Hand Hygiene in Healthcare Settings

Hospital Acquired Infections n 7-10% of patients acquire an infection n 7,000 death per year n The federal government spend > $950 million annually Source:Australian Council for Quality and Safety in Healthcare July 2003

Paediatric Nosocomial Infections n MORE Viral respiratory infections n MORE Gastrointestinal infections n MORE BACTEREMIAS n All children are exposed to maternal infections/siblings n HIGH RISK PATIENT GROUPS: Newborns and premature infants Children with congenital abnormalities

Obstetric Nosocomial Infections n Minimal invasive diagnostic procedures n Surgery not prolonged n Short hospital stay n Intact host defenses n Not subject to as many hospital pathogens n Not exposed to prolonged antibiotic courses

Obstetric Nosocomial Infections- Risks Increase With: n Urinary catheterisation n Intravenous therapy n Intra-uterine and foetal monitoring n PV examinations

“Hand Hygiene is the SINGLE most important practice to preventing nosocomial infections” Rotter ML 1997

Benefits of Hand Hygiene  Reduced number of deaths  Reduced number of infections:  Decreased antibiotic usage  Decreased patient length of stay  Decreased use of resources

Compliance with hand hygiene? Table 1. Compliance with hand hygiene in different hospital settings before intervention Table 2. Distribution of factors associated with non-compliance with hand hygiene Source: Pittet D, Boyce JM LANCET Infect Dis 2001

An overview  Definitions  Guidelines for hand hygiene  Soap versus Alcohol solution  Healthy Hands

Definition of Terms  Hand Hygiene a general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis.  Handwashing washing hands with plain ( ie. non-antimicrobial) soap and water.  Decontamination to reduce bacterial counts on the hands by performing antiseptic hand rub or antiseptic handwash. Guide for Hand Hygiene in Healthcare Settings: MMWR 2002; vol.51, no. RR-16

When To Perform Hand Hygiene?  “High Risk” for Contamination Activities  “Low Risk” for Contamination Activities

“High Risk” for Contamination  Immediately before and after patient contact  Immediately before and after a procedure

“High Risk” for Contamination  Before and after touching any devices/equipment directly connected to the patient e.g.  Indwelling catheter  External Ventricular Drains  Redivacs  Ventilation Equipment

“High Risk” for Contamination  Moving from contaminated to a clean body site  After contact with body fluids

“Low Risk” for Contamination  After contact with equipment e.g.patients charts, monitors  After removing gloves  After contact with own nose/mouth/hair

A quick and easy solution An alcohol gel!

Alcohol at EVERY bed helps increase compliance Biscoff WE et al 1998: Abstract K132

n Bed / cot n Trolley n Entrance to room Place gel/rinse at each:

Alcohol is more effective in reducing the number of bacteria Pittet D, Boyce JM. Lancet Infect Dis 2001 Mean change (log 10 CFU)

n Reduction in resident flora Alcohol has persistent activity Rotter ML. Chapter 87 in Mayhall CG 1999

n Less drying than soap and water A quick and easy solution : An alcohol gel!

n In all clinical situations EXCEPT: When your hands are visibly soiled When a surgical scrub is required When can you use an alcohol-based hand gel?

 Ensure that hands have no visible contamination  Apply product to palm of one hand and rub hands together covering all surfaces and fingers  Allow to air dry  The process takes about 15 seconds How to use an alcohol hand gel?

 Continue rubbing hands together until alcohol is dry (should take sec).  After using an alcohol based product, you will feel a “build up” on your hands. To remove this, wash your hands with soap and water as often as necessary. A few tips when using the gel…

 when hands are visibly contaminated with blood/body fluids  to remove “build-up” from the alcohol gel/rinse  before eating  after using the restroom When should you handwash?

How to wash your hands? Wet your hands 12 Apply solution and scrub for at least 15 seconds

How to wash your hands? 3 Scrub back of hands, wrists, between fingers and under fingernails 4 Rinse your hands

How to wash your hands? 5 Turn off water lever using your elbows 6 Dry with paper towel

 Instruct them to EITHER wash their hands or apply the gel:  Before holding the baby/child  Before feeding the baby/child  After nappy change Visitors and Relatives

 Hands visibly soiled Soap and water or antimicrobial soap  Hands not soiled Alcohol hand rub for all routine hand hygiene Summary of Recommendations

Use warm water, not hot Wet hands before applying soap Rinse hands well and pat dry Moisturise 3-4 times daily Healthy Hands:

Select a moisturiser compatible with Chlorhexidine gluconate Nails should be kept short (< ¼ inch) Artificial nails should not be worn in high risk areas e.g. ICU, NICU Healthy Hands:

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