This document discusses proper hand hygiene techniques for healthcare workers. It covers the importance of hand hygiene in reducing infection spread, different hand hygiene methods like hand washing, hand antisepsis, antiseptic hand rubs and surgical hand scrubs. The techniques for each method are described in detail. Barriers to hand hygiene compliance and strategies to improve practices are also reviewed.

1. Module 3: Hand Hygiene

2. Presentation outline
• Learning objectives
• PPP 3.1: Importance and kinds of hand hygiene
• PPP 3.2: Hand washing techniques
• PPP 3.3: Hand antisepsis and antiseptic hand rub
• PPP 3.4: Surgical hand scrub
• PPP 3.5: Improving hand hygiene practices

3. Learning objectives
3
At the end of this module, participants will
be able to:
• Explain the rational for hand hygiene
• List the kinds of hand hygiene technique
• Explain the purpose of each kinds of hand hygiene
technique
• Demonstrate how to prepare and use antiseptic
hand rub
• Demonstrate the different hand hygiene techniques
• Mention common malpractices related with hand
hygiene

4. PPP 3.1 Importance and kinds of
Hand hygiene

5. Why hand hygiene is important?
 Hand hygiene is a general term referring to any
action of hand cleaning
 Reduces the number of disease-causing
microorganisms on hands and arms
 Minimize cross-contamination
 It is the most important way to reduce the spread of
infections in the health care selling.

6. Kinds of Hand hygiene practices
 Hand washing
 Hand Antisepsis
 Antiseptic Hand-rub
 Surgical Hand scrub

7. The decision to choose which type of
hand hygiene practice depends on:
 Intensity of contact with patient and /or blood and
body fluids,
 The likelihood of microbial transmission,
 Patient’s susceptibility to infection, and
 Procedure being performed
 The activity or area of practice

8. PPP 3.2 Hand washing
Techniques

9. Hand washing
Purpose: to mechanically remove soil and debris from
skin and reduce the number of transient
microorganisms.
 It is THE SINGLE most important measure in
reducing the spread of infection!

10. When do we wash our hands?
 Immediately after arriving and leaving work
 Before and after examining
 After touching contaminated instruments or items
 After exposure to mucous membranes, blood, body
fluids, secretions or excretions

11. When do we wash our hands?
 Before putting on gloves and after removing
them
 Whenever our hands become visibly soiled
 After blowing nose or covering a sneeze
 Before eating or serving food
 After visiting the toilet

12. Steps for routine hand washing:
 Thoroughly wet hands with water.
 Apply plain soap (antiseptic agent is not
necessary).
 Vigorously rub all areas of hands and fingers for
10–15 seconds, paying close attention to areas
under fingernails and between fingers.
 Rinse hands thoroughly with clean water.
 Dry hands with personal dry clean towel or paper
towel
 Use a paper towel or a single use towel after
drying hands to turn off the water

13. Hand washing Technique
13
WHO. 2005. Guidelines on
Hand Hygiene in Health Care
(Advanced Draft): A
Summary. WHO: Geneva

14. PPP 3.3 Hand antisepsis
and
antisepsis hand rub

15. Hand Antisepsis
15
Purpose: Remove soil and debris as well as to
reduce both transient and resident flora
 It is similar to plain hand washing except that the
soap or detergent contains an antiseptic agent
(often chlorhexidine, Iodophoris, triclosan)
[[Hand antisepsis should be done before:
• Examining or caring for highly susceptible
patients
• Performing an invasive procedure
• Leaving the room of patients on Contact
Precautions (e.g. hepatitis A or E)

16. Antiseptic Hand rub
16
Purpose: to inhibit or kill transient and resident flora.
 Considered to be more effective than antimicrobial hand
washing agents or plain soap and water,
 It is quicker and easier to perform,
 but it should not be used when the hands are visibly
soiled.
 Do not rinse hands after applying hand rub

17. Advantages of Alcohol-based
hand rubs
 Require less time
 Act faster
 More accessible than sinks
 More effective for standard hand washing than soap
 Can even provide improved skin condition.

18. Antiseptic Handrub
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Preparation of Alcohol-based solution for hand rub:
 Add glycerin or sorbitol to alcohol (2 ml. in 100 ml. of
60–90% ethyl or isopropyl alcohol solution)
The technique for performing antiseptic hand rub is:
 Apply enough alcohol-based hand rub to cover the entire
surface of hands and fingers (about a teaspoonful -5ml)
 continue rubbing the solution over hands until they are dry
(15-30 seconds). ).
 Rub the solution vigorously into hands, especially between
fingers and under the nails, until dry.

20. PPP 3.4 Surgical Hand scrub

21. Surgical Hand scrub
21
Purpose: to mechanically remove soil, debris and
transient organisms and to reduce resident flora for the
duration of the surgery

22. Steps in Surgical Hand-scrub
22
 Remove rings, watches, and bracelets.
 Thoroughly wash hands and forearms to the elbow with
soap and water.
 Clean nails with a nail cleaner.
 Rinse hands and forearms with water.
 Apply an antiseptic agent (soap)
 Vigorously wash all surfaces of hands, fingers, and
forearms for at least 2 minutes.

23. Steps ….Cont’d
23
 Rinse hands and arms thoroughly with
clean water, holding hands higher than
elbows.
 Keep hands up and away from the body,
do not touch any surface or article.
 and dry hands with a clean sterile dry
towel.
 Put on sterile or HLD gloves.

24. PPP 3.5 Improving hand
hygiene practices

25. Why Healthcare Workers
Don’t Wash their Hands?
25
 Hand washing between every patient encounter is
unnecessary,
 Hand washing doesn’t affect clinical outcome,
 Hand washing is unnecessary when gloves are
worn,
 Frequent hand washing damages skin and causes
cracking, dryness, irritation and dermatitis,
 Hand washing damages nails and nail polish
 Hand washing facilities are not conveniently placed
or well designed,
 Hand washing takes too much time

26. Issues and considerations related
to hand hygiene
 Gloves:
o Wearing gloves do not replace the need for hand hygiene.
 Hand lotions and hand Creams:
o hand lotions, creams and moisturizing skin care products
that are water based and without fragrance can be used
o Do not use oil based barrier products

27. Issues … cont’d
 Lesions and skin Breaks
o Cuticles, hands, and forearms should be free from lesions
 Finger nails and artificial nails
o Keep nails short, Long nails may serve as a reservoir for
microorganisms and tend to puncture gloves more easily..
 Nail polish
o Dark colored nail polish may prevent dirt and debris under
fingernails from being seen and removed.

28. How to Improve Hand Hygiene
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 Have supplies available and at “point of use.”
 Disseminate and promote guidelines.
 Reinforce guidelines.
 Involve everybody.
 Give positive feedback.
 Reward role modeling.
 Benchmark best practices.

29. Summary: Efficacy of Hand Hygiene
Preparations in Killing Bacteria
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Good Better Best
Plain Soap Antimicrobial
soap
Alcohol-based
handrub