Transcript Everyone`s intact skin has normal bacteria on it

Hand Hygiene
An Educational Module*
*written by Tricia Just, RN, MSN, CIC
Bowling Green University
Now About Skin…..
Everyone’s intact skin has normal
bacteria on it called “normal flora”
Our intact skin is a fabulous barrier –
protecting us from this bacteria invading
our body
If the normal bacteria can invade, they
are then a pathogen, causing an infection
Vocabulary To Remember:
 Normal Flora – bacteria
that reside on our skin,
and throughout our bodies
 Pathogen – a germ
capable of causing an
infection
 HCW – healthcare
worker. RNs, LPNs,
nursing assistants,
physicians – everyone who
provides care to a patient.
Everyone also has small flecks of skin
that are shed daily that may contain these
potential skin pathogens. These can be
found on the patient’s gown, linen,
bedside table, and other items in the
room.
Touching a patient to check their pulse,
straightening sheets, or even checking a
water pitcher can create an opportunity
for the patient’s pathogens to spread to
the healthcare worker’s hands.
Then What?
If the healthcare
worker (HCW) goes
to the next patient’s
room without
cleaning their hands
– or not doing a good
job of cleaning their
hands – an infection
may be spread to a
sick patient with
altered immunity.
Resistant Bacteria
Over many years,
bacteria have learned
to resist treatment and
invade tissues.
Spread of these
bacteria can be
serious.
Some Resistant Organisms
 Methicillin Resistant Staphylococcus Aureus (MRSA)
 Penicillin Resistant Pneumococcus (PRP)
 Methicillin Resistant Coagulase Negative
Staphylococcus (MRCONS)
 Vancomycin Resistant Enterococcus (VRE)
 Vancomycin Resistant, Methicillin Resistant
Staphylococcus Aureus (VRMRSA)
 Acinetobacter and Citrobacter
 Stenotrophomonus Maltophilia
 Enterobacter and Serratia
Yuck! What’s a HCW to Do?
The CDC has written
guidelines that spell
out actions to take to
stop the spread of
infection from one
person to another by
hand contact.
Good hand cleaning (or hand hygiene)
greatly reduces the chance of spreading
pathogens from patient to patient as well
as to the HCW and their families.
Healthcare-related infections have been
shown to be lower after the use of
germicidal or antibacterial soap and
water washing OR with the use of
waterless alcohol products versus after
plain soap and water washing.
How Do I Know Which
Cleanser To Use?
Alcohol cleansers are not to be used when hands
are visibly dirty or contaminated with body
fluids.
Rubbing and lathering of hands
+ running water rinse
+ friction of drying hands on paper towel
Removes more visible soil or body fluids than
alcohol
More About Cleansers?
Alcohol cleansers
that have 60% or
more alcohol in
them:
quickly kill organisms
on the skin
help keep bacteria
from re-growing on
the skin
 Skin care products are
added to the alcohol
rubs to help keep the
alcohol from drying the
skin.
 Usually this means that
HCWs can use the
alcohol rub with less
skin problems than with
soap and water washing.
What About Irritated Skin?
Many HCWs have
found their hands
tend to stay in better
shape when less
rubbing of hands
with soap, water, and
paper towels is
happening.
 So…those who have
problems usually have
some healing after a
long weekend or other
period of time off.
 Upon return to work, use
an alcohol cleanser
except in certain
circumstances.
What Certain Circumstances?
HCWs should always use antibacterial or
germicidal soap and water for hand
hygiene when:
Hands are visibly dirty
Hands have body fluid on them
Before eating
After using the restroom
What About Hand Lotion?
Hand lotions that are provided by the
hospital are meant to work with our
soaps and alcohol rub products
Use only the products provided by the
hospital – other products may make small
holes in latex gloves or make your soap
ineffective
Isn’t Alcohol Flammable?
 Yes!
 Hands have to be
rubbed dry when the
alcohol product is used.
 Rubbing your hands dry
is not only for safety – in
order for the germs to be
killed, the alcohol must
be evaporated from the
hands.
Is That Really All?
The containers of
alcohol hand foam
need to be stored
away from high
temperatures
Europe has used
alcohol based
products for years
with hardly any
problems
Are There Other Special
Circumstances?
 Yes!
 Sometimes we have patients with diarrhea caused by a
a specific bacteria – C. difficile (Clostridium difficile).
 This type of bacteria is known as a spore-forming
bacteria.
 Neither germicidal, antibacterial soap, nor alcohol
cleansers kill the spore-forming bacteria.
 BUT…it is believed that the rubbing and friction
associated with soap and water cleansing and drying
with paper towels does more to rid hands of these
bacteria than the waterless cleansers.
A Word of Warning
C. difficile has been shown to live for a long time
in the environment.
So, even care that seems low-risk, like touching
the bedrail, bedside table, and bedding, can lead
to the organism getting on the HCW hands.
C. difficile is a perfect example of why hands
must always be washed after even a simple
touching of any patient and/or items in the
patient environment.
And Now a Word About Nails….
Studies show that
high numbers of
bacteria and yeast
exist under the
fingernails.
These germs
continue to be
present even after
careful handwashing.
Freshly applied fingernail polish does not lead
to increased numbers of bacteria.
BUT…chipped polish may provide space for the
pathogens to get between the polish and the
fingernail.
Disease outbreaks have been traced to HCWs
wearing artificial nails and to HCWs who
have long natural nails.
Studies have shown that more bacteria and
yeast live on artificial nails than on natural
nails, in spite of good handwashing.
Policy
Employees who work in positions that
provide direct patient care or who
work in Food Services cannot:
 Wear artificial fingernails, acrylic
overlays, nail tips or nail extenders.
and
 Natural nail tips are to be less than
one-fourth of an inch long.
Major Points To
Remember:
When hands are
visibly dirty or
contaminated with
body substances or
are soiled with blood
or other body fluids,
wash with soap
and water.
 If hands are not visibly
soiled, use an alcoholbased cleanser.
 Apply product to palm
of one hand, and rub
hands together,
covering all surfaces
of hands and fingers
until dry.
Remember –
When to Clean Your Hands…..
 Before and after
having direct contact
with patients
 Before and after
performing procedures
on patients – even
when gloves are worn.
 After touching items
such as medical
equipment, bed rails,
tables, etc. in a
patient’s room.
 Cleanse your hands
whenever you take
gloves off.
When to use soap and
water?
Whenever you’ve been in the room of a
patient with C. difficile – whether you
touch the patient or not!
Before eating
After using the restroom
Whenever your hands are visibly soiled or
contaminated
Handwashing 101
 Step 1: Wet hands with warm water
 Step 2: Use about 1 teaspoon of soap
 Step 3: Rub hands briskly for about 15 seconds (the
time it takes to sing the alphabet twice!)
 Step 3 ½: Be sure to rub all areas, including between
the fingers and the backs of the hands
 Step 4: Rinse under warm running water
 Step 5: Dry completely
 Step 6: Use the paper towel to turn off the faucet
Did You Know…
Using hot water to
wash your hands can
increase skin
irritation?
Warm water will
do the job!
If You Provide Direct Patient
Care or Work in Food Services
Do not wear
artificial nails, nail
extenders, nail tips,
or acrylic overlays.
Natural fingernails
should not be longer
than ¼ inch.
If fingernail polish is
chipped –.
Remove it before
coming to work.
Re-apply a fresh coat
to repair it.
And a Final Word on Gloves…
 Wear gloves when
contact with body fluids
or non-intact skin is
expected.
 Change gloves during
patient care if moving
from a contaminated
body site to a clean site.
 Never wear gloves from
a patient room to
another work area.
How About Hand Hygiene
at Home?
Plain soap and water
are all that is needed
for hand cleaning.
Antibacterial
products are not
necessary at home.
That’s It!
Complete the following brief post-test
and you’ll demonstrate your competency
about hand hygiene.
All of our patients and you as the
healthcare worker will benefit!