Hand Hygiene

Practice Questions
True or False
1. Many infections are transmitted on the hands of
healthcare personnel and could be prevented by
performing hand hygiene.
2. If you touch a surface area in the exam room and do
not touch the patient you do not have to practice hand
hygiene.
3. Hand hygiene must be performed before placing gloves
on and after glove removal.
4. Hand hygiene before and after patient contact and after
contact with the immediate patient care environment should
be performed, even if gloves are worn.
 Practice Questions
True or False
5. Your patient care practices send a powerful message and
show your patients and co-workers that you are serious
about their health
Multiple Choice
6. When should you practice hand hygiene in the healthcare
settings?
A. Both before and after having contact with a patient
B. Only when you think your hands are dirty
C. The time encompassing 5 moments of hand hygiene
D. Only when you think the patient is contaminated or dirt
 Learning Outcomes
At the end of the discussion, the student will be able
to:
• Understand the importance of Hand hygiene
procedure to healthcare settings
• Differentiate hand washing to alcohol-based hand
rub procedure
• Recognize the different uses and characteristics of
hand hygiene products
• Explain and demonstrate hand washing and
alcohol-based hand rub procedure
 Background

• 1846 - Ignaz Semmelweis observed higher mortality rate

on women giving birth attended by medical students and
physicians than those attended by midwives in two
Clinics
• Puerperal fever was caused by “cadaverous particles”
transmitted via the hands of students and physicians.
• 1847 - insisted that students and physicians clean their
hands between each patient in the clinic.
• Results showed reduction in the number of mortality rate
from 18%-1%
6/19/11 Marisa N. 6
Microorganisms on the Skin

• Transient Flora - are picked up by

contact with other people, objects or the
environment and do not survive
indefinitely on the hands (Maurer, 1991).
These organisms have the potential to do
harm as they have the ability to survive
long enough to be transferred to others.
Microorganisms on the Skin

Resident Flora –are persistently

present as part of the individuals own
flora, normal flora. They cannot be
permanently removed.
• Example:
–Skin – Staphylococcus epidermidis
Staphylococcus aureus
Chain of Infection
 Hand Hygiene
• Hand Hygiene is a general term that applies to
4 techniques: handwashing, antiseptic
hand wash, antiseptic hand rub, or
surgical hand antisepsis
• It is one of the most effective method of
preventing and controlling transmission of
infection
• CDC recommends that HCP should not wear
artificial fingernails or extensions
 Definition of Terms
• Handwashing - washing hands with plain soap and water. It
remains a sensible strategy for hand hygiene in non-
healthcare settings
• Antiseptic handwash – Washing hands with water and soap or
other detergents containing an antiseptic agent
• Alcohol-based hand rub (ABHR) – is an alcohol-containing
preparation applied to the hands
• Surgical hand antisepsis – is an antiseptic handwash or
antiseptic handrub performed preoperatively by surgical
personnel
 Facts about hand hygiene
• Surface as small as a pinhead may contain up to
10 million bacteria.
• Bacteria can double their number in 20 minutes.
• Survival of germs in hands (2-60 minutes)
• Proper hand hygiene can eliminate 90% of
germs.
• Wet hands spread 60, 400 bacteria, while dry
hands spread 200 bacteria
 Purposes
• To reduce the number of microorganisms on the
hands.
• To reduce the risk of transmission of
microorganisms to clients.
• To reduce the risk of cross-contamination among
clients.
• To reduce the risk of transmission of infectious
organisms to oneself.
 When is hand washing done?

• Before eating
• After use of bedpan/toilet
• After the hands have come in contact with
any body substance
• After hands have come in contact with any
unclean surface/object
• For healthcare workers, before and after
giving care
 Based on CDC
• When should you wash your hands?
• Before, during, and after preparing food
• Before eating food
• Before and after caring for someone who is sick
• Before and after treating a cut or wound
• After using the toilet
• After changing diapers or cleaning up a child who has used
the toilet
• After blowing your nose, coughing, or sneezing
• After touching an animal, animal feed, or animal waste
• After touching garbage
 5 Moments of Hand Hygiene

1. before touching a patient

2. before performing
clean/aseptic procedures
3. after body fluid
exposure/risk
4. after touching a patient
5. after touching patient
surroundings.
Important Characteristics of Hand
Hygiene Products
Active Ingredients
• Alcohol
–Ethyl, isopropanol, or n-propanol 60-90%
concentration
• Chlorhexidine 0.5 – 4% concentration
• Povidone Iodine 7.5 – 10% concentration
• Other active ingredients
–Quartenary ammonium compounds
–Hexachlorophene
–Cloroxylenol
–Triclosan
Important Characteristics of Hand
Hygiene Products

• Inactive Ingredients
–Plays an important role in determining
tolerability of hand hygiene products
• Preservatives
• Dyes
• Fragrances
Product Format
 Product Delivery
• No-touch dispensers
• Reduces cross-contamination by multiple user
• Control the amount product delivered
• Electronic / infrared sensors dispenses product
• Manual Dispensers
• Dependent on the pressure
• Point of care dispensers
• Within easy reach during patient care activities
• Personal carriage
✓Small volume carried or worn by HCW
• Wall mounted within patient zone
✓Located at patient care
✓Mounted on hospital bed or wall or fixed to mobile patient care devices
Common types of Faucet

Hand-operated faucet
Common types of Faucet

Foot- pedal faucet control

 Common types of Faucet

Infrared Control
 Preparation
• Assemble equipment
–Hand washing
• Sink with running warm water
• Antimicrobial or non-antimicrobial soap
• Paper towel
• Receptacle/waste disposal
–Antiseptic hand rub
• Alcohol-based, waterless, antiseptic-
containing emolient
 Assessment
1. Inspect surface of the hands for any breaks or
cuts in the skin or cuticles
2. Inspect hands for visible soiling (perform
hand washing if visibly soiled and ABHR
technique if not
3. Inspect condition of nails
4. Push wristwatch and long uniform sleeves
above the wrist. Avoid wearing rings
Hand washing procedure (WHO, 2019)
• Open the tap, adjust the temperature making
it warm (aids in the reduction / removal of
microorganisms in the hand) and wet the
hands under continuous running water
(Avoid splashing water against the sink and
the uniform)
1. Apply adequate amount of soap to cover all
surface of the hands (2-4 ml) or 4.5 ml.
2. Rub hands palm to palm
3. Right palm over left dorsum with finger
interlaced and vice versa
4. Palm to palm with fingers interlaced
5. Back of fingers to opposing palms with
finger interlocked
Hand washing procedure
6. Rotational rubbing of left thumb clasped in
right palm and vice versa
7. Rotational rubbing backward and forward
with clasped fingers of right hand in left
palm and vice versa
8. Rotational rubbing of both wrist (optional)
9. Rinse the hands thoroughly under running
water
10. Dry the hand with paper towel
11. Turn off the tap using a clean and dry
paper towel or elbow levers
How to handrub
• To effectively reduce the
growth of germs on
hands, handrubbing
must be performed
within 20–30 seconds
Case Scenario
 Summary
• Hand Hygiene is the single most important measure for
preventing the spread of infection – it is essential for
patient safety
• Hand hygiene composed of either handwashing with
soap and water and the use of alcohol-based hand
rub
• Formulation, Format, and Delivery are the important
characteristics of hand hygiene products
• Healthcare-associated Infections and Antibiotic-
resistant organisms are the factors that affected the
need for adopting an effective hand hygiene program
 References

• Association for Professionals of Infection Control, Inc. (2009). APIC

Text of infection control and epidemiology. (3rd ed.). USA:
Washington
• Berman, A., Snyder, S., and Frandsen, G. (2018). Kozier & Erb’s
Fundamentals of Nursing: Concepts, Process, and Practice. (10th ed).
Mind Mover Publishing House, Inc. Philippines
• Center for Disease Control and prevention. (2019). Hand hygiene in
the healthcare settings. Retrieved from
https://www.cdc.gov/handhygiene/index.html
• National Library of Medicine (2002). Guideline for Hand Hygiene in
Health-care Settings. MMWR. Vol. 51. No. RR-16
• World Health Organization. (2019). Five moments of hand hygiene.
Retrieved from https://www.who.int/infection-
prevention/campaigns/clean-hands/5moments/en/