Hand Hygiene and
Isolation Precautions
Anthony Stull
EME 6053
Hand Hygiene
1.7 million hospital-acquired infections annually
99,000 deaths annually
6 billion dollars annually

Northwestern Memorial Hospital
VRE and MRSA survive 24 hours on keyboard
Contact resulted in hand transfer of MRSA 92% of he
time

Lab coats contaminated with MRSA 65% of the time
when leaning over infected patient
Hand Hygiene
Plain soap
Detergent removes, soil, and organic substances
Some transient bacteria

Alcohol
60-95% alcohol to denature proteins rapidly
Potent against many different organisms
Not appropriate when hands visibly contaminated
May dry skin
Hand Hygiene
Chlorhexidine (CHG)
Used in anti-microbial soaps
Sustained residual activity
Microbial resistance can develop

Other
Quaternary ammonia
Triclosan
Iodaphors
Hand Hygiene
When to perform:
Before patient contact
After contact with blood, body fluids, or contaminated
surfaces
Before invasive procedures
After removing gloves
Standard Precautions
Assume that blood and body fluids from all patients
contains infectious organisms
Treat all patients the same
Anticipate potential exposures before they happen
Personal Protective
Equipment (PPE)
Gloves
Gowns
Masks
Goggles/Eye shield
Gloves
Use:
Utilize when skin could potentially come in contact
with blood or other potentially infectious body fluids
(OPIM)
Applying pressure to bleeding sites
Suctioning
Handling contaminated objects
Dressing changes
Performing procedures
Gloves
Change when soiled or torn
Single use
Change after patient contact
Hand hygiene
Gowns
Utilize when splashes, sprays, or droplets from body
fluids are anticipated
Wound irrigation
Cleaning instruments
Cleaning major blood spill
Mask/Eye Shield
Utilize when splashes, sprays, or droplets from body
fluids are anticipated
Suctioning
Intubation
Removing drains/devices
Eye glasses are not considered appropriate eye
protection
Isolation Precautions
Devised to prevent spread of certain infectious
organisms
Certain PPE required with any patient contact
Signs indicate isolation and appropriate PPE
Special Contact
MRSA, VRE, other MDRO
Daily cleaning
Patient specific equipment
Gown and gloves required for all contact
Patient transport
Patient wears gown, mask, and gloves (no gloves if on
stretcher)
Staff wears gown and gloves
Contact
C-diff, Scabies, Lice
Daily cleaning
Gown and gloves required for all contact
Patient transport
Patient wears gown and gloves (no gloves if on
stretcher)
Staff wears gown and gloves

Alcohol hand rubs not effective, must wash hands
All equipment cleaned with bleach solution
Droplet
Bacterial meningitis, mumps, certain pneumonias, influenza
Daily cleaning
Patient specific equipment
Mask and gloves required for all contact
Patient transport
Patient wears mask and gloves (no gloves if on stretcher)
Staff wears mask and gloves
High Risk Precautions
Immunosuppressed
Daily cleaning
Gloves and mask required for all contact
Patient transport
Patient wears mask whenever leaving room

Hand hygiene extremely important
PPE Removal
Gown
Gloves
Mask/Eye protection
Hand hygiene
References
Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene
in health-care settings: Recommendations of the healthcare infection control
practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene
task force. Morbidity and Mortality Weekly Report, 51(16).
Tampa General Hospital Bloodborne Pathogen Exposure Control Plan
Tampa General Hospital Standard Precautions and Transmission-Based Isolation
Precautions, IC11

Hand Hygiene and Isolation Precautions

  • 1.
    Hand Hygiene and IsolationPrecautions Anthony Stull EME 6053
  • 2.
    Hand Hygiene 1.7 millionhospital-acquired infections annually 99,000 deaths annually 6 billion dollars annually Northwestern Memorial Hospital VRE and MRSA survive 24 hours on keyboard Contact resulted in hand transfer of MRSA 92% of he time Lab coats contaminated with MRSA 65% of the time when leaning over infected patient
  • 3.
    Hand Hygiene Plain soap Detergentremoves, soil, and organic substances Some transient bacteria Alcohol 60-95% alcohol to denature proteins rapidly Potent against many different organisms Not appropriate when hands visibly contaminated May dry skin
  • 4.
    Hand Hygiene Chlorhexidine (CHG) Usedin anti-microbial soaps Sustained residual activity Microbial resistance can develop Other Quaternary ammonia Triclosan Iodaphors
  • 5.
    Hand Hygiene When toperform: Before patient contact After contact with blood, body fluids, or contaminated surfaces Before invasive procedures After removing gloves
  • 8.
    Standard Precautions Assume thatblood and body fluids from all patients contains infectious organisms Treat all patients the same Anticipate potential exposures before they happen
  • 9.
  • 10.
    Gloves Use: Utilize when skincould potentially come in contact with blood or other potentially infectious body fluids (OPIM) Applying pressure to bleeding sites Suctioning Handling contaminated objects Dressing changes Performing procedures
  • 11.
    Gloves Change when soiledor torn Single use Change after patient contact Hand hygiene
  • 12.
    Gowns Utilize when splashes,sprays, or droplets from body fluids are anticipated Wound irrigation Cleaning instruments Cleaning major blood spill
  • 13.
    Mask/Eye Shield Utilize whensplashes, sprays, or droplets from body fluids are anticipated Suctioning Intubation Removing drains/devices Eye glasses are not considered appropriate eye protection
  • 14.
    Isolation Precautions Devised toprevent spread of certain infectious organisms Certain PPE required with any patient contact Signs indicate isolation and appropriate PPE
  • 15.
    Special Contact MRSA, VRE,other MDRO Daily cleaning Patient specific equipment Gown and gloves required for all contact Patient transport Patient wears gown, mask, and gloves (no gloves if on stretcher) Staff wears gown and gloves
  • 17.
    Contact C-diff, Scabies, Lice Dailycleaning Gown and gloves required for all contact Patient transport Patient wears gown and gloves (no gloves if on stretcher) Staff wears gown and gloves Alcohol hand rubs not effective, must wash hands All equipment cleaned with bleach solution
  • 18.
    Droplet Bacterial meningitis, mumps,certain pneumonias, influenza Daily cleaning Patient specific equipment Mask and gloves required for all contact Patient transport Patient wears mask and gloves (no gloves if on stretcher) Staff wears mask and gloves
  • 19.
    High Risk Precautions Immunosuppressed Dailycleaning Gloves and mask required for all contact Patient transport Patient wears mask whenever leaving room Hand hygiene extremely important
  • 20.
  • 21.
    References Centers for DiseaseControl and Prevention. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Morbidity and Mortality Weekly Report, 51(16). Tampa General Hospital Bloodborne Pathogen Exposure Control Plan Tampa General Hospital Standard Precautions and Transmission-Based Isolation Precautions, IC11