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Dr. Mamta Shrivastav, profile picture
Uploaded byDr. Mamta Shrivastav
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"Hand Hygiene Through a Microbiologist’s Lens" (Microbes + Mechanisms + Moments)

"One Small Act Can Save a Patient’s Life"

Healthcare◦
The historical Turning point Story of hand hygiene begins hundreds of year ago… • 1843 – Oliver Wendell Holmes Sr. Recognized puerperal fever as potentially contagious and and emphasized the role of hand hygiene in preventing the transmission of puerperal fever. • 1847 – Ignaz Semmelweis Demonstrated that handwashing with chlorinated lime solution dramatically reduced maternal mortality from 18% to less than 2 %, from puerperal fever- an approx. 17 % point reduction with simple hand hygiene. Not Accepted at First –Later proven Right Today, hand hygiene is recognized as one of the most important and effective measures for preventing the transmission of HAIs.
We will discuss… • The historical turning point • Global burden of HAI • 5-step Hand transmission sequence • Why hand hygiene matter and why we perform hand hygiene • Microorganism survive on surface and transient /resident flora • Definition and type of hand hygiene • Mechanism of hand rub and hand wash • Requirements and hand rub products detail • Hand hygiene technique and missed area • Zoning • WHO 5 MOMENTS • GLOVES &HAND HYGIENE • COMMON BARRIER • FINGER IMPRESSION • REASON FOR FAILURES
How Germs Travel: The 5-step Hand transmission sequence. 1.Germ present 2. Contamination 3. Survival & multiplication 4. Persistent 5. Cross transmission Germs are present on patient skin and surroundings By direct and indirect contact, patient germs contaminate health workers' hands Germs survive and multiply on health workers' hands In the absence of hand hygiene action, Inadequate hand hygiene leaves germs remaining on the hands Contamination hands transfer germs to another patient or an invasive devices, causing infection Patient : S. aureus, P. mirabilis, Klebsiella spp. and Acinetobacter spp High touch surfaces: Staphylococci and Enterococci “Clean” activities (lifting patients, taking pulse, bp or oral temperature) : S. aureus ,Gram negative bacilli Germs can survive on unwashed hands for 2–60 minutes as per organism and condition . During longer duration of care Insufficient amount of product and/or insufficient duration of hand hygiene action handrubbing with ABHR is better hand washing with soap and water B/w patient A and patient B via health worker's hands “Invisible contamination on our hands can leads to visible infection in patients .”
Microorganisms can survive on surface ESKAPE Pathogen Approximate persistence on surfaces Common high-touch surfaces / reservoirs E – Enterococcus (including VRE) 5 days–4 months (capable of surviving on hands for 60 min.) Bed rails, bedside tables, doorknobs, commodes, medical equipment S – Staphylococcus aureus (including MRSA) 7 days–7 months Bed rails, bedside tables, BP cuffs, call bells, door handles, patient equipment K – Klebsiella spp. 2 hours–>30 months Bedside surfaces, sinks/wet areas, medical devices and frequently touched equipment A – Acinetobacter spp. 3 days–5 months (Acinetobacter lwoffii capable of surviving on hands for 60 min.) Bed rails, counters, sinks, bed cupboards, telephones, medical charts and equipment P – Pseudomonas aeruginosa 6 hours–16 months Moist/wet areas, sinks, taps, respiratory equipment and medical devices E – Enterobacter spp. Persistence may extend to weeks/months Patient-care equipment, hands of healthcare workers, moist/water-associated equipment and high-touch surfaces
Other Clinically Significant Microorganisms can survive on surfaces Microorganism Surface survival / persistence High-touch surfaces where contamination may occur E.Coli 1.5 hours -16 months Fecal contaminated surfaces-toilets Bed rails, contaminated equipment's, Burkholdea cepacia (cabaple of surviving on hands for 30 min.) Proteus vulgaris 1-2 days Contaminated surfaces HBV Remain viable at RT long period Blood-contaminated surfaces/equipment, procedure areas, sharps-related surfaces (require prompt cleaning/disinfection) HIV Does not survive well after drying; , Environmental transmission is not routine concern HAV Can persist in the environmentand may survive on surface for prolong period, survive long at 40 c in food storage) Toilets, flush handles, taps, door handles and other surfaces contaminated through the faeco- oral route HEV Environmental survival data are less well defined; contamination risk is mainly linked to faeco-oral transmission Candida auris Weeks or longer; can persist on healthcare surfaces Bed rails,bedside tables, chairs,equipments C
Difference between resident flora and transient flora of hand Resident flora Transient flora Site Residues on stratum corneum and skin surface (deeper layer) Colonizes superficial layer of the skin surface Normal flora Yes No Pathogenic potential Usually Non-pathogenic ;may cause infection in specific circumstance like enter in sterile area Pathogenic Transmission Not easily transmitted Easy, by direct or indirect contact Removal Difficult, by surgical scrub and to some extent by hand washing Easy, by any method of hand hygiene When reduction is indicated Only before surgery or aseptic procedure During routine patient care activities Example Diphtheroids , CONS Propionibacterium, Malassezia furfur GNB(ESKAPE Organisms) MRSA,MSSA,VRSA.VRE, Clostridium difficile, Novovirus
What is Hand hygiene Hand hygiene is a general term for any action of cleaning the hands using soap and water, antiseptic hand wash, alcohol-based hand rub, or surgical hand antisepsis to eliminate or deactivate microorganisms and prevent spread of infection .
Types of hand hygiene Hand Rub Hand Wash Surgical Hand Scrub Indication • If the hand are not visibly dirty, not contaminated with blood or body fluid. • During routine clinical rounds and handling patient • When hands are visibly dirty, contaminated with blood, or body fluid. • Potential exposure to spore forming organisms, nonenveloped viruses, • Handling patient having diarrhoea • After using toilets • Before handling medication or food • Before any surgical procedure Allow hands to dry before sterile gloves Duration 20-30 sec 40 -60 sec As per manufactures instruction The first surgical scrub of the day should be for 3-5 min with subsequent scrubs between surgeries can be performed for 3 minutes. Product Alcohol based handrub(AHBR) Plain soap, Antiseptic hand wash(CHG 4% RECOMMENDED) Chlorhexidine 4%(best) Povidone iodine Alcohol based handrub TARGET Transient flora Transient + few resident flora Transient +Reduce resident flora + suppress regrowth Choose the method based on the clinical situation — not convenience alone.,
Mechanism of Hand Rub ALCOHOL-BASED HANDRUB • Alcohol disrupts lipid membranes and denatures proteins • Rapid broad-spectrum activity against many bacteria and enveloped viruses • Fast action when hands are not visibly soiled More product” is not the same as “better technique
Mechanism of Hand Wash SOAP + WATER • Soap acts as a surfactant • Loosens microorganisms, dirt and organic material • Friction + rinsing physically removes contaminatio
Required Equipment Routine Handwashing • Clean running water (preferably warm) • Sink with elbow tab and with appropriate drainage • Soap (antimicrobial or nonantimicrobial) • Paper towels or clean disposable drying materials • Waste receptacle for towel disposal (hands- free preferred) • Alcohol-based hand sanitizer (if used as an adjunct when hands are not visibly soiled) • Nail cleaner or pick (if visibly soiled debris is present) Surgical Hand Antisepsis • Hands-free sink (eg, foot-, knee-, or sensor-operated controls) • Running water (temperature-controlled) • Brushes are not recommended • Pre-packaged sterile scrub/nail kit • Antimicrobial surgical scrub solution (eg, chlorhexidine or povidone-iodine) • Alcohol-based surgical hand rub (if using alcohol- based technique) • Sterile towels for drying hands and forearms • Surgical attire, such as a cap, mask, eye protection, and shoe covers • Sterile gloves (to be donned after antisepsis is complete)
Preparation Before Hand Hygiene • Keep fingernails short and clean • Remove rings, bracelets, watches & other hand/wrist jewellery • Avoid artificial nails and nail polish • Cover cuts or broken skin with a waterproof dressing • Keep sleeves above the wrists • Ensure hands are visibly clean and dry before using alcohol-based hand rub • Keep hands and wrists free from unnecessary accessories “CLEAN HANDS BEGIN WITH CLEAN , BARE HANDS”
Hand rub products and their antimicrobial properties
Surgical handrub technique Time : 1.5 - 3 minute & Surgical hand wash Time : 3-5 min
Most frequently Missed area • fingertips • thumbs • between fingers • backs of hands • Wrists • If a surface is missed, microorganisms can remain.
Patient zone v/s healthcare zone Patient Zone Immediate patient’s surroundings, including: • Patient and their body • Bed and bed rails • Bedside table • IV lines, monitors, ventilator, and other equipment dedicated to that patient Healthcare Zone outside the patient's immediate surroundings, such as: • Nurses' station • Medication preparation area • Corridors • Other patients and their surroundings • Shared equipment and common surfaces Clean hands when crossing the border.  Entering in patient Zone: Protects the patient from external hospital germs.  Leaving patient Zone: Protects the hospital environment from the patient's germs
My 5 Moments for Hand Hygiene
My 5 Moments for Hand Hygiene Examples of direct contact: • shaking hands, helping a patient to move around, get washed • applying oxygen mask, giving physiotherapy • taking pulse, blood pressure, • chest auscultation, • abdominal palpation, • recording ECG
My 5 Moments for Hand Hygiene Examples of clean/aseptic procedures: • brushing the patient's teeth, instilling eye drops , skin lesion care, • wound dressing, • subcutaneous injection. • catheter insertion, opening a vascular access system or a draining system, • secretion aspiration , • preparation of food, • medication, • pharmaceutical products, • sterile material
My 5 Moments for Hand Hygiene Examples of body fluid exposure risk: • brushing the patient's teeth, instilling eye drops, secretion aspiration • skin lesion care, wound dressing, subcutaneous injection, • drawing and manipulating any fluid sample, opening a draining system, endotracheal tube insertion and removal • clearing up urines, faeces, vomit, handling waste (bandages, napkin, incontinence pads), cleaning of contaminated and visibly soiled material or areas (soiled bed linen lavatories, urinal, bedpan, medical instruments)
My 5 Moments for Hand Hygiene Example of direct contact • shaking hands, stroking a child forehead • helping a patient to move around, get washed • applying oxygen mask, giving physiotherapy • Taking pulse, blood pressure, chest auscultation • abdominal palpation, recording ECG
My 5 Moments for Hand Hygiene Examples of contacts with patient surroundings: • changing bed linen, with the patient out of the bed • perfusion speed adjustment • monitoring alarm • holding a bed rail, leaning against a bed, a night table • clearing the bedside table
Gloves do NOT replace hand hygiene Gloves can become contaminated and can transfer organisms just like hands. BEFORE GLOVES Perform hand hygiene before donning gloves when indicated. Especially before an aseptic procedure. DURING CARE Change gloves when moving from contaminated to clean tasks. Do not wash or disinfect disposable gloves unless a validated policy/product specifically permits it. AFTER GLOVES Remove gloves safely. Perform hand hygiene immediately when indicated — glove removal does not guarantee clean hands. Think: Gloves are a barrier — not a substitute for clean hands. 11 Source: WHO hand hygiene guidance / 2025 FAQ.
🧤 Glove Use & Hand Hygiene 🟢 CLEAN / NON-STERILE GLOVES Risk of transmission of infection from patient to HCW. when exposure to: • Blood or body fluids • Non-intact skin / mucous membranes • Contaminated patient-care items,Contact precautions • Device-related care: ETT/suctioning, routine Foley catheter care, etc 🔵 STERILE GLOVES Use for: • Surgical procedures • Invasive procedures requiring sterility • Contact with sterile tissue/body sites • Maintaining a sterile field • Central line care when sterile/aseptic technique is required ⚪ GLOVES NOT ROUTINELY REQUIRED(except for contact precaution ) • BP, pulse, temperature • Routine patient examination • Oral medication administration • Routine care without anticipated exposure to blood/body fluids HAND HYGIENE IS MANDATORY BEFORE → 🧤 PUTTING ON GLOVES AFTER → 🧤 REMOVING GLOVES 🧤 Gloves do NOT replace hand hygiene. Change gloves between patients and when moving from a contaminated site to a clean site
Common Barriers to Hand Hygiene Compliance 🧴 Availability issues – Hand rub, soap, paper towels or functional dispensers not available ️ ⏱️Workload & time pressure – Emergency situations, high patient load and busy workflow ✋ Incorrect technique – Insufficient hand rub, inadequate duration, missed areas 🧤 Over-reliance on gloves – Gloves used as a substitute for hand hygiene 🩹 Skin irritation – Dryness, dermatitis or irritation due to frequent hand hygiene 🧠 Lack of awareness/motivation – Poor understanding of WHO 5 Moments or low compliance 🏥 Infrastructure barriers – Hand hygiene facilities not conveniently accessible at point of care 👥 Behaviors & culture – Poor role modelling, inadequate monitoring and feedback Key Message: “Hand hygiene compliance depends not only on knowledge, but also on accessibility, workload, technique, behavior and hospital culture.”
re- and post-hand-hygiene finger impression: a powerful teaching too Use it for demonstration, competency feedback and behaviour change — not as a standalone diagnostic test. BEFORE HAND HYGIENE Higher / mixed growth AFTER CORRECT HAND HYGIENE Marked reduction expected Standardize: same medium • same sampling method • same incubation/reporting • document technique gaps. 12 Educational demonstration concept; standardize local microbiology method.
Common hand-hygiene failures seen in our hospitals The aim of an ICO is not only to find gaps — but to make correct behaviour easy. Technique Too fast • missed thumbs/fingertips • insufficient product Timing Hand hygiene performed, but not at the correct WHO Moment Gloves Hand hygiene skipped because gloves are worn Access ABHR not available at point of care- corrected Environment High-touch surfaces not cleaned consistently Skin Irritation/dryness leads to avoidance or poor adherence- few Behaviour “I already did it” replaces observation of the actual moment Feedback Audit data collected but not converted into unit-level action 14
Key take-home messages A clean hand at the right moment can break a chain of transmission. • Hand hygiene is one of the simplest and most important IPC actions. • Transient flora are acquired; resident flora persist on the skin. • ABHR: routine preferred when hands are not visibly soiled — rub 20–30 sec and cover every surface. • Soap + water: use when hands are visibly soiled and when washing is indicated — 40–60 sec. • Surgical hand preparation has a different objective: reduce resident flora and suppress regrowth. • WHO 5 Moments convert “wash your hands” into a specific, observable behavior. • Finger-impression demonstrations can make invisible contamination visible and motivate better technique. • Gloves do not replace hand hygiene. OUR SMALL EFFORT ON HAND HYGIENE CAN SAVE A PATIENT’S LIFE 16
References & recommended resources • WHO. Guidelines on Hand Hygiene in Health Care. • WHO. Five Moments for Hand Hygiene. • WHO. How to Handrub? / How to Handwash? • WHO. Surgical hand preparation guidance. • CDC. Environmental Cleaning & Disinfection: pathogen survival on surfaces. • WHO World Hand Hygiene Day 2026 resources. 17