Download HAND HYGIENE IN HEALTH

HAND HYGIENE
IN
HEALTH-CARE
SETTING
HISTORY CONTD1975/1985-
CDC Guidelines
Recommended washing hands
with antimicrobial soap
before & after performing
invasive procedures.
1995- APIC Guidelines supported use
of alcohol based hand rubs in
clinical setting..
1996Healthcare infection control
practices advisory committee (HICPAC)
recommended that
either Antimicrobial soap
or
a Waterless Antiseptic Agent
should be used in case of patients with
multidrug resistant pathogens.
Purpose Of Hand washing
• Removes dirt & soil from hand.
• Reduces cross contamination
• Reduces risk of hand acting as carrier of
disease.
• Breaks the chain of infection spread.
• Prevents noscominal infections.
• Gives psychological cleanliness feeling to
the paramedical staff.
Behavioural pattern of
paramedical staff• Healthcare workers show
•
•
•
resistance to frequent hand
washingReasons behind thisAwareness of importance of
hand washing is lacking.
Negligence.
Irritation faced due to
contact dermatitis which
results due to frequent hand
washing.
Gloves
• General excuse given to avoid hand
washing is ……………
WE USE GLOVES.
CDC Guidelines says that
if hand washing is performed
carefully,
gloves are theoretically
not necessary.
Gloves give a false sense of security.
Journal of Infectious Diseases
1938,63,301-18.
• Rapid multiplication of bacteria
occurs under surgical gloves if hands
are washed with non antimicrobial soap &
growth is slow in case of
preoperative scrubbing with an antiseptic.
• Wearing of gloves does not provide
complete protection against infections
caused by hepatitis B & herpes simplex.
OTHER REASONS FOR NON
COMPLIANCE
• Shortage of time.
• Non availability of facility.
• Deleterious effects of hand washing
• Negligence when person is alone.
• Not convinced about the
importance of
HANDWASHING.
LETS UNDERSTAND IN DETAIL
THE
IMPORTANCE
OF
HANDWASHING.
LET US START WITH THE
ANATOMY FIRST
Physiology of normal skin
 THE SUPERFICIAL
REGION- Stratum
corneum
 THE VIABLE
EPIDERMIS
 THE DERMIS
 THE
HYPODERMIS
NORMAL BACTERIAL
SKIN FLORA
TOTAL BACTERIAL COUNT ON
HANDS OF MEDICAL PERSONNEL3.9 X 10,000
To
4.6 X 10,000 CFUs/ sq.cm.
(CFU- colony forming units)
COLONIES are of 2 types.
TRANSIENT FLORA
*Colonize on superficial
layers of skin.
*Abundant on fingertips.
*Frequently associated with
healthcare associated
infections.
*Removal by routine hand
washing.
RESIDUAL FLORA
Attached to deeper
layers of skin.
*Less likely to be
associated with
noscominal infections.
*Not easily removed by
scrubbing.
*Persistent
*
Transmission of pathogens on
hands of Paramedical staff.
Organisms from patient’s skin or in animate objects in
close proximity of patient
transferred to
Hands of Paramedical staff.
Survival of these organisms for some time on hands
Inadequate Hand washing OR with inappropriate agent
Contact with another patient with contaminated hands
Transmission of pathogens
Facts about Transmission
 Approximately 10x6 skin sqm containing viable
microorganisms are shed daily from
*Normal skin
*Patients gown
*Bed linen
*Bedside furniture
*Other objects in patients immediate
environment.
Contamination is
particularly likely caused
by
staphylococci
or
enterococci
which are resistant to
desiccation &
Capable of colonizing &
infecting wounds
AREAS FROM WHERE THE
MICROBES SPREAD
• HAIR
• FACE
• GROIN
• AXILLA
& UTMOST IMPORTANLY
HANDS – Basically fingernails.
CDC Recommendations
for hand washing
• Before & after touching wound.
• After touching contaminated inanimate
object.
• After taking care of infected patient.
• Situations where contamination might
have taken place.
• Before performing invasive procedures.
HANDWASING IS A MUST
ON
VISIBLY SOILED HAND
which is
Hand showing visible dirt or
visible contamination
with
proteinaceous material, blood
or other body fluids.
TYPES OF HANDWASHING
PLAIN HANDWASHING- Washing
hands with plain (non –antimicrobial)
soap & water.
 HAND ANTISEPSIS- Refers to
Antiseptic hand wash
or
Antiseptic hand rub.

ANTISEPTIC HAND WASH
Washing hands with water &
soap or other detergent
containing an antiseptic agent
ANTISEPTIC HAND RUB
Applying an antiseptic hand rub
product to all surfaces of the
hands to reduce the no. of
microorganism present.
SURGICAL HAND ANTISEPSIS
Antiseptic hand wash or
Antiseptic hand rub
performed preoperatively by
surgical personnel to eliminate
transient & reduce residual hand
flora.
HANDWASHING AGENTS
DETERGENTThese are compounds which
possess cleansing action.
PLAIN SOAPThis is the type of detergent which
does not contain antimicrobial
agent.
ANTIMICROBIAL SOAPThis is the detergent which contains
antimicrobial agent
ALCOHOL BASED HAND RUBSAn alcohol containing preparation
designed for application to the hands for
reducing the no. of viable
microorganisms on the hand.
Advantages of Alcohol based
preparations• Alcohols have excellent germicidal activity
against gram +ve & gram –ve bacteria
including MRSA & VRE,
mycobacterium tuberculosis &
various fungi.
• Lipophilic viruses like HIV, Influenza,
vaccinia, herpes implex are susceptible
to alcohols.Alcohols have activity against
hepatitis B also.
American Journal of Infection
Control
• Alcohols can prevent transfer of
healthcare associated pathogens .
• Alcohol based products reduce no of
MRSA recovered from hands of healthcare
workers more effectively than hand
washing by soap & water.
Choice of Antimicrobial Agent


Depends on the type of hand washing to
be performed.
Social or Hygienic hand washAny soap with antimicrobial agent is
recommended.
10 sec hand washing time is suggested.
Choice of Antimicrobial AgentFor Procedural Hand washing.
This is where the effect of antimicrobial
should remain at least till procedure is
completed.
30 sec hand washing time is suggested.
Choice of Antimicrobial Agent
Surgical Antisepsis
This is pre & post operative hand
scrubbing.
30 secs hand scrubbing 3 times
I.e. total 90 secs suggested.
Recommendations for
Surgical Hand Scrub*Should reduce microbes on intact skin
substantially.
* Non irritating to skin.
* Broad spectrum of activity.
* Fast acting & persistent.
Evaluation of antimicrobial agent
in surgical hand scrub is done at
three time intervals
Immediately after scrubbing.
 After wearing surgical gloves for 6
hrs.I.e. persistent action.
 After multiple application over 5
days. I.e. cumulative action.

Methods to evaluate Efficacy of
Hand- Hygiene products

US FDA Approved Tentative Final
Monograph for Healthcare antiseptic Drug
Products
(TFM)Product Should reduce no. of bacteria by 90
% on each hand within 1 min of product
application on day 1.
Bacterial cell count must not exceed
baseline within 6 hrs on day 1.
US FDA Approved Tentative Final
Monograph for Healthcare antiseptic Drug
Products (TFM)-
99 % reduction in micro flora
on each hand
within 1 min
by the end of second day.
US FDA Approved Tentative Final
Monograph for Healthcare antiseptic Drug
Products (TFM)-
99.9 % reduction of micro flora
on each hand
within 1 min
by the end of 5 the day.