INFECTION CONTROL&

Hand Hygiene

Hospital Acquired Infections – (HAI’s)• An infection that a patient acquires during their

hospital stay.• Commences >48-hours after admission.• An increasing problem in many hospitals. • Commonly involve respiratory and urinary tracts,

intravascular cannulas and surgical wounds. • Common hospital pathogens :– Methicillin-resistant Staphylococcus aureus, (MRSA) – Vancomycin-resistant enterococci and staphylococcus (on

the rise and gathering momentum!)

Control and prevention of hospital-acquired infections requires following infection control policies and;

• active surveillance and targeted interventions.

• Effective hand hygiene

• Prudent antimicrobial use

• Aseptic technique

• Short hospital stays

• Minimal use and early removal of invasive devices

Where have your hands been ?

Why is Hand Hygiene important? • Infections are a serious problem in healthcare.• Microorganisms which cause infection can be transmitted via the hands of

healthcare workers during their normal work activities.• Common occurrences :

– Transfer of a patient's own microorganisms from one body site to another

– Transfer of microorganisms from one patient to another patient– Transfer of microorganisms from the environment and healthcare

equipment– Healthcare workers acquire microorganisms on their hands as a result

of what they touch. – Healthcare workers can unknowingly transmit microorganisms from their

hands to patients and the environment.– Correct Hand Hygiene reduces the number of organisms on the hands

and limits the spread of these microorganisms.www.hha.org.au

Affects of poor hand hygiene

• Longer hospital stays• Complicated infections – chronic conditions• Possible death• Cost to patient• Cost to health care (length of stays, PPE,

therapy & medications / staffing etc)• Damage to reputation

• One metropolitan hospital with the worst compliance rate for hand hygiene had a significant and ongoing outbreak of VRE…….spending over $60,000 a month on gloves and gowns for infection control………….What are the costs associated with HAI’s to the health care budget and to the patients?

• Within the health care setting the number of infected and/or colonised individuals is high

• risk of infection is also high.

• Antibiotic therapy, the primary medical treatment for infection, also promotes a great danger – the development of drug-resistant strains of microorganisms such as MRSA and VRE.

What you can do!!!!!

Hand Hygiene

• Clinical hand basins must be provided for HCW’s to wash their hands appropriately.

• Hand Hygiene Australia ‘five moments’ initiative.

• Gloves are not a substitute for hand washing / hand hygiene.

• Gloves may have holes in them – too small to be seen.

• Gloves are porous allowing for transfer of microorganisms.

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Correct Hand Washing procedure

‘Clean Between’

A "Clean Between" program will complement any Hand Hygiene program as it:

•Minimises the risk of cross infection from hospital equipment•Aids the sustainability of the Hand Hygiene program.

•All non critical shared patient equipment needs to be cleaned after each use.•If equipment is visibly soiled then soap and water should be used •If equipment is visibly clean, then it can be wiped over with an alcohol impregnated wipe or a detergent wipe (e.g. BP cuffs, patient slides, stethoscopes, trolleys, key boards, ID tags, ward telephones etc) •Wipes should be placed in brackets on trolleys, in treatment areas, near shared patient equipment, and at point of use •These wipes are for equipment only - not hands  

Evidence?

• Studies show that a sustained improvement in hand hygiene practices directly correlate to a reduction in HAIs.

• Pittet et al 2001• Johnson 2005• Lindsay Grayson 2008– References available at www.hha.org.au

Will I be compliant ? ?

• Remember the importance to you and your client.

• Audits in hospitals and health care facilities.• No escape – National initiative.• Speak up – you do the right thing ….don't copy

bad habits…. Lead the way.

What about my skin?

• Generally ABHR is much better tolerated than soap

• See your OHS rep / line manager if you have any problems or concerns.

Hand Care

• Intact skin is a natural defense against infection. • Breaks or lesions of the skin are possible sources of entry for

pathogens…. Should be covered by a water-resistant occlusive dressing and changed as necessary.

• Jewellery should not be worn especially rings – impossible to perform correct technique for hand hygiene.

• Finger nails should be short and clean and artificial nails should not be worn as they contribute to increased bacterial count (Larson 1996).

• Repeated hand washing and wearing of gloves can cause irritation to the skin. Reassess hand washing technique and use of individual hand creams to counteract.

• Pat hands dry rather than rubbing to minimise chapping.

Nails• Studies have shown that artificial nails and

appliqués have been contaminated with germs (both bacteria and fungi) that have been passed to patient and caused serious infections.

• The wearing of nail enhancements hinders the effectiveness of hand hygiene.

• Studies have shown that hospital personnel with nail enhancements had more bacteria both before and after hand washing than did personnel with natural nails.

• Nail enhancements sometimes cause infections of the nail bed that are difficult to treat.

• Long-term artificial nail use causes natural nails to become thin, brittle or damaged.

• You may scratch or tear your clients skin with nail enhancements or long nails.

• Nails should be kept short and clean.