Hand hygiene

Hand Hygiene
Dr. Abhijeet Mane
Assistant Professor
Department of Microbiology
Bharati Vidyapeeth Deemed University Medical College
Pune
Thursday, August 24, 2017 1

Introduction
• Health Care Associated Infections (HCAIs) - a
major problem for patient safety.
• Impact of HCAIs
• What is Hand Hygiene (HH)?

How it all started…
• Ignaz Philipp Semmelweis
• Hungarian physician
• Introduced the concept of Hand Washing
• Now known as an early pioneer of antiseptic procedures
• Why?Thursday, August 24, 2017 3

Normal flora of hand
• 2 types of microbes colonize the hands
• Resident flora –
– microorganisms residing under the superficial cells
of stratum corneum
• Transient flora –
– colonize superficial layers
– More amenable to removal by routine HH

• Transient microorganisms survive but usually
do not multiply on the skin
• Acquired by HCW during direct contact with
patients or surrounding associated with HAIs

Colonisatioin of hands and role in
transmission
• Hands of HCWs are commonly colonised with
pathogens like MRSA, VRE, MDR GNB, Candida
spp & Cl. Difficle
• Approx 1000000 squames containing viable
organisms shed daily
• Contaminate fomites
• Hand carriage of above pathogens linked to HAI
• Highest rate in critical areas
• MRSA and VRE can survive for months on fomites

• Long survival on surfaces together with short
survival on hand --- suggest that contaminated
surfaces maybe source of transient
colonization despite negative hand cultures
• Hands become contaminated by merely
touching patients
• Rhinovirus, adenovirus, rotavirus have been
found on hands of HCW

Steps involved in transmission of HCA pathogens from
one patient to another via HCWs: *
Organisms present
on patient skin
Organisms
transferred to
hands of HCW
Organisms must be
capable of surviving
on HCWs hands
HH by HCW inadequate or
entirely omitted
Contaminated hands
of HCW - direct
contact with
another patient

5 moments of Hand Hygiene by WHO

5 moments of hand hygiene
1. Before pt contact – shaking hands, helping a pt
move around, clinical examination
2. Before an aseptic task – oral / dental care,
secretion aspiration, wound dressing
3. After body fluid exposure risk - oral / dental
care, secretion aspiration, phlebotomy, clearing
urine, etc.
4. After pt contact – shaking hands, helping a pt
move around, clinical examination
5. After contact with pt surroundings – changing
bed linen, perfusion speed adjustment

Organisms present on patient skin or
the immediate environment

Organism transfer from patient to
HCWs’ hands

Organism survival on HCWs’ hands

Incorrect hand cleansing

Failure to cleanse hands during patient care results in
within-patient cross-transmission

Definitions
• Hand hygiene
– General term that applies to either hand washing,
antiseptic handwash, antispetic hand rub or Sx
hand antisepsis
• Surgical hand wash / rub
– The cleansing of hands with antimicrobial soap
and water preoperatively by Sx team

Indications for HH
• With soap and water
1. Visibly dirty
2. Contaminated with
proteinaceous material,
blood
3. Body fluids
4. After using rest room
5. Before and after having
food
• Using ABHR
1. Before direct contact
with pt
2. Before donning sterile
gloves
3. After contact with pt
intact skin
4. After contact with
inanimate objects
surrounding pt
5. After removing gloves
Thursday, August 24, 2017 19Alcohol Based Hand Rub

Missed spots when hand washing

Agents of hand hygiene
• Non medicated soap
• Alcohols
• Chlorhexidine
• Iodine and iodophores
• Quaternary ammonium compounds
• Etc.

Reasons for poor HH compliance
• Physician status
• Nursing assistant status
• Male sex
• Working in icu
• Wearing gloves/gown
• Lack of role model
• Under staff, overcrowding
• Dryness due to HH
• Inconvenient sinks
• Forgetfulness

How to increase HH compliance
• Targeted, multifaceted approaches focusing
on system change, ABHR
• Positive role modeling
• Adequate supply of HH products
• Performance feedback

Checking efficiency of HH campaign
• HH audit form
• Check HH with handrub and fluorescent dye
• Monitor consumption of alcohol and soap

Method of hand washing
• Remove jewellery, rinse hands under running
water
• Lather with soap and using friction cover all
surfaces
• Wash under running water
• Turn tap off with wrist / elbow
• Dry hand with single use towel or forced air
drying
• Pat skin rather than rubbing to avoid cracking

Steps of Surgical hand preparation
• Prerequisites
1. Keep nails short and pay attention to them
2. Don't wear artificial nails / nail polish
3. Remove jewellery
4. Wash hands with non medicated soap before
entering OT
5. Clean subungal areas with nail file. Not nail
brush

Procedure- 3 -5 mins
1. Start timing
2. Scrub each side of each finger, between fingers,
back and front of hand for 2 mins
3. Proceed to scrub the arms , keeping the hands
higher than the arm at all times
4. Repeat process on other hand and arm – 1 min
5. Rinse hands – not back and forth
6. Proceed to OT holding hands above elbows
7. Dry hand s with sterile and aseptic technique
before donning gown and gloves

Hand hygiene

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