Hand hygiene

guest presentation
Dr.T.V.Rao MD

3/26/2017 Dr.T.V.Rao @!Hand Hygeine 1

 The world with Infection

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 A tribute to a Great soul
Semmelweis‘
(1818 – 1865)
• Hand hygiene is the simplest,
most effective measure for
preventing nosocomial
infections Despite advances
in infection control and
hospital epidemiology,
Semmelweis' message is
not consistently
translated into clinical
practice ,
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 HCAI: The worldwide burden
•Estimates are hampered by limited availability
of reliable data
•The burden of disease both outside and inside
health-care facilities is unknown in many countries
•No health-care facility, no country, no health-
care
system in the world can claim to
have solved the problem
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 Hospitals Continues to be a
Great Risk to many who avail the
Services

26-03-2017 Dr.T.V.Rao MD @Infection control 5

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 Public Confidence in Hospitals
lower rates of Hospital associated Infection
• Patients and the wider
public should have
complete confidence in
the cleanliness and
hygiene of their
healthcare environment
•So we Need
Standards and
26-03-2017
education Dr.T.V.Rao MD @Infection control 7
 Soap water and common sense are best
antiseptics
WILLIAM OSLER
•Hands can be
washed with soap
and water or, if they
are not visibly dirty,
a fast-acting
antiseptic solution
like a hand wipe or
hand gel.
26-03-2017 Dr.T.V.Rao MD @ MRSA
 What we Know
 we know:WELL
Bugs are on our hands
Bugs can be washed off
Washing bugs off our hands saves lives
 So what is the problem???
HCWs don’t wash their hands!!!
 Hand great Propagator of
Infections
• Hands are the most
common vehicle to
transmit health care-
associated pathogens
• Transmission of health
care-associated
pathogens from one
patient to another via
health-care workers’
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hands happens
 When should I wash my hands?
• Different situations where people can pick up "germs" include:
• When hands are visibly soiled.
• After using the washroom (includes changing diapers).
• After blowing your nose or after sneezing in your hands.
• Before and after eating, handling food, drinking or smoking.
• After touching raw meat, poultry, or fish.
• After handling garbage.
• Visiting or caring for sick people.
• Handling pets, animals or animal waste.
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Strategies for compliance
• Monitoring of hand
hygiene is a key
component in improving
processes and compliance.
rely on different measures
to gauge compliance.
Monitoring should be
conducted on a routine
basis and documented
•Do we Have ?
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 Hand washing agents
• Plain (non-antimicrobial) soap
• Alcohols
• Most alcohol-based hand antiseptics contain either ethanol,
isopropanol or n-propanol, or a combination of two of these
products.
• Chlorhexidine
• CHG, a cationic bisbiguanide, was developed in the United Kingdom in
the early 1950s and introduced into the USA in the 1970s.
Chlorhexidine base is barely soluble in water, but the digluconate
form is water-soluble
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 Hand washing agents
• Chloroxylenol
• Chloroxylenol, also known as para-chloro-meta-xylenol (PCMX), is a
halogen-substituted phenolic compound that has been used widely as a
preservative in cosmetics and other products and as an active agent in
antimicrobial soaps
• Hexachlorophene
• Hexachlorophene is a bisphenol composed of two phenolic groups and
three chlorine moieties. In the 1950s and early 1960s, emulsions
containing 3% hexachlorophene were widely used for hygienic
handwashing as surgical scrubs and for routine bathing of infants in
hospital nurseries

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 Hand washing agents
• Iodine and iodophors
• Iodine has been recognized as an effective antiseptic since the 1800s,
though iodophors have largely replaced iodine as the active ingredient in
antiseptics because iodine often causes irritation and discolouring of skin.
• Quaternary ammonium compounds
• Quaternary ammonium compounds (QACs) are composed of a nitrogen
atom linked directly to four alkyl groups Among this large group of
compounds, alkyl benzalkonium chlorides are the most widely used as
antiseptics
• Triclosan
• Triclosan (chemical name 2,4,4’–trichloro-2’-hydroxydiphenyl ether) is
known commercially as Irgasan DP-300

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How to clean your hands
• Handwashing with soap and water –
essential when
hands are visibly dirty or visibly soiled
(following visible exposure to body
fluids)
• Hand rubbing with alcohol-based hand
rub is the
preferred routine method of hand
hygiene if hands
are not visibly soiled

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How to perform hand hygiene
Proper technique is important when it comes to effective hand
hygiene. Without proper hand hygiene technique, we can still
spread many microorganisms with our hands. This section will
cover the proper techniques for the following methods:

Alcohol-based hand rub Soap and water Without water when hands are
soiled

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How to perform hand hygiene

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 Preventing
Healthcare
Transmission:
Hand Hygiene

26-03-2017 Dr.T.V.Rao MD @ MRSA

 What about
antibacterial soaps and
waterless hand scrubs?
• While it is true that regular
soap and water does not
actually kill microorganisms
(they create a slippery
surface that allows the
organisms to "slide off"),
antibacterial soaps are
typically considered to be
"overkill" for most purposes.
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 Use of Antiseptic Soaps
• The exception may be in a
hospital where special
situations are present
(e.g., before invasive
procedures, when caring
for severely immuno-
compromised patients,
critical care areas, intensive
care nurseries, etc..
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 WHEN ESSENTIAL TO USE
SOAP AND WATER
• If exposure to spore
forming organisms e.g.
Clostridium difficile is
strongly suspected or
proven, including during
outbreaks – clean hands
using soap and water
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 Changing trends on hand
hygiene
from Traditional soap to
Alcohol
• Hand hygiene prevents
cross-infection in hospitals,
but health-care workers'
adherence to guidelines
is poor. Easy, timely access
to both hand hygiene and
skin protection is necessary
for satisfactory hand
hygiene behavior.

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 Alcohol is preferred in Time Constrains
• Alcohol- based hand rubs
may be better than
traditional handwashing
as they require less time,
act faster, are less
irritating, and contribute
to sustained improvement
in compliance associated
with decreased infection
rates.
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 Alcohol association with C.difficile
Infections
• The widespread use of alcohol-based hand rubs was repeatedly given
the major blame for the increase of C. difficile-associated
disease rates because alcohol preserves spores and is used in the
laboratory to select C. difficile spores from stools.
• Although alcohol-based hand rubs may not be effective against.
difficile, it has not been shown that they trigger the rise of
C.difficile-associated disease.
• However rates began to rise in the USA long before the wide use of
alcohol-based hand rubs.

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 How to observe Hand Hygiene
• Direct observation is the most accurate method
• Observer must conduct the observation without interfering
with ongoing work
• Observer should be familiar with “The 5 Moments for
Hand Hygiene” and the data collection tool that is being
utilized
• Identify opportunities for hand hygiene and then record if
the worker being observed performed hand hygiene at that
time
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 FDA Standards in Hand Hygiene
ASTM standards
•ASTM E-1174202 Currently, hand wash or hand
rub agents are evaluated using this method in
North America. The efficacy criteria of the FDA’s
Tentative Final Monograph (TFM) are a 2-log10
reduction of the indicator organism on each hand
within 5 minutes after the first use, and a 3-log10
reduction of the indicator organism on each hand
within 5 minutes after the tenth use.
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 Time constraint =
major obstacle for hand hygiene
• Adequate handwashing with water and
soap requires
40–60 seconds

• Average time usually adopted by health-

care workers:
<10 seconds

• Alcohol-based hand rubbing: 20–30

seconds

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Markets are flooded with Many washing
agents

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 Skin irritation
- is an important barrier to compliance
- is more frequent with soap and water than
with handrubs
- is reduced and can be treated by emollient-
containing solutions

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

Kramer et al. J Hosp Infect 2002; 51:114
Larson et al. Heart Lung 2000; 29:139
Pittet. Emerging Inf Dis 2001; 2:234
 What can we do to help change
Provide easy access to hand hygiene materials
Handrub solution
Conveniently located:
at the patients bedside
at the patient’s room entrance
in convenient / appropriate locations
in high traffic public areas
Working appropriately
 Resources for success
• WHO has hundreds of resources including scientific
evidence to support their recommendations for hand
hygiene, as well as easy-to-use implementation guides
and training materials that can be adapted for use in
any healthcare setting..
Additionally, The CDC has several key resources and
a dedicated web course on hand hygiene for
healthcare providers. This resource can be access by
visiting the CDC website at www.cdc.gov.
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Accessibility for Hand Rubs
MESSAGE TO
MANY
• I must go the
washroom. I've
shaken a lot of
hands.”
Yann Martel

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BEST PRAYER IN THE HOSPITAL IS
SUPPORTING THE HYGIENE

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TRUTH ABOUT HAND
WASHING
• We all know well
• We forget when needed
• We Teach more than we
practice
• We blame others than self
introspection

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 YOU CAN VISIT ME AT

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 References
• WHO Guidelines on Hand Hygiene in Health CareFirst Global Patient
Safety Challenge Clean Care is Safer Care © World Health
Organization 2009
• CDC Guidelines on Hand Disinfection

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THANK YOU ALL

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