1. DR. H. BORAH DEPTT. OF COMMUNITY MEDICINE ASSAM MEDICAL COLLEGE

2. INTRODUCTION Hand washing: Washing hands with plain or antimicrobial soap and water. Hand cleansing: Action of performing hand hygiene for the purpose of physically or mechanically removing dirt, organic material, and/or microorganisms. Hygienic hand wash: Treatment of hands with an antiseptic hand wash and water to reduce the transient flora without necessarily affecting the resident skin flora. It is broad spectrum, but is usually less efficacious and acts more slowly than the hygienic hand rub. 3. Contd Antiseptic hand rubbing (or hand rubbing). Applying an antiseptic hand rub to reduce or inhibit the growth of microorganisms without the need for an exogenous source of water and requiring no rinsing or drying with towels or other devices. Hand washing is the simplest, most effective measure for preventing nosocomial infections. It is one of the basic measures of standard precautions. Despite advances in infection control and hospital epidemiology, healthcare workers adherence to recommended hand hygiene practices is unacceptably low. 4. Contd.. Compliance is usually estimated as less than 50%. 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. 5. Normal bacterial flora on hand In 1938, Price established that bacteria recovered from the hands could be divided into two categories, namely resident or transient. The resident flora (resident microbiota) consists of microorganisms residing under the superficial cells of the stratum corneum and can also be found on the surface of the skin. Staphylococcus epidermidis is the dominant species. 6. Contd. Other organisms like S. Hominis, coagulase negative staph. Coryneform bacteria, some fungi pityrosporum. Resident flora has two main protective functions: microbial antagonism and the competition for nutrients in the ecosystem. In general, resident flora is less likely to be associated with infections, but may cause infections in sterile body cavities, the eyes or on non intact skin. 7. Contd. Transient flora (transient microbiota), which colonizes the superficial layers of the skin, is more amenable to removal by routine hand hygiene. Transient microorganisms do not usually multiply on the skin, but they survive and sporadically multiply on skin surface. They are often acquired by HCWs during direct contact with patients or contaminated environmental surfaces adjacent to the patient. The transmissibility of transient flora depends on the species present, the number of microorganisms on the surface, and the skin moisture. 8. Transmission of pathogen by hand Transmission of pathogens from one patient to another via HCWs hands requires five sequential steps (i) organisms present on patients skin, or in the inanimate environment. (ii) organisms must be transferred to the hands of HCWs. (iii) organisms must be capable of surviving for at least several minutes on HCWs hands. (iv) defective hand cleansing, resulting in hands remaining contaminated. and (v) cross transmission of organism by contaminated hands. 9. I )Organisms present on patient skin or the immediate environment 10. ii)Organism transfer from patient to HCWs hands 11. iii)Organism survival on HCWs hands 12. iv)Incorrect hand cleansing 13. v)Failure to cleanse hands results in between-patient cross-transmission 14. Antiseptic used in hand hygiene Alcohols (60-70 %) Chloroxylenol (0.5-4 %) Chlorhexidine (0.5-4%) Hexachlorophene (3%) Iodophors (0.5-10 %) Triclosan(0.1-2%) Quaternary ammonium compounds. 15. When do you wash your hands? Most people say they wash their hands after using the bathroom but in reality all of us do not. Many of us do not wash our hands after coughing or sneezing. Some of us wash up after handling money and this is a great idea. Some of us also wash our hands after we handle our pets or clean their litter boxes. 16. When Should You Wash Your Hands After you use the bathroom. When you cough or sneeze into your hands. After you blow your nose. After cleaning animal waste or litter boxes. After touching your pet. 17. Contd. Before you prepare food. Before eating . Before and after touching or treating a cut or wound. Before inserting contact lenses. After using public restroom facilities. After using exercise equipment in a public gym. Before and after changing a babys diaper. 18. How to Wash Hands Properly Wet your hands with warm water and apply soap either liquid or from a bar. Lather well and rub hands vigorously together for 15-20 seconds or as long as it takes to sing the ABC song. Include the backs of the hands, under the nails and between your fingers. Dry thoroughly with a clean towel. Use a towel to turn off the faucet 19. Steps of proper hand washing 20. What happens when I do not wash my hands? Bacteria and viruses are picked up and stay on your hands. You can pass them to other people when you touch them with your hands. Also, bacteria and viruses can get into your body when you touch your eyes, mouth, or nose with your hands. 21. What if I do not have access to a sink and soap? If possible, carry a waterless antibacterial hand sanitizer with you. 22. What is the proper way to use hand sanitizer? Apply an amount about the size of a quarter to the palm of one hand. Rub your hands together using a washing motion (including your nails and between your fingers) until the cleanser has dried completely. 23. Surgical hand preparation key steps Keep nails short and pay attention to them when washing your hands most microbes on hands come from beneath the fingernails. Do not wear artificial nails or nail polish. Remove all jewellery (rings, watches, bracelets) before entering the operating theatre. Wash hands and arms with a non-medicated soap before entering the operating theatre area or if hands are visibly soiled. 24. Surgical hand preparation technique 25. Contd. 26. Contd 27. Contd.. 28. Contd The introduction of sterile gloves does not render surgical hand preparation unnecessary. 18% (range: 582%) of gloves have tiny punctures after surgery, and more than 80% of cases go unnoticed by the surgeon. After two hours of surgery, 35% of all gloves demonstrate puncture, thus allowing water (hence also body fluids) to penetrate the gloves without using pressure. A recent trial demonstrated that punctured gloves double the risk of SSIs. Double gloving decreases the risk of puncture during surgery, but punctures are still observed in 4% of cases after the procedure. Several reported outbreaks have been traced to contaminated hands from the surgical team despite wearing sterile gloves. 29. Strategies for successful promotion of Hand hygiene Education is a cornerstone for improvement of hand hygiene practices. Easy access to hand hygiene supplies, whether sink, soap, medicated detergent. Monitor HCWs adherence to recommended hand hygiene practices. Encourage patients and their families to remind HCWs to decontaminate their hand. 30. Contd Make improved hand hygiene adherence an institutional priority and provide appropriate administrative support and financial resources. To improve hand hygiene adherence among personnel who work in areas with high work loads, make an alcohol-based hand rub available in convenient locations and pocket sized to be carried by HCWs. 31. Contd.. Color posters emphasizing the importance of hand hygiene to be displayed in strategic areas within the hospital called Talking Walls. Bottles of hand rub solutions were distributed in large amounts to all wards. Active participation and feedback at both individual and organizational levels. 32. Conclusion All the above mentioned strategies cant be used alone. Strategies to improve compliance with hand hygiene practices should be multimodal and multidisciplinary. Clean Hands are Healing Hands. 33. THANK YOU