Hand hygiene Hygiene at healthcare settings October 15 th is the World Hadwashing Day (UNESCO)

Hand washing n When hands of health care personnel are visibly soiled, after using a toilet, before eating, after touching a patient, after touching animals, after blowing nose, the hands should be washed with soap and water. n The use of gloves does not eliminate the need for hand hygiene. n Likewise, the use of hand hygiene does not eliminate the need for gloves.

Hand hygiene facilities in health care settings should include: n sink n tap with warm water n liquid soap n hand disifectant n paper towels n bin n instruction of hand washing and hand disifection

Recommended sequence of actions in hygienic hand washing n wet hands with water, n apply soap, n rub hands together for at least 10s, n rinse hands with water, n dry hands with disposable towel, n close water tap with disposable towel, n do not touch waste disposal unit throwing the towel away.

Disinfection n Disinfection is the process of destroying microorganisms. n It can be done with use of chemical (H 2 O 2, chlorine) or physical (UV radiation) methods. n Antimicrobial agents applied to non-living objects to destroy microorganisms are disinfectants. n Antibiotics destroy microorganisms within the body. n Antiseptics destroy microorganisms on living tissue. n Sanitisers are high level disinfectants that kill over 99.9% of a target microorganism.

Disifection n Hand disinfection is considered adequate if rubbed with disinfectant for at least 30 seconds. n When using an alcohol-based hand rub, apply the product to the palm of one hand and rub hands together, covering all surfaces of hand and fingers, until hands are dry. n Alcohol-based hand rubs significantly reduce the number of microorganisms on skin, are fast acting, and cause less skin irritation. n Hand disinfection with alcohol-based preparations is recommended as a robust hand-hygiene method..

Registered disinfectants n Alcohols (ethanol, isopropanol) n Aldehydes (glutaraldehyde) n Halogens (chlorine, chloramine, iodine, sodium hypochlorite) n Oxidising agents (chlorine dioxide, hydrogen peroxide, ozone, acidic elecreolyzed water, peracetic acid, potassium permanganate (KMnO 4 ) n Phenolics (phenol) n Quaternary ammonium compounds n Other (dettol, virkon, septusin M, high-intensity UV).

Home disinfectants n By far the most cost-effective home disinfectant is common chlorine bleach (a 5% solution of sodium hypochlorite which is effective against most common pathogens, including such difficult organisms as HIV, tuberculosis (mycobacterium tuberculosis), viruses causing hepatitis B and C, fungi, and antibiotic-resistant strains of bacteria: staphylococcus and enterococcus. n It is not effective against giardia lamblia and cryptosporidium.

Nail hygiene in medicine n Health care personnel should avoid wearing artificial nails and keep natural nails less than one quarter of an inch long if they care for patients at high risk for acquiring infections. n Operating room personnel should not wear artificial nails and the natural ones should be kept short and clean. n Artificial nails weaken natural nails. Bump or knock to a long artificial nail may cause it to separate from the base of the natural nail, allowing a portal for bacterial or fungal entry.

Nail hygiene in medicine n Artificial nails are more likely to harbour gram-negative pathogens than natural nails, both before and after hand washing.

Ring wearing n Ring wearing causes slight decrease in efficacy of hand washing.

Tattooing n Tattooing does not affect efficacy of hand washing nor disinfecting with alcohol-based formulas.

Hand drying methods n Hand drying with a cotton or linen towel is not acceptable at health care settings as both can harbour bacteria. n Hot air drying increases the amount of bacterial contamination on hands. n Paper towel drying causes a slight decrease in contamination. This method is recommended.

Sterilization (or sterilisation) n is the elimination of all transmissible agents (such as bacteria, prions and viruses) and their spores from a surface, a piece of equipment, food, pharmaceuticals or biological culture medium.

Sterilization n Sterilization can be achieved through heat, chemicals, radiation, or filtration. n A widely-used method for heat sterilization is the autoclave. Autoclaves commonly use steam heated to 121°C (250°F), at 103 kPa (15 psi) above atmospheric pressure, for 15 minutes. The steam and pressure transfer sufficient heat into organisms to kill them.

Biological indicators ("bioindicators") n can be used to independently confirm autoclave performance. Several simple bioindicator devices are commercially available based on microbial spores. Most contain pure strains of the heat resistant microbe bacillus stearothermophilus which are among the toughest organisms an autoclave will have to destroy.

Other Methods Other heat methods include flaming, incineration, boiling, tindalization (the process involves boiling for 20 minutes, cooling, incubating for a day, boiling for 20 minutes, cooling, incubating for a day, boiling for 20 minutes, cooling, incubating for a day, and finally boiling for 20 minutes again), and using dry heat.

Chemical sterilization n Chemicals are also used for sterilization. Although heating provides the most effective way to rid an object of all transmissible agents, it is not always appropriate, because it destroys objects such as most fiber optics, most electronics, and some plastics.

Means used for chemical sterilization n Ethylene oxide n Ozone n Sodium hypochlorite n Glutaraldehyde and formaldehyde n Ortho-phthalaldehyde n Hydrogen peroxide n Formic acid

Radiation sterilization n X-rays n Gamma rays n Subatomic particles.

Medical gloves n are medical safety accessories that ensure sanitary conditions by limiting patients’ exposure to infectious matter. They also serve to protect health professionals from disease through contact with bodily fluids. n Medical gloves are traditionally made of latex and powdered with cornstarch.

Medical gloves n There are two main types of gloves: exam, and surgical. Surgical gloves have more precise sizing (numbered sizing, generally from size 5.5 to size 9), and may be made to higher specifications. n Due to the increasing rate of latex allergy among health professionals, there has been an increasing move to gloves made of non-latex materials such as vinyl or nitrile rubber.

Medical gloves testing n the air-leakage test where no air bubbles shall escape under water from an inflated glove n the water-leakage test, where no droplets shall escape from a glove filled with one litre of water within a timespan of 2 minutes n out of gloves, 80 must be tested and not more than 3 gloves may fail, otherwise the CE- mark cannot be affixed to the batch.

n Multidrug-resistant organisms (MDROs), including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), have become endemic in many acute care and long-term care facilities. Infections with these organisms are often difficult to treat, owing to a dwindling armamentarium of active antimicrobial agents.

What is the mechanism of action of chlorhexidine? n Chlorhexidine gluconate is an antiseptic agent that has broad-spectrum activity against many organisms, including S. aureus and enterococcus species. Unlike many other antiseptics, chlorhexidine has residual antibacterial activity, which may decrease the microbial burden on patients’ skin and prevent secondary environmental contamination.

What were the most common pathogens responsible for bloodstream infections in this study of patients in intensive care or transplant units? n Among the 221 primary bloodstream infections, the most common pathogens were staphylococci (30%), gram-negative bacilli (23%), enterococci (20%), and fungi (13%).

What were the results in the study of daily bathing with chlorhexidine-impregnated washcloths in an intensive-care unit setting? n The overall rate of MRSA or VRE acquisition was 23% lower during the intervention period. The rate of hospital-acquired bloodstream infections was 28% lower during the intervention period than during the control period. Similarly, the incidence rate of primary bloodstream infection caused by fungi was 53% lower during the intervention period than during the control period.