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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

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 is the SINGLE most important practice to preventing nosocomial infections”

Rotter ML 1997


Benefits of hand hygiene
Benefits of Hand Hygiene preventing nosocomial infections”

  • 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? preventing nosocomial infections”

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 preventing nosocomial infections”

  • Definitions

  • Guidelines for hand hygiene

  • Soap versus Alcohol solution

  • Healthy Hands


Definition of terms
Definition of Terms preventing nosocomial infections”

  • 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? preventing nosocomial infections”

  • “High Risk” for Contamination Activities

  • “Low Risk” for Contamination Activities


High risk for contamination
“High Risk” for Contamination preventing nosocomial infections”

  • Immediately before and after patient contact

  • Immediately before and after a procedure


High risk for contamination1
“High Risk” for Contamination preventing nosocomial infections”

  • 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 preventing nosocomial infections”

  • Moving from contaminated to a clean body site

  • After contact with body fluids


Low risk for contamination
“Low Risk” for Contamination preventing nosocomial infections”

  • 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 preventing nosocomial infections”

An alcohol gel!


Alcohol at every bed helps increase compliance
Alcohol at preventing nosocomial infections”EVERY bed helps increase compliance

Biscoff WE et al 1998: Abstract K132


Place gel rinse at each
Place gel/rinse at each: preventing nosocomial infections”

  • 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 preventing nosocomial infections”

Mean change (log10 CFU)

Pittet D, Boyce JM. Lancet Infect Dis 2001


Alcohol has persistent activity
Alcohol has persistent activity preventing nosocomial infections”

  • 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 : preventing nosocomial infections”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? preventing nosocomial infections”

  • 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? preventing nosocomial infections”

  • 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… preventing nosocomial infections”

  • 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? preventing nosocomial infections”

  • 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? preventing nosocomial infections”

1

2

Apply solution and scrub

for at least 15 seconds

Wet your hands


How to wash your hands1
How to wash your hands? preventing nosocomial infections”

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? preventing nosocomial infections”

5

6

Dry with paper towel

Turn off water lever

using your elbows


Visitors and relatives
Visitors and Relatives preventing nosocomial infections”

  • 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 preventing nosocomial infections”

  • Hands visibly soiled Soap and water or antimicrobial soap

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


Healthy hands
Healthy Hands: preventing nosocomial infections”

  • 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: preventing nosocomial infections”

  • 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? preventing nosocomial infections”

For more information visit

www.washup.org.au


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