Howard The Science of Hand Hygiene Final · 2019-04-19 · The Science of Hand Hygiene and Implications for the Medical/Surgical Nurse Keith Howard, DNP, RN, NEA -BC, CIC 29th Annual

TheScienceofHandHygieneand ImplicationsfortheMedical/SurgicalNurse

KeithHoward,DNP,RN,NEA-BC,CIC

29th AnnualMedicalSurgicalConference

April4th,2019

SanFrancisco,CA

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Objectives:

§ Describethemicrobiologyandpathophysiologyofskin.

§ Understandtheroleofresident,transientskinfloraandhoworganismstransmittedviathehands.

§ Identifyhandhygienepreparations,properuse,preventionofsideeffects,adjunctsthatimpedeproperhandhygieneandbehavioralmodificationstoimprovehandhygienecompliance.

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BeginningsofHandWashing&CurrentScience:

• 11th centuryMosesbenMiamindides

• 16th Century– GirolamoFrancastoro

• 1825– PaperPublished claimingbenefitsofHandWashinginHealthcare.

• 1843– OliverWendellHolmes–puerperal feverspreadbyhealthcareworkershands. - Noonelistened!

• 1846– IgnazSemmelweis– Firstevidenceshowingbenefitsofhandwashingbetweenpatients.

• 1950’s– Current

Nantasit Luangasanatip et al. BMJ 2015;351:bmj.h3728 3

NormalBacterialSkinFlora

• Normalhumanskiniscolonizedwithbacteria

• Bacterialcountsrangefrom3– 7millioncolonyformingunits(CFU)

• ResidentFlora– Good

• TransientFlora– Bad

• HealthcareWorkersHandscanbecomepersistentlycolonizedwithpathogenicflora.

LarsonE.Effectsofhandwashingagent,handwashingfrequency, andclinical areaonhandflora.AmJInfectControl 1984;11:76–82.

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PhysiologyofNormalSkin

• SkinisaDynamicStructure

• 2PrimaryLaters:• OuterPrimary–Epidermis• SecondaryInner- Dermis

CentersforDiseaseControlandPrevention.GuidelineforHandHygieneinHealth-CareSettings:Recommendations of theHealthcareInfectionControlPracticesAdvisoryCommitteeandtheHICPAC/SHEA/APIC/IDSAHandHygieneTaskForce.MMWR2002;51(No.RR- 16):[inclusivepagenumbers].

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TransmissionofPathogensonHands

• Health-careassociatedpathogens recoveredfrom:A. InfectedorDrainingWoundsB. Colonizedareasofnormal, intactpatient

skinC. PatientEnvironment (Skinshedding)

• ChronicMedicalConditions – SkinColonization

• Cleanactivities– PatientContact

• Devicerelatedcareorthatoftherespiratorytract– Increasedfingertip bacterialloading

LarsonEL,McGinleyKJ,FogliaAR,TalbotGH,LeydenJJ.Compo- sition andantimicrobic resistanceofskinflorainhospitalized andhealthyadults.JClinMicrobiol 1986;23:604–8. 6

MethodsusedtoevaluateHandHygieneproducts

• Handscontaminatedwithbacteriabeforeevaluatingproduct

• Methodusedtocontaminatehands

• Amount ofproductapplied tothehand

• Timeproduct isindirectcontactwiththeskin

• Methodsusedtorecoverbacteriaafterproductuse

• Determiningproducteffectiveness- RemovalofTransientorResidentBacteria

Comparison of Standard Culture-Based Method to Culture-Independent Method for Evaluation of Hygiene Effects on the Hand MicrobiomeC. Zapka, J. Leff, J. Henley, J. Tittl, E. De Nardo, M. Butler, R. Griggs, N. Fierer, S. Edmonds-WilsonmBio Mar 2017, 8 (2) e00093-17; DOI: 10.1128/mBio.00093-17

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ReviewofPreparationsusedforHandHygiene

• PlainSoap:• Detergentbasedesterifiedfattyacidsandsodiumorpotassiumhydroxide.

• Soap– resultinremovalofdirt,oilsandorganicsubstancesfromtheskin.

• PlainSoaps– Noantimicrobialactivity

• Alcohols:• Containeitherisopropanol,ethanol,n-propanol,oracombinationofthetwo.

• Alcohols– antimicrobialactivitythroughdenatureofproteins.

• Alcoholsolutionscontainingbetween60%- 95%alcoholaremosteffective

RotterM.Handwashingandhanddisinfection[Chapter 87].In:MayhallCG,ed.Hospitalepidemiologyandinfectioncontrol.2nded.Philadelphia,PA:LippincottWilliams&Wilkins,1999.RotterML,KollerW.Testmodelsforhygienichandrubandhygienichandwash:theeffectsof twodifferentcontaminationandsamplingtechniques. JHospInfect1992;20:163–71.

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ContactDermatitisresultingfromHandHygiene:

• 25%ofnursesreportsignsofdermatitis

• 85%reporthistoryofskinproblems

• IrritancyPotentialoftheProduct

• FactorsAssociatedwithDermatitis

Djihane, AhmedLecheheb &Cunat, Lisiane&Hartemann, Philippe&Hautemanière, Alexis.(2011).Prospectiveobservational studytoassesshandskincondition afterapplication ofalcohol-based handrubsolutions.Americanjournal ofinfection control.40.160-4.10.1016/j.ajic.2011.04.323. 9

HandHygieneProductSelection

• RigorousSelectionProcess

• Healthcareworkerproducttrialwithfeedbacktostakeholders

• PartofalargerHandHygieneproductpackage(Soap,Alcohol,&Lotion)

• Compatibilitywithotherhealthcareagents.

MAmirov,Chingiz&LCandon, Heather&Jacob, Latha.(2016).Makingchangeeasy:Apeer-to-peerguideontransitioning tonewhandhygieneproducts. Americanjournal ofinfection control. 45.10.1016/j.ajic.2016.05.020. 10

HandHygienePracticesamongNurses

• Nurseswashhandsonaveragebetween5- <100timespershift.

• NursesonMedical-SurgicalWardsaverage8handwashingepisodesperhour.

• Averagetimeperhandwashaveragedbetween6– 24seconds.

• Nursesfailedtocoverallsurfacesofhandsandfingerswhenwashing

CentersforDiseaseControlandPrevention.GuidelineforHandHygieneinHealth-CareSettings:RecommendationsoftheHealthcareInfectionControlPracticesAdvisoryCommitteeandtheHICPAC/SHEA/APIC/IDSAHandHygieneTaskForce.MMWR2002;51(No.RR- 16):[inclusivepagenumbers].

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BarrierstoperformingproperHandHygiene

• Gloves

• Forgettingwhentoperform

• Insufficienttimeforhandhygiene

• HighWorkload/Understaffing• Lackofhandhygieneproductin

thepatientcareenvironment

• Barrierstoaccessingproduct• Skinirritation

Hübner et al. BMC Infectious Diseases 2013, 13:226http://www.biomedcentral.com/1471-2334/13/226 12

WrapUp:

• HandHygieneperformance isadynamicprocessinthepatientcaresetting

• NooneisperfectatHandHygiene

• Beopen toremindersatthemomentofmissedHygieneHandopportunities

• HomeWork– 5momentsofHandHygiene!

• TreatYourSkin– Takecareofyourself!

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