Hand Hygiene and Chain of Infection

• Hand hygiene is a critical infection control practice.
• It is necessary to protect patients and healthcare workers.
• Hand hygiene can dramatically reduce the risk of transmitting infectious diseases and is a cornerstone of infection prevention.
• Practicing hand hygiene contributes to a safer environment for patients.
• It helps reduce healthcare-associated infections.

Chain of Infection

• The chain of infection is a process with a number of steps that lead to infection.
• The steps in the chain of infection include:
  • Germs (agent)
  • Where germs live (reservoir)
  • How germs get out (portal of exit)
  • Germs get around (mode of transmission)
  • How germs get in (portal of entry)
  • Next sick person (susceptible host).
• Babies, children, elderly, people with weakened immune system, unimmunized people and anyone can be susceptible hosts to infection.
• Germs enter through the mouth, cuts in the skin, and eyes.
• Germs get around through contact (hands, toys, sand) and droplets (when speaking, sneezing, or coughing).
• People, animals/pets, wild animals, food, soil, and water are places where germs live.
• Germs exit through the mouth (vomit, saliva), cuts in the skin (blood), during diapering and toileting(stool).
• Bacteria, viruses, and parasites are agents of infection.

Microbial Hazards

• Dental laboratories are prone to microbial contamination because they are high-risk environments due to exposure to patient materials.
• Common routes of infection include:
  • Direct contact
  • Indirect transmission
  • Airborne/droplet transmission
  • Cross-contamination between workstations.

Common Microorganisms

• Some common microorganisms include bacteria, viruses, fungi, and prions.
• Bacteria microorganisms include:
  • Streptococcus mutans that causes dental caries and is found in saliva and dental impressions.
  • Mycobacterium tuberculosis causes tuberculosis and is transmitted via aerosols and contaminated instruments.
  • Staphylococcus aureus (MRSA) causes skin infections and pneumonia and is found on contaminated hands and surfaces.
• Virus microorganisms include:
  • Hepatitis B (HBV) & C (HCV) that causes liver infection and are a high risk of transmission via blood, saliva, and dental tools.
  • Human Immunodeficiency Virus (HIV) that weakens the immune system and is transmitted through blood-contaminated materials.
• Fungi and prion microorganisms include:
  • Candida albicans that are a fungus that causes oral and systemic infections and is often are found on dentures and in moist environments.
  • Prions (Creutzfeldt-Jakob Disease - CJD) which is a rare but fatal neurodegenerative disease that can be transmitted via contaminated dental instruments.

Types of Hand Hygiene

• Handwashing is the most effective way to remove germs, dirt, and other contaminants.
• Hand sanitizing is a quick and convenient way to kill germs when soap and water are not available.
• Surgical hand antisepsis involves using an antiseptic solution to reduce the number of germs on hands before surgical procedures.

Hand Hygiene Techniques

• Wet hands with clean, running water (warm or cold).
• Apply enough soap to cover all surfaces of the hands.
• Rub hands together for at least 20 seconds, ensuring all surfaces are cleaned.
• Effective hand hygiene practices not only protect patients but also help prevent the spread of infections in the broader community.
• Hand hygiene plays a crucial role in minimizing the incidence of hospital-acquired infections, which lead to prolonged hospital stays and increased healthcare costs.

Misconceptions

• It is a myth that handwashing alone is sufficient for infection control.
• Alcohol-based rubs are not as effective as soap and water in certain hand sanitizers.
• Busy schedules prevent consistent hand hygiene practices.
• Wearing gloves does not eliminate the need for hand hygiene.

Pathogen Transmission

• Patients and staff come into close contact, increasing the risk of infection spread.
• Contaminated surfaces, equipment, and lack of hand hygiene enable pathogens to spread.
• Common transmission routes in hospitals and clinics include:
  • Airborne
  • Droplet
  • Contact transmission

Five Moments for Hand Hygiene

• Hand hygiene is a simple yet powerful way to prevent the spread of infections; handwashing technique and awareness of 5 key moments can make a difference in infection control.
• The critical points during patient care that requires hand hygiene to interrupt transmission of pathogens and healthcare associated infections are:
  • Before patient contact in order to protect the patient.
  • Before aseptic task to prevent infection.
  • After body fluid exposure to protect yourself.
  • After patient contact to protect yourself.
  • After contact with patient surroundings to protect the environment.

Before Patient Contact

• Washing hands reduces the risk of transferring germs from your hands to the patient.
• This ensures no harmful microbes are introduced to the patient.

Before Aseptic Tasks

• Washing hands before aseptic tasks is crucial when performing any procedure that involves sterile equipment or invasive procedures to prevent microorganisms into the sterile field.
• Hand hygiene plays a vital role in maintaining a sterile environment and maximizing patient safety.

After Body Fluid Exposure Risk

• Hand hygiene is crucial after potential exposure to bodily fluids such as blood, urine, or feces.
• Washing hands with soap and water or hand sanitizer minimizes any risk of contamination after accidental exposure and protects patients and healthcare staff.

After Patient Contact

• Washing hands after touching a patient helps prevent the spread of germs from the patient to other patients or healthcare personnel.
• It demonstrates commitment to patient safety and well-being.

After Contact with Patient Surroundings

• Bedrails in the patient surroundings need to be cleaned often because the patient may be harbouring microbes.
• Medical Equipment should be cleaned because germs can easily be transferred to hands.
• Tables and chairs should be cleaned as surfaces touched by multiple people may be contaminated.

Alcohol Based vs Soap and Water

• When using soap and water, you remove visible dirt and contaminents, but alcohol-based hand rubs quickly kill microbes without water.
• Soap and water are not always accessible or convenient, but alcohol is.
• Using soap and water can be time-consuming in busy settings, but alcohol-based rubs are effective against a wide range of pathogens.

Importance of Hand Hygiene Education and Training

• Teaches technicians proper techniques for hand hygiene.
• Highlights the critical role of hand hygiene.
• Encourages consistent hand hygiene practice.

Hygiene During Emergencies

• Enhanced procedures should be implemented.
• The availability of soap, water, and sanitizers must me ensured.
• Staff must be trained and the patients must be empowered on proper techniques.
• Compliance must be checked for and the need to respond to changes tracked.

Hand washing Steps

• Use running water and wet hands.
• Lather well with the soap.
• Scrub hands for at least 20 seconds.
• Remove all soap.
• Dry with a clean towel.

Hand Sanitization Steps

• Apply a generous amount of hand sanitizer to cover all surfaces.
• Rub hands together thoroughly, ensuring all areas are covered.
• Allow to air dry completely before touching any surfaces.
• It is important to note that hand sanitizer should not be used as a substitute for handwashing when hands are visibly soiled.

Barriers to Effective Hand Hygiene

• Busy workflows limit opportunities for proper handwashing due to lack of time.
• Sinks or sanitizers not being readily available at point of care and cause inconvenient access.
• Frequent handwashing leading to dry, cracked skin causes skin irritation.
• Busy healthcare providers may or may not be forgetful over hand hygiene.