Hand hygiene and prevention of infection in ICU Care by Dr.T.V.Rao MD

1. HAND HYGIENE
in
intensive care units
ICU’s
DR.T.V.RAO MD
Dr.T.V.RaoMD
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2. Health care Associated
Infections
 Healthcare-associated
infections affect 1.4 million
patients at any time
worldwide, as estimated by
the World Health Organization.
In intensive care units, the
burden of healthcare-
associated infections is greatly
increased, causing additional
morbidity and mortality.Dr.T.V.Rao MD
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3. Multi Drug Resistant Microbes can be
reduced with Hand hygiene
 Multidrug-resistant
pathogens are commonly
involved in such infections
and render effective
treatment challenging.
Proper hand hygiene is the
single most important,
simplest, and least
expensive means of
preventing healthcare-
associated infectionsDr.T.V.Rao MD
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4. CDC Says
 According to the Centers for Disease Control and Prevention
and World Health Organization guidelines on hand hygiene
in health care, alcohol-based hand rub should be used as
the preferred means for routine hand antisepsis. Alcohols
have excellent in vitro activity against Gram-positive and
Gram-negative bacteria, including multidrug-resistant
pathogens, such as methicillin-resistant Staphylococcus
aureus and vancomycin-resistant enterococci
Dr.T.V.Rao MD
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5. Our Hands are always
Contaminated with
Microbes
Dr.T.V.Rao MD
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6. OPTIMAL HAND
HYGEINE
 Correct hand hygiene
includes washing hands with
soap and water or using
alcohol-based hand
sanitizers (preferred). Hand
hygiene procedures should
be performed before and
after any and all direct
patient contact – even when
gloves are used.
Dr.T.V.Rao MD
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7. OPTIMAL HAND HYGEINE
 Direct patient contact includes:
examination of patient, specimen
collection, and all procedures.
Hands should be cleaned before
and after contact with the
patient’s immediate environment
or medical equipment. Hand
hygiene practices should be
performed before and after
eating, sneezing, coughing, and
using the restroom.Dr.T.V.Rao MD
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8. Every bed should have
 Every bed should have
attached alcohol based
anti-microbial instant
hand wash solution
source, which is used
before caregiver
(doctor/Nurse/relative/Par
amedical) handles the
patientDr.T.V.Rao MD
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9. Water basin
 Water basin at all
bedside has not proven
popular and successful
because of poor
compliance by one and
all and also for reasons
of space constraints and
maintenance issues.
Dr.T.V.Rao MD
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10. An operation room style sink
 An operation room style sink
with Elbow or foot operated
water supply system with
running hot and cold water
supply with antiseptic soap
solution source should be
there at a point easily
accessible and unavoidable
point, where two people can
wash hands at a time
Dr.T.V.Rao MD
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11. How you enter a ICU
 All entrants
(Irrespective of
Doctors or nurses
should don mask and
cap in ICU and
ideally an apron
which should be
replaced daily)Dr.T.V.Rao MD
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12. No dirty/soiled linen
 No dirty/soiled
linen/material should be
allowed to stay in ICU for
long times for fear of
spread of bad odour,
infection and should be
disposed off as fast as
possible. Dirty linen should
be replace regularly at
fixed intervals.
Dr.T.V.Rao MD
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13. All surrounding to be
clean
All surroundings of
ICU should be kept
absolutely clean
and green if
possible for
obvious reasons
Dr.T.V.Rao MD
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14. Care of the Catheters
 While the epidemiology of catheter infections is well
described in western literature, data from Indian
hospitals is scarce. Though one study of intermediate-
term central catheters in children reports rates of
catheter associated bloodstream infection of 1.3/1000
catheter days. The definitions of catheter infections are
very variable in the published studies and need to be
standardisedDr.T.V.Rao MD
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15. Catheters as source of
Infection
The high frequency of
fungal colonisation of
catheter tips and
candidemia (about 45%)
in a paediatric study is
also unusual and requires
further evaluation.
Dr.T.V.Rao MD
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16. Surveillance of Catheter associated
Infections
 All Institutions and
intensive care units
should measure
CABSI rates (A) 2. For
purposes of
surveillance all BSIs
count as CABSI
Dr.T.V.Rao MD
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17. Indication for culturing Blood
 Blood cultures are to be
drawn only when BSI is
clinically suspected (and
preferably before
antibiotics are started)
(A) Routine cultures of
vascular catheter tips are
not recommendedDr.T.V.Rao MD
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18. Implementation of Standard
Operating procedures
 Standard
methodology for
blood culture,
vascular catheter-tip
culture and
calculation of CABSI
rates are
encouragedDr.T.V.Rao MD
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19. Hand washing a great
priority
 Practical approaches to
promote hand hygiene in the
intensive care unit include
provision of a minimal
number of hand rub
dispensers per bed,
monitoring of compliance,
and choice of the most
attractive product. Lack of
knowledge of guidelines forDr.T.V.Rao MD
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20. Increased use of Alcohol in
Health care
 Multidisciplinary programs to
promote increased use of
alcoholic hand rub lead to
an increased compliance of
healthcare workers with the
recommended hand
hygiene practices and a
reduced prevalence of
nosocomial infections.
Dr.T.V.Rao MD
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21. Give everyone a
Clean Hand
Dr.T.V.Rao MD
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22. Program file Created by Dr.T.V.Rao
MD for Medical and Paramedical
Professionals for improving the health
care in Intensive care Units
 Email
doctortvrao@gmail.com
Dr.T.V.Rao MD
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