DR.T.V.RAO MD 1

HAND HYGIENEPRINCIPLES AND IMPLEMENTATION AT

TRAVANCORE MEDICAL COLLEGE, KOLLAM, KERALA. INDIADR.T.V.RAO MD

DR.T.V.RAO MD 2

THE WORK OF IGNAZ SEMMELWEISS• Hungarian doctor who worked in a maternity ward in

Austria in the 1840’s. • There were two wards in the maternity building:

One contained women due to give birth and was run by midwives. The other was used as a teaching hospital for medical students, who may have come straight from dissecting dead bodies.

• The wards were cleaned no more than once a month.

• The doctors rarely washed their hands and often wore dirty coats.

• Semmelweiss was horrified by the number of women who died after births that were trouble free. The women developed a very high temperature and died within a few days from an illness called childbed fever.

• No-one had any idea what caused this disease. No-one knew about bacteria or viruses then.

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THE WORK OF IGNAZ SEMMELWEISS

• Semmelweiss realised that more than three times as many women died from fever in the teaching ward than in the midwives’ ward. He was determined to try to reduce the number of deaths.

• He looked into at each factor that was different between the two wards, but nothing that he thought of seemed to make a difference. Then a professor was accidentally cut with a knife that was getting used to study the body of a woman who had died. The professor himself died, from a disease whose symptoms were like childbed fever.

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THE WORK OF IGNAZ SEMMELWEISS• Semmelweiss thought that there must have been

something on the knife that had caused the disease.

• He made all the doctors wash their hands in chlorine water before examining the women

• Within a very short time, the death rate had fallen

• Semmelweiss presented his findings to other doctors. His ideas were mocked.

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Evidence of Relationship Between Hand Hygiene and Healthcare-Associated Infections

Substantial evidence that hand hygiene reduces the incidence of infections

Historical study: Semmelweis

More recent studies: rates lower when antiseptic hand washing was performed

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Hand Hygiene DefinitionsHand washing

The application of non-antimicrobial soap and water to the surface of the hands

Antiseptic hand washWashing hands with water and soap or other detergents

containing an antiseptic agentAlcohol-based hand rub

an alcohol-containing preparation designed for application to the hands in order to reduce the number of viable organisms with maximum efficacy and speed

Surgical hand hygiene/antisepsisHand washing or using an alcohol-based hand rub before

operations by surgical personnel

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INDICATIONS FOR HAND WASHING

• Hand hygiene should be performed before and after every patient contact

• Hand hygiene should be performed after contact with patient’s environment

• Hand hygiene should be performed after using a restroom, after removing gloves, prior to and following meals

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Indications for Hand Hygiene

When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.

If hands are visibly clean, use an alcohol-based hand rub for routinely decontaminating hands.

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Wet hands.

Get soap. Wash hands.

Dry hands.

Throwaway.

1 2 3 4 5

Washing Hands Follow the Steps

Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children with Challenging Behavior. Tampa, Florida: University of South Florida, Early Intervention Positive Behavior Support.

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A CASUAL HAND WASH MAY MISS SEVERAL AREAS FROM DISINFECTION

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PRACTICE A LITTLE OF SCIENTIFIC STEPS IN HAND WASHING

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MAKE THE BEST USE OF SCIENTIFIC METHODS IN CRITICAL CARE OF PATIENTS

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Why we don’t wash our hands Too busy/insufficient time Patient needs take priority Understaffing/overcrowding

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

HCW are not bad just busy!

Poor design

Poor product

More education

Sinks are inconveniently located or lack of sinks

Lack of soap and paper towels Hand washing agents cause irritation

and dryness Low risk of acquiring infection from

patients

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What can we do to help change thisProvide easy access to hand hygiene

materialsHandrub solution

Conveniently located:at the patient’s bedsideat the patient’s room entrancein convenient / appropriate locationsin high traffic public areas

Working appropriatelyFull of productWithin use by date

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Glove UseHand hygiène is required regardless of whether

gloves are used or changedFailure to remove gloves after patient contact or

between dirty and clean body site care in the same patient has to be regarded as noncompliance with recommandations

Gloves should not be washed or reusedGloved HCWs can cause cross infections

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ACCORDING TO THE CDC

• Wet hands with running water; place soap in palms; rub together to make a lather; scrub hands vigorously for 20 seconds; rinse soap off hands.

• If possible, turn off the faucet by using a disposable paper towel.

• Dry hands with a disposable paper towel. Do not dry hands on clothing.

• Assist young children with washing their hands.

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SPECIFIC INDICATIONS FOR HAND HYGIENE• Before:

• Patient contact

• Donning gloves when inserting a CVC

• Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery

• After:• Contact with a patient’s skin

• Contact with body fluids or excretions, non-intact skin, wound dressings

• Removing gloves

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

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WHAT TO USE AND WHEN

When hands are visibly soiled use soap and water to wash

If your hands are visibly CLEAN use Alcohol based hand rubes

Before and after touching a patient Before and after a procedure After touching a patient’s surroundings Before and after glove use

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RUBapply to palm

ROLLrub hands together covering all aspects of your fingers &

hands until dry

SQUIRT one squirt (1-3 ml) to

your hands

Easy Message

. Recommendations for Hand Washing Facility:

Clean at all times;

Strategically located as per regulations, near

bathrooms and entrances to the processing area;

Dedicated to hand washing only;

Liquid soap in dispenser;

Hot water (43º C or 110º F);

Use of disposable paper towels or air blowers; and

Adjacent hand sanitizing facilities.

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Basic message always the same

“Clean you hands before and after every patient touch”

Instructions always the same Squirt Rub Roll

EASY MESSAGE

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SELF-REPORTED FACTORS FOR POOR ADHERENCE WITH HAND HYGIENE

Hand washing agents cause irritation and dryness

Sinks are inconveniently located/lack of sinks

Lack of soap and paper towels

Too busy/insufficient time

Understaffing/overcrowding

Patient needs take priority

Low risk of acquiring infection from patients

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

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EDUCATION/MOTIVATION PROGRAMS

• Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback

• Implement a multidisciplinary program to improve adherence to recommended practices

• Encourage patients and their families to remind HCWs to practice hand hygieneGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

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“Healthcare workers in a room with a senior staff member or peer who DID NOT

wash their hands were significantly less likely to wash their own hands”

EMERGING INFECTIOUS DISEASES FEB 2003

Failed Role Models

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- is an important barrier to compliance

- is more fréquent with soap and water than with handrubs

- is reduced and can be treated by emollient-containing solutions

Skin irritation A Limitation to Hand Washing

Boyce et al. Inf Contr Hosp Epi 2000;21:442Kramer et al. J Hosp Infect 2002; 51:114Larson et al. Heart Lung 2000; 29:139Pittet. Emerging Inf Dis 2001; 2:234

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CLEAN HANDS SAVES MANY LIVES HAVE ONE OURSELVES

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HOSPITAL ADMINISTRATION THANKS EVERYONE FOR WASHING HANDS

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REFERENCES

• WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) April 2006

• Guideline for Hand Hygiene in Health-Care Settings.MMWR 2002:vol,51,no RR-16

• HHA 5 Moments for Hand Hygiene,Advanced draft, August 2008

• Pittet D,Inf .Control Hospital Epidemiology 200:21:381-386

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• Programme Created by Dr.T.V.Rao MD for Medical and Paramedical

Professionals • Email

• doctortvrao@gmail.com