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1. Department of
Anesthesia
Techniques
Title of the lecture:
Hand hygiene
Dr. Mohammed Sami
Mohammed.sami.hasan@uomus.edu.iq
Dr. Alaa Hamid

2. Definition of health care- associated infection (also
referred to as “nosocomial” or “hospital” infection)
“An infection occurring in a patient during the process of
care in a hospital or other health-care facility
which was not present or incubating at the time of
admission. This includes infections acquired in the hospital
but appearing after discharge, and also
occupational infections among staff of the facility”

3. At any time, over 1.4 million people worldwide are suffering from
infections acquired in hospital
In modern hospitals in the developed world: 5-10% of patients
acquire one or more infections
In developing countries the risk of health care-associated infection
is 2 to 20 times higher than in developed countries and the
proportion of patients affected by HAI can exceed 25%
In intensive care units, HAI affects about 30% of patients and the
attributable mortality may reach 44%

4. Most frequent sites of infection and their risk
factors
34%
17%
13%
14%

5. Major patterns of transmission of health care-
associated germs
Mode of
transmission
Transmission Examples of germs
Direct Contact e.g. transmission by shaking hands,
giving the patient a bath, abdominal
palpation
Staphylococcus aureus, Gram
negative rods, Respiratory
viruses, HAV
Indirect Contact e.g. transmission by not changing
gloves between patients, sharing
stethoscope
Salmonella spp,
Pseudomonas spp,
Acinetobacter spp,
S. maltophilia

6. Major patterns of transmission of health care-
associated germs
Mode of
transmission
Transmission dynamics Examples of
pathogens
Droplet e.g. transmission by sneezing, talking, coughing,
suctioning
Influenza virus,
Staphylococcus
aureus, Respiratory
Syncytial Virus
Airborne ; e.g. breathing Mycobacterium
tuberculosis,
Legionella spp
Common vehicle drinking contaminated water, unsafe injection Salmonella spp,
HIV, HBV, Gram
negative rods

7. Hand transmission
• Hands are the most common vehicle to transmit
health care-associated pathogens
• Transmission of health care-associated pathogens
from one patient to another via healthcare workers’
hands requires 5 sequential steps

8. FIVE STEPS for Hand transmission:
1. Germs present on patient skin and environment
surfaces
2. Germ transfer on health-care workers’ hands
3. Germ survival on hands
4. Defective hand cleansing results in hands remaining
contaminated
5. Contaminated hands cross-transmit germs

9. Adequate handwashing with water and soap requires:
1 to 1.5 minutes
Averages time usually adopted by health-care workers: < 10 secs
Time = major obstacle for hand hygiene

10. Handrubbing is the solution to obstacles to
improve hand hygiene compliance
•Handwashing with soap and water only when hands
are visibly dirty or following visible exposure to body
fluids
• Adoption of alcohol-based handrub is the gold standard in all other
clinical situations

11. Handrubbing with alcohol-based solutions to
overcome the time constraint obstacle
handwashing
1 to 1.5 min
alcohol-based
handrubbing
15 to 20 sec

12. 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:
1) to protect the patient against harmful germs carried on your
hands or present on his/her own skin
2) to protect yourself and the health-care environment from
harmful germs

13. 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
• To clean your hands, you should prefer handrubbing with an alcohol-
based formulation, if available. Why? Because it is possible right at
the point of care, it is faster, and it is more effective, and better
tolerated. You should wash your hands with soap and water only
when visibly soiled
• You must perform hand hygiene using the appropriate technique and
time duration

14. THE 5 STEPS OF HAND TRANSMISSION
Pittet D et al, Lancet Infect Dis, Oct 2006

15. YOUR 5 MOMENTS FOR HAND HYGIENE
Clean your hands before
touching a patient when
approaching him/her!
To protect the patient
against harmful germs
carried on your hands!
Clean your hands immediately
after an exposure risk to body
fluids (and after glove removal)!
To protect yourself and the
health-care environment from
harmful germs!
Clean your hands immediately
before an aseptic task!
To protect the patient against
harmful germs, including the
patient’s own, entering his/her
body! Clean your hands after touching a
patient and his/her immediate
surroundings, when leaving the
patient’s side!
To protect yourself and the
health-care environment from
harmful germs!
Clean your hands after touching any object
or furniture in the patient’s immediate
surroundings, when leaving-even if the
patient has not been touched!
To protect yourself and the health-care
environment from harmful germs!

16. Can you identify the main examples of this indication during your
everyday practice of health care?
Some examples may be:
• shaking hands, stroking an
arm
• helping a patient to move
around, get washed, giving a
massage
• taking pulse, blood pressure,
chest auscultation,
abdominal palpation

17. Some examples may be:
• oral/dental care, giving eye
drops, secretion aspiration
• skin lesion care, wound
dressing, subcutaneous
injection
• catheter insertion, opening a
vascular access system or a
draining system
• preparation of food,
medication, dressing sets
Can you identify the main examples of this indication during your
everyday practice of health care?

18. Some examples may be:
• oral/dental care, giving eye
drops, secretion aspiration
• skin lesion care, wound
dressing, subcutaneous injection
• drawing and manipulating any
fluid sample, opening a draining
system, endotracheal tube
insertion and removal
• clearing up urines, faeces,
vomit, handling waste
(bandages, napkin, incontinence
pads), cleaning of contaminated
and visibly soiled material or
areas (lavatories, medical
instruments)
Can you identify the main examples of this indication during your
everyday practice of health care?

19. Some examples may be:
• shaking hands, stroking an
arm
• helping a patient to move
around, get washed, giving a
massage
• taking pulse, blood pressure,
chest auscultation,
abdominal palpation
Can you identify the main examples of this indication during your
everyday practice of health care?

20. Some examples may be:
• changing bed linen
• perfusion speed adjustment
• monitoring alarm
• holding a bed rail
• clearing the bedside table
Can you identify the main examples of this indication during your
everyday practice of health care?

22. Hand hygiene and glove use

23. Hand Hygiene should some times be supplemented with gloves:
Gloves must be worn according to STANDARD and
CONTACT
- STERILE GLOVES INDICATED
- CLEAN GLOVES INDICATED IN CLINICAL SITUATIONS

24. STERILE GLOVES INDICATED
• Any surgical procedure
• Vaginal delivery
• invasive radiological procedures
• performing vascular access and procedures (central lines)
• Preparing:
- total parenteral nutrition
- chemotherapeutic agents
Hand hygiene should be performed as
appropriate regardless of the indications for
glove use .

25. CLEAN GLOVES INDICATED IN CLINICAL SITUATIONS
Potential for touching blood, body fluids, secretions, excretions and items visibly soiled
by body fluids
DIRECT PATIENT EXPOSURE:
• contact with blood; mucous membranes or with non-intact skin;
• potential presence of highly infectious and dangerous organisms; epidemic or emergency
situations;
• IV insertion and removal; drawing blood; discontinuation of venous line;
• pelvic and vaginal examination;
• Suctioning non-closed systems of endotracheal tubes.
INDIRECT PATIENT EXPOSURE
• emptying emesis basins;
• handlingcleaning instruments;
• handling waste;
• cleaning up spills of body fluids.
Hand hygiene should be performed when appropriate
regardless of the indications for glove use .

26. GLOVES NOT INDICATED
No potential for exposure to blood or body fluids, or contaminated environment
(except for CONTACT precautions)
DIRECT PATIENT EXPOSURE:
taking blood pressure, temperature and pulse;
performing SC and IM injections;
Bathing and dressing the patient;
transporting patient;
caring for eyes and ears (without secretions);
any vascular line manipulation in absence of blood leakage.
placing non-invasive ventilation equipment and oxygen cannula;

27. GLOVES NOT INDICATED
No potential for exposure to blood or body fluids, or
contaminated environment
(except for CONTACT precautions)
INDIRECT PATIENT EXPOSURE:
using the telephone;
writing on the patient chart;
giving oral medication;
distributing or collecting patient meal trays;
removing and replacing linen on patient bed;
moving patient furniture.

28. Hand hygiene and glove use
•The use of gloves does not replace the need of 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