Hand hygiene in healthcare settings
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Hand Hygiene in Healthcare Settings. Hospital Acquired Infections. 7 -10% of patients acquire an infection 7,000 death per year The federal government spend > $950 million annually Source: Australian Council for Quality and Safety in Healthcare July 2003. Paediatric Nosocomial Infections.

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Hand Hygiene in Healthcare Settings

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Hand hygiene in healthcare settings

Hand Hygiene in Healthcare Settings


Hospital acquired infections

Hospital Acquired Infections

  • 7-10% of patients acquire an infection

  • 7,000 death per year

  • The federal government spend > $950 million annually

    Source:Australian Council for Quality and Safety in Healthcare July 2003


Paediatric nosocomial infections

Paediatric Nosocomial Infections

  • MORE Viral respiratory infections

  • MORE Gastrointestinal infections

  • MORE BACTEREMIAS

  • All children are exposed to maternal infections/siblings

  • HIGH RISK PATIENT GROUPS:

    • Newborns and premature infants

    • Children with congenital abnormalities


Obstetric nosocomial infections

Obstetric Nosocomial Infections

  • Minimal invasive diagnostic procedures

  • Surgery not prolonged

  • Short hospital stay

  • Intact host defenses

  • Not subject to as many hospital pathogens

  • Not exposed to prolonged antibiotic courses


Obstetric nosocomial infections risks increase with

Obstetric Nosocomial Infections- Risks Increase With:

  • Urinary catheterisation

  • Intravenous therapy

  • Intra-uterine and foetal monitoring

  • PV examinations


Hand hygiene in healthcare settings

“Hand Hygiene is the SINGLE most important practice to preventing nosocomial infections”

Rotter ML 1997


Benefits of hand hygiene

Benefits of Hand Hygiene

  • Reduced number of deaths

  • Reduced number of infections:

    • Decreased antibiotic usage

    • Decreased patient length of stay

    • Decreased use of resources


Compliance with hand hygiene

Compliance with hand hygiene?

Table 2. Distribution of factors associated with non-compliance with hand hygiene

Table 1. Compliance with hand hygiene

in different hospital settings before intervention

Source: Pittet D, Boyce JM LANCET Infect Dis 2001


An overview

An overview

  • Definitions

  • Guidelines for hand hygiene

  • Soap versus Alcohol solution

  • Healthy Hands


Definition of terms

Definition of Terms

  • Hand Hygienea general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis.

  • Handwashingwashing hands with plain ( ie. non-antimicrobial) soap and water.

  • Decontaminationto reduce bacterial counts on the hands by performing antiseptic hand rub or antiseptic handwash.

    Guide for Hand Hygiene in Healthcare Settings: MMWR 2002; vol.51, no. RR-16


When to perform hand hygiene

When To Perform Hand Hygiene?

  • “High Risk” for Contamination Activities

  • “Low Risk” for Contamination Activities


High risk for contamination

“High Risk” for Contamination

  • Immediately before and after patient contact

  • Immediately before and after a procedure


High risk for contamination1

“High Risk” for Contamination

  • Before and after touching any devices/equipment directly connected to the patient e.g.

    • Indwelling catheter

    • External Ventricular Drains

    • Redivacs

    • Ventilation Equipment


High risk for contamination2

“High Risk” for Contamination

  • Moving from contaminated to a clean body site

  • After contact with body fluids


Low risk for contamination

“Low Risk” for Contamination

  • After contact with equipmente.g.patients charts, monitors

  • After removing gloves

  • After contact with own nose/mouth/hair


A quick and easy solution

A quick and easy solution

An alcohol gel!


Alcohol at every bed helps increase compliance

Alcohol at EVERY bed helps increase compliance

Biscoff WE et al 1998: Abstract K132


Place gel rinse at each

Place gel/rinse at each:

  • Bed / cot

  • Trolley

  • Entrance to room


Alcohol is more effective in reducing the number of bacteria

Alcohol is more effective in reducing the number of bacteria

Mean change (log10 CFU)

Pittet D, Boyce JM. Lancet Infect Dis 2001


Alcohol has persistent activity

Alcohol has persistent activity

  • Reduction in resident flora

Rotter ML. Chapter 87 in Mayhall CG 1999


A quick and easy solution an alcohol gel

A quick and easy solution :An alcohol gel!

  • Less drying than soap and water


When can you use an alcohol based hand gel

When can you use an alcohol-based hand gel?

  • In all clinical situations EXCEPT:

    • When your hands are visibly soiled

    • When a surgical scrub is required


How to use an alcohol hand gel

How to use an alcohol hand gel?

  • Ensure that hands have no visible contamination

  • Apply product to palm of one hand and rub hands together covering all surfaces and fingers

  • Allow to air dry

  • The process takes about 15 seconds


A few tips when using the gel

A few tips when using the gel…

  • Continue rubbing hands together until alcohol is dry (should take 10-15 sec).

  • After using an alcohol based product, you will feel a “build up” on your hands. To remove this, wash your hands with soap and water as often as necessary.


When should you handwash

When should you handwash?

  • when hands are visibly contaminated with blood/body fluids

  • to remove “build-up” from the alcohol gel/rinse

  • before eating

  • after using the restroom


How to wash your hands

How to wash your hands?

1

2

Apply solution and scrub

for at least 15 seconds

Wet your hands


How to wash your hands1

How to wash your hands?

3

4

Rinse your hands

Scrub back of hands,

wrists, between fingers

and under fingernails


How to wash your hands2

How to wash your hands?

5

6

Dry with paper towel

Turn off water lever

using your elbows


Visitors and relatives

Visitors and Relatives

  • Instruct them to EITHER wash their hands or apply the gel:

    • Before holding the baby/child

    • Before feeding the baby/child

    • After nappy change


Summary of recommendations

Summary of Recommendations

  • Hands visibly soiled Soap and water or antimicrobial soap

  • Hands not soiled Alcohol hand rub for all routine hand hygiene


Healthy hands

Healthy Hands:

  • Use warm water, not hot

  • Wet hands before applying soap

  • Rinse hands well and pat dry

  • Moisturise 3-4 times daily


Healthy hands1

Healthy Hands:

  • Select a moisturiser compatible with Chlorhexidine gluconate

  • Nails should be kept short (< ¼ inch)

  • Artificial nails should not be worn in high risk areas e.g. ICU, NICU


Any questions

Any Questions?

For more information visit

www.washup.org.au


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