Chapter 11 hand hygiene

Copyright © 2017, Elsevier Inc. All Rights Reserved.
Hand Hygiene
Chapter 11
1

Learning Objectives
Lesson 11.1: Hand Hygiene
1. Describe how the hands are a means of
disease spread and differentiate between
resident and transient skin flora.
2. Describe the types of products available for
hand hygiene and their uses.
3. Describe the procedures for hand hygiene
and when hand hygiene should be
performed.
4. List properties to consider when selecting
hand hygiene products and other hand
hygiene considerations.
2

Hand Hygiene
 Number one rule in infection control because
hands are important sources of disease
spread
 Normal human skin is colonized with bacteria
3

Hand Hygiene
 Total bacteria on the hands of medical personnel
have been shown to be as high as half a million,
and numerous studies have shown that these
hand microbes can be easily spread to others
unless hand hygiene is performed.
 Microbiologically speaking, what we all do during
the day is use our hands to take samples of the
various microbes on different surfaces that
surround us. At the same time, we also
contaminate those surfaces with the microbes
already on our hands.
4

Hand Hygiene
 Sometimes we can see the dirt on our hands,
but often we cannot see the germs we have
picked up throughout the day.
5

Hands and Disease Spread
 Contaminated hands serve as a very
common means of spreading microbes
 Hands are the main route of spread of the
common cold
 Should perform hand hygiene more frequently
6

Hands and Disease Spread
 During a cold, the viruses are present in our
respiratory fluid and nasal secretions.
 When we cough into our hands or blow our
nose, and then touch surfaces with these
contaminated hands, others can pick up our
microbes by contacting the same surfaces.
 When we then rub our eyes, mouth, or nose
or touch food we are about to eat, the transfer
of microbes is completed.
7

Resident and Transient Flora
 Two types of microbial flora on hands:
 Resident skin flora
 Transient skin flora
8

Resident Flora
 Resident skin flora consists of
microorganisms that colonize the skin and
become permanent residents.
 These microorganisms are always on the skin
and can never be removed totally, even with
a surgical scrub.
9

Transient Flora
 Transient skin flora contaminates the hands
during the touching of or other exposure to
contaminated surfaces.
 They usually do not colonize and do not
survive on the hands for long periods.
 Transient flora can be removed or greatly
reduced by routine handwashing, usually
because the contaminating microorganisms
remain primarily on the outer layers of the
skin.
10

Hand Hygiene Agents
 Health care personnel handwashing products
contain low to medium levels of antimicrobial
agents
 Surgical scrub products contain highest levels
of antimicrobial agents
 Surgical scrub procedure still does not sterilize
hands
 Alcohol-based rubs are most effective
11

Hand Hygiene Agents
 See Table 11.1 for spectrum of hand hygiene
agents.
 Common antimicrobial agents in hand
hygiene products include alcohols (ethanol,
isopropanol, propanol), chlorhexidine
digluconate, iodophor, para-
chlorometaxylenol (PCMX or chloroxylenol),
triclosan, and quaternary ammonium
compounds.
12

Hand Hygiene Agents
 Recently, more emphasis has been placed on
the use of alcohol-based hand rubs.
 In the past these agents were recommended
mainly to be most useful when no sinks were
available because rinsing the hands after
using the hand rubs is not necessary.
13

Hand Hygiene Procedures
 Aseptic techniques associated with hand
hygiene include the use of:
 Faucets controlled by foot pedals
 Elbow handles
 “Electric eyes”
 Ultrasonics
 Squeeze-bottle soap dispensers facilitate
cross-contamination—not recommended
14

When To Perform Hand
Hygiene at Work
15

When To Perform Hand
Hygiene at Work
 Note the importance of performing hand
hygiene before gloving and after removing
gloves.
 When skin is tightly covered up, members of
the resident flora dramatically increase.
 If you use alcohol hand rubs throughout the
day, periodically (every 4 to 5 hand rubs)
wash and rinse your hands to remove build-
up of debris.
16

Different Procedures
 There are many different hand hygiene
procedures that depend upon many factors
 Beginning of the day
 Routine hand hygiene during the day
 Before surgery
 After surgery
 End of the day
17

Different Procedures
 Step-by-step procedures for routine hand
hygiene and surgical scrubbing are given in
Procedure 11.1.
 See Box 11.2 for respiratory hygiene/cough
etiquette recommendation from the CDC.
18

Similarities in Steps
 Although steps are slightly different, there are
many similarities
19

Handwashing
 It is extremely important to remove jewelry,
clean fingernails, and clean between fingers.
 Wearing rings with settings should be
avoided when working in health care; not only
does this type of jewelry harbor
microorganisms, but it also can cause tearing
of gloves.
 Be sure you are spending the appropriate
amount of time when washing, rinsing, and
drying.
20

Hand Hygiene for Routine
Dental Procedures
21

Dental Procedures (Cont.)
22

Dental Procedures (Cont.)
23

Figure 11.3
 A-Dispense soap using hand-free dispenser.
B- Vigorously lather hands.
 C- Rinse under cool tap water.
 D- Dry hands with clean paper towel.
 E- Use paper towel to turn off non–hands-free
faucet.
 F- Use an alcohol-based hand rub and rub
hands together until dry (when no visible soil
is present).
24

Properties of Hand Hygiene Agents
 There are several properties to consider
when choosing a handwashing agent (see
Box 11.3)
 Besides handwashing, there are a few other
considerations:
 Which lotions to use to prevent skin dryness
25

Properties of Hand Hygiene Agents
 Lotions with a base of petroleum, lanolin,
mineral oil, palm oil, or coconut oil have
detrimental effects on latex gloves, so these
types should be used only at the end of the
day.
 Lotions containing aloe vera, glycerin, vitamin
E, or vitamin A are fine to use.
26

Other Hand Hygiene Considerations
 Use lotions to prevent skin dryness
 Keep nails short
 Don’t wear artificial nails
 Don’t wear hand or arm jewelry
27

Other Hand Hygiene Considerations
 Keep nails short to allow for thorough cleaning and
to prevent glove tears.
 One should not wear artificial nails because they
can harbor microbes.
 One should not wear hand or arm jewelry during
surgical procedures or wear hand or nail jewelry
during nonsurgical procedures if they make
donning gloves more difficult or compromise the
appropriate fit and integrity of the gloves.
 Also, it’s more difficult to clean the skin beneath
jewelry during hand hygiene.
28

Chapter 11 hand hygiene

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