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Barrier technique hand hygiene [compatibility mode]


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Dr. Nahla Abdel Kader.MD, PhD. Infection Control Consultant, MOH Infection Control Surveyor, CBAHI Infection Control Director,KKH.

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Barrier technique hand hygiene [compatibility mode]

  2. 2. International Patient Safety Goals Identification Communication Medication Eliminate Infection Falls
  3. 3. Infections Reduce the Risk of Health Careacquired Infections A collaborative process is used to develop P&P that address reducing the risk of health care–associated infections   Comply with current published and distributed hand hygiene guidelines IPSG 5: Reduce the Risk of Health Care-Associated Infections
  4. 4. So Why All the Fuss About Hand Hygiene? Most common mode of transmission of pathogens is via hands!  Infections acquired in healthcare  Spread of antimicrobial resistance
  5. 5. All health care’s works involve the hands
  6. 6. Hands are contaminated Hands spread germs
  7. 7. The health care environment is contaminated
  8. 8. Colonized or Infected: What is the Difference?  People who carry bacteria without evidence of infection (fever, increased white blood cell count) are colonized  If an infection develops, it is usually from bacteria that colonize patients  Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers
  9. 9. The Iceberg Effect Infected Colonized
  10. 10. The inanimate environment is a reservoir of pathogens X represents a positive Enterococcus culture The pathogens are ubiquitous ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL.
  11. 11. The inanimate environment is a reservoir of pathogens Recovery of MRSA , VRE & ACINITOBACTER. Devine et al. Journal of Hospital Infection. 2007;43;72-75 Lemmen et al Journal of Hospital Infection. 2004; 56:191-197 Trick et al. Arch Phy Med Rehabil Vol 83, July 2006 Walther et al. Biol Review, 2007:849-869
  12. 12. Patients are vulnerable to infection
  13. 13. Types of hand hygiene  Normal hand washing  Antiseptic hand washing  Alcohol-based hand rub Can be used instead of hand washing , if hands are not visibly soiled with blood or any other patient body fluids  Surgical hand wash
  14. 14. Routine Hand Washing
  15. 15. Antiseptic Hand Washing
  16. 16. Waterless Hand Rub “alcohol-based hand rub
  17. 17. Hand Hygiene Options Wet hands, apply soap and rub for >10 seconds. Rinse, dry & turn off faucet with paper towel. Apply to palm; rub hands until dry ~ Use soap and water for visibly soiled hands ~ ~ Do not wash off alcohol handrub ~
  18. 18. Hand rubbing is the solution to obstacles to improve hand hygiene compliance Handwashing with soap and water when hands are visibly dirty or following visible exposure to body fluids Adoption of alcoholbased handrub is the gold standard in all other clinical situations WHO Guidelines on Hand Hygiene in Health Care (2010)
  19. 19. Surgical Hand Wash
  20. 20. Areas Most Frequently Missed HAHS © 1999
  21. 21. Time constraint = major obstacle for hand hygiene   Adequate handwashing with water and soap requires 40-60 seconds Average time usually adopted by health-care workers: <10 seconds
  22. 22. What is the KKH Multimodal Hand Hygiene Improvement Strategy? ONE System change  Based on the evidence and recommendation s from the WHO Guidelines on Hand Hygiene in Health Care (2010), a number of components make up an effective multimodal strategy for hand hygiene Access to a safe, continuous water supply as well as to soap and towels; readily accessible alcohol-based handrub at the point of care TWO Training / Education Providing regular training to all health-care workers THREE Evaluation and feedback Monitoring hand hygiene practices, infrastructure, perceptions and knowledge, while providing results feedback to health-care workers FOUR Reminders in the workplace Prompting and reminding health-care workers FIVE Institutional safety climate Creating an environment and the perceptions that facilitate awareness-raising about patient safety issues
  23. 23. KKH Hand Hygiene Compliance Hand Hygiene Comment Typical Compliance Observational studies of hand hygiene report compliance rates of 42.6%-57.9% Common Reported Barriers To Compliance Insufficient time, understaffing, patient overcrowding, lack of knowledge of hand hygiene guidelines, skepticism about hand washing efficacy, inconvenient location of sinks and hand disinfectants and lack of hand hygiene promotion by the institution
  24. 24. With hand hygiene they’re dead
  25. 25.  Skin irritation  Inaccessible hand washing facilities  Wearing gloves  Too busy  Lack of appropriate staff  Being a physician (“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)
  26. 26. Why Not?  Working in high-risk areas  Lack of hand hygiene promotion  Lack of role model  Lack of institutional priority  Lack of sanction of noncompliers
  27. 27. Hand Care  Nails  Rings  Hand creams  Cuts & abrasions  “Chapping”  Skin Problems
  28. 28. Fingernails & Artificial Nails  Keep fingernails short   Allows thorough cleaning and prevents glove tears Long nails make glove placement more difficult and may result in glove perforation
  29. 29. Fingernails & Artificial Nails  Follow MCH policy regarding artificial fingernails; use of artificial fingernails is not allowed. USAF Guidelines for Infection Control in Dentistry, 2004.
  30. 30. What is the Story on Moisturizers and Lotions? ONLY USE facility-approved and supplied lotions Because:    Some lotions may make medicated soaps less effective Some lotions cause breakdown of latex gloves Lotions can become contaminated with bacteria if dispensers are refilled ~ Do not refill lotion bottles ~
  31. 31. Gloves are not substitute for Gloves are not a a substitute for handwashing! handwashing! ≠
  32. 32. Wearing gloves does not replace the need for hand hygiene  Small, inapparent defects  Frequently torn during use  Hands frequently become contaminated during removal DeGroot-Kosolcharoen 2004, Korniewicz 1999, Kotilainen 2001, Olsen 1998, Larson 2005, Murray 2001, Burke 2005, Burke 1990, Nikawa 1994, Nikawa 2006, Otis 2007
  33. 33. What is the single most important reason for healthcare workers to practice good hand hygiene? 1. To remove visible soiling from hands 2. To prevent transfer of bacteria from the home to the hospital 3. To prevent transfer of bacteria from the hospital to the home 4. To prevent infections that patients acquire in the hospital
  34. 34. How often do you clean your hands after touching a PATIENT’S INTACT SKIN (for example, when measuring a pulse or blood pressure)? pressure)? 1. Always 2. Often 3. Sometimes 4. Never
  35. 35. Estimate how often YOU clean your hands after touching a patient or a contaminated surface in the hospital? 1. 25% 2. 50% 3. 75% 4. 90% 5. 100%
  36. 36. Which hand hygiene method is best at killing bacteria? 1. Plain soap and water 2. Antimicrobial soap and water 3. Alcohol-based hand rub
  37. 37. Which of the following hand hygiene agents is LEAST drying to your skin? 1. Plain soap and water 2. Antimicrobial soap and water 3. Alcohol-based hand rub
  38. 38. It is acceptable for healthcare workers to supply their own lotions to relieve dryness of hands in the hospital. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree
  39. 39. Healthcare-associated organisms are commonly resistant to alcohol. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree
  40. 40. When a healthcare worker touches a patient who is COLONIZED, but not infected with resistant organisms (e.g., MRSA or VRE) the HCW’s hands are a source for spreading resistant organisms to other patients. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree
  41. 41. A co-worker who examines a patient with VRE, then borrows my pen without cleaning his/her hands is likely to contaminate my pen with VRE. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree
  42. 42. How often do you clean your hands after touching an ENVIRONMENTAL SURFACE near a patient (for example, a countertop or bedrail)? 1. Always 2. Often 3. Sometimes 4. Never
  43. 43. Use of artificial nails by healthcare workers poses no risk to patients. 1. Strongly agree 2. Agree 3. Don’t know 4. Disagree 5. Strongly disagree
  44. 44. Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms. 3. Don’t know 4. Disagree 5. Strongly disagree