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M2_1_Standard precautions_Hand hygiene.pptx
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- 2. Learning objectives •Learn therationale for use of standard precautions and their importance in reducing the risk of infection transmission •Learn the personal responsibility in following standard precautions and assessing infection risk
- 3. Learning outcomes •Know whatstandard precautions are and when to apply them. •Know how to do risk assessment and how to manage them •List and describe the basic elements of standard precautions •Demonstrate Proper hand washing techniques •Know how to select appropriate PPE for a given situation within health care settings •How to wear and remove (don and doff) PPE properly
- 4. 4 STANDARD PRECAUTIONS • Definition: •Minimum infection prevention measures that apply to patient care regardless of suspected or confirmed infection status of the patient in any setting where care is delivered • Aim: • Prevent or stop spread of infection • From health worker to patient • From patient to patient • From patient environment to patient or health worker
- 5. Why use standardprecautions? • Delivery of healthcare is associated with a risk of transmission of infectious agents: • Via other patients and healthcare workers • In association with medical devices • Risk of transmission of infectious agents is determined by: • susceptibility, • route of transmission, • duration and intensity of exposure, • and availability and behaviour of healthcare workers with hands- on patient contact (APIC, 2005: 18-1)
- 6. Where are theorganisms?
- 7. Where are theorganisms?
- 8. Reservoirs for microorganisms 1.Main reservoir: colonised or infected patients 2. The immediate patient environment becomes colonised with patient flora 3. The environment in the healthcare facility contains a variety of different microorganisms and represents a secondary source of transmission Sax, 2007
- 9. Patient environment From: Ontario“Just Clean Your Hands Program “ http://www.health.gov.on.ca/en/ms/handhygiene/
- 10. 10 Standard Precautions Standard precautions Hand Hygiene Injectionsafety Use of PPE Safe sharp disposal Waste management Patient placement Cough etiquette Environmental cleaning Care of patient equipment Linen management Occupational health
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- 12. Learning Objectives •Know whathand hygiene is •Explain why, when and how to perform hand hygiene •Demonstrate correct hand hygiene technique •Know the different methods of hand hygiene
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- 14. Discussion What is handhygiene?
- 15. Hand Hygiene • Refersto cleaning and disinfection of hands • Cleaning: physically removing microorganisms and visible debris using soap and water • Disinfection: chemically killing microorganisms Examples:
- 16. Hand Hygiene • Ina healthcare facility, the hands of healthcare workers are the biggest cause of cross-infection • Require 3 – 30 applications of hand rub / hour during active patient care (Sax, 2007) • Compliance rates are generally low (40-60%) but improve if alcohol rub is available • Challenge is to sustain awareness about and increase compliance with hand hygiene • Multimodal approach is advocated: multidisciplinary teamwork and combination of education, supervision, and provision of acceptable hand hygiene products
- 17. Benefits of improvedHand Hygiene •Terminates outbreaks in healthcare facilities •Reduces transmission of resistant organisms, e.g. Methicillin Resistant Staphylococcus Aureus (MRSA) •Reduces overall infection rates CDC, 2002
- 18. Skin layers We arecontinuously shedding dead keratinised skin cells from the outer stratum corneum layer 1. Stratum corneum: dead keratinised skin cells 2. Epidermis: outer skin layer 3. Dermis: inner skin layer (with blood vessels) 1 2 3
- 19. Skin from tipof finger (x75 mag)
- 21. Using glo gelas an alcohol hand rub
- 22. Transmission of pathogens •HCWs can contaminate their hands with 100 – 1000 cfus of Klebsiella spp. during “clean activities” • Lifting a patient • Recording a patient’s pulse, blood pressure or oral temperature • Touching a patient’s hand, shoulder or groin • Direct patient contact and respiratory tract care • Most likely to contaminate the fingers of nurses • Gram negative bacilli and Staphylococcus aureus are frequently involved CDC, 2002 Cfus- Colony forming units
- 23. WHO: When toperform hand hygiene
- 24. WHO: When toperform hand hygiene
- 25. Promote effective handhygiene • Keep nails short • Remove rings, wrist watches and bracelets • No artificial nails or nail polish • Remove wrist watches and bracelets • Roll up long sleeves or remove long-sleeved clothing
- 26. When to useordinary soap For ordinary tasks: • When coming on duty • Before and after eating • Before and after patient contact • Before and after wearing gloves • Before preparing and handling medication • When hands are visibly soiled
- 27. When to usea alcohol hand rub •When your hands are not visibly soiled •Before and after direct patient contact •Before putting on gloves for invasive procedures •After removing gloves •Before handling clean equipment and medication •After contact with surfaces and objects in the patient’s environment
- 28. When to useantimicrobial soap •Before invasive procedures •Before contact with susceptible patients (immune- compromised, newborns) •After contact with contaminated areas (infected wound), blood, body fluids •After contact with patient colonized/infected with prominent pathogens / resistant organisms •After leaving room of patient on transmission-based precautions
- 29. Routine hand decontamination WASHWITH SOAP AND WATER • Use ordinary or antimicrobial soap and lukewarm water • Rub all areas (back of hands, between fingers, finger tips, thumbs, wrists, nails) vigorously for at least 60 seconds • Rinse well and pat dry with paper towel • Use towel to turn faucet off • Throw towel into waste bin without touching the bin Aim: To remove debris and transient microorganisms from hands
- 30. Routine hand decontamination USEAN ALCOHOL RUB • Dispense some of the alcohol-based solution in the palm of your one hand • Use enough to cover your entire hand surface • Rub over all the surfaces of your hands • Continue rubbing until dry • Your hands must remain wet for at least 15 seconds Aim: To remove transient microorganisms from hands
- 31. Surgical hand decontamination WASHWITH ANTIMICROBIAL SOAP AND WATER • Wet hands and forearms under running water • Apply antimicrobial soap to all surfaces of hands and forearms • Wash for 3-5 minutes • Rinse thoroughly • Dry thoroughly USE AN ALCOHOL RUB Skin contact time of 3 minutes (use manufacturer’s instructions) Aim: To remove transient and reduce resident microorganisms from hands before surgical procedures
- 32. Hand Hygiene Products Ordinary(standard) soap • Removes transient microorganisms from hands • Physically removes microorganisms as well as soil but does not kill the microorganisms Surgical scrubs • Removes transient and resident microorganisms from hands • Physically removes the microorganisms as well as soil; kills the microorganisms too • Chlorhexidine gluconate • Iodophors (povidone-iodine) • Triclosan Alcohol handrubs • Kills microorganisms but does not physically remove microorganisms and dirt
- 33. Alcohol-based hand rub •Place dispensers at point of patient care • Ideal: at each patient bedside = most efficient and least time- consuming • At entrances of high-care wards • At entrances of patient rooms • At each patient bed/incubator in ICU and high-care • On procedure trolleys • Do NOT use when dealing with a spore-forming organism like Clostridium difficile • In such a case staff must wash hands with soap and water exclusively
- 34. Finger imprints before(left) and after (right) use of alcohol rub
- 35. Use of products Collectinformation about the use of hand hygiene products in your facility: •Keep records of consumption per ward •Encourage staff to report all adverse events with hand hygiene products •Problems with products (e.g. skin irritations) will discourage staff from performing hand hygiene •Use the above info in conjunction with compliance statistics
- 36. Risk Management What willyou do? • No running water • Bar soap only • No paper towels
- 39. Ideal hand washingfacility • Readily available not too far from the point-of-care area • Wash basin dedicated for hand washing only • Basin has no plug and water stream is not aligned with outlet to prevent splash-back • Lukewarm, running water • Elbow-operated / “no touch” taps • Liquid soap • Paper towels • Pedal-operated “no touch” waste bin • Laminated poster with hand hygiene instructions
- 40. If piped wateris not available can use A bucket with tap and lid A pitcher or a jug to pour water over hands with a help of an assistant A foot-operated device or “tippy tap” ASIGN ONE PERSON TO ENSURE FRESH WATER IS ALWAYS AVAILABLE
- 41. Placement of handwashbasins • Inside each patient room next to entrance in addition to sink in patient en-suite bathroom • Inside treatment rooms and physical examination rooms • Inside any room with a toilet • Inside or close to each nursing station • Inside dirty utility room - in addition to sinks • Inside dirty linen holding area • Inside or close to the staff lounge
- 42. Placement of handwash basins (continued) • Rooms used for airborne precautions: in the patient room, in the patient bathroom and in the ante-room • Inside medication room • Inside any room where food is handled / prepared (hospital kitchen, ward kitchen, breast milk and baby formula handling areas) • Close to each laboratory work station • Inside each clinical laboratory and morgue • In areas where hands are likely to be contaminated – storage and disposal areas
- 43. Care of hands •Damagedskin allows for multiplication of flora •Cover all skin lesions before patient contact •Do not use water that is too hot – it will irritate the skin •Dry hands by patting and not rubbing •Dry hands completely •Use lotions and creams regularly •Do not expose hands to harsh chemicals
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- 48. SUMMARY • Hands arethe main way germs are spread in the healthcare facility • WHO 5 moments of hand hygiene must be observed • Do not use alcohol hand rub when hands are visibly soiled • Use soap and water when hands are visibly soiled
- 49. Watch hand hygienevideo
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