• Save
Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why?
Upcoming SlideShare
Loading in...5
×
 

Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why?

on

  • 10,794 views

Lecture on Gloves, Alcohol Hand Rubs, Soap and Water by Patricia Lynch during the 6th International Infection Control Conference 2006

Lecture on Gloves, Alcohol Hand Rubs, Soap and Water by Patricia Lynch during the 6th International Infection Control Conference 2006

Statistics

Views

Total Views
10,794
Views on SlideShare
10,626
Embed Views
168

Actions

Likes
4
Downloads
0
Comments
0

9 Embeds 168

http://infectioncontrolsociety.org 128
http://www.slideshare.net 26
http://www.infectioncontrolsociety.org 8
http://vle.ud.edu.sa 1
http://learn.vccs.edu 1
https://swc.blackboard.com 1
http://blackboard.central.wa.edu.au 1
http://learn.idahodigitallearning.org 1
http://bb9.francistuttle.edu 1
More...

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why? Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why? Presentation Transcript

  • Gloves, Alcohol Hand Rubs, Soap and Water: Which? When? Why? Patricia Lynch, RN, MBA ICSP Conference, Pakistan, 2006
  • 2 Decades of New News
    • Some practices are better for certain situations in hospitals than HW
    • An architecture of strategies to reduce transfer of organisms on hands exists
    • Gloves have significant advantages in some situations
    • So do alcohol hand rubs
  • HW in Non-hospital Settings: Public Health
    • 26 intervention, 24 correlational studies
    • 76% from developing countries
    • 42% from community, 42% from schools, 15% in individual households
    • All 15 studies in which handwashing was the only intervention reported significant reductions in diarrhea
    • Larson, APIC 2000
  • HW Advantages
    • The ONLY way to clean soilage off skin
    • Low cost
    • Plain soap & water less irritating than some antimicrobial products
    • Equivalent to alcohol hand rub in recent study: Sickbert-Bennett E et al. AJIC 2005 p. 67
  • HW Disadvantages
    • People don’t comply
    • Hard on hand skin Larson EL Heart Lung 1997
    • Less effective than alcohol rub
    • Takes more time
    • Requires soap, H2O + towel to dry
  • HW Disadvantages
    • Soap dispenser problems: dose, drips, etc
    • Maintenance: wash, dry, refill--no topoff
    • Paper towel problems: Contaminated towel dispensers &/or hands 12% Harrison W AJIC 2003 p 387
    • Cloth towel maintenance problems: wet, soiled, HCWs avoid
  • HW Compliance Example
    • “ Wash hands before touching MM or NI Skin for all patients”
    • Observation study found compliance <40%
    • “ Put on clean gloves before touching MM or NI Skin for all patients”
    • Observation study: 80-90% consistently
    • Lynch et al Am J Infect Control 1990;18:1-12 .
  • Handwashing Is Indicated:
    • When hands are physically soiled or likely to be physically soiled
    • When a better choice is not available
  • Advantages of HW with Antimicrobial Products
    • Persistent activity against most microbes with CHG, PCMX, less with hexachlorophene, Quats and Triclosan, good coverage but skin irritation with iodophors
    • Somewhat equivalent to single use of alcohol, better than plain HW product
  • Disadvantages of HW with Antimicrobial Products
    • Approximately twice the cost of alcohol in product alone, not counting H2O, towel, maintenance and time of personnel
    • Poor compliance
    • Skin irritation
  • HW with Antimicrobial Product is Indicated:
    • When hands are likely to be soiled with microbial substances
    • When alcohol rub is not available
    • For surgical antisepsis when alcohol and a product with persistent antimicrobial activity is not available
  • Alcohol Hand Rub Advantages
    • Much better compliance than HW
    • More effective than HW with plain or anti-microbial hand products Rotter in Mayhall 1996
    • Actually demonstrated to reduce infections Hilburn J AJIC 2003 p 109
  • Alcohol Hand Rub Advantages
    • Less skin damage than HW
    • Less waste than HW or gloves
    • Less costly in time, fast acting
    • Does not require H2O or towels
  • Alcohol Hand Rub Disadvantages
    • Cost for good emollients: very important
    • Philosophical position on alcohol
    • Flammability
    • May be incompatible with some lotions and antimicrobial hand products
    • Alcohol lacks persistent activity
  • Alcohol Hand Rub is Indicated:
    • Between patient contacts
    • Before invasive procedures
    • After touching objects
    • Before touching patients
    • ? after removing gloves: 13% had transfer organisms
    • Personal hygiene ? Olsen RJ, JAMA 1993 Adams . J Hosp Infect 1992
  • Glove Advantages
    • The BEST at reducing transfer of organisms from & to hands
    • Cost-effective when used according to directions
    • Much variety in types of gloves, appropriate usage and materials
  • Glove Advantages
    • Reduces bi-directional risk for transfer of organism
    • Reduces significantly the amount of blood that penetrates from a puncture: cleans off the outside of the needle Mast JID 1993
  • Glove Disadvantages
    • Cost
    • Frequency of improper use; failure to change when needed, etc.
    • HCWs think the gloves are only to protect THEM
    • Poor quality material not uncommon
    • Adds to the solid waste stream
    • Materials react with some hand products
  • Indications for Glove Use
    • Use sterile gloves that are sterile at the time of use for likely contact with all normally sterile tissues
      • even if tissue is infected
      • re-glove for new site or new patient
      • gloves may be reprocessed for non-sterile use
  • Indications for Glove Use
    • Use clean exam gloves that are clean at the time of use for likely contact with mucous membranes or non-intact skin
      • even if tissue is infected
      • without touching other objects or materials and then touching MM or NIS
      • even for children and babies
    • Used exam gloves may be used to handle soiled equipment
  • Indications for Glove Use
    • Use appropriate gloves for likely contact with moist body substances on articles or intact skin
      • may be household gloves, reprocessed exam or surgical gloves for handling soiled equipment
      • use gloves that are long enough to cover parts that are likely to be exposed
  • Indications for Glove Use
    • Wear appropriate gloves to protect hands of HCWs when risk of puncture or blood contact is likely
  • Problems With Glove Re-use
    • Washing gloves increases the frequency and size of leaks Adams . J Hosp Infect 1992
    • Sterilizing or high-level disinfection is difficult
    • Some glove material doesn’t hold up well to reprocessing
  • Key Elements: Frequency & Duration
    • Frequency: several studies show frequency of HH <40% of indicated need (different indications) Increasing frequency is very important
    • Duration: Recent study based on 10 seconds of contact activity Sickbert-Bennett E et al. AJIC 2005 p. 67
  • Results for Correct Hand Hygiene
    • 1. Sterile gloves just before contact with normally sterile sites
    • 2. Clean gloves just before contact with mucous membranes, non-intact skin
    • 3. Hand hygiene just before touching patients & when hands are visibly soiled
    • Compliance > 90%: Infection & colonization fell 30%
    • Lynch P et al. AJIC 1990