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Hand hygiene
Hygiene at healthcare settings
October 15th is the World
Hadwashing Day (UNESCO)
Hand washing
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When hands of health care personnel are visibly
soiled, after using a toilet, before eating, after
touching a patient, after touching animals, after
blowing nose, the hands should be washed with
soap and water.
The use of gloves does not eliminate the need for
hand hygiene.
Likewise, the use of hand hygiene does not
eliminate the need for gloves.
Hand hygiene facilities in health
care settings should include:
sink
 tap with warm water
 liquid soap
 hand disifectant
 paper towels
 bin
 instruction of hand washing and hand
disifection
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Recommended sequence of
actions in hygienic hand washing
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wet hands with water,
apply soap,
rub hands together for at least 10s,
rinse hands with water,
dry hands with disposable towel,
close water tap with disposable towel,
do not touch waste disposal unit throwing the
towel away.
Disinfection
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Disinfection is the process of destroying
microorganisms.
It can be done with use of chemical (H2O2,
chlorine) or physical (UV radiation) methods.
Antimicrobial agents applied to non-living
objects
to
destroy
microorganisms
are
disinfectants.
Antibiotics destroy microorganisms within the
body .
Antiseptics destroy microorganisms on living
tissue.
Sanitisers are high level disinfectants that kill
over 99.9% of a target microorganism.
Disifection
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Hand disinfection is considered adequate if rubbed
with disinfectant for at least 30 seconds.
When using an alcohol-based hand rub, apply
the product to the palm of one hand and rub hands
together, covering all surfaces of hand and fingers,
until hands are dry.
Alcohol-based hand rubs significantly reduce the
number of microorganisms on skin, are fast
acting, and cause less skin irritation.
Hand disinfection with alcohol-based preparations
is recommended as a robust hand-hygiene method.
.
Registered disinfectants
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Alcohols (ethanol, isopropanol)
Aldehydes (glutaraldehyde)
Halogens (chlorine, chloramine, iodine, sodium
hypochlorite)
Oxidising agents (chlorine dioxide, hydrogen
peroxide, ozone, acidic elecreolyzed water,
peracetic acid, potassium permanganate (KMnO4)
Phenolics (phenol)
Quaternary ammonium compounds
Other (dettol, virkon, septusin M, high-intensity
UV).
Home disinfectants
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By far the most cost-effective home disinfectant is
common chlorine bleach (a 5% solution of
sodium hypochlorite which is effective against
most common pathogens, including such difficult
organisms as HIV, tuberculosis (mycobacterium
tuberculosis), viruses causing hepatitis B and
C, fungi, and antibiotic-resistant strains of
bacteria: staphylococcus and enterococcus.
It is not effective against giardia lamblia and
cryptosporidium.
Nail hygiene in medicine
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Health care personnel should avoid wearing
artificial nails and keep natural nails less than
one quarter of an inch long if they care for
patients at high risk for acquiring infections.
Operating room personnel should not wear
artificial nails and the natural ones should be
kept short and clean.
Artificial nails weaken natural nails. Bump or
knock to a long artificial nail may cause it to
separate from the base of the natural nail, allowing
a portal for bacterial or fungal entry.
Nail hygiene in medicine
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Artificial nails are more likely to harbour
gram-negative pathogens than natural
nails, both before and after hand
washing.
Ring wearing
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Ring wearing causes slight decrease in
efficacy of hand washing.
Tattooing
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Tattooing does not affect efficacy of hand
washing nor disinfecting with alcohol-based
formulas.
Hand drying methods
Hand drying with a cotton or linen towel is
not acceptable at health care settings as
both can harbour bacteria.
 Hot air drying increases the amount of
bacterial contamination on hands.
 Paper towel drying causes a slight
decrease in contamination. This method is
recommended.
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Sterilization (or sterilisation)
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is the elimination of all transmissible agents
(such as bacteria, prions and viruses) and their
spores from a surface, a piece of equipment, food,
pharmaceuticals or biological culture medium.
Sterilization
Sterilization can be achieved through heat,
chemicals, radiation, or filtration.
 A widely-used method for heat sterilization
is the autoclave. Autoclaves commonly use
steam heated to 121°C (250°F), at 103 kPa
(15 psi) above atmospheric pressure, for 15
minutes. The steam and pressure transfer
sufficient heat into organisms to kill them.
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Biological indicators
("bioindicators")
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can be used to independently confirm
autoclave performance. Several simple
bioindicator devices are commercially
available based on microbial spores. Most
contain pure strains of the heat resistant
microbe bacillus stearothermophilus which
are among the toughest organisms an
autoclave will have to destroy.
Other Methods
Other heat methods include flaming,
incineration, boiling, tindalization (the
process involves boiling for 20 minutes,
cooling, incubating for a day, boiling for 20
minutes, cooling, incubating for a day,
boiling for 20 minutes, cooling, incubating
for a day, and finally boiling for 20 minutes
again), and using dry heat.
Chemical sterilization
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Chemicals are also used for sterilization.
Although heating provides the most
effective way to rid an object of all
transmissible agents, it is not always
appropriate, because it destroys objects
such as most fiber optics, most
electronics, and some plastics.
Means used for chemical
sterilization
Ethylene oxide
 Ozone
 Sodium hypochlorite
 Glutaraldehyde and formaldehyde
 Ortho-phthalaldehyde
 Hydrogen peroxide
 Formic acid
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Radiation sterilization
X-rays
 Gamma rays
 Subatomic particles.
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Medical gloves
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are
medical
safety
accessories that ensure
sanitary conditions by
limiting patients’ exposure
to infectious matter. They
also serve to protect health
professionals from disease
through
contact
with
bodily fluids.
Medical
gloves
are
traditionally made of latex
and
powdered
with
cornstarch.
Medical gloves
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There are two main types of gloves: exam, and
surgical. Surgical gloves have more precise sizing
(numbered sizing, generally from size 5.5 to size
9), and may be made to higher specifications.
Due to the increasing rate of latex allergy among
health professionals, there has been an increasing
move to gloves made of non-latex materials such
as vinyl or nitrile rubber.
Medical gloves testing
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the air-leakage test where no air bubbles shall
escape under water from an inflated glove
the water-leakage test, where no droplets shall
escape from a glove filled with one litre of water
within a timespan of 2 minutes
out of 10 000 gloves, 80 must be tested and not
more than 3 gloves may fail, otherwise the CEmark cannot be affixed to the batch.
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Multidrug-resistant organisms (MDROs),
including methicillin-resistant
Staphylococcus aureus (MRSA) and
vancomycin-resistant enterococcus (VRE),
have become endemic in many acute care
and long-term care facilities. Infections
with these organisms are often difficult to
treat, owing to a dwindling armamentarium
of active antimicrobial agents.
What is the mechanism of action of
chlorhexidine?
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Chlorhexidine gluconate is an antiseptic
agent that has broad-spectrum activity
against many organisms, including S.
aureus and enterococcus species. Unlike
many other antiseptics, chlorhexidine has
residual antibacterial activity, which may
decrease the microbial burden on
patients’ skin and prevent secondary
environmental contamination.
What were the most common pathogens responsible
for bloodstream infections in this study of patients in
intensive care or transplant units?
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Among the 221 primary bloodstream
infections, the most common pathogens
were staphylococci (30%), gram-negative
bacilli (23%), enterococci (20%), and fungi
(13%).
What were the results in the study of daily bathing
with chlorhexidine-impregnated washcloths in an
intensive-care unit setting?
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The overall rate of MRSA or VRE acquisition was
23% lower during the intervention period. The rate
of hospital-acquired bloodstream infections was
28% lower during the intervention period than
during the control period. Similarly, the incidence
rate of primary bloodstream infection caused by
fungi was 53% lower during the intervention
period than during the control period.