Transcript Hand Hygiene in Healthcare Settings Core

So Why All the Fuss About
Hand Hygiene?
Most common mode of transmission of
pathogens is via hands!
 Infections acquired in health care settings
 Spread of antimicrobial resistance
Evidence of Relationship
Between Hand Hygiene and
Health Care Associated
Infections
 Substantial evidence that hand hygiene
reduces the incidence of infections
 Historical study: Semmelweis
 More recent studies: rates lower when
antiseptic handwashing was performed
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Indications for Hand
Hygiene
 When hands are visibly dirty,
contaminated, or soiled, wash with nonantimicrobial or antimicrobial soap and
water.
 If hands are not visibly soiled, use an
alcohol-based handrub for routinely
decontaminating hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Specific Indications for
Hand Hygiene

Before:
– Patient contact
– Donning gloves when inserting a CVC
– Inserting urinary catheters, peripheral vascular
catheters, or other invasive devices that don’t
require surgery

After:
– Contact with a patient’s skin
– Contact with body fluids or excretions, nonintact skin, wound dressings
– Removing gloves
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Recommended Hand
Hygiene Technique

Handrubs
– Apply to palm of one hand, rub hands together
covering all surfaces until dry
– Volume: based on manufacturer

Handwashing
– Wet hands with water, apply soap, rub hands
together for at least 15 seconds
– Rinse and dry with disposable towel
– Use towel to turn off faucet
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Fingernails and Artificial
Nails

Natural nail tips should be kept short; no
longer than the end of the finger tip

Artificial nails should not be worn
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
PREVENTION
IS PRIMARY!
Protect patients…protect health care personnel…
promote quality health care!
Personal Protective Equipment
Definition
“specialized clothing or equipment worn by
an employee for protection against
infectious materials” (OSHA)
PPE Use in Healthcare Settings
Regulations and Recommendations
for PPE

OSHA issues workplace health and safety
regulations. Regarding PPE, employers must:
– Provide appropriate PPE for employees
– Ensure that PPE is disposed or reusable PPE is
cleaned, laundered, repaired and stored after use


OSHA also specifies circumstances for which PPE is
indicated
CDC recommends when, what and how to use PPE
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare
Settings
• Gloves – protect hands
• Gowns/aprons – protect skin and/or clothing
• Masks and respirators– protect mouth/nose
– Respirators – protect respiratory tract from
airborne infectious agents
• Goggles – protect eyes
• Face shields – protect face, mouth, nose, and
eyes
PPE Use in Healthcare Settings
Factors Influencing PPE Selection
• Type of exposure anticipated
– Splash/spray versus touch
– Category of isolation precautions
• Durability and appropriateness for the
task
• Fit
PPE Use in Healthcare Settings
Gloves
• Purpose –
• patient care
• environmental services
• Glove material –
• Vinyl
• Latex
• Nitrile
• Sterile or nonsterile
PPE Use in Healthcare Settings
Gloves
• Purpose – patient care, environmental
services, other
• Glove material – vinyl, latex, nitrile,
other
• Sterile or non-sterile
• One or two pair
• Single use or reusable
PPE Use in Healthcare Settings
Do’s and Don’ts of Glove Use

Change gloves
– During use if torn and when heavily soiled (even
during use on the same patient)
– After use on each patient

Discard in appropriate receptacle
– Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Aprons
• Purpose of use
• Material –
– Natural or man-made
– Reusable or disposable
– Resistance to fluid penetration
• Clean or sterile
PPE Use in Healthcare Settings
Face Protection
• Masks – protect nose and mouth
– Should fully cover nose and mouth and
prevent fluid penetration
• Goggles – protect eyes
– Should fit snuggly over and around eyes
– Personal glasses not a substitute for goggles
– Anti-fog feature improves clarity
PPE Use in Healthcare Settings
Face Protection

Face shields – protect face, nose, mouth, and
eyes
– Should cover forehead, extend below chin and
wrap around side of face
PPE Use in Healthcare Settings
Respiratory Protection
• Purpose – protect from inhalation of
infectious aerosols (e.g., Mycobacterium
tuberculosis)
• PPE types for respiratory protection
– Particulate respirators
– Half- or full-face elastomeric respirators
– Powered air purifying respirators (PAPR)
PPE Use in Healthcare Settings
Elements of a Respiratory
Protection Program
• Medical evaluation
• Fit testing
• Training
• Fit checking before use
PPE Use in Healthcare Settings
Key Points About PPE
• Don before contact with the patient,
generally before entering the room
• Use carefully – don’t spread
contamination
• Remove and discard carefully, either at
the doorway or immediately outside
patient room; remove respirator outside
room
• Immediately perform hand hygiene
PPE Use in Healthcare Settings
Sequence* for Donning PPE
• Gown first
• Mask or respirator
• Goggles or face shield
• Gloves
*Combination of PPE will affect sequence – be practical
PPE Use in Healthcare Settings
How to Don a Gown
• Select appropriate type and size
• Opening is in the back
• Secure at neck and waist
• If gown is too small, use two gowns
– Gown #1 ties in front
– Gown #2 ties in back
PPE Use in Healthcare Settings
How to Don a Mask
• Place over nose, mouth and chin
• Fit flexible nose piece over nose bridge
• Secure on head with ties or elastic
• Adjust to fit
PPE Use in Healthcare Settings
How to Don a Particulate Respirator
•
•
•
•
•
•
Select a fit tested respirator
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with elastic
Adjust to fit
Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around face
PPE Use in Healthcare Settings
How to Don Eye and Face Protection
• Position goggles over eyes
and secure to the head
using the ear pieces or
headband
• Position face shield over
face and secure on brow
with headband
• Adjust to fit comfortably
PPE Use in Healthcare Settings
How to Don Gloves
• Don gloves last
• Select correct type and size
• Insert hands into gloves
• Extend gloves over isolation gown cuffs
PPE Use in Healthcare Settings
How to Safely Use PPE
• Keep gloved hands away from face
• Avoid touching or adjusting other PPE
• Remove gloves if they become torn;
perform hand hygiene before donning
new gloves
• Limit surfaces and items touched
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings:
How to Safely Remove PPE
“Contaminated” and “Clean” Areas
of PPE
• Contaminated – outside front
• Areas of PPE that have or are likely to have been
in contact with body sites, materials, or
environmental surfaces where the infectious
organism may reside
• Clean – inside, outside back, ties on head
and back
• Areas of PPE that are not likely to have been in
contact with the infectious organism
PPE Use in Healthcare Settings
Sequence for Removing PPE
• Gloves
• Face shield or goggles
• Gown
• Mask or respirator
PPE Use in Healthcare Settings
Where to Remove PPE
• At doorway, before leaving patient room
or in anteroom*
• Remove respirator outside room, after
door has been closed*
*Ensure that hand hygiene facilities are available at the
point needed, e.g., sink or alcohol-based hand rub
PPE Use in Healthcare Settings
How to Remove Gloves (1)
• Grasp outside edge near
wrist
• Peel away from hand,
turning glove inside-out
• Hold in opposite gloved
hand
PPE Use in Healthcare Settings
How to Remove Gloves (2)
• Slide ungloved finger
under the wrist of the
remaining glove
• Peel off from inside,
creating a bag for
both gloves
• Discard
PPE Use in Healthcare Settings
Remove Goggles or Face Shield
• Grasp ear or head
pieces with ungloved
hands
• Lift away from face
PPE Use in Healthcare Settings
• Place in designated
receptacle for
reprocessing or
disposal
Removing Isolation Gown
• Unfasten ties
• Peel gown away from
neck and shoulder
• Turn contaminated
outside toward the
inside
• Fold or roll into a
bundle
PPE Use in Healthcare Settings
• Discard
Removing a Mask
• Untie the bottom, then
top, tie
• Remove from face
• Discard
PPE Use in Healthcare Settings
Removing a Particulate Respirator



Lift the bottom elastic
over your head first
Then lift off the top
elastic
Discard
PPE Use in Healthcare Settings
Hand Hygiene
• Perform hand hygiene immediately after
removing PPE.
– If hands become visibly contaminated during PPE
removal, wash hands before continuing to remove
PPE
• Wash hands with soap and water or use
an alcohol-based hand rub
*Ensure that hand hygiene facilities are available at the
point needed, e.g., sink or alcohol-based hand rub
PPE Use in Healthcare Settings
Standard Precautions
• Assumes blood and body fluid of ANY
patient could be infectious
• Recommends PPE and other infection
control practices to prevent transmission
in any healthcare setting
• Decisions about PPE use determined by
type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions (1)
• Gloves – Use when touching blood, body
fluids, secretions, excretions,
contaminated items; for touching mucus
membranes and nonintact skin
• Gowns – Use during procedures and
patient care activities when contact of
clothing/ exposed skin with blood/body
fluids, secretions, or excretions is
anticipated
PPE Use in
Healthcare Settings
PPE for Standard Precautions (2)
• Mask and goggles or a face shield – Use
during patient care activities likely to
generate splashes or sprays of blood,
body fluids, secretions, or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You Wear?
• Giving a bed bath?
• Suctioning oral
secretions?
• Transporting a patient
in a wheel chair?
• Responding to an
emergency where blood
is spurting?
PPE Use in Healthcare Settings
• Drawing blood from a
vein?
• Cleaning a patient with
diarrhea?
• Irrigating a wound?
• Taking vital signs?
What Type of PPE Would You Wear?
• Giving a bed bath?
• Generally none
• Suctioning oral secretions?
• Gloves and mask/goggles
or a face shield –
sometimes gown
• Transporting a patient in a
wheel chair?
• Generally none required
• Responding to an emergency
where blood is spurting?
• Gloves, fluid-resistant
gown, mask/goggles or a
face shield
PPE Use in Healthcare Settings
• Drawing blood from a vein?
• Gloves
• Cleaning an incontinent
patient with diarrhea?
• Gloves w/wo gown
• Irrigating a wound?
• Gloves, gown,
mask/goggles or a face
shield
• Taking vital signs?
– Generally none
PPE for Expanded Precautions
• Expanded Precautions include
– Contact Precautions
– Droplet Precautions
– Airborne Infection Isolation
PPE Use in Healthcare Settings
Use of PPE for Expanded
Precautions
• Contact Precautions – Gown and gloves for
contact with patient or environment of care
(e.g., medical equipment, environmental
surfaces)
• In some instances these are required for entering patient’s
environment
• Droplet Precautions – Surgical masks within 3
feet of patient
• Airborne Infection Isolation – Particulate
respirator*
*Negative pressure isolation room also required
PPE Use in Healthcare Settings
Hand Hygiene
• Required for Standard and Expanded
Precautions
• Perform…
– Immediately after removing PPE
– Between patient contacts
• Wash hands thoroughly with soap and water
or use alcohol-based hand rub
PPE Use in Healthcare Settings
PPE Use in Healthcare Settings:
Final Thoughts

PPE is available to protect you from exposure
to infectious agents in the healthcare
workplace

Know what type of PPE is necessary for the
duties you perform and use it correctly
Classes of
Microorganisms

Non-pathogenic
– normal
– do not produce disease
– beneficial

Pathogenic
– cause infection and disease

May be non-pathogenic in one
body system, pathogenic in
another (E. coli)
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Classes of
Microorganisms

Aerobic
– requires oxygen to live

Anaerobic
– does not require oxygen to live
2.02 Understand
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Classes of
Microorganisms

6 classes of microorganisms
–
–
–
–
–
–
Bacteria
Protozoa
Fungi
Rickettsiae
Viruses
Helminths
2.02 Understand
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Classes of
Microorganisms



Bacteria
Often considered the causes of
disease
Certain bacteria
– produce antibiotics
– live in the body without problems
– live on the roots of certain plants,
converting nitrogen into a usable form
– help break down dead organic matter
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
Classified by shape and arrangement
Treated with antibiotics
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Classes of
Microorganisms

Bacteria
– Cocci• round in shape
– diplococci
– streptococci
– staphylococci
Streptococci
Staphylococcal cluste
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Classes of Microorganisms

Bacteria
– Bacilli
• rod shape
– single
– pairs
– chains
• may have flagella
• may form spores
– difficult to treat
2.02 Understand
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Classes of
Microorganisms

Bacteria
– Spirilla
• spiral or corkscrew shape
– vibrio
Cholera
- spirochete
Treponema pallidum
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Classes of
Microorganisms



Bacteria
Some bacteria develop resistance to antibiotics
Very difficult to cure
– Methicillin-resistant Staphylococcus (MRSA)
– Multidrug-resistant Staphylococcus (MDSA)
2.02 Understand
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Classes of
Microorganisms

Protozoa
– One celled, animal-like organism
– Contain a nucleus and other defined organelles
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Classes of
Microorganisms

Fungi
– organisms that usually enjoy a symbiotic, but
sometimes parasitic relationship with their host
– provide numerous drugs and foods
– provide bubbles in bread, champagne, and beer
– cause a number of plant and animal diseases
– fungal diseases are very difficult to treat
2.02 Understand
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Classes of
Microorganisms

Fungi
2.02 Understand
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Classes of
Microorganisms

Rickettsiae
– rod-shaped, parasitic bacteria
– live in the tissues of ticks,
fleas, and lice
– transmitted to humans
through bites
– invade the new host from
within
2.02 Understand
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Classes of
Microorganisms

Viruses
–
–
–
–
small, infectious agent
requires a host for survival
over 5,000 types
can combine in multiple ways to produce a wide
range of diseases
– produce immune response in humans
– treated with antiviral drugs
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Classes of
Microorganisms

Helminths
–
–
–
–
–
–
Parasitic worm-like organisms
Live inside the host
Feed off their host
Disrupt nutrient absorption
Lead to weakness
Excrete toxins making host
susceptible to other diseases
– Approximately 30 billion people
globally are infected
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Classes of
Microorganisms






Bacteria
Protozoa
Fungi
Rickettsiae
Viruses
Helminths
2.02 Understand
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Methods used to control the
spread of infection
Vaccinations

Administration of a foreign antigen
to produce immunity to a disease.

Most effective and least expensive
method to prevent disease
2.02 Understand
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Methods used to control the
spread of infection
Vaccinations

Injected pathogen may be live,
weakened, killed or inactivated

Administered to stimulate the immune
response
2.02 Understand
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Methods used to control the
spread of infection
Vaccinations

May be given after disease exposure or after the
disease was contracted

Given by injection or orally
2.02 Understand
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Methods used to control the spread of
infection Aseptic Control

Antisepsis

Disinfection

Sterilization
2.02 Understand
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Methods used to control the
spread of infection
Aseptic Control

Antisepsis
– effective in preventing or inhibiting the growth of
pathogenic organisms, but not spores or viruses
– safe to be used on skin
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Methods used to control the
spread of infection Aseptic
Control

Disinfection
– destroys pathogenic organisms that are already
present
– not effective against spores or viruses
– chemicals are used
– not used on skin
2.02 Understand
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Methods used to control the
spread of infection
Aseptic Control

Sterilization
– kills all microorganisms, including spores and
viruses
– methods
•
•
•
•
steam under pressure
gas
radiation
chemicals
– not used on skin
2.02 Understand
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Methods used to control the
spread of infection
Aseptic Control

Antisepsis

Disinfection

Sterilization
2.02 Understand
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Methods used to control the spread of infection
Precautions
2.02 Understand
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Methods used to control the spread of
infection
Standard Precautions
 Used

on ALL patients
Includes:
– Hand washing
– Personal Protective
Equipment (PPE)
• Gloves
• Gowns
• Masks and eye
protection
–
–
–
–
–
Needle stick safety
Sharps
Spills and splashes
Resuscitation devices
Waste and linen
disposal
– Injuries
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Hand washing
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Personal protection equipment (PPE)
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Gloves
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Gowns
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Masks and eye protection
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Needlestick safety
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Sharps
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Spills and splashes
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Resuscitation devices
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Waste and linen disposal
2.02 Understand
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Methods used to control the
spread of infection
Standard Precautions

Injuries
2.02 Understand
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Methods used to control the spread of
infection
Standard Precautions
 Used

on ALL patients
Includes:
– Hand washing
– Personal Protective
Equipment (PPE)
• Gloves
• Gowns
• Masks and eye
protection
–
–
–
–
–
Needle stick safety
Sharps
Spills and splashes
Resuscitation devices
Waste and linen
disposal
– Injuries
2.02 Understand
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Methods used to control the spread of
infection
Bloodborne Pathogen Standard



Applies to all occupational exposure of blood or
other potentially infectious material.
Blood = human blood, blood components, blood
products
Bloodborne pathogens = disease causing
organisms in blood (Hep. B, Hep. C, HIV)
2.02 Understand
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Methods used to control the
spread of infection
Bloodborne Pathogen
Standard
In an emergency when you cannot
identify body fluids or tell whether they
contain blood, treat all body fluids as
potentially infectious.
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Methods used to control the
spread of infection
Tuberculosis Standard

OSHA Standard to reduce occupationally
transmitted/acquired TB

Requires FIT tested and training in the use of
specific respiratory PPE

PPD skin test annually
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Methods used to control the spread of
infection
Extended Infection Control
Precautions
Standard Precautions PLUS
 Airborne Precautions

Contact Precautions

Droplet Precautions
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Methods used to control the spread of
infection
Extended Infection Control
Precautions

Transmission based precautions
– Additional precautions used with patients infected
with pathogens that are spread via:
• airborne transmission
• droplet transmission
• direct contact
– Requires isolation
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Methods used to control the
spread of infection
Extended Infection Control
Precautions

Airborne precautions
– Patient pathogens are transmitted by airborne
droplets
– Specific PPEs• fitted mask
2.02 Understand
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Methods used to control the
spread of infection
Extended Infection Control
Precautions

Contact precautions
– Patient pathogens are able to
be spread by direct or indirect
contact
– Specific PPEs
• gloves
• gowns
2.02 Understand
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Methods used to control the
spread of infection
Extended Infection Control
Precautions

Droplet precautions
– Used when large-particle droplets are expelled
during coughing, sneezing, talking or laughing
– Specific PPEs• mask if working within
3 feet of patient
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Methods used to control the
spread of infection
Extended Infection Control
Precautions

Protective or reverse precautions
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Methods used to control the spread of
infection
Extended Infection Control
Precautions
Standard Precautions PLUS
 Airborne Precautions

Contact Precautions

Droplet Precautions
2.02 Understand
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Transmitting
Infection

Direct contact

Indirect contact

Airborne

Vector-borne
2.02 Understand
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Transmitting
Infection
Direct contact

Person to person

Animal to person

Mother to unborn child
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Transmitting Infection
Indirect contact

Pathogens are passed along on inanimate
objects
2.02 Understand
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Transmitting
Infection
Airborne


Pathogens are carried
through the air
Cling to surroundings and
are spread
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Transmitting
Infection
Vector-borne

Insects carry pathogen from
host to host
Flea
Mosquito
Tick
2.02 Understand
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Transmitting Infection

How you get an infection…
– Causative agent
– Reservoir
– Portal of exit
– Mode of transmission
– Portal of entry
– Susceptible host…breaking the chain!
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Chain of Infection
Causative agent
Source
or
reservoir
Susceptible host
Portal of entry
Portal of exit
Mode of transmission
2.02 Understand
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Chain of Infection

Causative agent
– pathogen
2.02 Understand
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Chain of Infection

Reservoir
– area where the pathogen
can live
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Chain of Infection

Portal of exit
– way for the pathogen to
escape from the reservoir
2.02 Understand
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Chain of Infection

Mode of transmission
– way for pathogen to be
transmitted
2.02 Understand
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Chain of Infection

Portal of entry
– way to enter new
reservoir
2.02 Understand
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Chain of Infection

Susceptible host
– able to be affected
– person likely to get sick
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Chain of Infection
Causative agent
Source
or
reservoir
Susceptible host
Portal of entry
Portal of exit
Mode of transmission
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Types of
Infections
2.02 Understand infection control procedures
Types of Infections
Infection


invasion of the body by microorganisms
invading microorganisms:
– use the host’s resources to multiply
– interfere with normal function
– 3rd leading cause of death in the U. S.
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Types of Infections
Local infection

only a specific portion of the body is infected
–
–
–
–
–
–
pain
redness
heat at the site
swelling
pus
foul smelling drainage
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Types of Infections
Systemic infection
 affects the entire body
–
–
–
–
–
–
fever
aches
chills
nausea
vomiting
weakness
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Types of Infections

Endogenous (endo- inside;
genous- type or kind)
– type or kind of infection or
disease that originates from
within the body

Exogenous (exo- outside; genoustype or kind)
– type or kind of infection or
disease that originates outside
the body
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Types of Infections

Nosocomial infections
– Hospital acquired infection
– Transmitted by the health care
worker

Opportunistic infections
– Infections that occur when the
body’s defenses are weakened
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Types of Infections
VERY IMPORTANT
Any sign of infection
must be reported to
the nurse or doctor!