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    HAND HYGIENEPRINCIPLES AND IMPLEMENTATION AT

    TRAVANCORE MEDICAL COLLEGE, KOLLAM, KERALA. INDIA

    DR.T.V.RAO MD

    DR.T.V.RAO MD 1

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    THE WORK OF IGNAZ SEMMELWEISS Hungarian doctor who worked in a maternity ward in

    Austria in the 1840s.

    There were two wards in the maternity building:One contained women due to give birth and wasrun by midwives. The other was used as ateaching hospital for medical students, who mayhave come straight from dissecting dead bodies.

    The wards were cleaned no more than once a

    month. The doctors rarely washed their hands and often

    wore dirty coats.

    Semmelweiss was horrified by the number ofwomen who died after births that were troublefree. The women developed a very high

    temperature and died within a few days from anillness called childbed fever.

    No-one had any idea what caused this disease.No-one knew about bacteria or viruses then.

    DR.T.V.RAO MD 2

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    THE WORK OF IGNAZ SEMMELWEISS

    Semmelweiss realised that more than three times as manywomen died from fever in the teaching ward than in themidwives ward. He was determined to try to reduce thenumber of deaths.

    He looked into at each factor that was different betweenthe two wards, but nothing that he thought of seemed tomake a difference. Then a professor was accidentally cut

    with a knife that was getting used to study the body of awoman who had died. The professor himself died, from adisease whose symptoms were like childbed fever.

    DR.T.V.RAO MD 3

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    THE WORK OF IGNAZ SEMMELWEISS

    Semmelweiss thought that there must havebeen something on the knife that had causedthe disease.

    He made all the doctors wash their hands inchlorine water before examining the women

    Within a very short time, the death rate hadfallen

    Semmelweiss presented his findings to otherdoctors. His ideas were mocked.

    DR.T.V.RAO MD 4

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    Evidence of Relationship Between Hand Hygiene andHealthcare-Associated Infections

    Substantial evidence that handhygiene reduces the incidence ofinfections

    Historical study: Semmelweis

    More recent studies: rates lower when

    antiseptic hand washing wasperformed

    DR.T.V.RAO MD 5

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    Hand Hygiene Definitions

    Hand washingThe application of non-antimicrobial soap and water to thesurface of the hands

    Antiseptic hand wash

    Washing hands with water and soap or other detergentscontaining an antiseptic agent

    Alcohol-based hand rub

    an alcohol-containing preparation designed for application to

    the hands in order to reduce the number of viable organisms withmaximum efficacy and speed

    Surgical hand hygiene/antisepsis

    Hand washing or using an alcohol-based hand rub beforeoperations by surgical personnel

    DR.T.V.RAO MD 6

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    INDICATIONS FOR HAND WASHING

    Hand hygiene should be performed before and

    after every patient contact

    Hand hygiene should be performed after contactwith patients environment

    Hand hygiene should be performed after using a

    restroom, after removing gloves, prior to andfollowing meals

    DR.T.V.RAO MD 7

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    Indications for Hand HygieneWhen hands are visibly dirty,

    contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap andwater.

    If hands are visibly clean, use an alcohol-

    based hand rub for routinelydecontaminating hands.

    Guideline for Hand Hygiene in Health-care Settings. MMWR2002; vol. 51, no. RR-16.

    DR.T.V.RAO MD 8

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    Wethands.

    Get soap. Washhands.

    Dryhands.

    Throwaway.

    1 2 3 4 5

    Washing Hands Follow

    the Steps

    Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children

    with Challenging Behavior. Tampa, Florida: University of South Florida,

    Early Intervention Positive Behavior Support.

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    A CASUAL HAND WASH MAY MISS

    SEVERAL AREAS FROM DISINFECTION

    DR.T.V.RAO MD 10

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    PRACTICE A LITTLE OF SCIENTIFIC

    STEPS IN HAND WASHING

    DR.T.V.RAO MD 11

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    MAKE THE BEST USE OF SCIENTIFIC

    METHODS IN CRITICAL CARE OF PATIENTS

    DR.T.V.RAO MD 12

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    Why we dont wash our hands

    Too busy/insufficient time

    Patient needs take priority

    Understaffing/overcrowding

    Adapted from Pittet D, Infect Control Hosp Epidemiol2000;21:381-386.

    HCW are not badjust busy!

    Poor design

    Poor product

    More education

    Sinks are inconveniently located or lack ofsinks

    Lack of soap and paper towels

    Hand washing agents cause irritationand dryness

    Low risk of acquiring infection frompatients

    DR.T.V.RAO MD 13

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    What can we do to help change thisProvide easy access to hand hygiene

    materials

    Handrub solution

    Conveniently located:at the patients bedside

    at the patients room entrance

    in convenient / appropriate locations

    in high traffic public areas

    Working appropriately

    Full of product

    Within use by dateDR.T.V.RAO MD 14

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    Glove UseHand hygine is required regardless of whether

    gloves are used or changed

    Failure to remove gloves after patient contact or

    between dirty and clean body site care in the samepatient has to be regarded as noncompliance withrecommandations

    Gloves should not be washed or reused

    Gloved HCWs can cause cross infections

    DR.T.V.RAO MD 15

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    DR.T.V.RAO MD 16

    C C

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    ACCORDING TO THE CDC

    Wet hands with running water; place soap inpalms; rub together to make a lather; scrub

    hands vigorously for 20 seconds; rinse soap off

    hands.

    If possible, turn off the faucet by using a

    disposable paper towel.

    Dry hands with a disposable paper towel. Do notdry hands on clothing.

    Assist young children with washing their hands.

    DR.T.V.RAO MD 17

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    SPECIFIC INDICATIONS FOR HAND HYGIENE

    Before: Patient contact

    Donning gloves when inserting a CVC

    Inserting urinary catheters, peripheral vascular catheters, or other invasivedevices that dont require surgery

    After: Contact with a patients skin

    Contact with body fluids or excretions, non-intact skin, wounddressings

    Removing gloves

    Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;vol. 51, no. RR-16.DR.T.V.RAO MD 18

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    WHAT TO USE AND WHEN

    When hands are visibly soiled use soap and water to

    wash

    If your hands are visibly CLEAN use Alcohol based handrubes

    Before and after touching a patient

    Before and after a procedure

    After touching a patients surroundings

    Before and after glove use

    DR.T.V.RAO MD 19

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    RUBapply to palm

    ROLLrub hands together coveringall aspects of your fingers &

    hands until dry

    SQUIRTone squirt (1-3 ml) to

    your hands

    Easy Message

    DR.T.V.RAO MD 20

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    . Recommendations for Hand Washing Facility:

    Clean at all times;

    Strategically located as per regulations, near

    bathrooms and entrances to the processing area;

    Dedicated to hand washing only;

    Liquid soap in dispenser;

    Hot water (43 C or 110 F);

    Use of disposable paper towels or air blowers; and

    Adjacent hand sanitizing facilities.

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    Basic message always the

    same

    Clean you hands before and

    after every patient touchInstructions always the same

    Squirt

    Rub

    Roll

    EASY MESSAGE

    DR.T.V.RAO MD 22

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    SELF-REPORTED FACTORS FOR POOR

    ADHERENCE WITH HAND HYGIENE Hand washing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks

    Lack of soap and paper towels

    Too busy/insufficient time

    Understaffing/overcrowding

    Patient needs take priority

    Low risk of acquiring infection from patients

    Adapted from Pittet D, Infect Control Hosp Epidemiol2000;21:381-386.DR.T.V.RAO MD 23

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    EDUCATION/MOTIVATIONPROGRAMS

    Monitor healthcare workers (HCWs)adherence with recommended handhygiene practices and give feedback

    Implement a multidisciplinary program toimprove adherence to recommendedpractices

    Encourage patients and their families toremind HCWs to practice hand hygiene

    Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51,no. RR-16.DR.T.V.RAO MD 24

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    Healthcare workers in a room with a

    senior staff member or peer who DID NOTwash their hands were significantly lesslikely to wash their own hands

    EMERGING INFECTIOUS DISEASES FEB 2003

    Failed Role Models

    DR.T.V.RAO MD 25

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    - is an important barrier to compliance- is more frquent with soap and

    water than with handrubs-

    is reduced and can be treated byemollient-containing solutions

    Skin irritation A Limitation toHand Washing

    Boyce et al. Inf Contr Hosp Epi 2000;21:442

    Kramer et al. J Hosp Infect 2002; 51:114Larson et al. Heart Lung 2000; 29:139Pittet. Emerging Inf Dis 2001; 2:234

    DR.T.V.RAO MD 26

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    CLEAN HANDS SAVES MANY LIVES

    HAVE ONE OURSELVES

    DR.T.V.RAO MD 27

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    HOSPITAL ADMINISTRATION THANKS

    EVERYONE FOR WASHING HANDS

    DR.T.V.RAO MD 28

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    REFERENCES

    WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) April

    2006

    Guideline for Hand Hygiene in Health-Care Settings.MMWR 2002:vol,51,no

    RR-16

    HHA 5 Moments for Hand Hygiene ,Advanced draft, August 2008

    Pittet D,Inf .Control Hospital Epidemiology200:21:381-386

    DR.T.V.RAO MD 29

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    Programme Created by Dr.T.V.Rao

    MD for Medical and ParamedicalProfessionals Email

    [email protected]

    DR.T.V.RAO MD 30


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