Download Alcohol-based Hand Rub is the preferred method of hand

 Background
 Costs
 Selection
of Agents
 Techniques
 Indications
 Summary
Healthcare Associated Infections (HAI’s) have
increased morbidity and mortality rates among
hospitalized patients worldwide
 HAI pathogen transmission most often occurs via
the contaminated hands of health care workers
 HAIs affect nearly 2 million individuals annually
in the United States
 Approximately 80,000 deaths each year
 Hand Hygiene with alcohol- based hand rub
(preferred) or soap and water has proven to be
most effective measure in preventing HAI’s.


Performing hand hygiene with soap and water or with alcohol
hand sanitizer costs less than a penny

However, healthcare workers cost hospitals $1.98 for every
missed hand hygiene opportunity (Bloomberg, 2008)

The missed action costs patients significantly more suffering

In the USA 1/136 patients become infected from HAI at a cost of
$4.5-5.7 billion per year

Bacteria can survive for DAYS on patient care equipment and
other surfaces.

By washing your hands you can prevent the spread of HAI’s to
your patient and yourself
 The
killing or removal of microorganisms
on the hands that have been picked up
by contact with patients, staff,
contaminated equipment or the
environment
 Hand Washing
with soap & water
– performed when hands are visibly soiled with
organic matters, i.e., food, soil, blood, body fluidurine, stool
-- performed when caring for a patient with
Clostridium difficile (C. diff)
 Hand
Sanitation with Alcohol-based Hand
Rub (ABHR)
– preferred method in healthcare settings to clean
hands that are not visibly soiled
 Alcohol-based
Hand Rub is the preferred
method of hand hygiene in a healthcare setting
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
Provides a rapid kill or removal of most bacteria on hands
Takes less time than using soap and water
Contains emollients to reduce skin irritation
They can be easily available at the “point of care”
Remember not to rinse off with water immediately
after application
• These cleansers are well tolerated, but may cause temporary stinging
when in contact with skin cracks.
• Regular Soap
Better
• Antimicrobial Soap
Good
• Alcohol Based hand rub
(foam or gel)
Best
 Types
of Hand Soap
1. All purpose soap
• Used for most patient care
• Appropriate for most hand washing
2. Antibacterial Soap
 Soap
and water hand washing works by rinsing
bacteria off the hand and down the drain.
 According to the Centers for Disease Control and
Prevention (CDC), antibacterial soaps are not
necessary, but washing your hands thoroughly
with ordinary soap and warm water is one of the
most effective ways to break a link in “the chain
of infection”.

HAND RUB (foam and gel)
• Apply to palm of one hand (the amount used depends on
specific hand rub product).
• Rub hands together, covering all surfaces, focusing in
particular on the fingertips and fingernails, until dry. Use
enough rub to require at least 15 seconds to dry.

HANDWASHING
• Wet hands with water.
• Apply soap.
• Rub hands together for at least 15 seconds, covering all
surfaces, focusing on fingertips and fingernails.
• Rinse under running water and dry with disposable towel.
• Use the towel to turn off the faucet.
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Healthy skin is the 1st line of defense
against infection
Dry and cracked skin harbor more
microbes
Apply hospital provided lotion to protect
skin after frequent hand washing to
prevent skin breakdown
 Hand
lotions are important to prevent skin
dryness and irritation.
 Only hospital-approved hand lotions
shall be used. Keep personal lotions at
home.
 Personal lotions are prohibited because
they can:
• make hand hygiene products less effective
• cause breakdown of latex gloves
• become contaminated with bacteria in the hospital
environment
Fingernails shall be natural and must be ¼
inch in length or less.
 Long nails, chipped polish, artificial nails,
and nail jewelry are a reservoir for
microorganisms.
 Shellac (gel) polish, gel overlays, acrylics,
and silks are considered artificial overlays
and not permitted by healthcare workers
 Artificial overlays have been implicated in
outbreaks and can tear gloves
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GBMC’s Hand Hygiene
policy is based on the
WHO (World Health
Organization) 5 Moments.
Policy is visible on the
“Info Web” under
Infection Prevention dept
tab
Includes a policy on Nail
length and prohibitions
regarding nail jewelry,
ie.,tips, shellacs etc. for
direct care givers, nurses,
nst, physicians.

GBMC participates in the Maryland Patient Safety
Center (MPSC) Hand Hygiene Collaborative
• State facilitated program
• Observations conducted by anonymous observers
• Report results monthly involving all inpatient units and all disciplines

GBMC also developed a patient observation
program titled “Hand to Hand”
• Anonymous patient and visitor submission regarding compliance
• Over 14,000 patients submitted survey’s on GBMC’s Hand Hygiene practices in
FY14!

GBMC is committed to improving compliance and
fostering a culture of safety for staff and patients. The
Goal for both programs in FY15 is 92% compliance.
ALWAYS perform Hand
Hygiene:
1)
2)
3)
4)
5)
Before touching a patient
Before a clean/aseptic
procedure
After body fluid exposure
risk; including after glove
removal
After touching a patient
After having contact with
the healthcare
environment
****AND….Crossing the
room threshold at entry
and exit
Semi-Private Rooms with
curtain divider:
• Health care providers should
perform hand hygiene upon
crossing the curtain line,
ensuring hands are
disinfected before moving to
the next patient
 Before
providing care, ask the following
questions?
 What is the risk of exposure? (microbes, non-intact
skin, body fluid & substance, mucous membrane,
contaminated equipment, etc.)
 How is this organism transmitted?
 Is the patient cooperative?
 How can I prevent spreading the microbes to
others?
 Having
the Questioning Attitude:
 “what task am I going to perform?”
 “what PPE do I need to wear to protect myself and
help stop the spread of infections”
 Gloves should be worn when:
• hands may become contaminated with blood, body
fluids, excretions, or secretions
• when touching mucous membranes, non-intact skin,
or contaminated surfaces or objects (urinary
catheters, endotrachael tubes).
 Key Reminders with glove use:
• Do not resuse or wash gloves
• Gloves are not a replacement for hand hygiene
• Always change gloves between patients
• Discard gloves prior to exiting patient room
 Bacteria
can survive for DAYS on patient care
equipment and other surfaces.
Bed rails
Privacy curtains
Light switches
IV pumps, and
Computer keyboards
Are all contaminated with bacteria.
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 It’s
important to practice hand hygiene after
you leave the room, even if you only touched
patient care equipment or environmental
surfaces.
 Colleagues, students, trainees, and
watch what you do!
other staff
• Research has shown that the actions of clinicians
influence the behavior of others.
• Show your colleagues that hand hygiene is an
important part of quality care.
 Your
patients watch you too!
• Your actions send a powerful message.
• Show your patients that you are serious about
their health and the prevention of infection
Hand Hygiene is the most effective way to prevent
the spread of healthcare associated infections (HAIs)
 Hand Hygiene is the most cost-effective measure to
prevent the spread of germs
 Wash hands with soap and water for at least 15
seconds and use warm water
 Preferably, if hands are not visibly soiled, use the
alcohol based hand sanitizer, as it is more effective
than soap and water and better for your skin
 Artificial Nail Enhancements are not allowed if
GBMC employee provides patient care
 Gloves do not prevent the need for hand hygiene

 Centers
for Disease Control and
Prevention (CDC): Guideline for Hand
Hygiene in Health-care Settings. MMWR
2002; vol. 51, no. RR-16.
 World Health Organization (WHO):
Guideline on Hand Hygiene in
Healthcare, 2009
http://whqlibdoc.who.int/publications/20
09/9789241597906_eng.pdf