Transcript HANDWASHING AT THE DAWN OF A NEW MILLENIUM

Mazen Kherallah, MD, FCCP
Critical Care Medicine and Infectious Disease
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Why should we clean our hands?
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Barriers to frequent handwashing
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How do hands become contaminated?
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Advantages of alcohol-based hand rubs
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New Hand Hygiene Recommendations
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To remove visible soiling from hands
To prevent transfer of bacteria from the home
to the hospital
To prevent transfer of bacteria from the
hospital to the home
To prevent infections that patients acquire in
the hospital
The Iceberg Effect
Infected
Colonized
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Many studies have shown that the bacteria
that cause hospital-acquired infections are
most frequently spread from one patient
to another on the hands of healthcare
workers
The Centers for Disease Control and
Prevention (CDC) and other healthcarerelated organizations believe that cleaning
your hands before and after having
contact with patients is one of the most
important measures for preventing the
spread of bacteria in healthcare settings
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Yes!
A scientific study performed in a hospital
nursery found that when nurses did not wash
their hands between patient contacts, babies
acquired Staph bacteria much more
frequently than babies cared for by nurses
who washed their hands with an antimicrobial
soap.
Several other studies also show that washing
hands between patient contacts reduces the
spread of bacteria in healthcare
Although handwashing has been proven to reduce the spread of
microorganisms in healthcare facilities, healthcare workers often do not wash
their hands when recommended.
90
80
70
60
50
40
30
20
10
0
Study
Average Compliance of Personnel in
34 Studies of Handwashing
34
31
28
25
22
19
16
13
10
7
Average
4
1
Percent Compliance
In 34 studies of handwashing, workers washed their hands only 40% of the
time.
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Heavy workloads (too busy)
Sinks are poorly located
Skin irritation caused by frequent
exposure to soap and water
Hands don’t look dirty
Handwashing takes too long
Compliance
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A recent study showed
that the busier
healthcare workers are,
the less likely they are to
wash their hands when
recommended
Nursing shortages have
caused nurses to be
busier than ever before
Handwashing
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Increasing Workload
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Sinks used for
handwashing are often
installed in
inconvenient locations.
Personnel may fail to
wash their hands when
indicated because it is
too much trouble to
get to the sinks
provided.
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Frequent handwashing
with soap and water
often causes skin
irritation and dryness.
In the winter months,
some personnel may
even develop cracks in
their skin that cause
bleeding, as seen in
the adjacent figure.
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Nurses, doctors and other
healthcare workers can get
100s or 1000s of bacteria on
their hands by doing simple
tasks, like
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pulling patients up in bed
taking a blood pressure or pulse
touching a patient’s hand
rolling patients over in bed
touching the patient’s gown or
bed sheets
◦ touching equipment like bedside
rails, over-bed tables, IV pumps
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How can this happen?
Culture plate showing
growth of bacteria 24
hours after a nurse
placed her hand on
the plate
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Patients with resistant
bacteria like methicillinresistant S. aureus
(MRSA) or vancomycinresistant enterococci
(VRE) often carry the
organism on many
areas of their skin,
even when they don’t
have any wounds or
broken skin.
Percent of Patients with
MRSA Who Carry the
Organism on Their Skin
13-25%
40%
30-39%
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Healthcare workers can contaminate their
hands by touching environmental surfaces
near affected patients.
Frequency of Environmental Contamination
of Surfaces in the Rooms of Patients with
Methicillin-Resistant S. aureus (MRSA)
Percent of Surfaces Contaminated
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Alcohol-based (hand)rub : An alcohol-containing preparation
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Antimicrobial (medicated) soap : Soap (detergent) containing
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(liquid, gel or foam).
an antiseptic agent at a concentration
Plain soap : Detergents that do not contain antimicrobial
agents, or that contain very low concentrations of
antimicrobial agents effective solely as preservatives.
Bacterial Reduction
%
99.9
log
3.0
99.0
2.0
Time After Disinfection
0
60
180 minutes
Alcohol-based handrub
(70% Isopropanol)
90.0
1.0
Antimicrobial soap
(4% Chlorhexidine)
0.0
0.0
Plain soap
Baseline
Good
Better
Plain Soap
Antimicrobial
soap
Best
Alcohol-based
handrub
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Since washing hands frequently with soap and
water is
• inconvenient
• time-consuming
• often causes skin irritation and dryness
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We need to make it easier for you to clean
your hands quickly, with a minimum efforts
and skin irritation.
One way to accomplish these goals is to clean
your hands with an alcohol-based handrub (a
gel, rinse or foam).
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More than 20
published studies
have shown that
alcohol-based
handrubs are more
effective than either
plain soap or
antibacterial soaps in
reducing the number
of live bacteria on the
hands
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When hospitals placed alcohol handrub dispensers
near each patient’s bed, healthcare workers cleaned
their hands significantly more often than they did
when only sinks were available for handwashing.
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When compared to traditional soap and
water handwashing, alcohol handrubs
have the following advantages:
• take less time to use
• can be made more accessible than sinks
• cause less skin irritation and dryness
• are more effective in reducing the number of
bacteria on hands
• makes alcohol-based handrubs readily
available to personnel
• has led to improved hand hygiene practices
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New guideline developed by the Centers
for Disease Control and Prevention (CDC)
and infection control organizations
recommends that healthcare workers
use an alcohol-based handrub (a gel,
rinse or foam) to routinely clean their
hands between patient contacts, as long
as hands are not dirty.
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Wash your hands with
plain soap and water, or
with antimicrobial soap
and water if:
• Your hands are visibly soiled
(dirty)
• Hands are visibly
contaminated with blood or
body fluids
• Before eating
• After using the restroom
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Wet hands first with water
Apply 3 to 5 ml of soap to
hands
Rub hands together for at
least 15 seconds
Cover all surfaces of the
hands and fingers
Rinse hands with water
Dry your hands with a
clean or disposable towel
Use paper towel to turn off
water faucet
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health Administration)
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If hands are not visibly soiled or
contaminated with blood or body fluids,
use an alcohol-based handrub for
routinely cleaning your hands:
• Before having direct contact with patients
• After having direct contact with a patient’s
skin
• After having contact with body fluids, wounds
or broken skin
• After touching equipment or furniture near the
patient
• After removing gloves
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Apply 1.5 to 3 ml of an alcohol gel or rinse to
the palm of one hand, and rub hands
together
Cover all surfaces of your hands and fingers
Include areas around/under fingernails
Continue rubbing hands together until
alcohol dries
If you have applied a sufficient amount of
alcohol hand rub, it should take at least 10 15 seconds of rubbing before your hands
feel dry.
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health Administration)
Although it's impossible to keep your hands germ-free,
times exist when it's critical to wash your hands to limit
the transfer of bacteria, viruses and other microbes.
1. Always
2. Often
3. Sometimes
4. Never
1.
15 minutes
2.
30 minutes
3.
1 hour
4.
2.5 hours
1.
Always
2.
Often
3.
Sometime
4.
Never
1.
Strongly agree
2.
Agree
3.
Don’t know
4.
Disagree
5.
Strongly disagree
1.
Strongly agree
2.
Agree
3.
Don’t know
4.
Disagree
5.
Strongly disagree
PREVENTION
IS PRIMARY!
Protect patients…protect healthcare
personnel…
promote quality healthcare!
‫ان هللا يحب العبد اذا عمل عمال أن يتقنه‬
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Wash our hands before and after we touch
you
Use alcohol-based hand rub
Make sure that physicians and all health
care workers do the same before and after
touching you
Will use glove use to reduce risk of
transmission of organisms