Hand hygiene

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  • WHY DO PEOPLE NOT WASH THEIR HANDS???
  • Hand hygiene

    1. 1. 1
    2. 2.  Is generally poorly adhered to across the board by all levels of Health Care Worker’s Hands: the most common way transporting microorganisms, & subsequently causing infection in patients seeking medical advice/care in health care facilities. 2
    3. 3. HCWs can get 100 or 1000 of Germs on their hands by doing simple tasks, such as:◦ Putting patients up in bed◦ Taking blood pressure or pulse◦ Touching a patients hand◦ Rolling patients over in bed◦ Touching the patients gown or bed sheets◦ Touching equipment like bed side rails, over bed tables, IV pumps 5
    4. 4. • Following contact with patients and/or contaminated environment, germs can survive on hands for differing lengths of time (2-60 minutes)• In the absence of hand hygiene action, the longer the duration of care, the higher the degree of hand contamination 6
    5. 5.  Contaminated HCWs hands have been associated with endemic Health Care Associated Infections and also with several HCAI outbreaks 7
    6. 6.  Prevention of spread of microorganisms in such situations necessitates hand hygiene to be adequately and properly performed. HH is considered to be the single most important practice in reducing transmission of infectious agents, and thus HCAI, during delivery of medical care. 3
    7. 7.  HH is the simplest, most effective measure for preventing nosocomial infections. Adherence of HCW’s to recommended HH practices is unacceptably low. 10
    8. 8.  Average compliance of HH recommendations varies between hospitals wards & among professional categories of HCWs according to working conditions. Compliance is usually estimated as < 50% 11
    9. 9.  Defective hand cleansing ◦ (e.g. using insufficient amount of product and / or insufficient duration of HH action) leads to poor hand decontamination Obviously , when HCWs fail to clean their hands during the sequence of care of a single patient and / or between patients contact microbial transfer is likely to occur 12
    10. 10.  Risk factors for noncompliance with HH have been determined objectively in several observational studies or interventions to improve compliance included: 13
    11. 11.  Being a physician or a nursing assistant rather than a nurse Being a male Working in an intensive care unit (ICU) Working during weekdays rather than the weekend Wearing gown and gloves Using an automated sink Performing activities with high risk for cross – transmission Many opportunities for HH per hour of patient care 14
    12. 12. RESIDENT HAND FLORA (commensals)  Low virulence, survive & multiply on skin  Protective function  Not easily removed by mechanical washing e.g. Coag. Neg. staph., Diphtheroids, anaerobic cocci, 15
    13. 13. TRANSIENT MICRO-ORGANISMSEasily acquired and transferred bydirect contact. Loosely attached to skin surface. Most abundant around finger tips. Important source of cross-infection eg, Staph. aureus, Streptococci, Gram-ve bacilli (E.coli, pseudomonas aeruginosa, klebsiella,acinetobacter, etc) 16
    14. 14. Handwashing  Washing hands with plain soap and water Remove soil/dirtAntiseptic handwash  Washing hands with water and an antiseptic soap or detergents Remove soil/dirt and transient micro-organismsAlcohol-based handrub  Rubbing hands with an alcohol-containing preparation Remove transient microorganisms 17
    15. 15. WHY IS HAND HYGIENE IMPORTANT ???? 18
    16. 16.  Most common mode of transmission Most important factor in preventing spread of organisms Reduce number of infections Decrease patient length of stay Decrease use of resources Reduce number of deaths 19
    17. 17.  USA:  Up to 2 million HAI/yr,  80,000 of them may contribute to death, and  generate 4.5 to 5.7 billion USD additional expenses/yr (WHO figures, 2005). UK:  320,000 HAI/yr,  5,000 of them may contribute to death, and  generate £1 billion additional expenses /year (WHO figures, 2005). 20
    18. 18. ?Why don’t we wash our hands Too busy/insufficient time HCW are not bad Patient needs take priority just busy! Understaffing/overcrowding Sinks are inconveniently located or Poor design lack of sinks Lack of soap and paper towels Hand washing agents cause Poor product irritation and dryness Low risk of acquiring infection More education from patients .Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386 22
    19. 19. Poor design Sinks areinconveniently located 23
    20. 20.  Interventions aimed at improving compliance with HH must be based on the various levels of behaviour interaction Thus, the interdependence of: Individual factors, Environmental constrains, and Institutional climateShould be considered in strategic planning and development of HH promotion campaigns 25
    21. 21. How can we overcome problems associated with hand washing? ! A quick and easy solution An Alcohol Based Hand Rub (ABHR) 26
    22. 22. More EffectiveIn Reducing The Number Of Bacteria On Hands Ability of Hand Hygiene Agents to Reduce Bacteria on Hands % log Time After Disinfection 99.9 3.0 0 60 180 minutes Bacterial Reduction 99.0 2.0 Alcohol-based handrub 90.0 1.0 Antimicrobial soap 0.0 0.0 Plain soap Baseline 27
    23. 23. Reduces bacterial count on handsMore effective for standard hand washReduces adverse outcomes/costs associated with HAI’sRequires less timeLess irritatingCan be readily accessible/portable 28
    24. 24. ◦ At every bed (ICU, Burn, ER)◦ At every ward entrance◦ Ward trolley◦ Entrance to every room◦ On every incubator 29
    25. 25. ◦ ABHR (gel , rinse or foam) should be used routinely to clean staff hands between patient contacts, as long as hands are not visibly dirty◦ After having contact with body fluids, wounds or broken skin.◦ After touching equipment or furniture near the patient◦ After removing gloves 30
    26. 26. ◦ An amount of 1.5 to 3 ml of an alcohol product should be used◦ All hand surfaces including fingers and under finger nails should be covered until alcohol dries◦ The procedure should take 20 – 30 seconds 31
    27. 27. ◦ ABHR should be completely dried before putting gloves◦ After removing gloves, hands should be decontaminated◦ Allow patients to remained you to decontaminate your hand 32
    28. 28. ◦ Chlorhexidine gluconate 1% solution & Ethyl Alcohol 61 % has: Proved its excellent effect Less time in application Made to lastProvides persistent kill (up to six hours) after application. Kills up to 99% of the germs on hands 33
    29. 29. 34
    30. 30.  My 5 Moments for HH approach defines the key moments when health-care workers should perform hand hygiene. This evidence-based, field-tested, evidence-based field-tested user-centered approach is designed to be: easy to learn, logical and applicable in a wide range of settings. 35
    31. 31. WHEN? Clean your hands before touching a patient when approaching him/her. BEFORE TOUCHING1 WHY? To protect the patient against harmful germs carried on your hands. A PATIENT2 WHEN? Clean your hands immediately before performing a clean/aseptic procedure. BEFORE CLEAN/ ASEPTIC WHY? To protect the patient against harmful germs, including the patients own, PROCEDURE from entering his/her body.3 WHEN? Clean your hands immediately after an exposure risk AFTER BODY FLUID To body fluids (And after glove removal). EXPOSURE RISK WHY? To protect yourself and the health-care environment from harmful patient germs.4 WHEN? Clean your hands after touching a patient and her/his. AFTER TOUCHING Immediate surroundings, when leaving the patients side. A PATIENT WHY? To protect yourself and the health-care environment from harmful patient germs.5 WHEN? Clean your hands after touching any object or furniture in the patients AFTER immediate surrounding, when leaving even if the patient has not been touched. TOUCHING PATIENT WHY? To protect yourself and the health-care environment from harmful patient SURROUNDINGS germs. 37
    32. 32. 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
    33. 33. Can you identify the main examples of this indication during your everyday practice of health care? Some examples may be: • secretion aspiration • skin lesion care, wound dressing • catheter insertion, opening a vascular access system or a draining system • preparation of medication, dressing sets
    34. 34. Can you identify the main examples of this indication during your everyday practice of health care? 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)
    35. 35. 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
    36. 36. Can you identify the main examples of this indication during your everyday practice of health care? Some examples may be: • changing bed linen • perfusion speed adjustment • monitoring alarm • holding a bed rail • clearing the bedside table
    37. 37. We should not forget the moments wherehand hygiene is indicated and falls underhygienic or social practices i.e.: after using the toilet, preparing foodand eating, after coughing etc…
    38. 38. 45
    39. 39. AREAS FREQUENTLY AREAS FREQUENTLYMISSED DURING HANDWASHINGMISSED DURING HANDWASHING
    40. 40. Important HH Considerations Important HH Considerations Keep natural nail tips short. Avoid nail polish, artificial nails and extenders. Avoid wearing rings or other hand jewelry. Avoid hot or cold water. Use papers towel to dry hands properly. Use papers towel to turn off tap/faucet. Do not use papers towel to dry hands after using ABHR. Use hand lotions to prevent skin dryness Do not follow this by washing hands with water Pseudomon Do not use antimicrobial soap concomitantly as nail infection
    41. 41.  Education is a cornerstone for improvement of hand hygiene practices. Easy access to hand hygiene supplies, whether sink, soap, medicated detergent. Monitor HCWs adherence to recommended hand hygiene practices. Encourage patients and their families to remind HCWs to decontaminate their hand.
    42. 42.  Make improved hand hygiene adherence an institutional priority Provide appropriate administrative support and financial resources. To improve hand hygiene adherence among personnel who work in areas with high work-loads ◦ ABHR should be available in convenient locations and pocket sized to be carried by HCWs.
    43. 43. 52

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