***Hand Hygiene is define as applying soap/solution (non-antimicrobial or antimicrobial) and water, or a waterless antimicrobial agent to the surface of the hands.**PE is designed to protect the skin and the mucous membranes of the eyes, nose, and mouth of dental health-care personnel from exposure to blood or other potentially infectious material.**Health care workers coming to contact with bacteria in their hand by doing simple tasks like:Pulling patient up in bedTaking blood pressure and pulseTouching patient handsRolling patients in bedTouching patients gown, bed or bed sheet, patient trayTouching equipment such as bed side rails, over bed tables, IV pumps, vital carts (Kampf, Löffler, & Gastmeier, 2009).
hospital-acquired pneumonia, cholera, influenza, MRSA, diarrhea, surgical site infections, catheter associated urinary infection, and Clostridium difficileinfection (C-diff)
Seven isolation categories (strict, respiratory, protective, enteric, wound and skin, discharge, and blood)
**in one acute and two convalescence and rehabilitation hospitals in Hong Kong.***The number of observed episodes for hand hygiene was 1037 and for glove use 304. Compliance with hand hygiene was 74.7% and with glove use 72.4%. In approximately two-third of episodes, participants washed their hands after each patient contact; though, 78.5% failed to rub their hands together vigorously for at least 15 seconds. The major break in compliance with glove use was failure to change gloves between procedures on the same patient. In 28Æ6% of observed glove use episodes, participants did not wear gloves during procedures that exposed them to blood, body fluids, excretion, non-intact skin or mucous membranes. Significant differences in performance scores on antiseptic hand rub were found between the two types of hospital and on glove use between the three groups of work experience
**123 families in 15-bed PICU of a medical centre located in central Taiwan***The authors developed a video-centred teaching program based on sociallearning principles to demonstrate hand-washing technique. A comparison wasmade between families who viewed the video and families who were taught the sametechniques with the aid of an illustrated poster in terms of compliance andimprovement in hand-washing skills.***A total of 123 families, who visited pediatric intensive care units, wererecruited and assigned to two groups – one experimental (61 families) and the othera comparison group (62). Participants in the comparison group were taught handwashingskills using simple illustrations. A 20-item hand-washing checklist was usedto examine hand-washing compliance and accuracy
***500 patients in Division of GeneralSurgery, King Khalid University Hospital, Riyadh, SaudiArabia.***Preoperative alcohol hand-rub preparations are as good asthe traditional surgical scrub in reducing SSI and in regardto surgeons’ skin tolerance. The alcohol hand-rub, however,was easier to use and therefore preferred by surgeons.
appropriate use of gloves was 92.3%, appropriate use of masks was 60.6%, and appropriate use of face PPE when required was 59%. Study findings also include the excess use of PPE such as gown, mask, surgical gloves etc. Variability in use of isolation terms by nurses’ decreases the adherence. and compliance with restrictions for non-immune persons entering the patient’s room was 45.4%.
physiotherapist students (21.9 ± 2.36), medical students (21.1 ± 2.35), and assistant radiologist students (20.5 ± 3.04; P < .001).
Handwashing & ppe ebp final
By Jennifer Amponsah & Abina Luitel
ObjectivesBy the end of this presentation students will; Demonstrate proper hand-washing and proper use of PPE. Verbalize at least three the importance of hand- washing and PPE in infection control. Verbalize when to wash hands and use PPE. Describe the history of hand hygiene and PPE. Describe the impact of hand washing and PPE on human health
PICO question Population: Health care workers and patients Interventions: Proper hand washing and PPE Comparison: No proper hand washing and use of PPE Outcome: Decrease spread of nosocomial infections PICO question: For Patients, does the use of proper hand washing and PPE by health care workers reduce the risk of nosocomial infection compared with improper hand washing and use of PPE?
Background Questions?? How often do you see nurses on your unit wash their hands? What is effective handwashing? What is the purpose of personal protective equipment (PPE)? How do Healthcare workers get contaminated with Bacteria ?
Introduction Hand-washing is a first break of infection, and the most effective and inexpensive ways to prevent infection including nosomical infections The majority of HAI cases are preventable through a combination of strategies including environmental control and cleaning, use of isolation precautions, and use of personal protective equipment (PPE) when appropriate(Landers, McWalters, Behta, Bufe, Ross, Vawdrey & Larson, 2010)
History of Hand-washing Concept of using antiseptic agent for hand-washing begin in 19th century In 1961, the U. S. Public Health Service produced a training film that demonstrated hand-washing techniques recommended for use by health-care workers (HCWs) In 1975 and 1985, formal written guidelines on hand- washing practices in hospitals were published by CDC(Hand hygiene for health care workers, 2009)
History of PPE In 1970, the US CDC recommended the use of seven isolation categories , later in 1983, tuberculosis isolation, drainage/secretion precautions, and blood and body fluid precautions were also included In 2007, CDC extended the level of standard precautions to incorporate safe injection practices, respiratory/cough etiquette and use of masks for invasive measures(Landers et al., 2010)
Statistics & Facts 1 in 10 person may experience nosocomial infection (Biddle, 2009) At any one time, an estimated 1.4 million people suffer from (Healthcare-associated infections) HAIs (Landers et al., 2010) Global Hand-washing Day is in October 15th of each year Hospital acquired infections account for 1.7 million infections and 99,000 deaths each year (CDC.gov)
When to Wash Hands Before and after direct contact with patient Before and after invasive procedures and sterile procedures After contact with body fluids or secretions, mucus membrane, non-intact skin, and wound dressing After contact with inanimate objects Before and after gloving (Kampf, Löffler, & Gastmeier, 2009).
Proper Hand-washing Technique Palm to palm Right palm over left dorsum and left palm over right dorsum Palm to palm, fingers interlaced Fingers to opposing palms Rotational rubbing of right thumb clasped over left and vice versa Rotational rubbing backwards and forwards(Pirie, 2010).
Selecting Appropriate PPE Anticipated exposure such as touch, splashes, sprays, blood or body fluids Categories of isolation precautions a patient Durability and appropriateness of PPE for the task PPE Fit the categories of exposure(Akridge, 2011)
Sequence for Donning PPE Gown: Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back, fasten in back of neck and waist Mask or respirator: Secure ties or elastic bands at middle of head and neck, fit flexible band to nose bridge, snug to face and below chin Goggles or face shield: Place over face and eyes to adjust Gloves: Extend to cover wrist of isolation gown(Transferring More than Patients, 2011)
Sequence of Removing PPE Gloves: Grasp outside of glove with opposite gloved hand to peel off, hold removed glove in gloved hand and slide fingers of ungloved hand under remaining glove at wrist. Peel and discard Goggles or face shield: handle by head band or ear pieces. Place in designated receptacle Gown: Unfasten ties. Pull away from neck and shoulders, touching inside of gown only. Turn gown inside out, fold or roll into a bundle and discard. Mask or respirator: Grasp bottom, then top ties or elastics and remove and discard(Transferring More than Patients, 2011)
Video for PPE http://www.youtube.com/watch?v=_IYrqiQjvyQ
Impact on Health Care WorkersExcessive hand-washing and wearing occlusive gloves can cause Sore and damaged skin Skin irritation and dryness In winter months some personnel may develop cracks in their skin that cause bleeding Darker skin has less skin irritation than darker skin Dermatitis (hand washing with soap before or after alcohol based product)(Bissett, 2007)
Impact on PatientsNosomocial infections causes Increase morbidity and mortality rate in patients Prolonged hospital stay Increase health care costs(Chen & Chiang, 2007)
Impact on Cost Estimated 1.4 million people suffer from HAIs which increased direct and indirect costs, prolonged hospitalization high rates of disability and death. In the US, estimated that HAIs account for direct hospital costs of $28.4–$45 billion per year(Landers et al. 2010)
Challenge and Barriers Skin irritation Time consuming (15-30 sec) Work load stress (too busy) Shortage of staff Availability of PPE Lack of knowledge Interfere in ability to provide care(Hinkin, Jayne & Cutter, 2008)
Research Article One In 206 hospital healthcare workers, observed episodes for hand hygiene and glove use . 74.7% for hand hygiene and 72.4% glove use . two-third of episodes, participants washed their hands after each patient contact. 78.5% failed to rub their hands together vigorously for at least 15 seconds. major break in compliance with glove use was failure to change gloves between procedures on the same patient. In 28.6% of observed glove use episodes, participants did not wear gloves during procedures that exposed them to blood, body fluids, excretion, non-intact skin or mucous membranes.(Chau, Thompson, Twinn, Lee, & Pang,2011).
Research Article Two 123 families in 15-bed PICU of a medical centre in central Taiwan A video-centered teaching program based on social learning principles The video-based teaching program was effective in increasing compliance and accuracy with a hand-washing policy among families with children in intensive care units. Study period indicate that compliance with hand washing in families in experimental group was higher than the comparison group at a statistically significant level.(Chen, & Chiang, 2007).
Research Article Three 500 patients in Division of General Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia. Preoperative alcohol hand-rub preparations are as effective as traditional surgical scrub in reducing SSI. The alcohol hand-rub easier to use and preferred by surgeons.(Al-Naami, Anjum, Afzal, Al-Yami, Al-Qahtani, Al-Dohayan, & ... Al-Saif, 2009)
Research Article Four 211 Registered Nurses from Trakya University Training and Research Hospital, Turkey participate in four curricula on infection control and to identify sources of information. There was significant increase in the quality of hand washing by the nurses after training. compliance with hand-washing recommendations was 70% before training and increased to 84% after training(Erkan, Findik, & Tokuc, 2011)
Research Article Five 317 Registered Nurses from three different hospital at campus in East-cost, US participate in describing isolation precautions correct identification of required personal protective equipment. Correct identification of hand hygiene recommendations across all scenarios was 94.6%, Identifying proper placement of patients in a private room when transmission-based precautions are required was 62.9%(Landers, McWalters, Behta, Bufe, Ross, Vawdrey, & Larson, 2010)
Research Article Six Cross-sectional studies done in 350 students studying medical, nursing, physiotherapist and assistant radiologist at Rouen University, France To evaluate the knowledge of healthcare students after four curricula on infection control and to identify sources of information The mean overall score (±SD) was 21.5 ± 2.84. Nursing students had a better mean overall score (23.2 ± 2.35)(Tavolacci, Ladner, Bailly, Merle, Pitrou, & Czernichow, 2008)
Does proper hand-washing and use of PPE helps to prevent the spread of infections???
Answer to PICO Question Six research studies analyzed support the use of proper hand washing and PPE by health care workers reduce the risk of nosocomial infection in patients compared with improper hand washing and use of PPE
Conclusion Studies show the bacteria that cause hospital acquired infections are frequently spread from patient to patient by health care workers hand CDC and many research support that proper hand-washing before and after having contacts with patients is the one most important measure for preventing the spread of infection in health care settings
Foreground Questions What are the importance of hand washing and PPE in infection control? When should healthcare workers wash their hands and use PPE? When did the concept of using antiseptic agent for hand washing begin? What are the impact of hand washing and PPE on human health?
ReferencesAkridge, J. (2011). Clinicians armor up with PPE to battle infections. Healthcare Purchasing News, 35(2), 20-26.Al-Naami, M., Anjum, M., Afzal, M., Al-Yami, M., Al-Qahtani, S., Al-Dohayan, A., & ... Al-Saif, F. (2009). Alcohol- based hand-rub versus traditional surgical scrub and the risk of surgical site infection: a randomized controlled equivalent trial. EWMA Journal, 9(3), 5.Biddle, C. (2009). Semmelweis revisited: Hand hygiene and nosocomial disease transmission in the anesthesia workstation. AANA Journal, 77(3), 229-237.Bissett, L. (2007). Skin care: An essential component of hand hygiene and infection control. British Journal Of Nursing (BJN), 16(16), 976Chen, Y., & Chiang, L. (2007). Effectiveness of hand-washing teaching programs for families of children in pediatric intensive care units. Journal Of Clinical Nursing, 16(6), 1173-1179 doi: 10.1111/j.1365- 2702.2006.01665.xChau, J., Thompson, D., Twinn, S., Lee, D., & Pang, S. (2011). An evaluation of hospital hand hygiene practice and glove use in Hong Kong. Journal Of Clinical Nursing, 20(9/10), 1319-1328.Erkan, T., Fındık, U., & Tokuc, B. (2011). Hand-washing behaviour and nurses knowledge after a training programme. International Journal Of Nursing Practice, 17(5), 464-469. doi:10.1111/j.1440- 172X.2011.01957.x
ReferencesHand hygiene for health care workers. (2009). http://www.learnwell.org/handhygiene.htmHinkin, J., Gammon, J., & Cutter, J. (2008). Review of personal protection equipment used in practice. British Journal Of Community Nursing, 13(1), 14-19.Kampf, G., Löffler, H., & Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial infections. Deutsches Aerzteblatt International, 106(40), 649-655. doi:10.3238/arztebl.2009.0649Landers, T., McWalters, J., Behta, M., Bufe, G., Ross, B., Vawdrey, D., & Larson, E. (2010). Terms used for isolation practices by nurses at an academic medical center. Journal Of Advanced Nursing, 66(10), 2309-2319. doi:10.1111/j.1365-2648.2010.05398.xPirie, S. (2010). Hand washing and surgical hand antisepsis. Journal Of Perioperative Practice, 20(5), 169-172.Tavolacci, M., Ladner, J., Bailly, L., Merle, V., Pitrou, I., & Czernichow, P. (2008). Prevention of nosocomial infection and standard precautions: Knowledge and source of information among healthcare students. Infection Control & Hospital Epidemiology, 29(7), 642-647.Transferring more than patients. (2011). Hospital Infection Control & Prevention, 38(11), 129-130.