Who guidelines for hand hygiene

1. Standard Precautions: Hand
Hygiene
- Based on WHO guidelines from openwho.org

2. Learning objectives: By the end of this course,
participants should be able to:
 Describe hand hygiene as a critical component of infection prevention and
control;
 identify the 5 Moments for Hand Hygiene;
 discuss glove use and hand hygiene during patient care activities;
 demonstrate the correct way to wash hands with soap and water
according to the WHO-recommended method;
 demonstrate the correct way to perform hand hygiene with an alcohol-
based handrub (ABHR) according to the WHO-recommended method

3. Purpose of hand hygiene
In the health care environment microorganisms, such as
bacteria, viruses and fungi, are transmitted through various
routes.
 If not cleaned at the right moments, using the proper methods,
the hands of HCWs play an important role in spreading
microorganisms between patients.

4. Fewer HAIs means fewer
resources spent on treating
infections that could have
been prevented, and
ultimately, less morbidity and
death. Fewer
 HAIs also reduces antibiotic
use, which contributes to
decreased antibiotic
resistance. Therefore, hand
hygiene is an essential health
care intervention that saves
both lives and money!

5. 5 Moments for hand hygiene
Moment 1. Before touching a
patient
Clean your hands before
touching a patient when
approaching him/her to
protect the patient against
harmful germs carried on your
hands.
Moment 2. Before a
clean/aseptic procedure
Clean your hands immediately
before accessing a critical site
with infectious risk for the
patient to protect the patient
against harmful germs,
including the patient’s own,
entering his/her body

6. Moment 3. After body fluid
exposure risk
Clean your hands immediately
after an exposure risk to body
fluids (and after glove removal).
This will protect both you and the
health care environment from
pathogens in blood and body
fluids.
Moment 4. After touching a
patient
Clean your hands after touching a
patient and his/her immediate
surroundings, and when leaving
the patient’s side, to protect
yourself and the health care
environment from harmful
microorganisms

7. Moment 5. After touching patient’s surroundings
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 prevent the spread of
harmful microorganisms from inside the patient zone to the rest
rest of the health care environment.

9. Hand hygiene during rounds: Case study

10. Pre-op
 The patient in Bed 1 is a pre-op patient.
The rounding team performed hand
hygiene at the sink before entering the
patient zone at Bed 1. Dr Lim gives a
verbal consult on prophylactic antibiotics
ahead of the surgery. The medical chart at
the end of the bed is touched by the
resident during the case review. The
patient in Bed 1 is not touched. After the
discussion, the team moves to Bed 2.

11. Bed 2: Post-op –
Hernia repair  The patient in Bed 2 had abdominal
surgery yesterday for a hernia repair. The
medical student performed an abdominal
examination. During the exam, the patient
starts to feel unwell and vomits to the side
of the bed. The nurse helps to clean up
the vomit. After ensuring that the patient
is stable, the rounding team moves on to
Bed 3.

12. Post-op -
Appendectomy  The patient in Bed 3 is recovering from an
appendectomy. The patient is immobile
and has a urinary catheter bag. During the
rounds, Dr Lim handles the urinary
catheter bag to check urine output. The
resident changes the dressing on the
central venous catheter. After these
activities, the rounding team resumes
other duties.

13. Gloves and hand hygiene
 If an HCW is wearing gloves, it does
NOT mean that hand hygiene can be
skipped.
 Gloves are worn when contact is
anticipated with blood or other body
fluids, mucous membranes, non-
intact skin, potentially infectious
material, or chemicals (such as
cleaning solutions).
 Hand hygiene is performed before
putting on gloves.
 Remove gloves after caring for a patient.
Do not wear the same pair of gloves for
the care of more than one patient.
 When wearing gloves, remove gloves
and perform hand hygiene during
patient care if moving from a
contaminated body site to another body
site that is not contaminated

14.  Perform hand hygiene after glove
removal. It is important to know
that hand contamination often
occurs during glove removal due
to poor technique and also,
possibly, as a result of small,
undetected holes in gloves

15. Cleaning hands with soap and water
 It is important to spend the
correct amount of time on
handwashing – washing hands for
30 seconds has been shown to
remove 10 times the amount of
bacteria as washing them for 15
seconds. The entire handwashing
procedure, if done correctly,
should take 40 to 60 seconds.
 Washing hands with soap and water
(rather than using alcohol-based hand
rub) is recommended in the following
situations:
 If hands are visibly dirty or soiled, or
contaminated with blood or other
body fluids.
 After using the toilet.
 When exposure to spore-forming
pathogens,

16. 0. Wet hands with water;

17. 1. Apply enough soap to cover all hand surfaces;

18. 2. Rub hands palm to palm

19. 3.Right palm over left dorsum with interlaced fingers and vice versa;

20. 4.Palm to palm with fingers interlaced

21. 5. Backs of fingers to opposing palms with fingers interlocked;

22. 6. Rotational rubbing of left thumb clasped in right palm and vice versa;

23. 7. Rotational rubbing, backwards and forwards with clasped fingers of right hand on
left palm and vice versa

24. 8. Rinse hands with water

25. 9. Dry hands thoroughly with a single-use towel;

26. 10. Use towel to turn off faucet

27. 11. Your hands are now safe

28. Drying hands
 Air-drying (manual drying by
movement of hands).
 Note: Warm-air dryers for drying
hands are not recommended in
health facilities, as forced air can
result in the spread of pathogens
through water droplets.
 Using a paper towel or single-use
cloth to pat hands dry—towels
should not be used multiple times
or by multiple individuals because
shared towels quickly become
contaminated.

29. Cleaning hands with alcohol-based handrub
(ABHR)
 Hand hygiene with ABHR has
advantages over hand hygiene
with soap and water, including:
 It takes less time—only 20 to 30
seconds. In a very busy work
environment, ABHR can save you
time!
 ABHR can be placed directly at the
point of care, making it
convenient and easy to perform
hand hygiene within your clinical
workflow.
 Hand hygiene with ABHR does not
need sinks, water, or towels—
hands are air-dried.

31. Thank You
Presented by: Dr
Harshita Das