Each year, nearly 2 million people in the United States get an infection as a result of receiving health care in a hospital and 88,000 die as a direct or indirect result of these infections. Hand-transmission is a major factor in the spread of bacteria, viruses, and other pathogens that cause disease, foodborne illnesses, and nosocomial infections. Everyone is vulnerable, but the elderly, young children, pregnant women, and those with a compromised immune system are at the highest risk.
Normal bacterial flora lives on external body surfaces and in the gastrointestinal tract. Transient floras colonize the superficial layers of the skin and are more susceptible to removal by routine handwashing. Healthcare workers often acquire these organisms during direct patient contact or from contact with contaminated environmental surfaces. Transient floras are the organisms most frequently associated with healthcare related infections. Prevention of their spread is everyone’s responsibility! We all must be aware of their devastating potential and practice excellent hand hygiene so patients, staff or State Surveyors do not have to question our process.
Unique to many other health care areas, the OR functions mostly in a sterile environment. Staff members begin each day attempting to remove as much debris and bacteria from the outside world so as not to contaminate the sterile environment of the operating room. The traditional hand scrub focuses on removing contaminants from a very allusive area, the fingernails. There is substantial scientific evidence that the area below the nail (subungual region of the hands) has the highest concentrations of bacteria and other pathogens. These pathogens can be transmitted from one patient to another via the hands of healthcare personnel, which is a leading cause of transmission of nosocomial infection. The CDC has identified the following sequence of events as modes of transmission: 1. Organisms present on a patient’s skin, or that have been shed onto inanimate objects in close proximity to a patient, must be transferred to the hands of healthcare workers. These organisms must then be capable of surviving for at least several minutes. 2. Next, hand washing or hand antisepsis by the worker must be inadequate or omitted entirely, or the agent used for hand hygiene must be inappropriate. 3. Finally, the contaminated hands of the caregiver must come in direct contact with another patient, or with an inanimate object that will come into direct contact with another patient.
As the fingernail grows out, it will eventually extend to a point where it is no longer attached to this skin. The majority of bacterial growth occurs at our fingertips adjacent to this area where the fingernail and subungual skin are no longer attached. The longer the nail, the more likely it is that bacteria can reside under its free edge. The Association of Operating Room Nurses (AORN) has issued a practice statement on artificial nails. “ Artificial nails of any type should not be worn in the perioperative setting. It does not matter whether the person is scrubbed or circulating, artificial nails are not acceptable in the operating room”.
In hand hygiene guidelines developed by the CDC’s Healthcare Infection Control Practices Advisory Committee, washing hands with soap and water is the traditional means of neutralizing bacteria, however rubbing hands with an alcohol hand rub is quickly becoming the primary means of hand hygiene to be used by healthcare personnel involved in routine patient care. The rationale behind this is the documented, increased antimicrobial efficacy of alcohol hand rubs over washing hands with either plain soap and water or an antimicrobial soap. In addition, there is the potential for increased compliance with hand hygiene because hand rubbing requires less time, results in less skin irritation, and does not require proximity to a sink. The only qualification is that the hands must be free from visible soiling prior to the use of an alcohol hand rub. As this change in hand hygiene evolves, staff must recognize the importance of using these devices and not allow them to blend into the environment, easily overlooked and unused.
As mentioned, the Operating Room is an unique environment requiring strict sterile technique to ensure the safety of their patients. Interlaced within this sterile environment is the day-to-day non-sterile operations and support requirements to ensure the surgical environment maintains sterility. At any given moment sterile and non-sterile share a very thin line within the perioperative environment. To prevent cross-contamination, a unique blending of available hand hygiene techniques must be used. Here are some basic guidelines for a Blending of handwashing and hand antisepsis · When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water. · If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands or alternatively, wash hands with an antimicrobial soap and water.
In any patient care area, and especially within the surgical suite, any time the hands go below the waist, pick up a contaminated item or in some way become non-sterile, you must remove the gloves, wash/rub your hands and re-glove. This process also must happen any time gloves are removed to review charts, use a keyboard or pen, or leave a room – remove gloves, wash/rub, and re-glove after the task is completed. Suggested Hand-hygiene technique When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use the towel to turn off the faucet. Avoid using hot water, because repeated exposure to hot water might increase the risk of dermatitis
In addition to hand washing, gloves play an important role in reducing the risks of transmission of microorganisms. However, you can not treat gloves as an impervious barrier protecting you from all evils. Wearing gloves does not replace the need for hand washing, because gloves may have small, in-apparent defects or may be torn during use, and hands can become contaminated during removal of gloves. Even the most minuscule perforation can allow a flood of microbes onto your hand without you even knowing it! Gloves are worn for three important reasons in hospitals. First , gloves are worn to provide a protective barrier and to prevent gross contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin; as mandated by the OSHA Bloodborne Pathogens Standard. Second , gloves are worn to reduce the likelihood that microorganisms present on the hands of personnel will be transmitted to patients during invasive or other patient-care procedures that involve touching a patient's mucous membranes and non-intact skin. Third , gloves are worn to reduce the likelihood that hands of personnel contaminated with microorganisms from a patient or object can transmit these microorganisms to another patient. In this situation, gloves must be changed between patient contacts and hands washed after gloves are removed.
The use of gloves does not eliminate the need for hand hygiene. Likewise, the use of hand hygiene does not eliminate the need for gloves. Gloves reduce hand contamination by 70% to 80%, prevent cross-contamination, and protect patients and health care personnel from infection. Hand rubs should be used before and after each patient just as gloves should be changed before and after each patient.
Thank you for your attention as we reviewed this very important infection prevention tool – hand hygiene! After watching this next video from the AORN, please take a moment to complete the quick post-test and return the results to your unit assistant. You will be provided a certificate of completion upon completion of your knowledge assessment.
Door county memorial hand washing made easy.ppt 2012
Hand Washing Made Easy! The Latest Guidelines on hand washing and the use of alcohol- based hand rubs
Perioperative Hand Hygiene• CDC advocates a comprehensive approach to hand hygiene using soap and water along with alcohol-based hand antiseptics• Patients, staff and State Surveyors watch closely to ensure every health care provider utilizes proper hand washing techniques to guarantee patient safety• An observed breech in established hand hygiene routine places all infection control principles in question
Hand Hygiene in the OR• OR Staff face unique hand hygiene issues – Sterile verse Clean staff duties• All staff begin their shift with a traditional hand scrub technique – Combines mechanical agitation with antiseptic wash – Removes gross particles, environmental dirt and debris from the skin and under the nails
Hand Hygiene and Nails• Health care providers who wear artificial nails are more likely to harbor gram-negative pathogens on their fingertips than are those who have natural nails, both before and after handwashing.• Long nails, both natural and artificial, can facilitate the colonization of bacteria on the hands by making handwashing less effective and the use of gloves less practical.
Hand Hygiene in the OR• Alcohol-based hand scrubs can be used to supplement throughout the day• Alcohol-based hand scrubs can be located in many locations in an OR• A problem arises: the more convenient the dispensers, the more complacent one can become to them, which can ultimately lead to an increase in surgical site infections
Two Environments of the OR• Hand hygiene must co-exist in both worlds of the OR: sterile and non-sterile• A logical approach to perioperative hand hygiene is a “blended” system using traditional hand washing and alcohol-based products
Two Environments of the OR• As a State Employee once mentioned, a “blended” approach allows staff to remove any gross contamination from their hands, while alcohol-based products provide an easy-to-implement, second-tier protection to help hands stay clean. Remember, when hands and gloves go below the waist, gloves come off and hands are washed before new gloves go on!
Why Wash Hands if Gloves were worn?• Any time gloves are removed (sterile or unsterile) you must wash your hands or at least use an alcohol-based foam• A perforated glove may have allowed microbes to enter and reside on your skin – If you do not wash your hands, you will spread these microbes to door knobs, keyboards, pens, your GI tract, etc…
Why Wash Hands if Gloves were worn?• The use of gloves do not eliminate the need for hand hygiene!• The use of hand hygiene does not eliminate the need for gloves!• Alcohol-based hand rubs should be used before and after using gloves, & before and after each patient.• Gloves must be changed whenever they migrate below the waist line or become contaminated.
Hand Hygiene in the OR •Establishing, maintaining, and improvinghealthcare environments is part ofproviding excellent care and services. Diligence with handwashing andmaintenance of short nails promotesprevention of nosocomial infections. Prevention is more invigorating thanillness and the power of prevention is inyour hands.