Hand hygiene is crucial for preventing the spread of infections, involving practices such as washing hands with soap and water or using alcohol-based rubs. It emphasizes the importance of cleaning hands before and after patient care, as well as other specific situations to minimize germs. The document also outlines procedures for surgical hand scrubbing and the principles of maintaining a sterile field.

1. Hand Hygiene
Dr: Mosa Alfageh

2. Introduction
 Hand Hygiene is the easiest and most important way to prevent
spread of infection.
 You use your hands for almost everything. They are easily
contaminated.

3. Handwashing
:
is an aseptic practice that involves scrubbing the hands with
nonantimicrobial or antimicrobial soap, water, and friction

4. Purpose
 1-To clean contaminated hands.
 2-To remove dirt
 3-minimize number of microorganism
 4-To prevent cross and nosocomial infection.

5. Indications
Hand hygiene is essential :
1-When hands are visible soiled
2-Before and after caring for a patient
3-After contact with organic material ,such as
feces ,wound drainage ,and mucus
4-In preparation for an invasive procedure ,such as
suction, catheterization ,or injections

6.  5-Before changing a dressing or having contact with open
wounds
 6-Befor preparing and administrating medications
 7-After removing disposable gloves
 8-Before and after using the toilet
 9-Before and after eating
 10-At the beginning and end of the shift.

8. Hands flora
Resident Flora:
 Deep seated (attached to
deeper layers of the skin)
 Difficult to remove
 Part of body’s natural
defence mechanism
 Associated with infection
following surgery/invasive
procedures.
Transient Flora:
 Superficial
 Transferred with ease to
and from hands
 Important cause of cross
infection
 Easily removed with good
hand hygiene.
the two types of flora carried by the hands.

9. Hand Hygiene includes
:
1- Hand washing
 Washing hands with plain soap and water
 2- Antiseptic hand wash
 Washing hands with water and soap or other antiseptic agent
 3- Alcohol-based hand rub
 Rubbing hands with an alcohol-containing preparation (used after hand washing)

10. 4- Surgical antisepsis
Hand washing with antiseptic soap or alcohol-
based handrub before operations by surgical
personnel

11. Level of hand hygiene
Routine
hand
hygiene
Water and plain
soap
Remove transient
microorganisms
Aseptic
hand
hygiene
Water and
antiseptic soap
Alcohol hand rub
Remove transient
microorganism
Reduce resident
microorganism
Surgical
hand
hygiene
Water and long
acting antiseptic
Remove transient
and most resident
microorganism

12. Hand Care
Nails
Rings
Hand creams
Cuts & abrasions
Skin Problems

13. Rings and Jewelry
Studies have demonstrated that skin underneath
rings is more heavily colonized than comparable
areas of skin on fingers without rings.

14. Fingernails
 Keep fingernails SHORT! Not excesses 1/4 inch
 Avoid artificial nails
 Avoid nail polish

15. Safety precautions
 Does not touch the sink during the washing procedure

16. Equipment
:
Soap
Tissue paper or small towels.
Sink
running water.
Trash can- nail cleaner

17. Procedure
Rational Actions
1-poor personal hygiene
and an open area of the
skin provide areas in which
microorganisms are able to
grow
1-inspect hands ,observing
for visible soiling, breaks or
cuts in the skin and cuticles
2-determine the type of
hand hygiene needed
2-determine amount of
contaminate of hands

18. Procedure… cont
.
Rational Actions
3-prevent contamination
of hands during and after
hand hygiene procedure
3-assess areas around the skin
that are contaminated
4-microorganisms collect
in jewelry and watch bands
;removing jewelry makes it
easier to wash all areas of
hands and wrists
4-remove jewelry except plain
wedding band and push watch
and long sleeves above wrist

19. Procedure… cont
.
Rational Actions
5-water is too hot or too cold can
chap skin ,and too much force can
cause splashing and spread
microorganisms to other
areas ,especially your clothing
5-adjust the water to
appropriate temperature and
force
6-hands are the most
contaminated part of the upper
extremities ;water should follow
from the wrists (least
contaminated areas) over the
hands ,and then down the drain
6-wet hands and wrist under
the running water ,always
keeping hands lower than
elbow s

20. Procedure… cont
.
Rational Actions
7- soap lather emulsifies fat
and aids in cleaning
7-lather hands with
liquid soap
8- helps to loosen soil and
microorganisms , both
resident (normally
present )and transient
(acquired from
contamination)
8-wash hands
thoroughly using a
firm ,circular motion
and friction:
a. Rub palms together

21. Procedure… cont
.
Rational Actions
b. Rub the back of both hands
c. Interlace and rub hands
together

22. Procedure… cont
.
Rational Actions
d. Interlock fingers and rub the
back of fingers of both
e. Rotational rubbing of left thumb
clasped in right palm and vice
versa

23. Procedure… cont
.
Rational Actions
f. Rotational rubbing, backwards
and forwards with clasped
fingers of right hand in left palm
and vice versa;
g. Rub both wrists in a rotating
manner ;

24. Procedure… cont
.
Rational Actions
9-Rinsing removes the loosened
microorganisms ,and re-lathering
ensures more thoroughly
cleaning . the greater the
contamination , the more
needed for longer washing
9-wash for 15 to 30 seconds ,rinse
thoroughly ,re lather ,and wash
another minutes ,using continuous
friction
10-The water should run from
cleaner areas (the wrists) over
the hands , and then down the
drain , rinsing microorganisms
away
10- rinse wrists and hands
completely
--- keep hands lower than elbows

25. Procedure… cont
.
Rational Actions
12-prevent
chapping .drying
should progress
from clean to less
clean , and the
cleanest areas are
now your fingers and
hands
12-dry hands thoroughly with paper
towels .
-start by patting at fingertips, then
hands ,then wrists and forearms

26. Procedure… cont
.
Rational Actions
13- keeps cleans hands
from touching
contaminated hands
13- turn of faucets using a
dry paper towels
14- keeps skin soft and
lubricated so it will not
crack easily
14-use hospital-approved
hand lotion if desired

27. Procedure… cont
.
Rational Actions
15- ensures cleanliness of
hands and nails
15-inspect hands and nails for
cleanliness
16-helps the patient
understand that hand
hygiene slows down the
spread of infection
16- provide patient
teaching .explain to the
patient the importance of
hand hygiene

28. Hand Hygiene: Frequently Missed Areas
Courtesy of SDS Kerr

29. Remember :Bacteria and viruses can
cause illness and even death
.
Hey, wait a minute!
We’re not all bad
!

30. And remember…
No Matter Where You Are…
No Matter What You Do…
WASH YOUR HANDS!

31. VIDEO

32. SURGICAL ASEPSIS

33. SURGICAL ASEPSIS
 Refers to the procedures used to keep the object or areas sterile or
completely free from micro organisms.
 In surgical asepsis all practices are directed to the elimination of
both pathogenic and nonpathogenic micro-organisms.

34. Principles in surgical asepsis
Principles Rationale
Always face the sterile field. Do not
turn back or side on a sterile field
Sterile objects which are out of vision
are considered questionable and their
sterility cannot be guaranted
.
Keep sterile equipment above your
waist level or above table level
.
Waist level and table level are
considered margins of safety and will
promote maximum visibility of the
sterile field
.
Do not speak, sneeze and cough over a
sterile field
.
To prevent or droplet infection
.
Never reach across sterile field When a nonsterile object is held above a
sterile object, Gravity causes micro
organisms to fall into the sterile field
.

35. Principles Rationale
Keep the unsterile objects away from
the sterile field
.
Preserve sterility by touching one
sterile item with another that is sterile
Once a sterile item touches something
that is not, it is considered
contaminated
.
Micro organisms may be transferred
whenever a non sterile object touches a
sterile field
.
Keep the sterile field dry Micro organisms do not pass easily
through a dry surface
.
The outer 1-inch margin of a sterile
area is considered a zone of
contamination
.
Proximity to a contaminated area makes
sterilty doubtful
.
Handle liquids cautiously near the
sterile field or prevent drapes or
wrappers from becoming wet
.
When a liquid wets it connects a
nonsterile field with a sterile field
.

36. Principles Rationale
Each sterile supply should be clearly
labeled as to its contents, time and
date of sterilization
.
To ensure sterility
.
Never assume that a object is sterile.
Always check the sterility expiration
date
.
Sterility of an object wrapped in paper
or cloth becomes doubtful after 4
weeks
.
Avoid sweeping and dusting when the
sterile objects are opened
.
Micro –organisms travel in the dust
particles
Put on mask, Wash hands, put on
gowns and gloves before handling
sterile supplies
.
To prevent contamination
.

37. PROCEDURES INCLUDED IN SURGICAL ASEPSIS
 Surgical hand scrub
 Donning a sterile gown
 Applying and removing a sterile gloves

38. 1
.
Surgical hand scrub
Purpose
:
Remove as many micro organisms from
the hands as possible before the sterile
procedure
.

39. 1.SURGICAL
HAND SCRUB

40. Equipment
 Warm running water
 Antiseptic Soap Solution
 Hand brush stored in a sterile container
 Transferring forceps
 Sterile towel

41. Steps of the procedure
1
.
Makesure fingernails are short,clean,healthy.Nail polish should be
removed
.
2
.
Remove jewelries(Rings, Bracelets)
.
3
.
Apply personal protective equipment(PPE) includes surgical shoe
covers , Cap , Facemask
and protective eyewear
.

42. 4
.
Open disposable brush impregnated with antimicrobial soap
5
.
If no disposable brush is not available/some hospital use brush
sterilized and stored in the small bin
.

43. 6
.
Use a transferring forceps to pick up
the brush from the sterile bin
.
7
.
Turn on the water and adjust the flow
so that the water is warm. Warm water
removes less of the protective oil of
the skin than hot water
.
8
.
Wet hands and arms. Keep hands
above elbows
Rationale: Movement of water and
dirt will flow from hands to less
clean areas thus preventing
contamination of the hands during
scrub
.

44. Wet hands and arms up to the elbows.
Use nail pick to clean nails under running water.

45. 9
.
Wet scrub brush or apply antibacterial soap if not already impregnated in the
brush
.
10
.
Anatomic timed scrub: Starting with fingertips, scrub each anatomic area
(Nail, fingers each side and web space , palmar , dorsal surface and Forearm)
for around 5 minutes
.

46. 11
.
Scrub vigorously using vertical strokes in a circular manner. Repeat with
other hand
.
Rationale: Ensures that all surfaces will be systematically scrubbed to
remove transient and resident micro organisms
.
12
.
Counted brush stroke method: Starting finger tips, scrub each
anatomic area for the designated number of strokes. Scrub vigorously
using vertical strokes
.

47. Wet sponge and squeeze to work up lather.
Wash each finger, hand, and arm to two inches above the elbows using
the non abrasive sponge for a total scrub time of three minutes.
Note: Use brush side only on nails and cuticles or on areas of visible soil.

50. 13
.
Rinse hands thoroughly under warm running water, holding hands
upward. This is to allow water to drain towards the flexed elbows
.
Rationale : Prevents contamination of the hands from dirtier areas.
Remember do not touch anything before and after rinsing hands.
Touching non sterile objects would mean the surgical scrub need to be
repeated
.

51. 14
.
Keep hands held upward to allow water to drip from the hands to
elbow
.
15
.
Dry hands with a sterile towel
.

52. Video

53. Technique for the application of surgical hand preparation using alcohol-based
handrub

55. USA:
Up to 2 million HAI/yr,
80,000 of them may contribute to death, and
generate 4.5 to 5.7 billion USD additional expenses/yr (WHO
figures, 2005).
UK:
320,000 HAI/yr,
5,000 of them may contribute to death, and
generate £1 billion additional expenses /year
(
WHO figures, 2005
.)
55
BETWEEN 40 AND 50% OF HAI ARE
CONSIDERED TO BE PREVENTABLE