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Chapter 11 hand hygiene
1.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Chapter 11 1
2.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Learning Objectives Lesson 11.1: Hand Hygiene 1. Describe how the hands are a means of disease spread and differentiate between resident and transient skin flora. 2. Describe the types of products available for hand hygiene and their uses. 3. Describe the procedures for hand hygiene and when hand hygiene should be performed. 4. List properties to consider when selecting hand hygiene products and other hand hygiene considerations. 2
3.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Number one rule in infection control because hands are important sources of disease spread Normal human skin is colonized with bacteria 3
4.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Total bacteria on the hands of medical personnel have been shown to be as high as half a million, and numerous studies have shown that these hand microbes can be easily spread to others unless hand hygiene is performed. Microbiologically speaking, what we all do during the day is use our hands to take samples of the various microbes on different surfaces that surround us. At the same time, we also contaminate those surfaces with the microbes already on our hands. 4
5.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Sometimes we can see the dirt on our hands, but often we cannot see the germs we have picked up throughout the day. 5
6.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hands and Disease Spread Contaminated hands serve as a very common means of spreading microbes Hands are the main route of spread of the common cold Should perform hand hygiene more frequently 6
7.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hands and Disease Spread During a cold, the viruses are present in our respiratory fluid and nasal secretions. When we cough into our hands or blow our nose, and then touch surfaces with these contaminated hands, others can pick up our microbes by contacting the same surfaces. When we then rub our eyes, mouth, or nose or touch food we are about to eat, the transfer of microbes is completed. 7
8.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Resident and Transient Flora Two types of microbial flora on hands: Resident skin flora Transient skin flora 8
9.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Resident Flora Resident skin flora consists of microorganisms that colonize the skin and become permanent residents. These microorganisms are always on the skin and can never be removed totally, even with a surgical scrub. 9
10.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Transient Flora Transient skin flora contaminates the hands during the touching of or other exposure to contaminated surfaces. They usually do not colonize and do not survive on the hands for long periods. Transient flora can be removed or greatly reduced by routine handwashing, usually because the contaminating microorganisms remain primarily on the outer layers of the skin. 10
11.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Agents Health care personnel handwashing products contain low to medium levels of antimicrobial agents Surgical scrub products contain highest levels of antimicrobial agents Surgical scrub procedure still does not sterilize hands Alcohol-based rubs are most effective 11
12.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Agents See Table 11.1 for spectrum of hand hygiene agents. Common antimicrobial agents in hand hygiene products include alcohols (ethanol, isopropanol, propanol), chlorhexidine digluconate, iodophor, para- chlorometaxylenol (PCMX or chloroxylenol), triclosan, and quaternary ammonium compounds. 12
13.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Agents Recently, more emphasis has been placed on the use of alcohol-based hand rubs. In the past these agents were recommended mainly to be most useful when no sinks were available because rinsing the hands after using the hand rubs is not necessary. 13
14.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene Procedures Aseptic techniques associated with hand hygiene include the use of: Faucets controlled by foot pedals Elbow handles “Electric eyes” Ultrasonics Squeeze-bottle soap dispensers facilitate cross-contamination—not recommended 14
15.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. When To Perform Hand Hygiene at Work 15
16.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. When To Perform Hand Hygiene at Work Note the importance of performing hand hygiene before gloving and after removing gloves. When skin is tightly covered up, members of the resident flora dramatically increase. If you use alcohol hand rubs throughout the day, periodically (every 4 to 5 hand rubs) wash and rinse your hands to remove build- up of debris. 16
17.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Different Procedures There are many different hand hygiene procedures that depend upon many factors Beginning of the day Routine hand hygiene during the day Before surgery After surgery End of the day 17
18.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Different Procedures Step-by-step procedures for routine hand hygiene and surgical scrubbing are given in Procedure 11.1. See Box 11.2 for respiratory hygiene/cough etiquette recommendation from the CDC. 18
19.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Similarities in Steps Although steps are slightly different, there are many similarities 19
20.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Handwashing It is extremely important to remove jewelry, clean fingernails, and clean between fingers. Wearing rings with settings should be avoided when working in health care; not only does this type of jewelry harbor microorganisms, but it also can cause tearing of gloves. Be sure you are spending the appropriate amount of time when washing, rinsing, and drying. 20
21.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene for Routine Dental Procedures 21
22.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene for Routine Dental Procedures (Cont.) 22
23.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Hand Hygiene for Routine Dental Procedures (Cont.) 23
24.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Figure 11.3 A-Dispense soap using hand-free dispenser. B- Vigorously lather hands. C- Rinse under cool tap water. D- Dry hands with clean paper towel. E- Use paper towel to turn off non–hands-free faucet. F- Use an alcohol-based hand rub and rub hands together until dry (when no visible soil is present). 24
25.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Properties of Hand Hygiene Agents There are several properties to consider when choosing a handwashing agent (see Box 11.3) Besides handwashing, there are a few other considerations: Which lotions to use to prevent skin dryness 25
26.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Properties of Hand Hygiene Agents Lotions with a base of petroleum, lanolin, mineral oil, palm oil, or coconut oil have detrimental effects on latex gloves, so these types should be used only at the end of the day. Lotions containing aloe vera, glycerin, vitamin E, or vitamin A are fine to use. 26
27.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Other Hand Hygiene Considerations Use lotions to prevent skin dryness Keep nails short Don’t wear artificial nails Don’t wear hand or arm jewelry 27
28.
Copyright © 2017,
Elsevier Inc. All Rights Reserved. Other Hand Hygiene Considerations Keep nails short to allow for thorough cleaning and to prevent glove tears. One should not wear artificial nails because they can harbor microbes. One should not wear hand or arm jewelry during surgical procedures or wear hand or nail jewelry during nonsurgical procedures if they make donning gloves more difficult or compromise the appropriate fit and integrity of the gloves. Also, it’s more difficult to clean the skin beneath jewelry during hand hygiene. 28
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