HAND HYGIENE

Definition (What?)

 Hand Hygiene includes cleaning hands with soap

and water or alcohol-based hand rub for the
purpose of remove germs, removing soil, and dirt
in order to prevent cross- contamination and
minimize nosocomial infections.
Handwashing
 Washing hands with plain soap and water
 To remove soil and dirt

Antiseptic handwash
 Washing hands with water and soap or other detergents
containing an antiseptic agent
 To remove soil, dirt and transient microorganisms

Alcohol-based handrub
 Rubbing hands with an alcohol-containing preparation
 To remove transient microorganisms
 Healthcare Workers’
 Healthcare Workers’ Hands
Hands

The greatest transmitter of

GERMS !!!!!
The most common means of
spread of INFECTION.
 Hands are the most common mode of transmission of
infections

Most important factor in preventing spread of organisms

Reduce number of infections

Decrease patient length of stay

Decrease use of resources

Reduce number of deaths

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RESIDENT HAND FLORA (commensals)

 Low virulence, survive & multiply on skin

Protective function

Not easily removed by mechanical washing

e.g. Coag. Neg. staph., Diphtheroids, anaerobic cocci,

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TRANSIENT MICRO-ORGANISMS

• Easily acquired and transferred

• by direct contact.

• Loosely attached to skin surface.

• Most abundant around finger tips.
• Important source of cross-infection
eg, Staph. aureus, Streptococci, Gram-ve bacilli
(E. coli, pseudomonas aeruginosa, klebsiella, acinetobacter, etc)

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BEFORE touching a patient
 Why??
 To protect the patient against harmful germs
carried on your hands

Before taking temperature,

blood pressure or pulse
Can you identify the main examples of this indication
during your everyday practice of health care?

Some examples may be:

• shaking hands, stroking an

arm
• helping a patient to move
around, get washed, giving
a massage
• taking pulse, blood
pressure, chest auscultation,
abdominal palpation
BEFORE clean/aseptic procedures
 Why?
 To protect the patient against harmful germs, including the
patients own, from entering his/her body
Can you identify the main examples of this indication during
your everyday practice of health care?

Some examples may be:

• secretion aspiration
•skin lesion care, wound
dressing
•catheter insertion, opening
a vascular access system or
a draining system
•preparation of
medication, dressing sets
AFTER body fluid exposure risk
 Why?
 To protect yourself and the health-care environment from
harmful patient germs
Can you identify the main examples of this indication
during your everyday practice of health care?
Some examples may be:
•oral/dental care, giving eye drops,
secretion aspiration
•skin lesion care, wound dressing,
subcutaneous injection
•drawing and manipulating any fluid
sample, opening a draining system,
endotracheal tube insertion and
removal
•clearing up urines, faeces, vomit,
handling waste (bandages, napkin,
incontinence pads), cleaning of
contaminated and visibly soiled material
or areas (lavatories, medical
instruments)
 AFTER touching a patient
 Why?
 To protect yourself and the health-care environment from
harmful patient germs
Can you identify the main examples of this indication during
your everyday practice of health care?

Some examples may be:

• shaking hands, stroking an

arm
• helping a patient to move
around, get washed, giving
a massage
• taking pulse, blood
pressure, chest auscultation,
abdominal palpation
AFTER touching patients surroundings
 Why?
 To protect yourself and the health-care environment
from harmful patient germs
Can you identify the main examples of this indication during
your everyday practice of health care?

Some examples may be:

• changing bed linen

• perfusion speed adjustment
• monitoring alarm
• holding a bed rail
• clearing the bedside table
TYPES OF HAND WASH..!!!!
 SOCIAL HAND WASHING

• Social (routine) hand washing with soap and warm

water
• Remove dirt, dead skin, transient organisms etc
AREAS FREQUENTLY MISSED
 Equipment
1. Antimicrobial Soap ( liquid or bar)
2. Warm running water
3. Paper towels/ cloth towel (sterile)
Before Washing The Hands;

 Cut the nails

 Avoid nail polish
 Remove all the rings
 Remove wrist watch
 Remove bangles and threads
 Medical Hand washing

The procedure to decontaminate hands using soap and water

involves
three stages

1. Preparation,
2. Washing
3. Rinsing and drying

And it should take about 40-60 seconds

 2. Surgical Hand washing

Surgical hand washing requires the removal and killing

of transient micro-organisms and substantial reduction
and suppuration of the resident flora of the surgical
team for the duration of the operation, in case a
surgical glove is punctured/torn, Ensure that
fingernails are kept short and clean.
 Surgical hand scrub
 Start timing. Scrub each side of each finger, between
the fingers, and the back and front of the hand for 2
minutes.
 Proceed to scrub the arms, keeping the hand higher
than the arm at all times. This helps to avoid
recontamination of the hands by water from the
elbows and prevents bacteria-laden soap and water
from contaminating the hands.
 Wash each side of the arm from wrist to the elbow
 Repeat the process on the other hand and arm, keeping hands
above elbows at all times. If the hand touches anything at any
time, the scrub must be lengthened by 1 minute for the area that
has been contaminated.
 Rinse hands and arms by passing them through the water in one
direction only, from fingertips to elbow. Do not move the arm
back and forth through the water.
 Proceed to the operating theatre holding hands above elbows.
 At all times during the scrub procedure, care should be taken
not to splash water onto surgical attire.
 Once in the operating theatre, hands and arms should be dried
using a sterile towel and aseptic technique before donning gown
and gloves.
 The total surgical hand wash takes 3 to 5 minutes.
 Why don’t we wash our hands?
 Too busy/insufficient time
HCW are not bad
 Patient needs take priority just busy!
 Understaffing/overcrowding
 Sinks are inconveniently located or Poor design
lack of sinks
 Lack of soap and paper towels
 Hand washing agents cause Poor product
irritation and dryness
 Low risk of acquiring infection More education
from patients
.Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386

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 Poor
design

Sinks are
inconveniently
located

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How can we overcome problems associated with
hand washing?

A quick and easy solution

An Alcohol Based Hand Rub

(ABHR)

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 Hand rubbing or hand washing?
 Hand rubbing with an alcohol-based hand rub is the preferred
method in most routine clinical situations.
 This is because alcohol acts more quickly than soaps to
inactivate microorganisms, its effect lasts longer, and the
cleaning procedure takes less time to perform.
 On repeated use, as is required in health-care settings, adverse
effects, such as drying and scaling, are less severe if correct
formulations of hand rubs are used, as compared to repeated
hand washing with soap and water.
 Another advantage is that hand rubbing is more easily done at
the point of care since it is not dependent on the availability of
clean water, soap and towels. However, there are specific
situations in which hand washing is recommended.