Hand Hygiene latest.pptx

Hand Hygiene
Dr. Abhijeet Mane
Associate Professor (Microbiology) &
Coordinator – Infection Control
Bharati Vidyapeeth (DTU) Medical College &
Hospital, Pune
Abhijeet Mane - YouTube

Introduction
• Health Care Associated Infections (HCAIs) - a
major problem for patient safety.
• Hands of Health care worker (HCW) remain a
common mode of transmission of HAIs – think
AMR is transferred…
• Bacterial counts on the hands of HCWs have been
reported to range from 39,000 – 4,60,000 CFUs /
cm2
• Hence effective hand Hygiene (HH) is cornerstone
among all measures to prevent HAIs
Friday, April 21, 2023 Hand Hygiene 2

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?

Microbial flora of Hand
• 2 types of flora are
present
• Resident flora
• Transient flora
• What is difference
between the two?

Resident v/s Transient flora
Resident flora Transient flora
Site Skin surface
(deep - seated in the epidermis)
Colonizes on superficial layer of
skin surface
Normal Flora Yes No
Pathogenic
potential
Non pathogenic Pathogenic
Transmission Difficult Easy among HCWs by direct contact
Removal Difficult, by Surgical scrub Easy, by Hand wash / rub
When is
reduction
necessary
Only before Surgery / Aseptic
procedure
During routine health care service
Examples Diphtheroids,
Propionibacterium, CoNS
GNB,
MRSA/MSSA/VRSA
VRE, C.difficile,

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
capable of
surviving on
HCWs hands
HH by HCW inadequate or
entirely omitted
Contaminated
hands of HCW
- direct
contact with
another
patient

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

What is Hand Hygiene?
• Hand hygiene: A general term referring to any
action of hand cleansing
• It includes Hand washing and using Alcohol
Based Hand Rub

For effective HH
Following criteria must be met:
• using an effective compound,
• sufficient amount of product available to
cover hands, (atleast 1.5ml x 2 times)
• use of correct technique to cover all areas,
and
• performing HH at the right moment.

5 moments of Hand Hygiene by WHO

Moment 1&4
Before &.Before & After
Moment 2 & 3
Before aseptic procedure
or after body fluid
exposure
Moment 5 After touching
patient surrounding
1. Taking pulse, blood
pressure
2. Auscultation & palpation
3. Shaking hands
4. Helping patient to move
around
5. Applying oxygen mask
6. Giving physiotherapy
7. Recording ECG
8. Use of gloves
Oral & dental care
Aspiration of secretions
Assessing in situ drains
Skin lesion care
Wound dressing
Administrating injections
Drawing of blood/sterile
fluid
Handling device
Clearing up urine
Handling bandages
Instilling eye drops
Moving from
contaminated body site to
another body site during
care of same patient
After contact with
Handling the case sheet
Medical equipment in the
immediate vicinity of the
patient
Bed or bed rail
Changing bed linen
Decanting urine

Hand Hygiene methods
Indications for using:
Hand rub
(20-30 sec)
Hand wash
(40-60 sec)
Hand scrub
(3-5 mins)
Followed during 5 moments
of HH
Visible dirt, blood or body fluids Prior to any
surgical
procedure
During routine clinical rounds
and handling pt.
Potential exposure to spore forming
organisms (C.difficile); rotavirus,
Emergency where no time or
lack of facility for hand wash
Handling pt. having diarrhea
Hands are not visibly dirty,
blood, body fluids
After using restroom
Before handling medication or food

Missed spots during HH
Hence, last two steps of
HH are very important

• Hand wash products
• Water
• Plain soap
– Action
– For routine Hand wash
– Liquid soaps

• Hand rub products
– Alcohol based hand rubs recommended by WHO
– 60-80% ethanol recommended
– Duration 20-30 sec
– Volume – 3-5 ml
• Alcohol – chlorhexidine (2%) combination – High risk
areas
• Routine use of antiseptic soap solution (e.g.
chlorhexidine gluconate, povidone iodine, or triclosan)
is not necessary for everyday HW even in intensive
and high dependency, neonatal, transplant, burns, and
renal units.

Points to note…
• Drying of hands
– Single use paper towels
– most recommended
– Pat dry, do not rub
– Cloth towels strictly
prohibited for drying
• Artificial nails/ nail
polish – prohibited
• Long nails – prohibited
• Rings, bracelets –
prohibited

Gloves
• Not substitute for hand hygiene. HH to be
performed immediately after removing
gloves.
• Gloves creates a moist, warm, and occlusive
environment - the skin and glove; supports
microbial growth.
• Even new gloves may have microscopic holes.

• Jewellery, long
fingernails, and other
mechanical stresses
during use can cause
holes and tears on
gloves.

• Hand Care
– Frequent use leads to chronic dermatitis
– Can be reduced by addition of humectants – to
moisturize
• Prevent dermatitis by:
– Avoid washing hands immediately before or after
using ABHR
– Don’t wear gloves when hands are still wet
– Apply an emollient hand cream regularly to protect
skin from drying
– Avoid use of very hot water

References
• WHO document on Hand Hygiene in Outpatient and Home-based Care and
Long-term Care Facilities
• Study material – JIPMER HIC and AMSP National Workshop August 2022
• Manual of Infection Prevention and Control 4th edn. by Nizam Damani
2019
• WHO Guidelines on Hand Hygiene in Health Care 2009

Further learning…
Open WHO courses.. Self learning, self paced
1. Basic microbiology
2. Infection Prevention and Control (IPC) core components and multimodal
strategies
3. Introduction to Infection Prevention and Control (IPC)
4. Standard precautions: Hand hygiene
5. Standard precautions: Environmental cleaning and disinfection
6. Standard precautions: Injection safety and needle-stick injury management
7. Health-care associated infection surveillance
8. Bloodstream infections
9. Antimicrobial resistance and infection prevention and control
10. Surgical site infections
11. Catheter-associated urinary tract infections
12. Infection Prevention and Control in Maternal and Neonatal Care
13. Standard precautions: The role of personal protective equipment
14. Transmission-based Precautions
15. Decontamination and sterilization of medical devices
16. Outbreak investigations in health facilities

Thank You!
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