Transcript Healthcare-Associated Infection

Hand Hygiene
Rapid Response Team (RRT)
Infection Control Platform
Objectives
Upon completion of this session, attendees should be able to:
1) Define, and explain the impact and burden of Healthcare-Associated
Infection (HAI) on the hospital and on the patients
2) Identify the modes of transmission of the healthcare-associated germs
with particular focus on hand transmission
3) Name three infection control practices to prevent the transmission of these
germs
4) Identify the “five moments” for Hand Hygiene
5) Demonstrate the proper techniques for handwashing and handrubbing
6) Explain the limitation of AHR use
7) Demonstrate the correct way of “Glove use and HH”
Definitions:
• Infection: Invasion and multiplication of an infectious agent in the
tissue of a host.
• Healthcare-Associated Infection:
• Infection associated with healthcare delivery in any setting
• Infections occurring in a patient during the process of care in a
hospital or other health-care facility
• Not present or incubating at the time of admission.
• This includes infections acquired in the hospital but appearing after
discharge, and also occupational infections among staff of the
facility.
• Hospital Acquired Infection (Nosocomial Infection): Acquired in
hospital after 72 hours of admission (not incubating nor present on
admission.
• Community Acquired Infection: Infection that is present or
incubating on admission to hospital that can be traced to a community
source (during the first 72 hours of admission)
Ducel G et al. Prevention of hospital-acquired infections. A practical guide. WHO 2002
Estimated Rates of Healthcare-Associated Infection
(HAI) Worldwide
At any time, over 1.4 million people worldwide are suffering from
infections acquired in hospitals
In modern hospitals in the “developed” world, 5-10% of patients acquire
one or more infections
In “developing” countries, the risk of health care-associated infection is 2
to 20 times higher than in developed countries and the proportion of
patients affected by HAI can exceed 25%
In Intensive Care Units, HAI affects about 30% of patients and the
attributable mortality may reach 44%
Healthcare-Associated Infection:
Scale and Costs Worldwide
Country
N°of Cases/Year
N°of Deaths/Year
Costs/Year
UK
100,000
5,000
UK£ 1 billion
USA
2 millions
90,000
US$ 4.5 billion
MEXICO
450,000
32/100,000
inhabitants
US$ 1.5 billion
The Impact of Healthcare-Associated Infection
(HAI)
HAI Can Cause:
▪ More Serious Illness
▪ Prolongation of Hospital Stay (Availability of Beds)
▪ Long-Term Disability
▪ Excess Deaths
▪ High Personal Costs on Patients and their Families
▪ Reputation of the Hospital
The hip I had waited so long for got infected
and had to be removed. I was devastated and
so disappointed with it all. Now I have more
pain than ever.
I CAN BE YOUR MOM
My catheter
an infection,
which meant
I CANcaused
BE YOUR
HUSBAND
I spent another two weeks in hospital
I'm afraid
to go BE
into hospital
my cancer
I CAN
YOUR for
SON
treatment in case I pick up an infection
again.
My daughter
went BE
in toYOUR
hospitalWIFE
for routine
I CAN
surgery but she developed an infection and died
as a result. I’ll never trust hospitals anymore.
Transmission of
health care-associated germs with a particular focus on hand transmission
Hand Transmission
• Hands are the most common vehicle to
transmit healthcare-associated
pathogens
• Transmission of healthcare-associated
pathogens from one patient to another via
healthcare workers’ hands requires 5
sequential steps
Hand Transmission
1.
2.
3.
4.
5.
Presence of Germs
Transmission on Hands
Germs Survival on Hands
Defective Hand Hygiene
Cross Transmission of Germs
Hand Transmission:
Step 1
The Lancet Infectious Diseases 2006
Germs present on patient skin and environment surfaces
•
Germs (S. aureus, P. mirabilis, Klebsiella spp and Acinetobacter spp.)
present on intact areas of some patients’ skin: 100-1 million colony
forming units (CFU)/cm2
•
Nearly 1 million skin squames containing viable germs are shed daily
from normal skin
•
Patients immediate surroundings (bed linen, furniture, objects) become
contaminated (especially by staphylococci and enterococci) by patient
germs
Hand Transmission:
Step 2
The Lancet Infectious Diseases 2006
Germ transfer on healthcare workers’ hands – examples
•
•
•
Nurses could contaminate their hands with 100-1,000 CFU of
Klebsiella spp. during “clean” activities (lifting patients, taking the
patient's pulse, blood pressure, or oral temperature)
15% of nurses working in an isolation unit carried a median of 10,000
CFU of S. aureus on their hands
In a general hospital, 29% nurses carried S. aureus on their hands
(median count, 3,800 CFU) and 17-30% carried Gram negative bacilli
(median counts: 3,400-38,000 CFU)
Hand Transmission: Step 3
The Lancet Infectious Diseases 2006
Germ survival on hands
•
•
Following contact with patients and/or contaminated environment,
germs can survive on hands for differing lengths of time (2-60
minutes)
In the absence of hand hygiene action, the longer the duration of
care, the higher the degree of hand contamination
Hand Transmission:
Step 4
The Lancet Infectious Diseases 2006
Defective hand cleansing results in hands remaining
contaminated
• Insufficient amount of product and/or insufficient duration of
hand hygiene action lead to poor hand decontamination
• Transient microorganisms are still recovered on hands
following handwashing with soap and water, whereas
handrubbing with an alcohol-based solution has been
proven significantly more effective
Hand Transmission:
Step 5
The Lancet Infectious Diseases 2006
Contaminated hands crosstransmit germs
• In many outbreaks, germ
transmission between
patients and the
environment (both the care
setting and patient
surroundings) to patients
through healthcare workers’
hands has been
demonstrated
Prevention of Healthcare-Associated Infection
(HAI)
• Validated and standardized prevention strategies are available to reduce
HAI
• At least 50% of HAI could be prevented
• Most solutions are simple and not resource-demanding, and can be
implemented in developed, as well as in transitional and developing
countries
Strategies for Infection Control
General Measures
Surveillance
Standard Precautions
Transmission-based Precautions
Antibiotic Control
Specific Measures
Specifically targeted against:
- Urinary tract infections
- Surgical site infections
- Respiratory infections
- Bloodstream infections
Standard and Transmission-based
Precautions (CDC, 1996)
Features
Standard Precautions
Contact Precautions
Droplet Precautions
Airborne Precautions
Patient room
Standard
Private
Private
Private; door closed; negative
pressure; 6-12 air changes/hour;
appropriate discharge of air
outdoors or air filtration
Hand hygiene
After contact with body fluids and
contaminated items, after glove
removal, between patients; with
plain soap or alcohol-based handrub
Standard; with antiseptic soap or
alcohol-based handrub
Standard
Standard
Gloves
Before contact with body fluids and
contaminated items; clean, nonsterile
Before entering the room; clean,
non-sterile
Standard
Standard
Gown
Before procedures likely to generate
projections of body fluids
Standard; before entering the
room when substantial patient
contact is anticipated, or if the
patient has diarrhoea, open
wound drainage, secretions
Standard
Standard
Mask/eye
protection/face
shield
Before procedures likely to generate
projections of body fluids
Standard
Standard
Mask if within 1 metre
of patient
Before entering the room;
possibly N95 respirator
Examples
All patients
Multidrug-resistant bacteria
(MRSA, VRE), Clostridium
difficile, diarrhoea, RSV infection
Meningitis, pertussis,
influenza, mumps,
rubella, diphteria
Tuberculosis, varicella, measles
Simple evidence…
Ignaz Philipp Semmelweis: The Pioneer of Hand
Hygiene
Vienna, Austria
General Hôpital,
1841-1850
Fighting Puerperal Fever
May 15, 1847
First
Second
2
4 6
8 10 12 14 16 18
Intervention
0
Maternal Mortality
Maternal Mortality Rates,
First and Second Obstetrics Clinics,
General Hospital of Vienna
1841 1842 1843 1844 1845 1846 1847 1848 1849 1850
Semmelweis IP, 1861
Evidence of Relationship Between Hand Hygiene
and Healthcare-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.
What are the TOP 10
carriers of infectious agents?
How Can We Overcome Problems Associated with
Handwashing?
Washing hands frequently with soap and water is
▪ inconvenient
More convenient
▪ time-consuming
Faster
▪ often
causes
skin irritation and dryness
Less skin
irritating
Experts recommended that healthcare workers
routinely clean their hands with an alcohol-based
hand rub (a gel, rinse or foam)
Handrubbing is the Solution to Obstacles to
Improve Hand Hygiene Compliance
• Handwashing with soap and
water only when hands are
visibly dirty or following visible
exposure to body fluids (and
dealing with spores forming
germs)
• Adoption of alcohol-based
handrub is the gold standard
in all other clinical situations
Are Alcohol-Based Hand Rubs Really Effective?
• Numerous published studies have shown that
alcohol-based hand rubs remove bacteria from
hands more effectively than washing hands
with plain soap and water
• In most studies, alcohol-based hand rubs
removed bacteria from the hands to a greater
degree than did washing hands with an
antimicrobial soap and water
Boyce JM, Pittet D et al. MMWR 2002;51 (RR-16):1-45
Application time of Hand Hygiene (handwashing and
handrubbing) and Reduction of Bacterial Contamination
Hand Hygiene with:
Handwashing
Handrubbing
Pittet and Boyce, Lancet Infectious Diseases 2001
Won’t Frequent Use of Alcohol Dry Out My Skin?
• Several studies have proven that nurses who
routinely cleaned their hands between
patients by using an alcohol-based hand rub
had less skin irritation and dryness than
nurses who washed their hands with soap
and water
• Alcohol-based hand rubs contain skin
conditioners (emollients) that help prevent the
drying effects of alcohol
Boyce JM et al. Infect Control Hosp Epidemiol 2000;21:442 Winnefeld M et al. Br J Dermatol 2000;143:546
The Golden Rules for Hand Hygiene
• Hand hygiene must be performed exactly where you
are delivering health care to patients (at the point of
care)
• During healthcare delivery, there are 5 moments when
it is essential that you perform hand hygiene
• You must perform hand hygiene using the appropriate
technique and time duration
The geographical conceptualization of the transmission risk
Clean
site
Body fluid
site
THE 5 STEPS OF HAND TRANSMISSION
Pittet D et al, Lancet Infect Dis, Oct 2006
YOUR 5 MOMENTS FOR HAND HYGIENE
Clean your hands immediately
before an aseptic task!
Clean your hands
before touching a
patient when
approaching him/her!
To protect the patient against
harmful germs, including the
patient’s own, entering his/her
body!
Clean your hands after
To protect the patient
against harmful germs
carried on your hands!
Clean your hands immediately
after an exposure risk to body
fluids (and after glove
removal)!
To protect yourself and the
health-care environment from
harmful germs!
touching a patient and his/her
immediate surroundings, when
leaving the patient’s side!
To protect yourself and the
health-care environment from
harmful germs!
Clean your hands after touching any
object or furniture in the patient’s
immediate surroundings, when leavingeven if the patient has not been
touched!
To protect yourself and the health-care
environment from harmful germs!
Can you identify the main examples of this indication
during your everyday practice of health care?
Some examples may be:
• shaking hands, stroking an
arm
• helping a patient to move
around, get washed, giving a
massage
• taking pulse, blood pressure,
chest auscultation,
abdominal palpation
Can you identify the main examples of this indication
during your everyday practice of health care?
Some examples may be:
• secretion aspiration
• skin lesion care, wound
dressing
• catheter insertion, opening a
vascular access system or a
draining system
• preparation of medication,
dressing sets
Can you identify the main examples of this indication
during your everyday practice of health care?
Some examples may be:
• oral/dental care, giving eye
drops, secretion aspiration
• skin lesion care, wound
dressing, subcutaneous injection
• drawing and manipulating any
fluid sample, opening a draining
system, endotracheal tube
insertion and removal
• clearing up urines, faeces,
vomit, handling waste
(bandages, napkin, incontinence
pads), cleaning of contaminated
and visibly soiled material or
areas (lavatories, medical
instruments)
Can you identify the main examples of this indication
during your everyday practice of health care?
Some examples may be:
• shaking hands, stroking an
arm
• helping a patient to move
around, get washed, giving a
massage
• taking pulse, blood pressure,
chest auscultation,
abdominal palpation
Can you identify the main examples of this indication
during your everyday practice of health care?
Some examples may be:
• changing bed linen
• perfusion speed adjustment
• monitoring alarm
• holding a bed rail
• clearing the bedside table
BUT…
We should not forget the
moments where Hand
Hygiene is indicated and
falls under hygienic or
social practices
i.e: after using the
toilet preparing food and
eating, after coughing
etc…
To effectively reduce the
growth of germs on hands,
handwashing must last
40-60 secs and should be
performed by following
all steps illustrated on the left
To effectively reduce the
growth of germs on hands,
handrubbing must be
performed by following all
steps illustrated on the left.
This takes only 20-30 secs!
Hand hygiene and glove use
Hand Hygiene and Glove Use
The use of gloves does not replace the need of
cleaning your hands!
You should wear gloves only when indicated
Skin Care
Dry skin ???
REMEMBER THAT YOU LIVE IN RIYADH
If hand skin problems following use
of antiseptic hand hygiene, seek
medical assistance
More Tips on How to Use an Alcohol-Based
Hand Rub
If you feel a “build-up” of emollients on your hands
after cleaning your hands 5 to 10 times with an alcoholbased hand rub, wash your hands with soap and water
If you clean your hands with an alcohol-based hand rub
before putting on gloves, make sure the alcohol has
dried completely before putting on gloves
In Summary
At MOH Hand Hygiene is an
EXPECTATION not
an OPTION.
We will never be able to improve our Hand Hygiene
compliance if not each and everyone of us presumes
that the patient to be touched might be his/her father,
mother, sister, brother or child
THANK YOU
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