Principles of Hand Hygiene in Healthcare : Principles of Hand Hygiene in Healthcare Essential Question: What are the Basic Infection Control Principles of Hand Hygiene : Essential Question: What are the Basic Infection Control Principles of Hand Hygiene Understand and become familiar with universal precautions.
Learn the importance of good hygiene and handwashing.
Learn proper handwashing techniques.
Learn the proper technique for applying and removing gloves. Slide 3: HAND HYGIENE PRACTICES Important topics:
Why should we clean our hands?
Barriers to frequent handwashing
How do hands become contaminated?
Advantages of alcohol-based hand rubs
New Hand Hygiene Recommendations Slide 4: Why is cleaning your hands
between patients important? Many 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
The Centers for Disease Control and Prevention (CDC) and other healthcare-related organizations believe that cleaning your hands before and after having contact with patients is one of the most important measures for preventing the spread of bacteria in healthcare settings Slide 5: Does handwashing really reduce the spread of bacteria in healthcare settings? Yes!
A scientific study performed in a hospital nursery found that when nurses did not wash their hands between patient contacts, babies acquired Staph bacteria much more frequently than babies cared for by nurses who washed their hands with an antimicrobial soap.
Several other studies also show that washing hands between patient contacts reduces the spread of bacteria in healthcare. Slide 6: Average Although handwashing has been proven to reduce the spread of microorganisms in healthcare facilities, healthcare workers often do not wash their hands when recommended.
In 34 studies of handwashing, workers washed their hands only 40% of the time. How is our track record on handwashing in healthcare facilities? Average Compliance of Personnel in
34 Studies of Handwashing Slide 7: Why is compliance with recommended handwashing so poor? Here are some reasons why healthcare workers do not wash their hands as often as they should:
heavy workloads (too busy)
sinks are poorly located
skin irritation caused by frequent exposure to soap and water
hands don’t look dirty
handwashing takes too long Slide 8: Increasing Workload Handwashing
Compliance Personnel with heavy workloads have little time to wash their hands A recent study showed that the busier healthcare workers are, the less likely they are to wash their hands when recommended
Nursing shortages have caused nurses to be busier than ever before Slide 9: Sinks used for handwashing are often installed in inconvenient locations.
Personnel may fail to wash their hands when indicated because it is too much trouble to get to the sinks provided.
Can you find the sink in this picture? Sinks are often
poorly located Slide 10: The sink mentioned in the previous slide is located behind the patient’s bed and behind several IV pumps.
Personnel are unlikely to use handwashing sinks if they are not readily accessible. Location, location, location ... Slide 11: Frequent handwashing with soap and water often causes skin irritation and dryness.
In the winter months, some personnel may even develop cracks in their skin that cause bleeding, as seen in the adjacent figure. Another reason why personnel don’t wash their hands often Slide 12: Many personnel don’t realize when they have germs on their hands Nurses, doctors and other healthcare workers can get 100s or 1000s of bacteria on their hands by doing simple tasks, like
pulling patients up in bed
taking a blood pressure or pulse
touching a patient’s hand
rolling patients over in bed
touching the patient’s gown or bed sheets
touching equipment like bedside rails, over-bed tables, IV pumps
How can this happen? Culture plate showing growth of bacteria 24 hours after a nurse placed her hand on the plate Slide 13: 13-25%
30-39% Patients often carry resistant bacteria on their skin Patients with resistant bacteria like methicillin-resistant S. aureus (MRSA) or vancomycin-resistant enterococci (VRE) often carry the organism on many areas of their skin, even when they don’t have any wounds or broken skin.
The Figure shows the percent of patients with methicillin-resistant S. aureus (MRSA) who carry the organism on the skin under their arms, on their hands or wrists, or in the groin area. Percent of Patients with MRSA Who Carry the Organism on Their Skin Slide 14: Percent of Surfaces Contaminated Frequency of Environmental Contamination
of Surfaces in the Rooms of Patients with
Methicillin-Resistant S. aureus (MRSA) Resistant bacteria on the skin or in the gastrointestinal tract of patients can often be found on common items
Healthcare workers can contaminate their hands by touching environmental surfaces near affected patients. Here’s another way healthcare workers contaminate their hands Slide 15: Since washing hands frequently with soap and water is
often causes skin irritation and dryness
experts have suggested that hospitals, extended care facilities, and home health agencies develop new strategies for improving hand hygiene among healthcare workers.
We need to make it easier for you to clean your hands quickly, with a minimum of effort and skin irritation.
One way to accomplish these goals is to clean your hands with an alcohol-based handrub (a gel, rinse or foam). How can we overcome problems associated with handwashing? Efficacy of Hand Hygiene Preparations in Killing Bacteria : Efficacy of Hand Hygiene Preparations in Killing Bacteria Good Better Best
Plain Soap Antimicrobial Alcohol Sanitizer Slide 17: Using an alcohol-based handrub takes less time than handwashing One study found it took ICU nurses an average of 62 seconds to go to a sink, wash and dry their hands, and return to patient care activities.
However, in the same hospital, it was estimated that if an alcohol-based handrub was available at each patient’s bedside, it would take nurses about 15 seconds to clean their hands.
So, one of the advantages of using alcohol hand rubs is that they require much less time to use. Slide 18: If hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based handrub for routinely cleaning your hands:
before having direct contact with patients
after having direct contact with a patient’s skin
after having contact with body fluids, wounds or broken skin
after touching equipment or furniture near the patient
after removing gloves When should you use an
alcohol-based handrub? Slide 19: Here are some more tips on how to use an alcohol-based handrub If after cleaning your hands 5 to 10 times with an alcohol-based handrub, you feel a “build-up” of emollients on your hands, wash your hands with soap and water.
If you clean your hands with an alcohol-based handrub before putting on gloves, make sure the alcohol has dried completely before putting on gloves. Slide 20: Are alcohol-based handrubs really effective? More than 20 published studies have shown that alcohol-based handrubs are more effective than either plain soap or antibacterial soaps in reducing the number of live bacteria on the hands. Slide 21: Won’t frequent use of
alcohol dry out my skin? No!
In fact, studies have proven that nurses who routinely cleaned their hands between patients by using a modern alcohol-based handrub had less skin irritation and dryness than nurses who washed their hands with soap and water.
Modern alcohol-based handrubs contain skin conditioners (emollients) that help prevent the drying effects of alcohol. Slide 22: Apply 1.5 to 3 ml of an alcohol gel or rinse to the palm of one hand, and rub hands together
Cover all surfaces of your hands and fingers
Include areas around/under fingernails
Continue rubbing hands together until alcohol dries
If you have applied a sufficient amount of alcohol hand rub, it should take at least 10 -15 seconds of rubbing before your hands feel dry. Here are some tips on how to use an alcohol handrub Slide 23: Promoting alcohol hand rubs
improve hand hygiene habits Several studies like the one shown on the right have found that when hospitals placed alcohol handrub dispensers near each patient’s bed, healthcare workers cleaned their hands significantly more often than they did when only sinks were available for handwashing. Hand Hygiene Compliance by ICU Personnel Before & After Alcohol Dispensers Were Installed Next to Every 4th Bed And Next to Every Bed Slide 24: When compared to traditional soap and water handwashing, alcohol handrubs have the following advantages:
take less time to use
can be made more accessible than sinks
cause less skin irritation and dryness
are more effective in reducing the number of bacteria on hands
makes alcohol-based handrubs readily available to personnel
has led to improved hand hygiene practices Advantages of cleaning hands with alcohol-based handrubs Slide 25: For the reasons cited on previous slides, a new guideline developed by the Centers for Disease Control and Prevention (CDC) and infection control organizations recommends that healthcare workers use an alcohol-based handrub (a gel, rinse or foam) to routinely clean their hands between patient contacts, as long as hands are not dirty.
New recommendations are shown on the following slides. New CDC guideline recommends frequent use of alcohol-based handrubs Slide 26: Wash your hands with plain soap and water, or with antimicrobial soap and water if:
your hands are visibly soiled (dirty)
hands are visibly contaminated with blood or body fluids
after using the restroom When should you wash your
hands with soap and water? Slide 27: When washing hands with plain or antimicrobial soap,
wet hands first with water (avoid HOT water)
apply 3 to 5 ml of soap to hands
rub hands together for at least 15-30 seconds
cover all surfaces of the hands and fingers, don’t forget your wrist
rinse hands with water and dry thoroughly
use paper towel to turn off water faucet Here are some tips on how to
wash your hands effectively Universal Health Precautions : Universal Health Precautions Universal Precautions : Universal Precautions As defined by the Centers for Disease Control (CDC): Universal Precautions (UP) are a set of practices designed to prevent the transmission of HIV, Hepatitis B and other blood borne pathogens (bacteria and viruses). Under UP, blood and other body fluids of all patients are considered potentially infectious. UP recommends the use of Personal Protective Equipment : UP recommends the use of Personal Protective Equipment Gloves
Masks Universal Precautions also include: : Universal Precautions also include: Proper handling and disposal of needles.
Taking precautions to prevent injury from scalpels, needles, and other sharp instruments. When to wear Gloves? : When to wear Gloves? Anytime you may come in contact with blood or other body fluids such as urine, saliva, vomit, or the mucous membranes of the mouth or nose.
When touching skin that may have sores, open wounds, cuts, or scratches.
When handling any object that may have been soiled with blood or body fluids.
When you have a cut or scratch on your hands. If I wear gloves, do I still have to wash my hands? : If I wear gloves, do I still have to wash my hands? YES!
Wash hands before putting on gloves.
Wash hands immediately after removing gloves.
Gloves should be changed every time you are in contact with a new person. Summary: : Universal Precautions recommend that you treat all bodily fluids as if they are infected with a blood-borne disease.
Personal protective equipment includes gloves, face shields or eyewear, gowns, aprons and masks.
Wash hands before putting on gloves and immediately after removing gloves.
Wet your hands with warm water; apply soap and scrub really well 10-15 seconds. Rinse and dry. Summary: Gloving : Gloving Wear gloves when contact with blood or other potentially infectious materials is possible
Remove gloves after caring for a patient
Do not wear the same pair of gloves for the care of more than one patient
Do not wash gloves Fingernails and Artificial Nails : Fingernails and Artificial Nails Natural nail tips should be kept to ¼ inch in length
Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR) Slide 37: Any Questions?