Barrier technique hand hygiene [compatibility mode]

International Patient Safety
Goals

Identification

Communication Medication Eliminate Infection

Falls

Infections

Reduce the Risk of Health Careacquired Infections
A collaborative process is used to develop P&P
that address reducing the risk of health
care–associated infections





Comply with current published and
distributed hand hygiene guidelines

IPSG 5: Reduce the Risk of Health
Care-Associated Infections

So Why All the Fuss About Hand
Hygiene?
Most common mode of transmission
of pathogens is via hands!

 Infections acquired in
healthcare
 Spread of antimicrobial
resistance

All health care’s works involve the
hands

Hands are contaminated

Hands
spread
germs

The health care environment is
contaminated

Colonized or Infected:
What is the Difference?


People who carry bacteria without
evidence of infection (fever,
increased white blood cell count)
are colonized



If an infection develops, it is
usually from bacteria that colonize
patients



Bacteria that colonize patients can
be transmitted from one patient to
another by the hands of healthcare
workers

The Iceberg Effect
Infected

Colonized

The inanimate environment is a
reservoir of pathogens
X represents a positive Enterococcus culture

The pathogens are ubiquitous

~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+)
Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL.

The inanimate environment is a
reservoir of pathogens
Recovery of MRSA , VRE & ACINITOBACTER.

Devine et al. Journal of Hospital Infection. 2007;43;72-75
Lemmen et al Journal of Hospital Infection. 2004; 56:191-197
Trick et al. Arch Phy Med Rehabil Vol 83, July 2006
Walther et al. Biol Review, 2007:849-869

Patients are vulnerable to
infection

Types of hand hygiene
 Normal

hand washing
 Antiseptic hand washing
 Alcohol-based hand rub
Can be used instead of hand
washing , if hands are not
visibly soiled with blood or
any other patient body
fluids
 Surgical hand wash

Waterless Hand Rub
“alcohol-based hand rub

Hand Hygiene Options
Wet hands, apply
soap and rub for
>10 seconds.
Rinse, dry & turn
off faucet with
paper towel.

Apply to palm; rub
hands until dry

~ Use soap and water for visibly soiled hands ~
~ Do not wash off alcohol handrub ~

Hand rubbing is the solution to obstacles
to improve hand hygiene compliance
Handwashing with soap and water when hands are
visibly dirty or following visible exposure to body fluids

Adoption of alcoholbased handrub is
the gold standard
in all other clinical
situations

WHO Guidelines on Hand Hygiene in Health Care (2010)

Areas Most Frequently Missed

HAHS © 1999

Time constraint =
major obstacle for hand hygiene




Adequate
handwashing
with water and
soap requires
40-60 seconds
Average time
usually adopted
by health-care
workers:
<10 seconds

What is the KKH Multimodal Hand
Hygiene Improvement Strategy?
ONE System change


Based on the
evidence and
recommendation
s from the WHO
Guidelines on
Hand Hygiene in
Health Care
(2010), a
number of
components
make up an
effective
multimodal
strategy for hand
hygiene

Access to a safe, continuous water supply as well as
to soap and towels; readily accessible alcohol-based
handrub at the point of care
TWO Training / Education

Providing regular training to all health-care workers

THREE Evaluation and feedback
Monitoring hand hygiene practices, infrastructure,
perceptions and knowledge, while providing
results feedback to health-care workers

FOUR Reminders in the workplace
Prompting and reminding health-care
workers
FIVE Institutional safety climate
Creating an environment and the
perceptions that facilitate awareness-raising
about patient safety issues

KKH Hand
Hygiene
Compliance
Hand Hygiene

Comment

Typical
Compliance

Observational studies of hand hygiene
report compliance rates of 42.6%-57.9%

Common
Reported
Barriers To
Compliance

Insufficient time, understaffing, patient
overcrowding, lack of knowledge of hand
hygiene guidelines, skepticism about hand
washing efficacy, inconvenient location of
sinks and hand disinfectants and lack of
hand hygiene promotion by the institution

With hand hygiene they’re dead

 Skin

irritation
 Inaccessible hand washing
facilities
 Wearing gloves
 Too busy
 Lack of appropriate staff
 Being a physician
(“Improving Compliance with Hand Hygiene in Hospitals” Didier
Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6
Page 381)

Why Not?
 Working

in high-risk areas
 Lack of hand hygiene
promotion
 Lack of role model
 Lack of institutional priority
 Lack of sanction of noncompliers

Hand Care
 Nails
 Rings
 Hand

creams
 Cuts & abrasions
 “Chapping”
 Skin Problems

Fingernails & Artificial Nails


Keep fingernails short




Allows thorough cleaning and prevents
glove tears
Long nails make glove placement more
difficult and may result in glove
perforation

Fingernails & Artificial Nails


Follow MCH policy regarding artificial
fingernails; use of artificial
fingernails is not allowed.

USAF Guidelines for Infection Control in Dentistry, 2004.

What is the Story on Moisturizers
and Lotions?
ONLY USE facility-approved and supplied lotions

Because:






Some lotions may make medicated
soaps less effective
Some lotions cause breakdown of latex
gloves
Lotions can become contaminated with
bacteria if dispensers are refilled

~ Do not refill lotion bottles ~

Gloves are not substitute for
Gloves are not a a substitute for
handwashing!
handwashing!

≠

Wearing gloves does not replace the
need for hand hygiene


Small, inapparent
defects



Frequently torn during
use



Hands frequently
become contaminated
during removal

DeGroot-Kosolcharoen 2004, Korniewicz 1999, Kotilainen 2001, Olsen 1998, Larson 2005,
Murray 2001, Burke 2005, Burke 1990, Nikawa 1994, Nikawa 2006, Otis 2007

What is the single most important reason
for healthcare workers to practice good
hand hygiene?
1. To remove visible soiling from hands
2. To prevent transfer of bacteria from
the home to the hospital
3. To prevent transfer of bacteria from
the hospital to the home
4. To prevent infections that patients
acquire in the hospital

How often do you clean your hands
after touching a PATIENT’S INTACT
SKIN (for example, when measuring
a pulse or blood pressure)?
pressure)?

1.

Always

2.

Often

3.

Sometimes

4.

Never

Estimate how often YOU clean your
hands after touching a patient or a
contaminated surface in the hospital?

1.

25%

2.

50%

3.

75%

4.

90%

5.

100%

Which hand hygiene method
is best at killing bacteria?
1. Plain soap and water
2. Antimicrobial soap and
water
3. Alcohol-based hand rub

Which of the following hand hygiene
agents is LEAST drying to your skin?

1. Plain soap and water
2. Antimicrobial soap and
water
3. Alcohol-based hand rub

It is acceptable for healthcare workers to supply
their own lotions to relieve dryness of hands in
the hospital.

1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree

Healthcare-associated organisms are
commonly resistant to alcohol.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree

When a healthcare worker touches a patient who is
COLONIZED, but not infected with resistant
organisms (e.g., MRSA or VRE) the HCW’s hands
are a source for spreading resistant organisms to
other patients.

1. Strongly agree
2. Agree
3. Don’t know
4. Disagree

A co-worker who examines a patient with VRE,
then borrows my pen without cleaning his/her
hands is likely to contaminate my pen with VRE.

1. Strongly agree
2. Agree
3. Don’t know
4. Disagree

How often do you clean your hands after touching an
ENVIRONMENTAL SURFACE near a patient (for
example, a countertop or bedrail)?

1. Always
2. Often
3. Sometimes
4. Never

Use of artificial nails by healthcare
workers poses no risk to patients.

1. Strongly agree
2. Agree
3. Don’t know
4. Disagree

Glove use for all patient care contacts is a
useful strategy for reducing risk of
transmission of organisms.

3. Don’t know
4. Disagree
5. Strongly
disagree

Barrier technique hand hygiene [compatibility mode]

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