The need and importance of hand washing in healthcare system and for people involved in patient care. When and how to wash hands? Differences between alcohol based hand rubs and hand washing. WHO and CDC guidelines on hand washing.

1. Hand Washing
Dr. Mohammad Amir
MS. (General Surgery)
Department of General Surgery
Era’s Lucknow Medical College, Lucknow.

2. HAND WASHING
• A solution to many problem.
• Reason to Save Many.
• HCAI- Health Care Acquired Infections.
• CR-UTI
• CR- BSI

3. CLEAND HANDS COUNT …

5. Prevalence
• In developed countries, HCAI concerns 5–15% of hospitalized
patients.
• Affects 9–37% of those admitted to intensive ICUs.
• Recent studies conducted in Europe reported hospital-wide
prevalence rates of patients affected by HCAI ranging from 4.6% to
9.3%.

6. HCAI related Morbidity Mortality
• In general, attributable mortality due to HCAI in Europe is estimated
to be 1% (50 000deaths per year).
• HCAI contributes to death in at least 2.7% of cases (135 000 deaths
per year).

7. Hand Hygiene and Health
• Hand washing is like a "do- it- yourself" vaccine.
• Reduce the spread of diarrheal and respiratory illness in children and
adults.
• Early training of children in hand washing
improves their health and hygiene.
• More important for doctors, medical students
and healthcare workers.

8. Historical Perspective
• In the mid-1800s- Ignaz Semmelweis in Vienna, Austria.
• “Saviour of Mothers"
• Oliver Wendell Holmes in Boston, USA.
• Hospital-acquired diseases were transmitted via the hands of HCWs.
• In 1847, Semmelweiss was appointed as a house officer in one of the
two obstetric clinics at the University of Vienna Allgemeine
Krankenhaus (General Hospital).

9. Historical Perspective
• He observed that maternal mortality rates, mostly attributable to
puerperal fever, were substantially higher in one clinic compared with
the other (16% versus 7%).
• He also noted that doctors and medical students often went directly
to the delivery room after performing autopsies and had a
disagreeable odour on their hands despite handwashing with soap
and water before entering the clinic.
• He hypothesized therefore that “cadaverous particles” were
transmitted via the hands of doctors and students from the autopsy
room to the delivery theatre and caused the puerperal fever.

10. Historical Perspective
• As a consequence, Semmelweis recommended that hands be
scrubbed in a chlorinated lime solution before every patient contact
and particularly after leaving the autopsy room.
• Following the implementation of this measure, the mortality rate fell
dramatically to 3% in the clinic most affected and remained low
thereafter.

14. Normal Bacterial Flora on Hands
• In 1938, Price established that bacteria- Two categories-
• Resident or Transient.
• Staphylococcus epidermidis is the dominant species and oxacillin
resistance is extraordinarily high, particularly among HCWs.
• S. hominis and other coagulase-negative staphylococci, coryneform
bacteria (propionibacteria, corynebacteria, dermobacteria, and
micrococci).
• Fungi, the most common genus of the resident skin flora, when
present, is Pityrosporum (Malassezia).

15. • Resident flora has two main functions.
 Protective functions
 Microbial antagonism and the competition for nutrients.
• Resident flora is less likely to be associated with infections,
but may cause infections in sterile body cavities, the eyes, or
on non-intact skin.

16. • The Global Hand washing Day- October 15, 2008.
• By UN General Assembly in accordance with year 2008 as the
International Year of Sanitation

17. • Normal human skin- Total aerobic bacterial counts ranging from more
than 1 x 106 CFU/cm2 on the scalp, 5 x 105 CFUs/cm2 in the axilla,
and 4 x 104 CFU/cm2 on the abdomen to 1 x 104 CFU/cm2 on the
forearm.
• Total bacterial counts on the hands of HCWs have ranged from 3.9 x
104 to 4.6 x 106 CFU/cm.

18. Transmission of Pathogens
• Organisms present on patient skin or in the inanimate environment.
• Organism transfer to health-care workers’ hands.
• Defective hand cleansing, resulting in hands remaining contaminated
• Organism survival on hands.
• Cross-transmission of organisms by contaminated hands.

22. Antiseptic Spectrum of Action

23. Comparison of Antiseptics

24. Device-associated Infection

25. Surgical Hand Preparation

26. Protocol for Surgical Scrub

30. Avoid the Embarrassment!

36. My Five Moments for Hand Hygiene

43. How Long to Wash?
• Hand Hygiene Technique with Alcohol-Based Formulation-
Duration of the entire procedure: 20-30 seconds
• CDC- Till dry.
• Hand Hygiene Technique with Soap and Water- Duration of
the entire procedure: 40-60 seconds

44. Cost Burden of HCAI

45. REFERENCES
• WHO Guidelines on Hand Hygiene in Health Care- 2009
• Burden of endemic health-care-associated infection in developing
countries: systematic review and meta-analysis, Allegranzi, Benedetta
et al. The Lancet , Volume 377 , Issue 9761 , 228 – 241.
• CDC 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.

46. NEJM- Hand Hygiene

47. Thank You
… and wash your hands!