Hand hygiene is the foundation of infection prevention.

1. Module 3: Hand Hygiene

2. Presentation outline
• Learning objectives
• PPP 3.1: Importance and kinds of hand hygiene
• PPP 3.2: Hand washing techniques
• PPP 3.3: Hand antisepsis and antiseptic hand rub
• PPP 3.4: Surgical hand scrub
• PPP 3.5: Improving hand hygiene practices

3. Learning objectives
3
At the end of this module, participants will
be able to:
• Explain the rational for hand hygiene
• List the kinds of hand hygiene technique
• Explain the purpose of each kinds of hand hygiene
technique
• Demonstrate how to prepare and use antiseptic
hand rub
• Demonstrate the different hand hygiene techniques
• Mention common malpractices related with hand
hygiene

4. PPP 3.1 Importance and kinds of
Hand hygiene

5. Why hand hygiene is important?
 Hand hygiene is a general term referring to any
action of hand cleaning
 Reduces the number of disease-causing
microorganisms on hands and arms
 Minimize cross-contamination
 It is the most important way to reduce the spread of
infections in the health care selling.

6. Kinds of Hand hygiene practices
 Hand washing
 Hand Antisepsis
 Antiseptic Hand-rub
 Surgical Hand scrub

7. The decision to choose which type of
hand hygiene practice depends on:
 Intensity of contact with patient and /or blood and
body fluids,
 The likelihood of microbial transmission,
 Patient’s susceptibility to infection, and
 Procedure being performed
 The activity or area of practice

8. PPP 3.2 Hand washing
Techniques

9. Hand washing
Purpose: to mechanically remove soil and debris from
skin and reduce the number of transient
microorganisms.
 It is THE SINGLE most important measure in
reducing the spread of infection!

10. When do we wash our hands?
 Immediately after arriving and leaving work
 Before and after examining
 After touching contaminated instruments or items
 After exposure to mucous membranes, blood, body
fluids, secretions or excretions

11. When do we wash our hands?
 Before putting on gloves and after removing
them
 Whenever our hands become visibly soiled
 After blowing nose or covering a sneeze
 Before eating or serving food
 After visiting the toilet

12. Steps for routine hand washing:
 Thoroughly wet hands with water.
 Apply plain soap (antiseptic agent is not
necessary).
 Vigorously rub all areas of hands and fingers for
10–15 seconds, paying close attention to areas
under fingernails and between fingers.
 Rinse hands thoroughly with clean water.
 Dry hands with personal dry clean towel or paper
towel
 Use a paper towel or a single use towel after
drying hands to turn off the water

13. Hand washing Technique
13
WHO. 2005. Guidelines on
Hand Hygiene in Health Care
(Advanced Draft): A
Summary. WHO: Geneva

14. PPP 3.3 Hand antisepsis
and
antisepsis hand rub

15. Hand Antisepsis
15
Purpose: Remove soil and debris as well as to
reduce both transient and resident flora
 It is similar to plain hand washing except that the
soap or detergent contains an antiseptic agent
(often chlorhexidine, Iodophoris, triclosan)
[[Hand antisepsis should be done before:
• Examining or caring for highly susceptible
patients
• Performing an invasive procedure
• Leaving the room of patients on Contact
Precautions (e.g. hepatitis A or E)

16. Antiseptic Hand rub
16
Purpose: to inhibit or kill transient and resident flora.
 Considered to be more effective than antimicrobial hand
washing agents or plain soap and water,
 It is quicker and easier to perform,
 but it should not be used when the hands are visibly
soiled.
 Do not rinse hands after applying hand rub

17. Advantages of Alcohol-based
hand rubs
 Require less time
 Act faster
 More accessible than sinks
 More effective for standard hand washing than soap
 Can even provide improved skin condition.

18. Antiseptic Handrub
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Preparation of Alcohol-based solution for hand rub:
 Add glycerin or sorbitol to alcohol (2 ml. in 100 ml. of
60–90% ethyl or isopropyl alcohol solution)
The technique for performing antiseptic hand rub is:
 Apply enough alcohol-based hand rub to cover the entire
surface of hands and fingers (about a teaspoonful -5ml)
 continue rubbing the solution over hands until they are dry
(15-30 seconds). ).
 Rub the solution vigorously into hands, especially between
fingers and under the nails, until dry.

20. PPP 3.4 Surgical Hand scrub

21. Surgical Hand scrub
21
Purpose: to mechanically remove soil, debris and
transient organisms and to reduce resident flora for the
duration of the surgery

22. Steps in Surgical Hand-scrub
22
 Remove rings, watches, and bracelets.
 Thoroughly wash hands and forearms to the elbow with
soap and water.
 Clean nails with a nail cleaner.
 Rinse hands and forearms with water.
 Apply an antiseptic agent (soap)
 Vigorously wash all surfaces of hands, fingers, and
forearms for at least 2 minutes.

23. Steps ….Cont’d
23
 Rinse hands and arms thoroughly with
clean water, holding hands higher than
elbows.
 Keep hands up and away from the body,
do not touch any surface or article.
 and dry hands with a clean sterile dry
towel.
 Put on sterile or HLD gloves.

24. PPP 3.5 Improving hand
hygiene practices

25. Why Healthcare Workers
Don’t Wash their Hands?
25
 Hand washing between every patient encounter is
unnecessary,
 Hand washing doesn’t affect clinical outcome,
 Hand washing is unnecessary when gloves are
worn,
 Frequent hand washing damages skin and causes
cracking, dryness, irritation and dermatitis,
 Hand washing damages nails and nail polish
 Hand washing facilities are not conveniently placed
or well designed,
 Hand washing takes too much time

26. Issues and considerations related
to hand hygiene
 Gloves:
o Wearing gloves do not replace the need for hand hygiene.
 Hand lotions and hand Creams:
o hand lotions, creams and moisturizing skin care products
that are water based and without fragrance can be used
o Do not use oil based barrier products

27. Issues … cont’d
 Lesions and skin Breaks
o Cuticles, hands, and forearms should be free from lesions
 Finger nails and artificial nails
o Keep nails short, Long nails may serve as a reservoir for
microorganisms and tend to puncture gloves more easily..
 Nail polish
o Dark colored nail polish may prevent dirt and debris under
fingernails from being seen and removed.

28. How to Improve Hand Hygiene
28
 Have supplies available and at “point of use.”
 Disseminate and promote guidelines.
 Reinforce guidelines.
 Involve everybody.
 Give positive feedback.
 Reward role modeling.
 Benchmark best practices.

29. Summary: Efficacy of Hand Hygiene
Preparations in Killing Bacteria
29
Good Better Best
Plain Soap Antimicrobial
soap
Alcohol-based
handrub