Transcript No Slide Title

Hand Hygiene in
Healthcare Settings
Hospital Acquired Infections

7-10% of patients acquire an infection

7,000 death per year

The federal government spend > $950 million
annually
Source:Australian Council for Quality and Safety in Healthcare July 2003
Paediatric Nosocomial
Infections
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MORE Viral respiratory infections
MORE Gastrointestinal infections
MORE BACTEREMIAS
All children are exposed to maternal
infections/siblings
HIGH RISK PATIENT GROUPS:

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Newborns and premature infants
Children with congenital abnormalities
Obstetric Nosocomial
Infections
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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
Obstetric Nosocomial
Infections- Risks Increase With:
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Urinary catheterisation
Intravenous therapy
Intra-uterine and foetal monitoring
PV examinations
“Hand Hygiene is the SINGLE
most important practice to
preventing nosocomial
infections”
Rotter ML 1997
Benefits of Hand Hygiene

Reduced number of deaths

Reduced number of infections:
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Decreased antibiotic usage
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Decreased patient length of stay
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Decreased use of resources
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
Table 2. Distribution of factors associated
with non-compliance with hand hygiene
An overview

Definitions
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Guidelines for hand hygiene
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Soap versus Alcohol solution
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Healthy Hands
Definition of Terms

Hand Hygiene
a general term that applies to either handwashing,
antiseptic handwash, antiseptic hand rub or surgical hand
antisepsis.

Handwashing
washing hands with plain ( ie. non-antimicrobial) soap and
water.
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Decontamination
to 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
When To Perform Hand Hygiene?
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“High Risk” for Contamination Activities
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“Low Risk” for Contamination Activities
“High Risk” for Contamination
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Immediately before and after patient contact
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Immediately before and after a procedure
“High Risk” for Contamination
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Before and after touching any devices/equipment
directly connected to the patient e.g.
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Indwelling catheter
External Ventricular Drains
Redivacs
Ventilation Equipment
“High Risk” for Contamination
 Moving from contaminated to a clean body site
 After contact with body fluids
“Low Risk” for Contamination
 After contact with equipment
e.g.patients charts, monitors
 After removing gloves
 After contact with own nose/mouth/hair
A quick and easy solution
An alcohol gel!
Alcohol at EVERY bed helps
increase compliance
Percent Compliance
50
45
40
35
30
25
20
15
10
5
0
Baseline
1 Dispenser per
4 Beds
Biscoff WE et al 1998: Abstract K132
1 Dispenser for
Every Bed
Place gel/rinse at each:
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Bed / cot
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Trolley
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Entrance to room
Alcohol is more effective in
reducing the number of bacteria
4
3.5
3
2.5
2
1.5
1
0.5
0
Soap
Iofophor
4% CHG
Pittet D, Boyce JM. Lancet Infect Dis 2001
70% alcohol
Alcohol has persistent activity
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Reduction in
resident flora
Rotter ML. Chapter 87 in Mayhall CG 1999
A quick and easy solution :
An alcohol gel!
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Less drying than soap and water
When can you use an
alcohol-based hand gel?
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In all clinical situations EXCEPT:
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When your hands are visibly soiled
When a surgical scrub is required
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
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.
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
How to wash your hands?
1 Wet your hands
2 Apply solution and scrub
for at least 15 seconds
How to wash your hands?
3 Scrub back of hands,
wrists, between fingers
and under fingernails
4 Rinse your hands
How to wash your hands?
5 Turn off water lever
using your elbows
6 Dry with paper towel
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
Summary of Recommendations
 Hands visibly soiled
Soap and water or antimicrobial soap
 Hands not soiled
Alcohol hand rub for all routine hand hygiene
Healthy Hands:
 Use warm water, not hot
 Wet hands before applying soap
 Rinse hands well and pat dry
 Moisturise 3-4 times daily
Healthy Hands:
 Select a moisturiser compatible with
Chlorhexidine gluconate
 Nails should be kept short (< ¼ inch)
 Artificial nails should not be worn in
high risk areas e.g. ICU, NICU
Any Questions?
For more information visit
www.washup.org.au