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HAND HYGIENE IN HEALTH-CARE SETTING

HAND HYGIENE IN HEALTH-CARE SETTING. HISTORY CONTD-. 1975/1985- CDC Guidelines Recommended washing hands with antimicrobial soap before & after performing invasive procedures.

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HAND HYGIENE IN HEALTH-CARE SETTING

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  1. HAND HYGIENE IN HEALTH-CARE SETTING

  2. HISTORY CONTD- 1975/1985- CDC Guidelines Recommended washing hands with antimicrobial soap before & after performing invasive procedures.

  3. 1995- APIC Guidelines supported use of alcohol based hand rubs in clinical setting.. 1996- Healthcare infection control practices advisory committee (HICPAC) recommended that either Antimicrobial soap or a Waterless Antiseptic Agent should be used in case of patients with multidrug resistant pathogens.

  4. Purpose Of Hand washing • Removes dirt & soil from hand. • Reduces cross contamination • Reduces risk of hand acting as carrier of disease. • Breaks the chain of infection spread. • Prevents noscominal infections. • Gives psychological cleanliness feeling to the paramedical staff.

  5. Behavioural pattern of paramedical staff- • Healthcare workers show resistance to frequent hand washing- Reasons behind this- • Awareness of importance of hand washing is lacking. • Negligence. • Irritation faced due to contact dermatitis which results due to frequent hand washing.

  6. Gloves • General excuse given to avoid hand washing is …………… WE USE GLOVES. CDC Guidelines says that if hand washing is performed carefully, gloves are theoretically not necessary. Gloves give a false sense of security.

  7. Journal of Infectious Diseases1938,63,301-18. • Rapid multiplication of bacteria occurs under surgical gloves if hands are washed with non antimicrobial soap & growth isslow in case of preoperative scrubbing with an antiseptic. • Wearing of gloves does not provide complete protection against infections caused by hepatitis B & herpes simplex.

  8. OTHER REASONS FOR NON COMPLIANCE • Shortage of time. • Non availability of facility. • Deleterious effects of hand washing • Negligence when person is alone. • Not convinced about the importance of HANDWASHING.

  9. LETS UNDERSTAND INDETAILTHEIMPORTANCEOF HANDWASHING.LET US START WITH THE ANATOMY FIRST

  10. Physiology of normal skin • THE SUPERFICIAL REGION- Stratum corneum • THE VIABLE EPIDERMIS • THE DERMIS • THE HYPODERMIS

  11. NORMAL BACTERIAL SKIN FLORA TOTAL BACTERIAL COUNT ON HANDS OF MEDICAL PERSONNEL- 3.9 X 10,000 To 4.6 X 10,000 CFUs/ sq.cm. (CFU- colony forming units) COLONIES are of 2 types.

  12. TRANSIENT FLORA *Colonize on superficial layers of skin. *Abundant on fingertips. *Frequently associated with healthcare associated infections. *Removal by routine hand washing.

  13. RESIDUAL FLORA * Attached to deeper layers of skin. *Less likely to be associated with noscominal infections. *Not easily removed by scrubbing. *Persistent

  14. Transmission of pathogens on hands of Paramedical staff. Organisms from patient’s skin or in animate objects in close proximity of patient transferred to Hands of Paramedical staff. Survival of these organisms for some time on hands Inadequate Hand washing OR with inappropriate agent Contact with another patient with contaminated hands Transmission of pathogens

  15. Facts about Transmission • Approximately 10x6 skin sqm containing viablemicroorganisms are shed daily from *Normal skin *Patients gown *Bed linen *Bedside furniture *Other objects in patients immediate environment.

  16. Contamination isparticularly likely caused by staphylococci or enterococci which are resistant to desiccation & Capable of colonizing & infecting wounds

  17. AREAS FROM WHERE THE MICROBES SPREAD • HAIR • FACE • GROIN • AXILLA & UTMOST IMPORTANLY HANDS – Basically fingernails.

  18. CDC Recommendationsfor hand washing • Before & after touching wound. • After touching contaminated inanimate object. • After taking care of infected patient. • Situations where contamination might have taken place. • Before performing invasive procedures.

  19. HANDWASING IS A MUST ON VISIBLY SOILED HAND which is Hand showing visible dirt or visible contamination with proteinaceous material, blood or other body fluids.

  20. TYPES OF HANDWASHING • PLAIN HANDWASHING- Washing hands with plain (non –antimicrobial) soap & water. • HAND ANTISEPSIS- Refers to Antiseptic hand wash or Antiseptic hand rub.

  21. ANTISEPTIC HAND WASH Washing hands with water & soap or other detergent containing an antiseptic agent

  22. ANTISEPTIC HAND RUB Applying an antiseptic hand rub product to all surfaces of the hands to reduce the no. of microorganism present.

  23. SURGICAL HAND ANTISEPSIS Antiseptic hand wash or Antiseptic hand rub performed preoperatively by surgical personnel to eliminate transient & reduce residual hand flora.

  24. HANDWASHING AGENTS DETERGENT- These are compounds which possess cleansing action. PLAIN SOAP- This is the type of detergent which does not contain antimicrobial agent.

  25. ANTIMICROBIAL SOAP- This is the detergent which contains antimicrobial agent ALCOHOL BASED HAND RUBS- An alcohol containing preparation designed for application to the hands for reducing the no. of viable microorganisms on the hand.

  26. Advantages of Alcohol based preparations- • Alcohols have excellent germicidal activity against gram +ve & gram –ve bacteriaincluding MRSA & VRE, mycobacterium tuberculosis & various fungi. • Lipophilic viruses like HIV, Influenza,vaccinia, herpes implex are susceptible to alcohols.Alcohols have activity against hepatitis B also.

  27. American Journal of Infection Control • Alcohols can prevent transfer of healthcare associated pathogens . • Alcohol based products reduce no of MRSA recovered from hands of healthcare workers more effectively than hand washing by soap & water.

  28. Choice of Antimicrobial Agent • Depends on the type of hand washing to be performed. • Social or Hygienic hand wash- Any soap with antimicrobial agent is recommended. 10 sec hand washing time is suggested.

  29. Choice of Antimicrobial Agent- For Procedural Hand washing. This is where the effect of antimicrobial should remain at least till procedure is completed. 30 sec hand washing time is suggested.

  30. Choice of Antimicrobial Agent Surgical Antisepsis This is pre & post operative hand scrubbing. 30 secs hand scrubbing 3 times I.e. total 90 secs suggested.

  31. Recommendations for Surgical Hand Scrub- *Should reduce microbes on intact skin substantially. * Non irritating to skin. * Broad spectrum of activity. * Fast acting & persistent.

  32. Evaluation of antimicrobial agent in surgical hand scrub is done at three time intervals • Immediately after scrubbing. • After wearing surgical gloves for 6 hrs.I.e. persistent action. • After multiple application over 5 days. I.e. cumulative action.

  33. Methods to evaluate Efficacy of Hand- Hygiene products • US FDA Approved Tentative Final Monograph for Healthcare antiseptic Drug Products (TFM)- Product Should reduce no. of bacteria by 90 % on each hand within 1 min of product application on day 1. Bacterial cell count must not exceed baseline within 6 hrs on day 1.

  34. US FDA Approved TentativeFinal Monograph for Healthcare antiseptic Drug Products (TFM)- 99 % reduction in micro flora on each hand within 1 min by the end of second day.

  35. US FDA Approved TentativeFinal Monograph for Healthcare antiseptic DrugProducts (TFM)- 99.9 % reduction of micro flora on each hand within 1 min by the end of 5 the day.

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