Hand Hygiene LEARNING OBJECTIVES 1 Identify 3 reported factors for noncompliance with hand hygiene. 2 List 5 moments for hand hygiene. 3 Identify the amount of time for proper handwashing and use of ABHR.
Background went down when adherence to recommended hand hygiene practices improved. Definitions The most common mode of transmission of pathogens is via the hands. Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings. Frequent a (HAIs). The Centers for Disease Control (CDC) estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection. More widespread adherence to recommended hand hygiene practices promotes patient safety and prevents infection. There is substantial evidence that hand hygiene reduces the incidence of infections. In 1847, Dr. Semmelweis demonstrated that the mortality rate among mothers who delivered in the First Obstetrics Clinic at the General Hospital of Vienna was significantly lower when hospital staff cleaned their hands with an antiseptic agent than when they washed their hands with plain soap and water. Recently, studies have shown that infection rates were lower when antiseptic handwashing was performed by personnel and In general, adherence of healthcare workers to recommended hand hygiene procedures has been poor. There are a number of selfreported factors from healthcare workers that affect compliance, including but not limited to: Handwashing 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; and Low risk of acquiring infection from patients. Education of staff members on the importance of hand hygiene and constant reinforcement of good hand hygiene habits is crucial to containment of healthcare associated infections. The following definitions for hand hygiene come from the CDC: Hand Hygiene performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing washing hands with plain soap and water Antiseptic Handwash washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-Based Handrub rubbing hands with an alcohol-containing preparation Surgical Hand Hygiene/Antisepsis handwashing or using an alcohol-based handrub before operations by surgical personnel 2
Indications/Selections of Agents Hands should be washed with soap and water if they are visibly dirty, contaminated or soiled but if hands are not visibly soiled an alcohol-based hand rub (ABHR) can be used. More often than not, an ABHR will be able to be used so having them conveniently and strategically placed throughout your facility will help to increase hand hygiene compliance. ABHRs are actually more effective than handwashing at killing bacteria and are less damaging to the skin. Techniques Hand hygiene technique is very important. There really is a right way to clean your hands. The World Health Organization (WHO) recommends specific techniques and frequency for hand hygiene. My 5 Moments for Hand Hygiene approach defines the key moments when healthcare workers should perform hand hygiene. This evidence-based, field-tested, user-centered approach is designed to be easy to learn, logical and applicable in a wide range of settings. This approach, from the WHO, recommends healthcare workers to clean their hands: 1. Before touching a patient/donning gloves, 2. Before clean/aseptic procedures, 3. After body fluid exposure/risk, 4. After touching a patient/removing gloves, and 5. After touching patient surroundings. With this approach, very frequent hand hygiene is required. Proper handwashing should last 40-60 seconds and include the following steps: 1. Wet hands with water; 2. Apply enough soap to cover all hand surfaces; 3. Rub hands palm to palm; 4. Right palm over left dorsum with interlaced fingers and vice versa; 5. Palm to palm with fingers interlaced; 6. Backs of fingers to opposing palms with fingers interlocked; 7. Rotational rubbing of left thumb clasped in right palm and vice versa; 8. Rotational rubbing backwards and forwards with clasped fingers of right hand in left palm and vice versa; 9. Rinse hands with water; 10. Dry hands thoroughly with a single use towel; 11. Use towel to turn off faucet; 12. Your hands are now safe. 3
(continued) Proper use of alcohol-based hand rub should last 20-30 seconds and include the following steps: 1. Apply a palmful of the product in a cupped hand, covering all surfaces; 2. Rub hands palm to palm; 3. Right palm over left dorsum with interlaced fingers and vice versa; 4. Palm to palm with fingers interlaced; Get more information on the web! You can find posters of these techniques with pictures on the following website http://www.cdc.gov/handhygiene/basics.html. Nail length is important because even after frequent and thorough handwashing, healthcare workers often harbor substantial numbers of potential pathogens in the subungual spaces. Numerous studies have documented that subungual areas of the hand harbor high concentrations of bacteria. Per AORN Recommended Practices for Surgical Attire, natural nail tips should be kept to ¼ inch in length and artificial nails and rings should not be worn by healthcare workers in the perioperative environment. Wearing gloves reduces the risk of healthcare workers acquiring infections from patient, prevents flora from being transmitted from healthcare workers to patients and reduces contamination of the hands of healthcare workers by flora that can be transmitted from one patient to another. Gloves should always be worn when healthcare workers have contact with blood or other body fluids and must be removed after caring for a patient. The same pair of gloves should never be worn for the care of more than one patient and should not be washed or reused. 4
Surgical Surgical antisepsis can be done with a traditional scrub or with an alcohol-based hand rub (ABHR). You must ensure that the manufacturer s recommendations are being followed for both methods. If a traditional scrub is being used it must last 3-5 minutes. There are different manufacturer s recommendations for different ABHR products. Some of the most common products and directions for use (DFU) are as follows: Avagard 1. Dispense one pump (2 ml) into the palm of one hand. Dip fingertips of the opposite hand into the hand prep and work under fingernails. Spread remaining hand prep over the hand and up to just above the elbow. 2. Dispense one pump (2 ml) and repeat procedure with opposite hand. 3. Dispense one pump (2 ml) of hand prep into either hand and reapply to all aspects of both hands up to the wrists. 4. Rub hand prep into hands until completely dry. Purell 1. Place 2 ml of product into palm of one hand, dip fingertips of opposite hand into the product and work under nails. 2. Spread remaining product evenly over the hands and lower 2/3 of one forearm paying particular attention to the nails, cuticles and interdigital spaces. 3. Place 2 ml of product into opposite hand and repeat steps B and C. 4. Allow to air dry completely before gloving. Alcare Plus 1. Dispense one pump, tennis ball size, of foam into palm and apply to both hands up to the elbow and let dry. 2. Dispense a second pump, golf ball size, of foam into palm and apply to both hands up to the wrist and let dry. 5
S U M M A R Y Monitoring for hand hygiene compliance should be implemented in each facility with all healthcare workers, including physicians as part of the ongoing surveillance of a comprehensive infection control program. Proper and frequent hand hygiene is of utmost importance to protect patients and healthcare workers. One way to raise awareness and assess hand hygiene compliance is to do a study using a product such as GloGerm (http://www.glogerm.com/) This is great exercise to get people s attention and demonstrate how vigilant we must be to assure adequate hand hygiene. Healthcare workers need feedback on their hand hygiene compliance to keep the importance upper most in their mind. Additional strategies to improve hand hygiene compliance include; ABHRs and gloves are conveniently placed throughout the facility; Adequate staffing levels; Availability of sinks and hand washing products (soap, paper towels); Post signs and reminders in patient care areas, bathrooms and at sinks; and Consistent hand hygiene monitoring, feedback and reinforcement. Resources: CDC Hand Hygiene in Healthcare Settings http://www.cdc.gov/handhygiene/ World Health Organization http://www.who.int/gpsc/en/ Hand Hygiene Resource Center http://www.handhygiene.org/ 6
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