HAND

HYGIENE
HAND HYGIENE

 Single most important practice to prevent

the transmission of infection.

 Single most effective way to prevent

Healthcare-associated infection (HAI)
HANDS

Hands dual roles:

 Instrument of care

 Vehicle for spread of pathogen

Bacterial transmission by hand

 Contact with other site of own body.

 Contact with the infected or colonized pt.
 Contact with the contaminated pt care
equipment.
 Contact with the environment.
SKIN FLORA

 Transient flora
 Rest on the superficial layers of skin
 Easily transmitted by contact
 Acquired by HCW during contact with patients
 Resident flora
 Lives permanently in deeper layers of skin
 More resistant to removal
 Hands of HCW may become persistently
colonized or infected with pathogens
Definition of hand hygiene

 Hand hygiene is a term applies to the process

of hand washing, or hand decontamination.
 Hand washing involve washing hand with
plain, ie non antimicrobial soap and water.
 Hand decontamination involves washing
hands with antimicrobial soap and water or
alcohol / chlorhexidine hand rub.
Purpose of hand hygiene

 To remove dirt, debris and reduce microbes

from hands.
 To reduce cross contamination / infections.
 To interrupt mode of transmission by
contact.
 Image of cleanliness, creadibility of HCW.
Important history
 150 years ago, Ignaz Semmelweis (Hungarian
physician 1818-1865) made one of the most
important discoveries in modern medicine:
“Failure of some
doctors to wash their
hands spread fatal
infection from one pt to
another.”
Important history

 1847 – Semmelweise was credited as the 1st

person to demonstrate the importance of
person-to-person transmission of infection by
hands and hand washing acted to deter such
transmission.
 1st clinician to reduce mortality by introducing
hand washing policy.
Impact of hand hygiene education in
the community in a developing
country
Luby et al. Lancet 2005 ; 366: 225-233

 Result
 ↓ diarrhoea
 ↓ skin infection
 ↓ respiratory infections
 ↓ mortality among children
Major obstacle for hand hygiene…
time constraint

Handwashing Alcohol-based
Soap + water hand rub

1 to 1.5 min 15 to 20 sec

Other obstacles to hand hygiene
compliance
 Effect of washing on skin: cracking, drying,
chapping.
 Inconvenient facility location / supplies.
 Lack of personal responsibility.
 Unwillingness to acknowledge that hand
hygiene can make a difference in clinical
outcome.
 Glove
Hand hygiene recommendations

 If hands are not visibly soiled, use an alcohol-based

hand rub for routine decontaminations in all clinical
situation.

 Adoption of alcohol-based hand rub is the gold

standard in all other clinical situations, whenever
possible.

 Alternatively, wash hand with either an antimicrobial

soap and water or non-antimicrobial soap and water.
Indication for hand hygiene
 Before and after having direct contact with pt.
 After removing gloves.
 Before handling an invasive device (regardless of
whether or not gloves are used) for pt care.
 After contact with body fluids or excretions, mucous
membranes, non-intact skin or wound dressings.
 If moving from a contaminated body site to a clean
body site during pt care.
 After contact with inanimate object (including medical
equipment) in the immediate vicinity of the pt.
*Wet your hand first
HOW SERIOUS ARE SKIN PROBLEMS?

Many studies have reported much higher

incidences amongst HCWs than other
profession.
HOW SERIOUS ARE SKIN PROBLEMS?

 3rd highest cause of occupational disease.

 One report: almost half of all pts presenting
to a contact dermatitis investigation clinics
were HCWs.
 AJIC: skin breakdown is a major occupational
disease.
WHY SKIN PROBLEM IS AN ISSUES?

 Lead to low or non-compliance to hand hygiene

practices
 Heavier colonization of microorganisms and
increase of Healthcare-acquired Infections (HCAI).
 Increased risk of occupational exposure to
potentially blood borne pathogens such as Hep B,
C, HIV, etc.
 Lost productivity, job reassignment, lower job
satisfaction or may cause disability.
CDC Recommendation

To provide HCWs with

moisturizing skin- care
product.
UK NHS Recommendation

 Hand lotions will prevent dry skin and reduce

the risk of developing skin irritations and
dermatitis.
 Frequent and consistently use of appropriate
lotions is an integral component of a hand
hygiene regime.
CONCLUSION
HAND HYGIENE

Acknowledge and proven

effective in reducing
infection by contact

(WHO, CDC, UK NHS, KKM)

THANK YOU