Chapter 2 REVIEW OF RELATED LITERATURE This chapter contains various literature and studies that are related to the

study and is hereby presented.

Hand hygiene

Hand hygiene is a general term that includes handwashing (using plain soap and water), antiseptic handwash (using antimicrobial substances and water), antiseptic hand rub (using alcohol-based rub), and surgical hand antisepsis (using antiseptic handwash or antiseptic hand rub preoperatively by surgical personnel to eliminate transient and reduce resident hand flora) (CDC, 2002). When hands are visibly dirty wash hands with soap (plain or antimicrobial) and water. If hands are not visibly soiled, an alcohol-based hand rub may be used (CDC, 2002).

Hand hygiene, the first line of defence in medical asepsis is good hand hygiene. Hand hygiene refers to any method approved by the Centers for Disease Control and Prevention for decontaminating the hands. Handwashing refers to using soap and water to clean the hands. Friction or rubbing increases the amount of soil and microorganisms removed. When performing hand hygiene, wash from areas of clean to less clean. (Harkreader, et al., Fundamentals of Nursing Caring and Clinical Judgment, 2nd Edition, p. 464, Elsevier (Singapore) Pte Ltd, 2005).

It is important that both the nurses¶ and the patients¶ hands be washed at the following times to prevent the spread of micro-organisms: before eating. For routine patient care. antimicrobial foam. It is considered one of the most effective infection control measures. The nurse is also at higher risk because the normal skin barrier has been broken. which do not require soap and water. hand gel or vigorous handwashing under a stream of water for at least 10 seconds using liquid soap or antimicrobial liquid soap should be performed. Studies have shown that the convenience of antimicrobial foams and gels. the patient may be at higher risk because handwashing does not decrease bacterial counts on skin with dermatitis. and are frequently supplied in dispensers at the sink. If the nurse develops dermatitis. Antimicrobial soaps usually provided in high-risk areas. after using the bedpan or toilet. including hospitals. healthcare workers should wash their hands before and after giving care of any kind to every patient. may increase healthcare worker¶s adherence to hand cleansing (Bischoff et al.Handwashing is important in every setting.. It is important to recognize that handwashing with either plain or soap or antimicrobial soap can damage the skin through the drying effect of the detergents or chemicals. such as the intensive care units. Any patient may be harbour microorganisms that are currently harmless to the patient yet potentially harmful to another person or the same patient if they find a portal of entry. 2000). In addition. . Although lotions. such as sputum or drainage from a wound. and after the hands have come in contact with anybody substances.

Handwashing should be performed after arriving from work. when hands are visibly soiled. Fundamentals of Nursing Concepts. after removing gloves. 2008. 5th Edition. brief rubbing together of all surfaces of the hands lathered in soap.) Handwashing is the most important and most basic technique in preventing and controlling transmission of infections. (Potter and Perry. Soaps that contain antimicrobial agents are frequently used in high-risk areas such as emergency departments and nurseries. (Kozier. Pearson Education Limited.. p. 207-209. Handwashing is a vigorous. between client contacts. before .852) Handwashing is the rubbing together of all surfaces and crevices of the hands using a soap or chemical and water. water. 1996). et al. before leaving work. Friction is the most important element of the trio because it physically removes soil and transient flora.moisturisers and emollients have been tried. pp. The three essential elements of Handwashing are soap or chemical. B. The purpose is to remove soil and transient organisms from the hands and to reduce total microbial counts. process and practice. and friction. followed by rinsing under a stream of water (Larson. Handwashing is a component of all types of isolation precautions and is the most basic and effective infection-control measure to prevent and control the transmission of infectious agents. Fundamentals of Nursing. no research has yet confirmed their effectiveness in decreasing the problem.

Soiled hands usually require more time (CDC. High-risk areas. after contact with body fluids.eating. In phase II.) Using alcohol-based hand gel/ hand rub (sanitizer) Alcohol-based hand gels (sanitizer) are available to the general public and to healthcare institutions as a substitute for soap-and-water handwashing of physically clean hands. prior to any intervention. A washing time of 10 to 15 seconds is recommended to remove transient flora from the hands. However. Lois.527-529. researchers designed three phases to specifically address the question of frequency of handwashing by nurses. pp. such as nurseries. and after handling contaminated equipment. before and after performing invasive procedures. (White. physicians and ancillary personnel (Technicians and therapies) into intensive care units. Thomson Delmar Learning Inc. In phase I. In this study by Earl et al. usually require about a minimum 2-minute handwash. limited research has been conducted on the effectiveness of these gels from perspectives of their ability to kill microorganisms. United Kingdom. alcohol gel dispensers were installed inside and outside of patient rooms and both opportunities and occurrences for handwashing with either soap-and-water or gel were . The exact duration of time required for handwashing depends on the circumstances. the number of opportunities to wash hands was compared to actual compliance with handwashing over four weeks. (2001). 2002). effect handwashing frequency. or impact skin condition. 2nd edition. Foundations of Nursing. 2005) Hand hygiene Techniques 1. after excretion of body waste (urination and defecation).

The authors recognized weaknesses in the study.5 seconds) than with soap-and-water in phase I (9. In this case. However the gel did take less time and was most likely more effective than the inadequate nine-second soap use.6%. In addition. including the common Hawthorne effect. phase II. Although the gel dispenses succeeded in increasing the percentage of compliance with hand degerming. The results were as follow: phase I. The highest rates of compliance were by ancillary personnel. (Kozier et al. 2008) . phase III. the health care providers may have paid more attention to hand antisepsis than they would have had the study not been performed. 39. This effect states that the participant¶s behaviour may change purely by knowing that a study is being conducted. Although total amount of required time (including walking to the sinks) was not determined. 52. 57%. at is not possible to extrapolate these results to other institutions and types of care units. this study is an important example of the need to assess. However. intervene and reassess effectiveness of procedures designed to increases the safety and health of both providers and patients.4 seconds). The alcohol gel was used instead of soap about 50% to 60% of the time.counted for four weeks.6% compliance. Phase III examined opportunities and occurrences for handwashing between 10 and 14 weeks after installation for the dispensers. The study could easily be replicated in other settings and the results expanded to include other variables such as cost and true time savings. followed by nursing staff and then physicians. less actual time was spent in hand antisepsis with gel in phase III (7. the researches expressed concerned that the final rate was still only about 60% of the incidences requiring antisepsis.

because repeated exposure to hot water may increase the risk dermatitis.Apply product to palm of one hand and rub hands together covering all surfaces of hands and fingers until hands are dry. Avoid using hot water. Tub hands together. 2005) 2. Rinse hands with water and dry thoroughly with a disposable towel. (Harkreader.) Soap and water and alcohol gel ( ) 3. Spreads rub to cover all aspects of hands and fingers. Amount of rub required varies by product. et al. covering hands and fingers on all sides. apply an amount of product recommended by the manufacturer to hands. covering all surfaces of the hands and fingers.) Sink with running water and soap ( ) 2. Follow the manufacturer¶s recommendations regarding the volume of product to use. Use towel to turn off the faucet. 2005) Apply the recommended amount of product to one hand. et al.) Alcohol . Continue rubbing until hands are dry. and rub hands together vigorously for at least 15 seconds. (Harkreader.) When washing hands with soap and water Wet hands first with water.) Alcohol-based hand gel 4. Allows the rub to work. 2005) Materials used for hand hygiene 1. (Lois White.

or sneezing 7. After blowing your nose. and after preparing food 2. coughing. After changing diapers or cleaning up a child who has used the toilet 5. After touching garbage 9. Hand hygiene is easy to do and it's one of the most effective ways to prevent the spread of many types of infection and illness in all settings²from your home and workplace to child care facilities and hospitals. the following are the advantages of handwasing: 1.) To reduce the number of microorganisms on the hands 2. Before eating food 3. Clean hands can stop germs from spreading from one person to another and throughout an entire community. during.) To reduce the risk of cross-contamination among patients 4. Before and after caring for someone who is sick 6. Before. When should adults wash their hands? The following are some of the answers: 1. After touching an animal or animal waste 8. Before and after treating a cut or wound . After using the toilet 4.) To reduce the risk of transmission of infectious organisms to oneself.) To reduce the risk of transmission of microorganisms to patients 3.Advantages of hand hygiene According to Kozier et al 2008.

numbers 6-7 are optional (http://www. . However. numbers 5-7 are optional when it comes to when should adult wash their hands.gov/Features/Handwashing/). numbers 2-3 and 6-7 are applicable for children. On the other hand.Basing from the aforementioned instances.cdc.

12. ³Germs´ a. Hand hygiene Techniques : Check all the techniques you usually use in hand hygiene? ____ alcohol-based hand gel/ hand rub (sanitizer) technique .QUESTIONNAIRE CHECKLIST Part I: Profile of Respondents: Name: _________________________________________________________________ Age: __________ Grade: ________________________ School: ________________________________________________________________ Part II: Level of knowledge on hand hygiene: Direction: Encircle the letter of the correct answer. materials and advantages of hand hygiene: Directions: Below are questions regarding techniques and materials used in hand hygiene as well as the advantages one could get from it. none of the aboves Part III: Techniques. hand hygiene will get rid of them d. 1. they can make you sick b. they are too small to see c.

Materials used in hand hygiene: Check all the materials you usually use in handwashing? ____ Soap and water ____ alcohol-based hand gel (sanitizer) ____ Alcohol 3. Advantages of hand hygiene: Do you understand that: a) ³Germs´ (bacteria and viruses) can make you sick? _____ Yes _____ No _____ don¶t know b) Hand hygiene can get rid of ³germs´? _____ Yes _____ No _____ don¶t know c) Proper hand hygiene is the most effective way to prevent the spread of many types of infection and illness? _____ Yes _____ No _____ don¶t know 4.____washing hands with soap and water technique ____Alcohol technique 2. When do you usually wash your hand? ____ Before eating food .

____ After using the toilet ____ After blowing your nose. or sneezing ____ After touching an animal or animal waste 5. Is there anything else you can tell about hand hygiene? __________________________________________________________________ __________________________________________________________________ . coughing.

Maawatam kadi nga: a. Markaan iti tsek (¥) dagiti ususarem para iti panang-buggo iti imam _____ sabon ken danom _____alcohol-based hand gel _____ alcohol lang 3. ____ alcohol-based hand gel/ hand rub technique ____ washing hands with soap and water technique ____Alcohol technique 2. Markaan iti tsek (¥) dagiti wagas nga ususaren iti panangbuggo iti ima.) Dagiti mikrobyo wenno bakterya ket makaited iti sakit? _____ wen _____ saan b.) Ti panang-buggo iti ima ket wagas a panang-ikkat iti bakterya? _____ wen _____ diak masigurado ______ diak sigurado _____ diak masigurado .SALUDSOD PARA ITI SURVEY Nagan: ______________________________________________________________ Tawen: __________ Grado: _____________________________ Pagadalan:________________________________________________________ Direksyon: Dagiti nakasurat iti baba ket saludsod panggep iti wagas ken kasapulan para iti panang-buggo iti ima ken dagiti nasayaat a maited detoy. 1.

Ti nasayaat nga panang-buggo iti ima ket epektibo a wagas ti panangpasardeng iti panagwaras iti adu a klase ti sakit ken impeksyon iti bagi tayo? _____ wen _____ saan _____ diak masigurado 4. pusa. Kaano ti panang-buggom iti imam? _____ kasangwanan ti pananga _____ kalpasan nga agusar iti kasilya weno comfort room _____ kalpasan iti panag-pangres.c. Ada kadi pay mainayon mo maipanggep iti panagbuggo iti ima? _____________________________________________________________________ _____________________________________________________________________ . manok. panaguyek ken panagbaeng _____ kalpasan ti panangigem wenno panangpakan iti taraken nga aso. baboy ken daduma pay a taraken 5.

hand hygiene is required: y Before and after contact with any patient/resident. or with alcohol-based hand rubs. blood and body fluids (use soap and running water whenever hands are visibly soiled) .Why is hand hygiene important? Hand hygiene refers to removing or killing microorganisms (germs) on the hands. When should hand hygiene be performed? In health care. hand hygiene is used to eliminate transient microorganisms that have been picked up via contact with patients. their body substances or items contaminated by them y y y y Between different procedures on the same patient/resident Before and after performing invasive procedures Before preparing. Hand hygiene may be performed either by using soap and running water.g. contaminated equipment or the environment. excretions.g. handling. When performed correctly. toileting or doing wound care) y y y Before putting on and after taking off gloves After performing personal functions (e. blowing your nose) When hands come into contact with secretions. hand hygiene is the single most effective way to prevent the spread of communicable diseases and infections. assisting patient to blow nose. serving or eating food or feeding a patient/resident After assisting patients/residents with personal care (e. using the toilet. In health care.

If used. They are widely used in health care settings. Any type of plain soap may be used. bar soaps are not acceptable in health care settings except for single patient/resident personal use. Soap containers must not be topped up. Won't frequent hand hygiene dry my skin? Intact skin is the first line of defence against microorganisms. bar soap should be kept in a self draining holder that is cleaned thoroughly before new bars are put out.When should soap and water be used? The mechanical action of washing. rinsing and drying removes transient bacteria present on the hands. as there is a risk of contamination of residual soap. or in situations where running water is not available. Using alcohol-based hand rub is better than washing hands (even with an antibacterial soap) when hands are not visibly soiled. However. wet your hands before applying soap and . provided they contain more than 60% alcohol. When should alcohol-based hand rubs be used? Alcohol-based hand rubs/gels/rinses are the preferred method for decontaminating hands. hence it is important to maintain good skin care. Liquid soap containers should be used until empty and then discarded. Hand washing with soap and running water must be performed whenever hands are visibly soiled. or in other areas where invasive procedures are performed. Antibacterial soaps may be used in critical care areas such as ICU. To prevent chafing.

he/she should be referred to Occupational Health for assessment. Do this for at least 15 seconds. making a soapy lather. being careful not to wash the lather away. Follow these five simple steps to keeping hands clean: 1. Frequent use of alcohol-based hand rub actually lessens the incidence of skin breakdown. Remove hand and arm jewellery and wet your hands with warm (not hot) running water. Most alcohol-based hand rubs contain emollients to reduce the incidence of skin irritation. as well as between your fingers and under your nails. as it does not subject hands to the friction and abrasion involved in hand washing and drying hands. 3.use a mild lotion soap with warm water. pat rather than rub hands dry. . 2. and apply lotion liberally and frequently. Rinse your hands well under warm running water. Hand Hygiene Procedures How do I use soap and water? Good hand hygiene technique is easy to learn. Wash the front and back of your hands. using a rubbing motion. Add soap. If an individual develops compromised skin integrity. and then rub your hands together. Skin lotions should be chosen that will not interfere with glove integrity.

Apply enough antiseptic to make about the size of a quarter onto your hands. Rub hands until your hands feel dry (minimum 15-30 seconds). Rubbing vigorously with paper towels can damage the skin. 5. particularly between fingers. 4. Jewellery is very hard to clean and hides bacteria and viruses from the mechanical action of the washing/rubbing. Use a rubbing motion to evenly distribute the antiseptic product over all surfaces of the hands. back of hands and base of thumbs. as they trap bacteria and are difficult to keep clean.4. 2. Turn off tap using paper towel so that you do not recontaminate your hands. including under your nails (1-2 pumps). enough when you rub your hands together to cover all areas of your hands. How do I use alcohol-based hand rubs? Alcohol-based hand rubs should only be used if no visible dirt is present on the hands. as bacteria may become trapped along the edges . fingertips.  DON'T use artificial nails. Wipe and dry hands gently with paper towel. What are some mistakes I should avoid regarding hand hygiene?  DON'T leave hand jewellery on when performing hand hygiene. Remove hand and arm jewellery. 3. 1. nail enhancements or long (>3-4mm) nails.  DON'T wear chipped nail polish.

. DON'T use a common hand towel. Remember that germs thrive on moist surfaces. DON'T use a single damp cloth to wash a group of patient's/resident's/children's hands.    DON'T use a standing basin of water to rinse hands. DON'T use sponges or non-disposable cleaning cloths.

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