Hand hygiene

1. HAND HYGIENE
PRINCIPLES AND IMPLEMENTATION
DR.T.V.RAO MD
DR.T.V.RAO MD 1

2. 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

3. 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

4. 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

5. Evidence of Relationship Between Hand Hygiene and
Healthcare-Associated Infections
Substantial evidence that hand
hygiene reduces the incidence of
infections
Historical study: Semmelweis
More recent studies: rates lower when
antiseptic hand washing was
performed
DR.T.V.RAO MD 5

6. 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 personnel
DR.T.V.RAO MD 6

7. 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 meals
DR.T.V.RAO MD 7

8. 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

9. Wet
hands.
Get soap. Wash
hands.
Dry
hands.
Throw
away.
1 2 3 4 5
Washing Hands Follow
the Steps
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.

10. A CASUAL HAND WASH MAY MISS
SEVERAL AREAS FROM DISINFECTION
DR.T.V.RAO MD 10

11. PRACTICE A LITTLE OF SCIENTIFIC
STEPS IN HAND WASHING
DR.T.V.RAO MD 11

12. MAKE THE BEST USE OF SCIENTIFIC
METHODS IN CRITICAL CARE OF PATIENTS
DR.T.V.RAO MD 12

13. Why we don’t wash our hands
 Too busy/insufficient time
 Patient needs take priority
 Understaffing/overcrowding
Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.
HCW are not bad
just busy!
Poor design
Poor product
More education
 Sinks are inconveniently located or lack of
sinks
 Lack of soap and paper towels
 Hand washing agents cause irritation
and dryness
 Low risk of acquiring infection from
patients
DR.T.V.RAO MD 13

14. What can we do to help change this
Provide 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

15. Glove Use
Hand hygiène is required regardless of whether
gloves are used or changed
Failure 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
recommandations
Gloves should not be washed or reused
Gloved HCWs can cause cross infections
DR.T.V.RAO MD 15

16. DR.T.V.RAO MD 16

17. 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

18. 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;
vol. 51, no. RR-16.
DR.T.V.RAO MD 18

19. 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 use
DR.T.V.RAO MD 19

20. RUB
apply to palm
ROLL
rub hands together covering
all aspects of your fingers &
hands until dry
SQUIRT
one squirt (1-3 ml) to
your hands
Easy Message
DR.T.V.RAO MD 20

21. . 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.

22. Basic message always the
same
“Clean you hands before and
after every patient touch”
Instructions always the same
 Squirt
 Rub
 Roll
EASY MESSAGE
DR.T.V.RAO MD 22

23. 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 patients
Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.
DR.T.V.RAO MD 23

24. 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,
no. RR-16.
DR.T.V.RAO MD 24

25. “Healthcare workers in a room with a
senior staff member or peer who DID NOT
wash their hands were significantly less
likely to wash their own hands”
EMERGING INFECTIOUS DISEASES FEB 2003
Failed Role Models
DR.T.V.RAO MD 25

26. - 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
Skin irritation A Limitation to
Hand Washing
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

27. CLEAN HANDS SAVES MANY LIVES
HAVE ONE OURSELVES
DR.T.V.RAO MD 27

28. HOSPITAL ADMINISTRATION THANKS
EVERYONE FOR WASHING HANDS
DR.T.V.RAO MD 28

29. 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 200:21:381-386
DR.T.V.RAO MD 29

30. • Programme Created by Dr.T.V.Rao
MD for Medical and Paramedical
Professionals
• Email
• doctortvrao@gmail.com
DR.T.V.RAO MD 30