1. 1

2.  Is generally poorly adhered to across the
board by all levels of Health Care Worker’s
 Hands: the most common way transporting
microorganisms, & subsequently causing
infection in patients seeking medical
advice/care in health care facilities.
2

3. HCWs can get 100 or 1000 of Germs on
their hands by doing simple tasks,
such as:
◦ Putting patients up in bed
◦ Taking blood pressure or pulse
◦ Touching a patient's hand
◦ Rolling patients over in bed
◦ Touching the patient's gown or bed
sheets
◦ Touching equipment like bed side rails,
over bed tables, IV pumps
5

4. • Following contact with patients
and/or contaminated
environment, germs can survive
on hands for differing lengths of
time (2-60 minutes)
• In the absence of hand hygiene
action, the longer the duration of
care, the higher the degree of hand
contamination
6

5.  Contaminated HCWs hands have been
associated with endemic Health Care
Associated Infections and also with several
HCAI outbreaks
7

6.  Prevention of spread of microorganisms
in such situations necessitates hand
hygiene to be adequately and properly
performed.
 HH is considered to be the single most
important practice in reducing
transmission of infectious agents, and
thus HCAI, during delivery of medical
care.
3

7.  HH is the simplest, most effective measure for
preventing nosocomial infections.
 Adherence of HCW’s to recommended HH
practices is unacceptably low.
10

8.  Average compliance of HH recommendations
varies between hospitals wards & among
professional categories of HCWs according to
working conditions.
 Compliance is usually estimated as < 50%
11

9.  Defective hand cleansing
◦ (e.g. using insufficient amount of product and /
or insufficient duration of HH action) leads to
poor hand decontamination
 Obviously , when HCWs fail to clean their
hands during the sequence of care of a
single patient and / or between patients
contact microbial transfer is likely to
occur
12

10.  Risk factors for noncompliance with HH
have been determined objectively in several
observational studies or interventions to
improve compliance included:
13

11.  Being a physician or a nursing assistant rather
than a nurse
 Being a male
 Working in an intensive care unit (ICU)
 Working during weekdays rather than the
weekend
 Wearing gown and gloves
 Using an automated sink
 Performing activities with high risk for cross –
transmission
 Many opportunities for HH per hour of patient
care
14

12. 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,
15

13. 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)
16

14. Handwashing
 Washing hands with plain soap and water

 Remove soil/dirt
Antiseptic handwash
 Washing hands with water and an antiseptic soap or
detergents

 Remove soil/dirt and transient micro-organisms
Alcohol-based handrub
 Rubbing hands with an alcohol-containing preparation

 Remove transient microorganisms
17

15. WHY
IS HAND HYGIENE
IMPORTANT ????
18

16.  Most common mode of transmission
 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
19

17.  USA:
 Up to 2 million HAI/yr,
 80,000 of them may contribute to death, and
 generate 4.5 to 5.7 billion USD additional expenses/yr (WHO
figures, 2005).
 UK:
 320,000 HAI/yr,
 5,000 of them may contribute to death, and
 generate £1 billion additional expenses /year
(WHO figures, 2005).
20

18. ?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
22

19. Poor
design
Sinks are
inconveniently
located
23

20.  Interventions aimed at improving
compliance with HH must be based on the
various levels of behaviour interaction
 Thus, the interdependence of:
 Individual factors,
 Environmental constrains, and
 Institutional climate
Should be considered in strategic planning and
development of HH promotion campaigns
25

21. How can we overcome problems associated with
hand washing?
!
A quick and easy solution
An Alcohol Based Hand Rub
(ABHR)
26

22. More Effective
In Reducing The Number Of Bacteria On Hands
Ability of Hand Hygiene Agents to Reduce Bacteria on Hands
% log Time After Disinfection
99.9 3.0 0 60 180 minutes
Bacterial Reduction
99.0 2.0
Alcohol-based handrub
90.0 1.0
Antimicrobial soap
0.0 0.0 Plain soap
Baseline
27

23. Reduces bacterial count on hands
More effective for standard hand wash
Reduces adverse outcomes/costs associated with HAI’s
Requires less time
Less irritating
Can be readily accessible/portable
28

24. ◦ At every bed (ICU, Burn, ER)
◦ At every ward entrance
◦ Ward trolley
◦ Entrance to every room
◦ On every incubator
29

25. ◦ ABHR (gel , rinse or foam) should be used
routinely to clean staff hands between patient
contacts, as long as hands are not visibly dirty
◦ After having contact with body fluids, wounds or
broken skin.
◦ After touching equipment or furniture near the
patient
◦ After removing gloves
30

26. ◦ An amount of 1.5 to 3 ml of an alcohol product
should be used
◦ All hand surfaces including fingers and under
finger nails should be covered until alcohol dries
◦ The procedure should take 20 – 30 seconds
31

27. ◦ ABHR should be completely dried before putting
gloves
◦ After removing gloves, hands should be
decontaminated
◦ Allow patients to remained you to decontaminate your
hand
32

28. ◦ Chlorhexidine gluconate 1% solution & Ethyl
Alcohol 61 % has:
 Proved its excellent effect
 Less time in application
 Made to last
Provides persistent kill (up to six hours) after
application.
 Kills up to 99% of the germs on hands
33

29. 34

30.  My 5 Moments for HH approach defines the
key moments when health-care workers should
perform hand hygiene.
 This evidence-based, field-tested,
evidence-based field-tested user-centered
approach is designed to be:
easy to learn,
logical and applicable in a wide range of settings.
35

31. WHEN? Clean your hands before touching a patient when approaching him/her.
BEFORE TOUCHING
1 WHY? To protect the patient against harmful germs carried on your hands.
A PATIENT
2 WHEN? Clean your hands immediately before performing a clean/aseptic procedure.
BEFORE CLEAN/ ASEPTIC WHY? To protect the patient against harmful germs, including the patient's own,
PROCEDURE
from entering his/her body.
3 WHEN? Clean your hands immediately after an exposure risk
AFTER BODY FLUID To body fluids (And after glove removal).
EXPOSURE RISK WHY? To protect yourself and the health-care environment from harmful patient
germs.
4 WHEN? Clean your hands after touching a patient and her/his.
AFTER TOUCHING Immediate surroundings, when leaving the patient's side.
A PATIENT WHY? To protect yourself and the health-care environment from harmful patient
germs.
5 WHEN? Clean your hands after touching any object or furniture in the patient's
AFTER immediate surrounding, when leaving even if the patient has not been touched.
TOUCHING PATIENT WHY? To protect yourself and the health-care environment from harmful patient
SURROUNDINGS germs.
37

32. 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

33. 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

34. 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)

35. 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

36. 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

37. We should not forget the moments where
hand hygiene is indicated and falls under
hygienic or social practices
i.e.: after using the toilet, preparing food
and eating, after coughing etc…

39. 45

40. AREAS FREQUENTLY
AREAS FREQUENTLY
MISSED DURING HANDWASHING
MISSED DURING HANDWASHING

41. Important HH Considerations
Important HH Considerations
 Keep natural nail tips short.
 Avoid nail polish, artificial nails and extenders.
 Avoid wearing rings or other hand jewelry.
 Avoid hot or cold water.
 Use papers towel to dry hands properly.
 Use papers towel to turn off tap/faucet.
 Do not use papers towel to dry hands after using
ABHR.
 Use hand lotions to prevent skin dryness
 Do not follow this by washing hands with water Pseudomon
 Do not use antimicrobial soap concomitantly as
nail
infection

42.  Education is a cornerstone for improvement of
hand hygiene practices.
 Easy access to hand hygiene supplies,
whether sink, soap, medicated detergent.
 Monitor HCWs adherence to recommended
hand hygiene practices.
 Encourage patients and their families to
remind HCWs to decontaminate their hand.

43.  Make improved hand hygiene adherence an institutional
priority
 Provide appropriate administrative support and financial
resources.
 To improve hand hygiene adherence among personnel
who work in areas with high work-loads
◦ ABHR should be available in convenient locations and pocket
sized to be carried by HCWs.

44. 52