Your basic message was the same no matter who you were educating
The part of role models should not be underplayed either and it was IMPORTANT TO EMPHASIZE THE EFFECT THAT SENIOR STAFF OR PEERS HAVE ON OUR BEHAVIOUR THIS WAS A STUDY SHOWING THAT STAFF WERE MUCH LESS LIKELY TO WASH THEIR OWN HANDS IF A PEER OR SENIOR MEDICAL STAFF MEMBER DIDN’T WASH THEIR HANDSWE ALL HAVE AN IMPORTANT ROLE TO PLAY - SO RECUIT ALL Staff its important not to single out any one group include the CEO, NUMs, surgeons, Psa’s everyone
Hand Hygiene at Travancore Medical College Kollam India
HAND HYGIENE PRINCIPLES AND IMPLEMENTATION AT TRAVANCORE MEDICAL COLLEGE, KOLLAM, KERALA. INDIA DR.T.V.RAO MDDR.T.V.RAO MD 1
THE WORK OF IGNAZ SEMMELWEISS• Hungarian doctor who worked in a maternity ward in Austria in the 1840’s.• There were two wards in the maternity building: One contained women due to give birth and was run by midwives. The other was used as a teaching hospital for medical students, who may have come straight from dissecting dead bodies.• The wards were cleaned no more than once a month.• The doctors rarely washed their hands and often wore dirty coats.• Semmelweiss was horrified by the number of women who died after births that were trouble free. The women developed a very high temperature and died within a few days from an illness called childbed fever.• No-one had any idea what caused this disease. No-one knew about bacteria or viruses then. DR.T.V.RAO MD 2
THE WORK OF IGNAZ SEMMELWEISS• Semmelweiss realised that more than three times as many women died from fever in the teaching ward than in the midwives’ ward. He was determined to try to reduce the number of deaths.• He looked into at each factor that was different between the two wards, but nothing that he thought of seemed to make a difference. Then a professor was accidentally cut with a knife that was getting used to study the body of a woman who had died. The professor himself died, from a disease whose symptoms were like childbed fever. DR.T.V.RAO MD 3
THE WORK OF IGNAZ SEMMELWEISS • Semmelweiss thought that there must have been something on the knife that had caused the disease. • He made all the doctors wash their hands in chlorine water before examining the women • Within a very short time, the death rate had fallen • Semmelweiss presented his findings to other doctors. His ideas were mocked.DR.T.V.RAO MD 4
Evidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSubstantial evidence that hand hygiene reduces the incidence of infectionsHistorical study: SemmelweisMore recent studies: rates lower when antiseptic hand washing was performedDR.T.V.RAO MD 5
Hand Hygiene Definitions Hand washing The application of non-antimicrobial soap and water to the surface of the hands Antiseptic hand wash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based hand rub an alcohol-containing preparation designed for application to the hands in order to reduce the number of viable organisms with maximum efficacy and speed Surgical hand hygiene/antisepsis Hand washing or using an alcohol-based hand rub before operations by surgical personnelDR.T.V.RAO MD 6
INDICATIONS FOR HAND WASHING• Hand hygiene should be performed before and after every patient contact• Hand hygiene should be performed after contact with patient’s environment• Hand hygiene should be performed after using a restroom, after removing gloves, prior to and following mealsDR.T.V.RAO MD 7
Indications for Hand Hygiene When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are visibly clean, use an alcohol- based hand rub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.DR.T.V.RAO MD 8
Washing Hands Follow the Steps 1 2 3 4 5Wet Get soap. Wash Dry Throwhands. hands. hands. away. Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children with Challenging Behavior. Tampa, Florida: University of South Florida, Early Intervention Positive Behavior Support.
A CASUAL HAND WASH MAY MISS SEVERAL AREAS FROM DISINFECTIONDR.T.V.RAO MD 10
PRACTICE A LITTLE OF SCIENTIFIC STEPS IN HAND WASHINGDR.T.V.RAO MD 11
MAKE THE BEST USE OF SCIENTIFIC METHODS IN CRITICAL CARE OF PATIENTSDR.T.V.RAO MD 12
Why we don’t wash our hands Too busy/insufficient time HCW are not bad Patient needs take priority just busy! Understaffing/overcrowding Sinks are inconveniently located or lack of sinks Poor design Lack of soap and paper towels Hand washing agents cause irritation Poor product and dryness Low risk of acquiring infection from More education patients Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.DR.T.V.RAO MD 13
What can we do to help change thisProvide easy access to hand hygiene materials Handrub solution Conveniently located: at the patient’s bedside at the patient’s room entrance in convenient / appropriate locations in high traffic public areas Working appropriately Full of product Within use by date DR.T.V.RAO MD 14
Glove UseHand hygiène is required regardless of whether gloves are used or changedFailure to remove gloves after patient contact or between dirty and clean body site care in the same patient has to be regarded as noncompliance with recommandationsGloves should not be washed or reusedGloved HCWs can cause cross infections DR.T.V.RAO MD 15
ACCORDING TO THE CDC• Wet hands with running water; place soap in palms; rub together to make a lather; scrub hands vigorously for 20 seconds; rinse soap off hands.• If possible, turn off the faucet by using a disposable paper towel.• Dry hands with a disposable paper towel. Do not dry hands on clothing.• Assist young children with washing their hands.DR.T.V.RAO MD 17
SPECIFIC INDICATIONS FOR HAND HYGIENE • Before: • Patient contact • Donning gloves when inserting a CVC • Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery • After: • Contact with a patient’s skin • Contact with body fluids or excretions, non-intact skin, wound dressings • Removing gloves Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; DR.T.V.RAO MD 18 vol. 51, no. RR-16.
WHAT TO USE AND WHEN When hands are visibly soiled use soap and water to wash If your hands are visibly CLEAN use Alcohol based hand rubes Before and after touching a patient Before and after a procedure After touching a patient’s surroundings Before and after glove useDR.T.V.RAO MD 19
Easy Message ROLL SQUIRT RUB rub hands together covering one squirt (1-3 ml) to apply to palm all aspects of your fingers & your hands hands until dryDR.T.V.RAO MD 20
. Recommendations for Hand Washing Facility: Clean at all times; Strategically located as per regulations, near bathrooms and entrances to the processing area; Dedicated to hand washing only; Liquid soap in dispenser; Hot water (43º C or 110º F); Use of disposable paper towels or air blowers; and Adjacent hand sanitizing facilities.
EASY MESSAGEBasic message always the same“Clean you hands before and after every patient touch”Instructions always the same Squirt Rub RollDR.T.V.RAO MD 22
SELF-REPORTED FACTORS FOR POOR ADHERENCE WITH HAND HYGIENE Hand washing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patientsDR.T.V.RAO MD 23 Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.
EDUCATION/MOTIVATION PROGRAMS• Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback• Implement a multidisciplinary program to improve adherence to recommended practices• Encourage patients and their families to remind HCWs to practice hand hygiene Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51,DR.T.V.RAO RR-16. no. MD 24
Failed Role Models “Healthcare workers in a room with asenior staff member or peer who DID NOT wash their hands were significantly less likely to wash their own hands”EMERGING INFECTIOUS DISEASES FEB 2003DR.T.V.RAO MD 25
Skin irritation A Limitation to Hand Washing- is an important barrier to compliance- is more fréquent with soap and water than with handrubs- is reduced and can be treated by emollient-containing solutions Boyce et al. Inf Contr Hosp Epi 2000;21:442 Kramer et al. J Hosp Infect 2002; 51:114 Larson et al. Heart Lung 2000; 29:139 Pittet. Emerging Inf Dis 2001; 2:234 DR.T.V.RAO MD 26
CLEAN HANDS SAVES MANY LIVES HAVE ONE OURSELVESDR.T.V.RAO MD 27
HOSPITAL ADMINISTRATION THANKS EVERYONE FOR WASHING HANDSDR.T.V.RAO MD 28
REFERENCES• WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) April 2006• Guideline for Hand Hygiene in Health-Care Settings.MMWR 2002:vol,51,no RR-16• HHA 5 Moments for Hand Hygiene,Advanced draft, August 2008• Pittet D,Inf .Control Hospital Epidemiology 200:21:381-386DR.T.V.RAO MD 29
• Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals • Email • firstname.lastname@example.orgDR.T.V.RAO MD 30