Hand Hygiene in Healthcare Settings

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Hand Hygiene in Healthcare Settings
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Hospital Acquired Infections

• 7-10 of patients acquire an infection
• 7,000 death per year
• The federal government spend gt 950 million
  annually
• SourceAustralian Council for Quality and Safety
  in Healthcare July 2003

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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

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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

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Obstetric Nosocomial Infections- Risks Increase
With

• Urinary catheterisation
• Intravenous therapy
• Intra-uterine and foetal monitoring
• PV examinations

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Hand Hygiene is the SINGLE most important
practice to preventing nosocomial infections
Rotter ML 1997
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Benefits of Hand Hygiene

• Reduced number of deaths
• Reduced number of infections
• Decreased antibiotic usage
• Decreased patient length of stay
• Decreased use of resources

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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
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An overview

• Definitions
• Guidelines for hand hygiene
• Soap versus Alcohol solution
• Healthy Hands

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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

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When To Perform Hand Hygiene?

• High Risk for Contamination Activities
• Low Risk for Contamination Activities

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High Risk for Contamination

• Immediately before and after patient contact
• Immediately before and after a procedure

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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

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High Risk for Contamination

• Moving from contaminated to a clean body site
• After contact with body fluids

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Low Risk for Contamination

• After contact with equipmente.g.patients charts,
  monitors
• After removing gloves
• After contact with own nose/mouth/hair

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A quick and easy solution

• An alcohol gel!

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Alcohol at EVERY bed helps increase compliance
Biscoff WE et al 1998 Abstract K132
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Place gel/rinse at each

• Bed / cot
• Trolley
• Entrance to room

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Alcohol is more effective in reducing the number
of bacteria
Mean change (log10 CFU)
Pittet D, Boyce JM. Lancet Infect Dis 2001
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Alcohol has persistent activity

• Reduction in resident flora

Rotter ML. Chapter 87 in Mayhall CG 1999
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A quick and easy solution An alcohol gel!

• Less drying than soap and water

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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

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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

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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.

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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

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How to wash your hands?
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2
Wet your hands
Apply solution and scrub for at least 15 seconds
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How to wash your hands?
3
4
Scrub back of hands, wrists, between fingers and
under fingernails
Rinse your hands
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How to wash your hands?
5
6
Turn off water lever using your elbows
Dry with paper towel
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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

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Summary of Recommendations

• Hands visibly soiled Soap and water or
  antimicrobial soap
• Hands not soiled Alcohol hand rub for all
  routine hand hygiene

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Healthy Hands

• Use warm water, not hot
• Wet hands before applying soap
• Rinse hands well and pat dry
• Moisturise 3-4 times daily

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Healthy Hands

• Select a moisturiser compatible with
  Chlorhexidine gluconate
• Nails should be kept short (lt ¼ inch)
• Artificial nails should not be worn in high risk
  areas e.g. ICU, NICU

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Any Questions?

• For more information visit
• www.washup.org.au