Hand washing, Saving Lives

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Hand washing, Saving Lives

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Hand washing, Saving Lives

  1. 1. Dr.T.V.Rao MD<br />Hand washing a solution to hospital infections<br />Dr.T.V.Rao MD<br />1<br />
  2. 2. Most common mode of transmission of pathogens is via hands!<br />So Why All the Fuss About Hand Hygiene?<br />Dr.T.V.Rao MD<br />2<br />
  3. 3. Dr. Ignaz Semmelweis postulated<br />He postulated that the students might be carrying the infection from their dissections to birthing mothers. He ordered doctors and medical students to wash their hands with a chlorinated solution before examining women in labour. The mortality rate in his maternity wards eventually dropped to less than one per cent. <br />Dr.T.V.Rao MD<br />3<br />
  4. 4. Dr. Ignaz Semmelweis Proved the Hypothesis – Many ignored<br />In the late 1840's, Dr. Ignaz Semmelweis was an assistant in the maternity wards of a Vienna hospital. There he observed that the mortality rate in a delivery room staffed by medical students was up to three times higher than in a second delivery room staffed by midwives. In fact, women were terrified of the room staffed by the medical students. Semmelweis observed that the students were coming straight from their lessons in the autopsy room to the delivery room. <br />Dr.T.V.Rao MD<br />4<br />
  5. 5. Does Hand washing Work?Semmelweis - 1847<br />Dr.T.V.Rao MD<br />5<br />
  6. 6. Hand-borne Microorganisms<br />Presence – bacterial counts on hands range from 104 to 106<br />resident microorganisms-attached to deeper layers of the skin and are more resistant to removal; less likely to be associated with HAIs.<br />transient microorganisms-colonize the superficial layers of skin and amenable to removable; acquired by direct contact with patients or contaminated environment surfaces; frequently associated with HAIs.<br />Dr.T.V.Rao MD<br />6<br />
  7. 7. Estimated rates of HCAI worldwide<br />At any time, over 1.4 million people worldwide are suffering from infections acquired in health-care facilities<br />In modern health-care facilities in the developed world: 5–10% of patients acquire one or more infections<br />In developing countries the risk of HCAI is 2–20 times higher than in developed countries and the proportion of patients affected by HCAI can exceed 25%<br />In intensive care units, HCAI affects about 30% of patients and the attributable mortality may reach 44%<br />Dr.T.V.Rao MD<br />7<br />
  8. 8. Why should you clean your hands?<br />Any health-care worker, caregiver or person involved in patient care needs to be concerned about hand hygiene<br />Therefore hand hygiene concerns you!<br />You must perform hand hygiene to:<br />protect the patient against harmful germs carried on your hands or present on his/her own skin<br />protect yourself and the health-care environment from harmful germs<br />Dr.T.V.Rao MD<br />8<br />
  9. 9. Hands are the most common vehicle to transmit health care-associated pathogens <br />Transmission of health care-associated pathogens from one patient to another via health-care workers’ hands requires 5 sequential steps<br />Hands are the major source of pathogens<br />Dr.T.V.Rao MD<br />9<br />
  10. 10. Indications for Hand Hygiene<br /><ul><li>When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.
  11. 11. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands.</li></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.<br />Dr.T.V.Rao MD<br />10<br />
  12. 12. Specific Indications for Hand Hygiene<br />Before:<br />Patient contact <br />Donning gloves when inserting a CVC<br />Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery<br />After:<br />Contact with a patient’s skin <br />Contact with body fluids or excretions, non-intact skin, wound dressings<br />Removing gloves<br />Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.<br />Dr.T.V.Rao MD<br />11<br />
  13. 13. Efficacy of Hand Hygiene Preparations in Killing Bacteria<br />Better<br />Good<br />Best<br />Antimicrobial soap<br />Plain Soap<br />Alcohol-based handrub<br />Dr.T.V.Rao MD<br />12<br />
  14. 14. Time Spent Cleansing Hands:one nurse per 8 hour shift<br /><ul><li>Hand washing with soap and water: 56 minutes</li></ul>Based on seven (60 second) handwashing episodes per hour<br /><ul><li>Alcohol-based handrub: 18 minutes</li></ul>Based on seven (20 second) handrub episodes per hour<br />~ Alcohol-based handrubsreduce time needed for hand disinfection ~<br />Voss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.<br />Dr.T.V.Rao MD<br />13<br />
  15. 15. Recommended Hand Hygiene Technique<br />Handrubs<br />Apply to palm of one hand, rub hands together covering all surfaces until dry <br />Volume: based on manufacturer<br />Handwashing<br />Wet hands with water, apply soap, rub hands together for at least 15 seconds<br />Rinse and dry with disposable towel<br />Use towel to turn off faucet<br />Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.<br />Dr.T.V.Rao MD<br />14<br />
  16. 16. Surgical Hand Hygiene/Antisepsis<br />Use either an antimicrobial soap or alcohol-based handrub <br />Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer<br />Alcohol-based handrub: follow manufacturer’s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap<br />Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.<br />Dr.T.V.Rao MD<br />15<br />
  17. 17. 5 stages of hand transmission<br />one<br />two<br />three<br />four<br />five<br />Germs present on patient skin <br />and immediate environment surfaces<br />Germ transferonto health-care worker’s hands<br />Germs survive on hands for several minutes<br />Suboptimal or omitted hand cleansing results in hands remaining contaminated<br />Contaminated hands transmit germs via direct contact with patient or patient’s immediate environment<br />Dr.T.V.Rao MD<br />16<br />
  18. 18. Most frequent sites of infection and their risk factors<br />LOWER RESPIRATORY TRACT INFECTIONS<br />Mechanical ventilation<br />Aspiration<br />Nasogastric tube<br />Central nervous system depressants<br />Antibiotics and anti-acids<br />Prolonged health-care facilities stay<br />Malnutrition<br />Advanced age<br />Surgery<br />Immunodeficiency<br />13%<br />URINARY TRACT INFECTIONS<br />Urinary catheter<br />Urinary invasive procedures<br />Advanced age<br />Severe underlying disease<br />Urolitiasis<br />Pregnancy<br />Diabetes<br />34%<br />Most common sites of health care-associated infection and the risk factors underlying the occurrence of infections<br />LACK OF HAND HYGIENE<br />SURGICAL SITE INFECTIONS<br />Inadequate antibiotic prophylaxis<br />Incorrect surgical skin preparation<br />Inappropriate wound care<br />Surgical intervention duration<br />Type of wound<br />Poor surgical asepsis<br />Diabetes<br />Nutritional state<br />Immunodeficiency<br />Lack of training and supervision<br />BLOOD INFECTIONS<br />Vascular catheter<br />Neonatal age<br />Critical careSevere underlying disease<br />Neutropenia<br />Immunodeficiency<br />New invasive technologies<br />Lack of training and supervision<br />14%<br />17%<br />Dr.T.V.Rao MD<br />17<br />
  19. 19. Indications for Hand washing and Hand Antisepsis<br />Hands are visibly dirty or soiled, wash with nonantimicrobial soap and water or antimicrobial soap and water. Category IA<br />If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands in all other clinical situations. IA. Alternatively, wash hands with antimicrobial soap and water. IB<br />Before having direct contact with patients. IB<br />Before donning sterile gloves when inserting a central intravascular catheter. IB<br />Dr.T.V.Rao MD<br />18<br />
  20. 20. Indications for Hand washing and Hand Antisepsis<br />Decontaminate hands not visibly soiled with handrub/antimicrobial (continued)<br />Before inserting urinary catheter, peripheral vascular catheter, or other invasive device. IB<br />After contact with a patient’s intact skin. IB<br />After contact with body fluids, mucous membrane, nonintact skin or wound dressings, as long as hands are not soiled. IA<br />If moving from a contaminated body site to clean site. II<br />After contact with inanimate objects in vicinity of patient. II<br />After removing gloves. <br />Dr.T.V.Rao MD<br />19<br />
  21. 21. Adequate hand washing with water and soap requires 40–60 seconds<br />Average time usually adopted by health-care workers: <10 seconds<br />Alcohol-based <br />hand rubbing: 20–30 seconds<br />Time constraint = major obstacle for hand hygiene<br />Dr.T.V.Rao MD<br />20<br />
  22. 22. Routine Hand Wash<br />Repeat procedures until hands are clean<br />Dr.T.V.Rao MD<br />21<br />
  23. 23. Dr.T.V.Rao MD<br />22<br />
  24. 24. The “My 5 Moments for Hand Hygiene” approach<br />Dr.T.V.Rao MD<br />23<br />
  25. 25. HCAI can cause:<br />more serious illness<br />prolongation of stay in a health-care facility<br />long-term disability<br />excess deaths <br />high additional financial burden<br />high personal costs on patients and their families<br />The impact of HCAI<br />Dr.T.V.Rao MD<br />24<br />
  26. 26. Most frequent sites of infection and their risk factors<br />LOWER RESPIRATORY TRACT INFECTIONS<br />Mechanical ventilation<br />Aspiration<br />Nasogastric tube<br />Central nervous system depressants<br />Antibiotics and anti-acids<br />Prolonged health-care facilities stay<br />Malnutrition<br />Advanced age<br />Surgery<br />Immunodeficiency<br />13%<br />URINARY TRACT INFECTIONS<br />Urinary catheter<br />Urinary invasive procedures<br />Advanced age<br />Severe underlying disease<br />Urolitiasis<br />Pregnancy<br />Diabetes<br />34%<br />Most common sites of health care-associated infection and the risk factors underlying the occurrence of infections<br />LACK OF HAND HYGIENE<br />SURGICAL SITE INFECTIONS<br />Inadequate antibiotic prophylaxis<br />Incorrect surgical skin preparation<br />Inappropriate wound care<br />Surgical intervention duration<br />Type of wound<br />Poor surgical asepsis<br />Diabetes<br />Nutritional state<br />Immunodeficiency<br />Lack of training and supervision<br />BLOOD INFECTIONS<br />Vascular catheter<br />Neonatal age<br />Critical careSevere underlying disease<br />Neutropenia<br />Immunodeficiency<br />New invasive technologies<br />Lack of training and supervision<br />14%<br />17%<br />Dr.T.V.Rao MD<br />25<br />
  27. 27. Why Hand Washing Reduces Diarrheal Diseases<br />Diarrhoeal diseases kill more than 1.5 million children under five each year but the simple act of hand washing can reduce these diseases by >45%. <br />
  28. 28. Many countries worldwide are committed to improve hand hygiene <br />You are part of a global movement!<br />Countries committed in 2005, 2006, 2007 and 2008 Countries planning to commit in 2009<br />Current status, March 2009<br />Dr.T.V.Rao MD<br />27<br />
  29. 29. Dr.T.V.Rao MD<br />28<br />
  30. 30. Create awareness at several places<br />Hand washing is likely to be especially important where people congregate (schools, offices), where ill or vulnerable people are concentrated (hospitals, nursing homes), where food is prepared and shared and in homes, especially where there are young children and vulnerable adults. <br />
  31. 31. Why <br />Don’t Staff Wash their Hands<br />(Compliance estimated at less than 50%)<br />Dr.T.V.Rao MD<br />30<br />
  32. 32. Why Not?<br />Skin irritation<br />Inaccessible hand washing facilities<br />Wearing gloves<br />Too busy<br />Lack of appropriate staff<br />Being a physician<br />(“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)<br />Dr.T.V.Rao MD<br />31<br />
  33. 33. Why Not?<br />Working in high-risk areas <br />Lack of hand hygiene promotion<br />Lack of role model<br />Lack of institutional priority<br />Lack of sanction of non-compliers<br />Lack of rewarding of compliers<br />Dr.T.V.Rao MD<br />32<br />
  34. 34. Successful Promotion <br />Education<br />Routine observation & feedback<br />Engineering controls<br />Location of hand basins<br />Possible, easy & convenient<br />Alcohol-based hand rubs available<br />Patient education<br /> (Improving Compliance with Hand Hygiene in Hospitals. Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)<br />Dr.T.V.Rao MD<br />33<br />
  35. 35. Teach them earlier in life<br />Dr.T.V.Rao MD<br />34<br />
  36. 36. Make all Kids partners in Hand washing<br />Dr.T.V.Rao MD<br />35<br />
  37. 37. Based on the evidence and recommendations from the WHO Guidelines on Hand Hygiene in Health Care (2009), a number of components make up an effective multimodal strategy for hand hygiene<br />What is the WHO Multimodal Hand Hygiene Improvement Strategy?<br />ONE System change<br />Access to a safe, continuous water supply as well as to soap and towels; readily accessible alcohol-based handrub at the point of care <br />TWO Training / Education Providing regular training to all health-care workers<br />THREE Evaluation and feedback Monitoring hand hygiene practices, infrastructure, perceptions and knowledge, while providing results feedback to health-care workers<br />FOUR Reminders in the workplace<br />Prompting and reminding health-care workers <br />FIVE Institutional safety climate<br />Creating an environment and the perceptions that facilitate awareness-raising about patient safety issues<br />Dr.T.V.Rao MD<br />36<br />
  38. 38. Prevention of health care-associated infection <br />Validated and standardized prevention strategies have been shown to reduce HCAI<br />At least 50% of HCAI could be prevented <br />Most solutions are simple and not resource-demanding and can be implemented in developed, as well as in transitional and developing countries<br />Dr.T.V.Rao MD<br />37<br />
  39. 39. Hand Care also includes<br />Nails<br />Rings<br />Hand creams<br />Cuts & abrasions<br />“Chapping”<br />Skin Problems<br />Dr.T.V.Rao MD<br />38<br />
  40. 40. New CDC Hand Hygiene GuidelinesMajor Difference<br />Old CDC, APIC-nonantimicrobial between most patient contacts, antimicrobial before invasive procedures or caring for high-risk patients<br />New CDC-if hands are not visibly soiled, use an alcohol-based handrub for decontaminating hands in all clinical situations; alternatively, wash hands with antimicrobial soap and water<br />Dr.T.V.Rao MD<br />39<br />
  41. 41. Our support to hand washing makes the difference<br />HCAI places a serious disease burden and significant economic impact on patients and health-care systems<br />Good hand hygiene – the simple task of cleaning hands at the right times and in the right way – saves lives<br />There are 5 Moments for Hand Hygiene in Health Care<br />Global compliance with the My 5 Moments for Hand Hygiene approach is universally sub-optimal <br /><insert name of facility> has implemented an Action Plan to improve hand hygiene and reduce infection<br />Your support and compliance with the initiatives is essential to save lives in our facility<br />Dr.T.V.Rao MD<br />40<br />
  42. 42. Sir William Osler on Hand Washing<br />Soap,Water and Common sense, are still the best Antiseptics.<br />Dr.T.V.Rao MD<br />41<br />
  43. 43. Inspire your children on hand hygiene<br />Dr.T.V.Rao MD<br />42<br />
  44. 44. The Global Hand washing Day<br />The Global Hand washing Day took place for the first time on October 15, 2008, the date appointed by UN General Assembly in accordance with year 2008 as the International Year of Sanitation <br />
  45. 45. Global Hand washing Day<br />Global Hand washing Day is a campaign to motivate and mobilize millions around the world to wash their hands with soap. The campaign is dedicated to raising awareness of hand washing with soap as a key approach to disease prevention. <br />Dr.T.V.Rao MD<br />44<br />
  46. 46. Dr.T.V.Rao MD<br />45<br />
  47. 47. Hand washing a Tribute to Dr. Ignaz Semmelweis<br />Dr.T.V.Rao MD<br />46<br />
  48. 48. Dr.T.V.Rao MD<br />47<br />For Articles of Interest on microbiology and infectious diseases follow me on<br />
  49. 49. Wish to save more lives with hand washing ……<br />Visit the SAVE LIVES: Clean Your Hands website at: <br />www.who.int/gpsc/5may/en/<br />Dr.T.V.Rao MD<br />48<br />
  50. 50. Programme created by Dr.T.V.Rao MD for Health care workers in the Developing World<br />Email <br />doctortvrao@gmail.com<br />Dr.T.V.Rao MD<br />49<br />

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