Hand Hygiene

The only way to increase the

awareness of all staff is by
frequent reminders of the
process through various forms
o f e d u c a t i o n .
 Why is the skin so important?
The skin harbor 2 types of microorganisms:

1. The resident flora → Coagulase negative

staphylococci and diphtheroids , difficult to
r e m o v e m e c h a n i c a l l y

2. The transient flora → Gram Negative bacilli e.g

Pseudomonas aeruginosa and Salmonella
species. – Highly pathogenic and responsible for
nosocomial infection and multi resistant
o r g a n i s m s .
 What is hand Hygiene?
Total bacterial count on the hands of healthy
person range from 3.9 x 10 – 4.6 x 10

The objective of hand hygiene is to reduce

colonization of the hand with transient flora.

It is achieved by either
1. Handwashing
2. Hand disinfection.
 Hand washing

Process of washing the hands with

unmedicated soap or detergent and water.
The process removes the dirt and only
l o o s e t r a n s i e n t f l o r a .
 Hand disinfection (Hygienic
handwash)
Addition of an antiseptic to the detergent or soap
leading to significant reduction in numbers of
m i c r o o r g a n i s m s

Alcohol → the most rapid bactericidal action

and are preferred agent for hygienic hand rub
→ called waterless hand disinfection e.g. N-
prophylalcohol is preferred more tha n
e t h y l a l c o h o l .
 Compliance

• Low in hospital 30 -50% of HCW

•N u r s e > D o c t o r
 Factor contributing in poor
compliance to hand hygiene
1. Skin irritation and dryness
2. Patient’s care priority over hand hygiene
3. Inconveniently placed /absent wash basins
4. Misconception that glove use dispenses with
the need for additional hand hygiene
5. High workload and understaffing
6. Lack of interest in , or awareness of ,
guidelines for hand hygiene.
7. Ignorance of the role of the hand in cross
infection
 Standard precaution
Defined by CDC as
‘ are the set of precautions designed to prevent
transmission of human immunodeficiency virus
(HIV), Hepatitis B virus (HBV) and other
bloodborne pathogens, when providing first aid
o r h e a l t h c a r e .

Used when:
- Coming in contact with blood , body fluids,
secretion and excretion except sweat, non-intact
skin and mucous membrane.
 Route of infections
1. P a r e n t e r a l
2. Mucous membrane
3. C o n j u n c t i v a l e . g .
4. Non-intact skin e.g.
h a
e . g . i n j e c t i o n
e.g. splash into mouth
spray onto the eyes
contamination of cut on
n d .

So standard precaution are intended to prevent

infection by the previous routes.
 Why standard precaution are
essential
•Infectious patients may not manifest any
sign /symptoms of infection
•Infectious status is often determined only
by laboratory test → no time for emergency
c a r e .
•Pa t i e n t s m a y b e i n f e c t i o u s b e f o r e
laboratory tests are positive / signs of
diseases are manifested.
•HCW / patients may be placed at risk of
cross infection from those who are
asymptomatic but infectious.
 The main principle are:-
•Hand washing after any contamination of
h a n d s

•C a r e o f i n t a c t n o r m a l s k i n .

•Protection of damaged skin by covering

with dressing / gloves.

•G o o d h a n d h y g i e n e p r a c t i c e s

•The use of personal protective equipment.

 Protective barriers
1. Hands: must be washed before and after all
patient contact, and after removal of gloves
2. Gloves should worn before contact with blood,
body fluid, secretion /excretion or contaminated
objects.
3. Mask and eye protection to protect mucous
membrane
4. Gowns to protect skin and clothing during
procedures that results in splashing of blood
/other body fluid.