Hand Hygiene AT TRAVANCORE MEDICAL COLLEGE KOLLAM

8/2/2019 Hand Hygiene AT TRAVANCORE MEDICAL COLLEGE KOLLAM

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HAND HYGIENEPRINCIPLES AND IMPLEMENTATION AT

TRAVANCORE MEDICAL COLLEGE, KOLLAM, KERALA. INDIA

DR.T.V.RAO MD

DR.T.V.RAO MD 1


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

Austria in the 1840s.

There were two wards in the maternity building:One contained women due to give birth and wasrun by midwives. The other was used as ateaching hospital for medical students, who mayhave 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 ofwomen who died after births that were troublefree. The women developed a very high

temperature and died within a few days from anillness 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 manywomen died from fever in the teaching ward than in themidwives ward. He was determined to try to reduce thenumber of deaths.

He looked into at each factor that was different betweenthe two wards, but nothing that he thought of seemed tomake a difference. Then a professor was accidentally cut

with a knife that was getting used to study the body of awoman who had died. The professor himself died, from adisease whose symptoms were like childbed fever.

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THE WORK OF IGNAZ SEMMELWEISS

Semmelweiss thought that there must havebeen something on the knife that had causedthe disease.

He made all the doctors wash their hands inchlorine water before examining the women

Within a very short time, the death rate hadfallen

Semmelweiss presented his findings to otherdoctors. His ideas were mocked.

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Evidence of Relationship Between Hand Hygiene andHealthcare-Associated Infections

Substantial evidence that handhygiene reduces the incidence ofinfections

Historical study: Semmelweis

More recent studies: rates lower when

antiseptic hand washing wasperformed

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Hand Hygiene Definitions

Hand washingThe application of non-antimicrobial soap and water to thesurface of the hands

Antiseptic hand wash

Washing hands with water and soap or other detergentscontaining an antiseptic agent

Alcohol-based hand rub

an alcohol-containing preparation designed for application to

the hands in order to reduce the number of viable organisms withmaximum efficacy and speed

Surgical hand hygiene/antisepsis

Hand washing or using an alcohol-based hand rub beforeoperations 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 contactwith patients environment

Hand hygiene should be performed after using a

restroom, after removing gloves, prior to andfollowing meals

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Indications for Hand HygieneWhen hands are visibly dirty,

contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap andwater.

If hands are visibly clean, use an alcohol-

based hand rub for routinelydecontaminating hands.

Guideline for Hand Hygiene in Health-care Settings. MMWR2002; vol. 51, no. RR-16.

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Wethands.

Get soap. Washhands.

Dryhands.

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 dont wash our hands

Too busy/insufficient time

Patient needs take priority

Understaffing/overcrowding

Adapted from Pittet D, Infect Control Hosp Epidemiol2000;21:381-386.

HCW are not badjust busy!

Poor design

Poor product

More education

Sinks are inconveniently located or lack ofsinks

Lack of soap and paper towels

Hand washing agents cause irritationand dryness

Low risk of acquiring infection frompatients

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

materials

Handrub solution

Conveniently located:at the patients bedside

at the patients room entrance

in convenient / appropriate locations

in high traffic public areas

Working appropriately

Full of product

Within use by dateDR.T.V.RAO MD 14


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Glove UseHand hygine is required regardless of whether

gloves are used or changed

Failure to remove gloves after patient contact or

between dirty and clean body site care in the samepatient has to be regarded as noncompliance withrecommandations

Gloves should not be washed or reused

Gloved HCWs can cause cross infections

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DR.T.V.RAO MD 16

C C


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ACCORDING TO THE CDC

Wet hands with running water; place soap inpalms; 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 notdry 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 invasivedevices that dont require surgery

After: Contact with a patients skin

Contact with body fluids or excretions, non-intact skin, wounddressings

Removing gloves

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.DR.T.V.RAO MD 18


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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 handrubes

Before and after touching a patient

Before and after a procedure

After touching a patients surroundings

Before and after glove use

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RUBapply to palm

ROLLrub hands together coveringall aspects of your fingers &

hands until dry

SQUIRTone squirt (1-3 ml) to

your hands

Easy Message

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. 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 (43 C or 110 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 touchInstructions 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 Epidemiol2000;21:381-386.DR.T.V.RAO MD 23


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EDUCATION/MOTIVATIONPROGRAMS

Monitor healthcare workers (HCWs)adherence with recommended handhygiene practices and give feedback

Implement a multidisciplinary program toimprove adherence to recommendedpractices

Encourage patients and their families toremind HCWs to practice hand hygiene

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51,no. RR-16.DR.T.V.RAO MD 24


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Healthcare workers in a room with a

senior staff member or peer who DID NOTwash their hands were significantly lesslikely 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 frquent with soap and

water than with handrubs-

is reduced and can be treated byemollient-containing solutions

Skin irritation A Limitation toHand Washing

Boyce et al. Inf Contr Hosp Epi 2000;21:442

Kramer 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

DR.T.V.RAO MD 28


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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 Epidemiology200:21:381-386

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Programme Created by Dr.T.V.Rao

MD for Medical and ParamedicalProfessionals Email

[email protected]

DR.T.V.RAO MD 30

Hand Hygiene AT TRAVANCORE MEDICAL COLLEGE KOLLAM

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