Transcript
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 insidehealth-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 problem3/26/2017 Dr.T.V.Rao @!Hand Hygeine 4
Hospitals Continues to be a Great Risk to many who avail the
Services
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Public Confidence in Hospitalslower 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 education
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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 Knowwe know:WELLBugs are on our handsBugs can be washed offWashing bugs off our hands saves lives
HCWs don’t wash their hands!!!
So what is the problem???
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’ hands happens
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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 ?3/26/2017 Dr.T.V.Rao @!Hand Hygeine 12
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 handsare not visibly soiled
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How to perform hand hygieneProper 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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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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• 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
Time constraint = major obstacle for hand hygiene
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- is an important barrier to compliance
- is more frequent with soap and water thanwith handrubs- is reduced and can be treated by emollient-
containing solutions
Skin irritation
Boyce et al. Inf Contr Hosp Epi 2000;21:442Kramer et al. J Hosp Infect 2002; 51:114Larson et al. Heart Lung 2000; 29:139Pittet. 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 bedsideat 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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MESSAGE TO MANY
• I must go the washroom. I've shaken a lot of hands.”
Yann Martel
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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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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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