medical students. Semmelweis observed that the students were coming straight from their lessons in the autopsy room to the delivery room.
      Dr.T.V.Rao MD
      4
    • Does Hand washing Work?Semmelweis - 1847
      Dr.T.V.Rao MD
      5
    • Hand-borne Microorganisms
      Presence – bacterial counts on hands range from 104 to 106
      resident microorganisms-attached to deeper layers of the skin and are more resistant to removal; less likely to be associated with HAIs.
      transient microorganisms-colonize the superficial layers of skin and amenable to removable; acquired by direct contact with patients or contaminated environment surfaces; frequently associated with HAIs.
      Dr.T.V.Rao MD
      6
    • Estimated rates of HCAI worldwide
      At any time, over 1.4 million people worldwide are suffering from infections acquired in health-care facilities
      In modern health-care facilities in the developed world: 5–10% of patients acquire one or more infections
      In developing countries the risk of HCAI is 2–20 times higher than in developed countries and the proportion of patients affected by HCAI can exceed 25%
      In intensive care units, HCAI affects about 30% of patients and the attributable mortality may reach 44%
      Dr.T.V.Rao MD
      7
    • 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 concerns 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
      Dr.T.V.Rao MD
      8
    • Hands are the most common vehicle to transmit health care-associated pathogens
      Transmission of health care-associated pathogens from one patient to another via health-care workers’ hands requires 5 sequential steps
      Hands are the major source of pathogens
      Dr.T.V.Rao MD
      9
    • Indications for Hand Hygiene
      • When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.
      • If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands.
      Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
      Dr.T.V.Rao MD
      10
    • Specific Indications for Hand Hygiene
      Before:
      Patient contact
      Donning gloves when inserting a CVC
      Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery
      After:
      Contact with a patient’s skin
      Contact with body fluids or excretions, non-intact skin, wound dressings
      Removing gloves
      Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
      Dr.T.V.Rao MD
      11
    • Efficacy of Hand Hygiene Preparations in Killing Bacteria
      Better
      Good
      Best
      Antimicrobial soap
      Plain Soap
      Alcohol-based handrub
      Dr.T.V.Rao MD
      12
    • Time Spent Cleansing Hands:one nurse per 8 hour shift
      • Hand washing with soap and water: 56 minutes
      Based on seven (60 second) handwashing episodes per hour
      • Alcohol-based handrub: 18 minutes
      Based on seven (20 second) handrub episodes per hour
      ~ Alcohol-based handrubsreduce time needed for hand disinfection ~
      Voss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.
      Dr.T.V.Rao MD
      13
    • 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
      Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
      Dr.T.V.Rao MD
      14
    • Surgical Hand Hygiene/Antisepsis
      Use either an antimicrobial soap or alcohol-based handrub
      Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer
      Alcohol-based handrub: follow manufacturer’s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap
      Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
      Dr.T.V.Rao MD
      15
    • 5 stages of hand transmission
      one
      two
      three
      four
      five
      Germs present on patient skin
      and immediate environment surfaces
      Germ transferonto health-care worker’s hands
      Germs survive on hands for several minutes
      Suboptimal or omitted hand cleansing results in hands remaining contaminated
      Contaminated hands transmit germs via direct contact with patient or patient’s immediate environment
      Dr.T.V.Rao MD
      16
    • Most frequent sites of infection and their risk factors
      LOWER RESPIRATORY TRACT INFECTIONS
      Mechanical ventilation
      Aspiration
      Nasogastric tube
      Central nervous system depressants
      Antibiotics and anti-acids
      Prolonged health-care facilities stay
      Malnutrition
      Advanced age
      Surgery
      Immunodeficiency
      13%
      URINARY TRACT INFECTIONS
      Urinary catheter
      Urinary invasive procedures
      Advanced age
      Severe underlying disease
      Urolitiasis
      Pregnancy
      Diabetes
      34%
      Most common sites of health care-associated infection and the risk factors underlying the occurrence of infections
      LACK OF HAND HYGIENE
      SURGICAL SITE INFECTIONS
      Inadequate antibiotic prophylaxis
      Incorrect surgical skin preparation
      Inappropriate wound care
      Surgical intervention duration
      Type of wound
      Poor surgical asepsis
      Diabetes
      Nutritional state
      Immunodeficiency
      Lack of training and supervision
      BLOOD INFECTIONS
      Vascular catheter
      Neonatal age
      Critical careSevere underlying disease
      Neutropenia
      Immunodeficiency
      New invasive technologies
      Lack of training and supervision
      14%
      17%
      Dr.T.V.Rao MD
      17
    • Indications for Hand washing and Hand Antisepsis
      Hands are visibly dirty or soiled, wash with nonantimicrobial soap and water or antimicrobial soap and water. Category IA
      If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands in all other clinical situations. IA. Alternatively, wash hands with antimicrobial soap and water. IB
      Before having direct contact with patients. IB
      Before donning sterile gloves when inserting a central intravascular catheter. IB
      Dr.T.V.Rao MD
      18
    • Indications for Hand washing and Hand Antisepsis
      Decontaminate hands not visibly soiled with handrub/antimicrobial (continued)
      Before inserting urinary catheter, peripheral vascular catheter, or other invasive device. IB
      After contact with a patient’s intact skin. IB
      After contact with body fluids, mucous membrane, nonintact skin or wound dressings, as long as hands are not soiled. IA
      If moving from a contaminated body site to clean site. II
      After contact with inanimate objects in vicinity of patient. II
      After removing gloves.
      Dr.T.V.Rao MD
      19
    • Adequate hand washing with water and soap requires 40–60 seconds
      Average time usually adopted by health-care workers: <10 seconds
      Alcohol-based
      hand rubbing: 20–30 seconds
      Time constraint = major obstacle for hand hygiene
      Dr.T.V.Rao MD
      20
    • Routine Hand Wash
      Repeat procedures until hands are clean
      Dr.T.V.Rao MD
      21
    • Dr.T.V.Rao MD
      22
    • The “My 5 Moments for Hand Hygiene” approach
      Dr.T.V.Rao MD
      23
    • HCAI can cause:
      more serious illness
      prolongation of stay in a health-care facility
      long-term disability
      excess deaths
      high additional financial burden
      high personal costs on patients and their families
      The impact of HCAI
      Dr.T.V.Rao MD
      24
    • Most frequent sites of infection and their risk factors
      LOWER RESPIRATORY TRACT INFECTIONS
      Mechanical ventilation
      Aspiration
      Nasogastric tube
      Central nervous system depressants
      Antibiotics and anti-acids
      Prolonged health-care facilities stay
      Malnutrition
      Advanced age
      Surgery
      Immunodeficiency
      13%
      URINARY TRACT INFECTIONS
      Urinary catheter
      Urinary invasive procedures
      Advanced age
      Severe underlying disease
      Urolitiasis
      Pregnancy
      Diabetes
      34%
      Most common sites of health care-associated infection and the risk factors underlying the occurrence of infections
      LACK OF HAND HYGIENE
      SURGICAL SITE INFECTIONS
      Inadequate antibiotic prophylaxis
      Incorrect surgical skin preparation
      Inappropriate wound care
      Surgical intervention duration
      Type of wound
      Poor surgical asepsis
      Diabetes
      Nutritional state
      Immunodeficiency
      Lack of training and supervision
      BLOOD INFECTIONS
      Vascular catheter
      Neonatal age
      Critical careSevere underlying disease
      Neutropenia
      Immunodeficiency
      New invasive technologies
      Lack of training and supervision
      14%
      17%
      Dr.T.V.Rao MD
      25
    • Why Hand Washing Reduces Diarrheal Diseases
      Diarrhoeal diseases kill more than 1.5 million children under five each year but the simple act of hand washing can reduce these diseases by >45%.
    • Many countries worldwide are committed to improve hand hygiene
      You are part of a global movement!
      Countries committed in 2005, 2006, 2007 and 2008 Countries planning to commit in 2009
      Current status, March 2009
      Dr.T.V.Rao MD
      27
    • Dr.T.V.Rao MD
      28
    • Create awareness at several places
      Hand washing is likely to be especially important where people congregate (schools, offices), where ill or vulnerable people are concentrated (hospitals, nursing homes), where food is prepared and shared and in homes, especially where there are young children and vulnerable adults.
    • Why
      Don’t Staff Wash their Hands
      (Compliance estimated at less than 50%)
      Dr.T.V.Rao MD
      30
    • Why Not?
      Skin irritation
      Inaccessible hand washing facilities
      Wearing gloves
      Too busy
      Lack of appropriate staff
      Being a physician
      (“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
      Dr.T.V.Rao MD
      31
    • Why Not?
      Working in high-risk areas
      Lack of hand hygiene promotion
      Lack of role model
      Lack of institutional priority
      Lack of sanction of non-compliers
      Lack of rewarding of compliers
      Dr.T.V.Rao MD
      32
    • Successful Promotion 
      Education
      Routine observation & feedback
      Engineering controls
      Location of hand basins
      Possible, easy & convenient
      Alcohol-based hand rubs available
      Patient education
      (Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
      Dr.T.V.Rao MD
      33
    • Teach them earlier in life
      Dr.T.V.Rao MD
      34
    • Make all Kids partners in Hand washing
      Dr.T.V.Rao MD
      35
    • Based on the evidence and recommendations from the WHO Guidelines on Hand Hygiene in Health Care (2009), a number of components make up an effective multimodal strategy for hand hygiene
      What is the WHO Multimodal Hand Hygiene Improvement Strategy?
      ONE System change
      Access to a safe, continuous water supply as well as to soap and towels; readily accessible alcohol-based handrub at the point of care
      TWO Training / Education Providing regular training to all health-care workers
      THREE Evaluation and feedback Monitoring hand hygiene practices, infrastructure, perceptions and knowledge, while providing results feedback to health-care workers
      FOUR Reminders in the workplace
      Prompting and reminding health-care workers
      FIVE Institutional safety climate
      Creating an environment and the perceptions that facilitate awareness-raising about patient safety issues
      Dr.T.V.Rao MD
      36
    • Prevention of health care-associated infection
      Validated and standardized prevention strategies have been shown to reduce HCAI
      At least 50% of HCAI could be prevented
      Most solutions are simple and not resource-demanding and can be implemented in developed, as well as in transitional and developing countries
      Dr.T.V.Rao MD
      37
    • Hand Care also includes
      Nails
      Rings
      Hand creams
      Cuts & abrasions
      “Chapping”
      Skin Problems
      Dr.T.V.Rao MD
      38
    • New CDC Hand Hygiene GuidelinesMajor Difference
      Old CDC, APIC-nonantimicrobial between most patient contacts, antimicrobial before invasive procedures or caring for high-risk patients
      New CDC-if hands are not visibly soiled, use an alcohol-based handrub for decontaminating hands in all clinical situations; alternatively, wash hands with antimicrobial soap and water
      Dr.T.V.Rao MD
      39
    • Our support to hand washing makes the difference
      HCAI places a serious disease burden and significant economic impact on patients and health-care systems
      Good hand hygiene – the simple task of cleaning hands at the right times and in the right way – saves lives
      There are 5 Moments for Hand Hygiene in Health Care
      Global compliance with the My 5 Moments for Hand Hygiene approach is universally sub-optimal
      <insert name of facility> has implemented an Action Plan to improve hand hygiene and reduce infection
      Your support and compliance with the initiatives is essential to save lives in our facility
      Dr.T.V.Rao MD
      40
    • Sir William Osler on Hand Washing
      Soap,Water and Common sense, are still the best Antiseptics.
      Dr.T.V.Rao MD
      41
    • Inspire your children on hand hygiene
      Dr.T.V.Rao MD
      42
    • The Global Hand washing Day
      The Global Hand washing Day took place for the first time on October 15, 2008, the date appointed by UN General Assembly in accordance with year 2008 as the International Year of Sanitation
    • Global Hand washing Day
      Global Hand washing Day is a campaign to motivate and mobilize millions around the world to wash their hands with soap. The campaign is dedicated to raising awareness of hand washing with soap as a key approach to disease prevention.
      Dr.T.V.Rao MD
      44
    • Dr.T.V.Rao MD
      45
    • Hand washing a Tribute to Dr. Ignaz Semmelweis
      Dr.T.V.Rao MD
      46
    • Dr.T.V.Rao MD
      47
      For Articles of Interest on microbiology and infectious diseases follow me on
    • Wish to save more lives with hand washing ……
      Visit the SAVE LIVES: Clean Your Hands website at:
      www.who.int/gpsc/5may/en/
      Dr.T.V.Rao MD
      48
    • Programme created by Dr.T.V.Rao MD for Health care workers in the Developing World
      Email
      doctortvrao@gmail.com
      Dr.T.V.Rao MD
      49