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


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

  • 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

  • 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:

  • 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

  • Reduced number of deaths

  • Reduced number of infections:

    • Decreased antibiotic usage

    • Decreased patient length of stay

    • Decreased use of resources


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

  • Definitions

  • Guidelines for hand hygiene

  • Soap versus Alcohol solution

  • Healthy Hands


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?

  • “High Risk” for Contamination Activities

  • “Low Risk” for Contamination Activities


“High Risk” for Contamination

  • Immediately before and after patient contact

  • Immediately before and after a procedure


“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 Contamination

  • Moving from contaminated to a clean body site

  • After contact with body fluids


“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

An alcohol gel!


Alcohol at EVERY bed helps increase compliance

Biscoff WE et al 1998: Abstract K132


Place gel/rinse at each:

  • Bed / cot

  • Trolley

  • Entrance to room


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

  • Reduction in resident flora

Rotter ML. Chapter 87 in Mayhall CG 1999


A quick and easy solution :An alcohol gel!

  • Less drying than soap and water


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?

  • 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…

  • 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 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?

1

2

Apply solution and scrub

for at least 15 seconds

Wet your hands


How to wash your hands?

3

4

Rinse your hands

Scrub back of hands,

wrists, between fingers

and under fingernails


How to wash your hands?

5

6

Dry with paper towel

Turn off water lever

using your elbows


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

  • Hands visibly soiled Soap and water or antimicrobial soap

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


Healthy Hands:

  • Use warm water, not hot

  • Wet hands before applying soap

  • Rinse hands well and pat dry

  • Moisturise 3-4 times daily


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?

For more information visit

www.washup.org.au


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