HAND
HYGIENE
Outline
The hand of the HCW
Transmission of HC associated organisms
Hand cleansing methods
Reviewing the 5 moments
HH technique
Improving HH practice
Hand care
Hand Hygiene
HW practice - long history (1800)
Accepted as the simplest and
most economical procedure for
reduction of HAI.
Numerous studies proved HW
effective in reduction of HAI
Low compliance rate
Various reported factors for low
compliance rate.
Introduction of ABHR improve
compliance.
The hands
• Resident flora: 80% of resident flora
reside in the first 5 layers of stratum
corneum 20% in the hair follicles and
sebaceous glands
• Transient flora: Organism that
are temporarily lodged on the skin.
Can easily be removed
Hand transmission
• Hands are the most common vehicle to
transmit health care associated organisms.
• Transmission of health care associated
organisms from one patient to another via
health care provider hands requires five
sequential steps
Hand transmission
Organisms present on patient skin and environment
surfaces
Organisms transfer on health care providers’ hands
– eg: touching pt, environment, equipment, linen
lifting, etc.
Organisms survival on hands
Defective hand hygiene results in hands
remaining contaminated (technique, HH agent)
Contaminated hands cross-transmit organisms
How to clean hands
1 2
Alcohol-based hand rub Handwashing with soap and
is the preferred method for running water must be
cleaning hands. It is done when hands are
better than washing hands visibly soiled.
(even with antibacterial
soap) when hands are not
If running water is not
visibly soiled.
available, use moistened
towelettes to remove the
visible soil, followed by
alcohol-based hand rub.
5 moments for HH
Some examples may be:
shaking hands, stroking an arm
helping a patient to move around, get washed, giving a massage
taking pulse, blood pressure, chest auscultation, abdominal palpation
before adjusting an IV rate
5 moments for HH
Some examples may be:
oral/dental care, giving eye drops, secretion aspiration
skin lesion care, wound dressing, subcutaneous injection
catheter insertion, opening a vascular access system or a draining system
preparation of medication, dressing sets
5 moments for HH
Some examples may be:
oral/dental care, giving eye drops, secretion aspiration
skin lesion care, wound dressing, subcutaneous injection
drawing and manipulating any fluid sample, opening a draining system, endotracheal tube insertion
and removal
clearing up urine, faeces, vomit, handling waste (bandages, napkin, incontinence pads), cleaning of
contaminated and visibly soiled material or areas (bathroom, medical instruments)
5 moments for HH
5 moments for HH
Frequently missed….
L.J.Taylor, “An Evaluation of handwashing techniques – 1” Nursing Times (1978)
KKM P&P
WHO Guidelines
WHO & KKM HW
WHO & KKM HR
Improving HH Practice.
• Administrative support and Financial resources.
• Ensure HCW, understand key elements of HH practice
(demonstrate knowledge). (Educational activities)
• HCW, (all cat) demonstrates competence in hh
technique. (live demo, training video etc) & Emphasize
on product volume, correct technique.
• Availability of HH facilities (enable staff to practice). Eg
ABHR at the point of care. Conveniently located sinks.
• Initiating a multi-component publicity campaign (e.g.
posters, drawing, screen saver with targeted messaging)
• Periodic auditing
Skin condition related to HH
There are two major types of skin reactions
• Contact dermatitis : most common type includes
symptoms which can vary from quite mild to
debilitating, including dryness, irritation, itching, and
even cracking and bleeding.
• Allergic contact dermatitis: is rare and represents an
allergy to some ingredient in a hand hygiene
product. Symptoms range from mild and localized to
severe and generalized. In its most serious form, may
be associated with respiratory distress and other
symptoms of anaphylaxis.
WHO HH Guidelines
Hand Care
• Important to look after the skin & fingernails
• Damaged skin leads to loss of a smooth skin surface &
increases the risk of skin colonisation with resistant
micro organisms
• Continuing to work with damaged, cracked or weeping
skin may expose the healthcare worker to increased
infection risk, which could ultimately lead to dermatitis
Recommendations
• To provide HCWs with moisturizing skin-care products*
• Hand lotions will prevent dry skin and reduce the risk of
developing skin irritations and dermatitis.
• Frequent and consistent use of an appropriate lotions*
is an integral component of a hand hygiene
regime
* compatible with both Chlorhexidine and latex gloves
Hand Care Strategies for HCWs
Keep your hands
moisturised while you
are working
Moisturise and Restore
(repair) your skin barrier
while you are at home or
sleeping
Conclusion
The hand of the HCW
Transmission of HC associated organisms
Hand cleansing methods
Reviewing the 5 moments
HH technique
Improving HH practice
Hand care
11th ASM of ICAM
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