HAND HYGIENE

PRINCIPLES AND PRACTICE

Dr.T.V.Rao MD

DR.T.V.RAO MD

THE WORK OF IGNAZ SEMMELWEISS

Hungarian doctor who worked in a maternity ward in

Austria in the 1840s. There were two wards in the maternity building: One contained women due to give birth and was run by midwives. The other was used as a teaching hospital for medical students, who may have come straight from dissecting dead bodies. The wards were cleaned no more than once a month. The doctors rarely washed their hands and often wore dirty coats. Semmelweiss was horrified by the number of women who died after births that were trouble free. The women developed a very high temperature and died within a few days from an illness called childbed fever. No-one had any idea what caused this disease. No-one knew about bacteria or viruses then.

DR.T.V.RAO MD

THE WORK OF IGNAZ SEMMELWEISS

Semmelweiss realised that more than three times as many women died from fever in the teaching ward than in the midwives ward. He was determined to try to reduce the number of deaths. He looked into at each factor that was different between the two wards, but nothing that he thought of seemed to make a difference. Then a professor was accidentally cut with a knife that was getting used to study the body of a woman who had died. The professor himself died, from a disease whose symptoms were like childbed fever.
DR.T.V.RAO MD

THE WORK OF IGNAZ SEMMELWEISS

Semmelweiss thought that there must have been something on the knife that had caused the disease. He made all the doctors wash their hands in chlorine water before examining the women Within a very short time, the death rate had fallen Semmelweiss presented his findings to other doctors. His ideas were mocked.
DR.T.V.RAO MD

Evidence of Relationship Between Hand Hygiene and Healthcare-Associated Infections

Substantial evidence that hand hygiene reduces the incidence of infections

Historical study: Semmelweis More recent studies: rates lower when antiseptic hand washing was performed
DR.T.V.RAO MD

Hand Hygiene Definitions

Hand washing
The application of non-antimicrobial soap and water to the surface of the hands

Antiseptic hand wash

Washing hands with water and soap or other detergents containing an antiseptic agent

Alcohol-based hand rub

an alcohol-containing preparation designed for application to the hands in order to reduce the number of viable organisms with maximum efficacy and speed

Surgical hand hygiene/antisepsis

Hand washing or using an alcohol-based hand rub before operations by surgical personnel
DR.T.V.RAO MD

Why we dont wash our hands

Too busy/insufficient time
Patient needs take priority Understaffing/overcrowding Sinks are inconveniently located or lack of sinks Lack of soap and paper towels Hand washing agents cause irritation and dryness Low risk of acquiring infection from patients

HCW are not bad just busy! Poor design

Poor product More education

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

DR.T.V.RAO MD

INDICATIONS FOR HAND WASHING

Hand hygiene should be performed before and after every patient contact Hand hygiene should be performed after contact with patients environment Hand hygiene should be performed after using a restroom, after removing gloves, prior to and following meals

DR.T.V.RAO MD

Washing Hands
1 2 3 4 5

Wet hands.

Get soap.

Wash hands.

Dry hands.

Throw away.

Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children with Challenging Behavior. Tampa, Florida: University of South Florida, Early Intervention Positive Behavior Support.

A CASUAL HAND WASH MAY MISS SEVERAL AREAS FROM DISINFECTION

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PRACTICE A LITTLE OF SCIENTIFIC STEPS IN HAND WASHING

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MAKE THE BEST USE OF SCIENTIFIC METHODS IN CRITICAL CARE OF PATIENTS

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Indications for Hand Hygiene

When hands are visibly dirty, contaminated, or soiled, wash with nonantimicrobial or antimicrobial soap and water.
If hands are visibly clean, use an alcoholbased hand rub for routinely decontaminating hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
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What can we do to help change this

Provide easy access to hand hygiene materials
Handrub solution
Conveniently located:
at the patients bedside at the patients room entrance in convenient / appropriate locations in high traffic public areas

DR.T.V.RAO MD

Working appropriately Full of product Within use by date

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Glove use
Hand hygine is required regardless of whether gloves are used or changed Failure to remove gloves after patient contact or between dirty and clean body site care in the same patient has to be regarded as noncompliance with recommendations

Gloves should not be washed or reused Gloved HCWs can cause cross infections

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DR.T.V.RAO MD

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ACCORDING TO THE CDC

Wet hands with running water; place soap in palms; rub together to make a lather; scrub hands vigorously for 20 seconds; rinse soap off hands. If possible, turn off the faucet by using a disposable paper towel. Dry hands with a disposable paper towel. Do not dry hands on clothing.

Assist young children with washing their hands.

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SPECIFIC INDICATIONS FOR HAND HYGIENE Before:

Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that dont require surgery

After:
Contact with a patients skin Contact with body fluids or excretions, non-intact skin, wound dressings

Removing gloves

DR.T.V.RAO MD

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

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WHAT TO USE AND WHEN

When hands are visibly soiled use soap and water to wash
If your hands are visibly CLEAN use ABHR

Before and after touching a patient

Before and after a procedure After touching a patients surroundings Before and after glove use
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Easy Message

SQUIRT
one squirt (1-3 ml) to your hands

RUB
apply to palm

ROLL rub hands together covering all aspects of your fingers & hands until dry

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Recommendations for Hand Washing Facility:

Clean at all times;

Strategically located as per regulations, near bathrooms and entrances to the processing area; Dedicated to hand washing only; Liquid soap in dispenser;

Hot water (43 C or 110 F);

Use of disposable paper towels or air blowers; and Adjacent hand sanitizing facilities.

EASY MESSAGE
Basic message always the same Clean you hands before and after every patient touch

Instructions always the same

Squirt Rub

Roll

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SELF-REPORTED FACTORS FOR POOR ADHERENCE WITH HAND HYGIENE

Hand washing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks

Lack of soap and paper towels

Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients

DR.T.V.RAO MD

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

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EDUCATION/MOTIVATION PROGRAMS
Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. MD DR.T.V.RAO RR-16.
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Failed Role Models

Healthcare workers in a room with a senior staff member or peer who DID NOT wash their hands were significantly less likely to wash their own hands
EMERGING INFECTIOUS DISEASES FEB 2003

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- is an important barrier to compliance - is more frquent with soap and

water than with handrubs - is reduced and can be treated by emollient-containing solutions

Skin irritation A Limitation to Hand Washing

Boyce et al. Inf Contr Hosp Epi 2000;21:442 Kramer et al. J Hosp Infect 2002; 51:114 Larson et al. Heart Lung 2000; 29:139 Pittet. Emerging Inf Dis 2001; 2:234

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CLEAN HANDS SAVES MANY LIVE HAVE ONE OURSELVES

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HOSPITAL ADMINISTRATION THANKS EVERYONE FOR WASHING HANDS

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REFERENCES
WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) April 2006

Guideline for Hand Hygiene in Health-Care Settings.MMWR 2002:vol,51,no RR-16

HHA 5 Moments for Hand Hygiene,Advanced draft, August 2008 Pittet D,Inf .Control Hospital Epidemiology 200:21:381-386

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 Programme Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World
Email

doctortvrao@gmail.com
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