This document discusses hand hygiene and proper hand washing techniques for healthcare workers. It begins by defining various types of hand hygiene and outlines the normal bacterial flora found on hands. It then explains how pathogens can be transmitted between patients via healthcare workers' hands if hand hygiene is not properly performed. The document provides guidelines for proper hand washing and surgical hand preparation. It stresses that hand hygiene is the most effective way to prevent hospital-acquired infections. Finally, it discusses various strategies that can be used to promote and monitor hand hygiene compliance among healthcare workers.

1. DR. H. BORAH
DEPTT. OF COMMUNITY MEDICINE
ASSAM MEDICAL COLLEGE

2. INTRODUCTION
 Hand washing: Washing hands with plain or
antimicrobial soap and water.
 Hand cleansing: Action of performing hand hygiene
for the purpose of physically or mechanically removing
dirt, organic material, and/or microorganisms.
 Hygienic hand wash: Treatment of hands with an
antiseptic hand wash and water to reduce the transient
flora without necessarily affecting the resident skin
flora. It is broad spectrum, but is usually less
efficacious and acts more slowly than the hygienic
hand rub.

3. Contd…
 Antiseptic hand rubbing (or hand rubbing). Applying
an antiseptic hand rub to reduce or inhibit the growth of
microorganisms without the need for an exogenous source
of water and requiring no rinsing or drying with towels or
other devices.
 Hand washing is the simplest, most effective measure for
preventing nosocomial infections.
 It is one of the basic measures of standard precautions.
 Despite advances in infection control and hospital
epidemiology, healthcare workers’ adherence to
recommended hand hygiene practices is unacceptably low.

4. Contd…..
 Compliance is usually estimated as less than 50%.
 Studies have shown that the bacteria that cause
hospital-acquired infections are most frequently
spread from one patient to another on the hands of
healthcare workers.

5. Normal bacterial flora on hand
 In 1938, Price established that bacteria recovered from
the hands could be divided into two categories, namely
resident or transient.
 The resident flora (resident microbiota) consists of
microorganisms residing under the superficial cells of
the stratum corneum and can also be found on the
surface of the skin.
 Staphylococcus epidermidis is the dominant species.

6. Contd….
 Other organisms like S. Hominis, coagulase negative
staph. Coryneform bacteria, some fungi pityrosporum.
 Resident flora has two main protective functions:
microbial antagonism and the competition for
nutrients in the ecosystem.
 In general, 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.

7. Contd….
 Transient flora (transient microbiota), which colonizes the
superficial layers of the skin, is more amenable to removal by
routine hand hygiene.
 Transient microorganisms do not usually multiply on the skin,
but they survive and sporadically multiply on skin surface.
 They are often acquired by HCWs during direct contact with
patients or contaminated environmental surfaces adjacent to the
patient.
 The transmissibility of transient flora depends on the species
present, the number of microorganisms on the surface, and the
skin moisture.

8. Transmission of pathogen by hand
 Transmission of pathogens from one patient to another via
HCWs’ hands requires five sequential steps
(i) organisms present on patient’s skin, or in the inanimate
environment.
(ii) organisms must be transferred to the hands of HCWs.
(iii) organisms must be capable of surviving for at least several
minutes on HCWs’ hands.
(iv) defective hand cleansing, resulting in hands remaining
contaminated. and
(v) cross transmission of organism by contaminated hands.

9. I )Organisms present on patient skin or
the immediate environment

10. ii)Organism transfer from patient to HCWs’
hands

11. iii)Organism survival on HCWs’ hands

12. iv)Incorrect hand cleansing

13. v)Failure to cleanse hands results in between-patient
cross-transmission

14. Antiseptic used in hand hygiene
 Alcohols (60-70 %)
 Chloroxylenol (0.5-4 %)
 Chlorhexidine (0.5-4%)
 Hexachlorophene (3%)
 Iodophors (0.5-10 %)
 Triclosan(0.1-2%)
 Quaternary ammonium compounds.

15. When do you wash your hands?
 Most people say they wash their hands after using the
bathroom but in reality all of us do not.
 Many of us do not wash our hands after coughing or
sneezing.
 Some of us wash up after handling money and this is a
great idea.
 Some of us also wash our hands after we handle our pets or
clean their litter boxes.

16. When Should You Wash Your Hands
 After you use the bathroom.
 When you cough or sneeze into your hands.
 After you blow your nose.
 After cleaning animal waste or litter boxes.
 After touching your pet.

17. Contd….
 Before you prepare food.
 Before eating .
 Before and after touching or treating a cut or wound.
 Before inserting contact lenses.
 After using public restroom facilities.
 After using exercise equipment in a public gym.
 Before and after changing a baby’s diaper.

18. How to Wash Hands Properly
 Wet your hands with warm water and apply soap either
liquid or from a bar.
 Lather well and rub hands vigorously together for 15-20
seconds or as long as it takes to sing the ABC song.
 Include the backs of the hands, under the nails and
between your fingers.
 Dry thoroughly with a clean towel.
 Use a towel to turn off the faucet

19. Steps of proper hand washing

20. What happens when I do not wash my
hands?
 Bacteria and viruses are picked up and stay on your hands.
 You can pass them to other people when you touch them with
your hands.
 Also, bacteria and viruses can get into your body when you
touch your eyes, mouth, or nose with your hands.

21. What if I do not have access to a sink
and soap?
 If possible, carry a waterless antibacterial hand
sanitizer with you.

22. What is the proper way to use
hand sanitizer?
 Apply an amount about the size of a quarter to the
palm of one hand.
 Rub your hands together using a “washing” motion
(including your nails and between your fingers) until
the cleanser has dried completely.

23. Surgical hand preparation –key steps
 Keep nails short and pay attention to them when
washing your hands – most microbes on hands come
from beneath the fingernails.
 Do not wear artificial nails or nail polish.
 Remove all jewellery (rings, watches, bracelets) before
entering the operating theatre.
 Wash hands and arms with a non-medicated soap
before entering the operating theatre area or if hands
are visibly soiled.

24. Surgical hand preparation technique

25. Contd….

26. Contd…

27. Contd…..

28. Contd…
 The introduction of sterile gloves does not render surgical hand
preparation unnecessary.
 18% (range: 5–82%) of gloves have tiny punctures after surgery, and
more than 80% of cases go unnoticed by the surgeon.
 After two hours of surgery, 35% of all gloves demonstrate puncture,
thus allowing water (hence also body fluids) to penetrate the gloves
without using pressure.
 A recent trial demonstrated that punctured gloves double the risk of
SSIs.
 Double gloving decreases the risk of puncture during surgery, but
punctures are still observed in 4% of cases after the procedure.
 Several reported outbreaks have been traced to contaminated hands
from the surgical team despite wearing sterile gloves.

29. Strategies for successful
promotion of Hand hygiene
 Education is a cornerstone for improvement of hand
hygiene practices.
 Easy access to hand hygiene supplies, whether sink, soap,
medicated detergent.
 Monitor HCWs adherence to recommended hand hygiene
practices.
 Encourage patients and their families to remind HCWs to
decontaminate their hand.

30. Contd…
 Make improved hand hygiene adherence an
institutional priority and provide appropriate
administrative support and financial resources.
 To improve hand hygiene adherence among personnel
who work in areas with high work loads, make an
alcohol-based hand rub available in convenient
locations and pocket sized to be carried by HCWs.

31. Contd…..
 Color posters emphasizing the importance of hand
hygiene to be displayed in strategic areas within the
hospital called “Talking Walls”.
 Bottles of hand rub solutions were distributed in large
amounts to all wards.
 Active participation and feedback at both individual
and organizational levels.

32. Conclusion
 All the above mentioned strategies can’t be used alone.
 Strategies to improve compliance with hand hygiene
practices should be multimodal and multidisciplinary.
 Clean Hands are Healing Hands.

33. THANK YOU