This document discusses the importance of hand hygiene in preventing infection. It provides three key points: 1) In 1847, it was noticed that maternal mortality increased when physicians treated patients compared to nurses, because physicians saw more patients and could spread "evil ghosts." Insisting that physicians clean hands between patients reduced mortality. 2) Despite good evidence, the practice of hand cleaning was not widely adopted for 40 years. 3) A study found many disease-causing bacteria on the hands even of nurses, showing how important hand hygiene is to prevent spread of infection.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Hand
hygiene
Dr fatma salah elnaggar
Infection preventionist
Assuit University Hospital
Infection control unit

2. Standard Precautions
= every pt. … every time
Hand hygiene
PPE
Aseptic
technique
Decontamination
Waste Management
Linen & laundry
Environmental
cleaning

3. Is there evidence that handwashing matters?
• 1847- I.Selmewwis notice that maternal mortality increase
when were treated by physicians in the comparison by if
treated by nurses,,,, he thought that the cause was that ,
the physician make another procedure and deal with more
pt. ,, so he may bring evil ghost to pregnant women ….. So
he insisted that physicians clean hands with chlorine
between each patient,, so Maternal mortality dropped &
stayed low.
• Forty years later the practice was not widely used.. despite
good evidence.

4. (
‫ميكروبات‬
‫الجلد‬
)
Microbial Flora of the Skin
 Resident microorganisms( (
‫الجراثيم‬
‫المستوطنة‬ (colonizing or
endogenous flora) include Staphylococcus species and diptheroids.
These microorganisms are considered permanent residents of the
skin and are not readily removed by mechanical friction. Resident
microorganisms in the deep layers may not be removed by
handwashing with plain soaps and detergents, but they can usually
be killed or inhibited by hand hygiene with products that contain
antimicrobial ingredients.
 Transient microorganisms( (
‫الجراثيم‬
‫العابرة‬ (non-colonizing or
exogenous flora) include microorganisms that come into contact
with skin through interactions with patients, with equipment, or with
the environment. Non-colonizing flora are not consistently present in
the majority of persons and survive only a limited period of time. These
organisms are most frequently associated with Hospital-acquired
infections and are often acquired through activities that involve close
contact with a patient’s secretions or excreta. Non-colonizing flora are
easily removed by routine handwashing. ,,, are sticky m.o.
Video (1)

5. Blood culture of one nurse's hand

6. The 5 movement of Hand
:
Hygiene

7. Video 2

8. How to make Hand Hygiene?
 Hand wash (40 -60sec.)
- When visible contaminant
- On the beginning & end of day
- After use of bathroom & eat
 Alcohol based hand rub (20-30 sec)
must be no visible dirt
Method : video 3&4

9. o
2-3 min.)
)
Antiseptic hand wash or rub
Before urinary catheter / deep wound /burn/ deal with
cases of decrease immunity or neoborn
 Must with antiseptic compound.
 to half of forearm

10. o Surgical hand scrub: 5 min before first operation)
2-5 min before next opertaions
Before op./ C.V.P./ aspirate or C.S.F.
 Must with antiseptic compound.
 to above elbow by 5 cm (sterile zone)
 Keep hands above the level of the
waist and do not touch anything before putting
on sterile gown and surgical gloves.
 Using a sterile towel
Video (5)

11. Hand hygiene audit: (WHO form)

12. Result of H.H. audit of Assuit urology
hospital:
is 17% :O
H.H.
Movement
8% (false replaced by
gloves 88%)
Before pt.
3%
Before aseptic
25%
After body fluid
16%
After pt.
After end of all pt. 30%
falsy
After surronding

13. Hand hygine is simple… why not use?
 Handwashing agents cause skin irritation or dryness
 no sinks ,,,Lack of soap or paper towels
 Too busy/insufficient time
Understaffing/overcrowding
 Perception of low risk of acquiring infection from
patients
 Beliefs that glove use obviates the need for hand
hygiene
 No role model from colleagues or superiors
 Skepticism about the value of hand hygiene
 Lack of appreciation for its importance or lack of
knowledge of guidelines/protocols

14. Residual
effect
Appear of
effect
uses
Ideal conc.
Type of
antiseptic
no
rapidly
Hand rubbing
65-95%
alcohol
Yes
intermediate
Hand
washing
&
rub
bing
2-4%
chlorhexidin
e
+/-
intermediate
Hand washing
7.5%
iodophors
spor
es
fungal
T.B.
Non-
Envelo
ped
viruses
Envelop
ed
viruses
Gram
neg.
bacteri
a
Gram
post.
bacteri
a
Type of
antiseptic
+++
+++
++
+++
+++
+++
alcohol
+
+
+
++
++
+++
chlorhexid
ine
+/-
++
++
++
++
+++
+++
iodophors

15. Thank you 