Hand Hygiene PDF

Hand Hygiene Hand Hygiene Hand hygiene is a general term referring to any action of hand cleaning. Hand hygiene relates to the removal of visible soil and removal or killing of transient microorganisms from the hands while maintaining the good skin integrity. Any health-care worker, caregiver or pe...

Hand Hygiene Hand Hygiene Hand hygiene is a general term referring to any action of hand cleaning. Hand hygiene relates to the removal of visible soil and removal or killing of transient microorganisms from the hands while maintaining the good skin integrity. Any health-care worker, caregiver or person involved in direct or indirect patient care needs to be concerned about hand hygiene and should be able to perform it correctly and at the right time. 4 5 Hand Hygiene Techniques: 1- Routine / Social hand Washing 2- Alcohol hand rub 3- Aseptic/Clinical Hand Hygiene 4- Surgical hand wash (scrubbing) 6 1. Routine Hand Hygiene (Soap and Water) Definition A measure carried out to reduce numbers of microorganisms present on the skin surface. Purposes Promote hygiene Prevent the spread of germs and infectious diseases. Soap and water should be used in the following situations: 1. When hands are visibly soiled 2. The patient is experiencing vomiting and/or diarrhea 3. There is direct hand contact with bodily fluids; i.e. if gloves have not been worn. 4. There is an outbreak of Norovirus, Clostridium difficile or other diarrheal illnesses 5. After using the toilet 6. Before and after preparing, handling or eating food 7. Before and after an aseptic technique 8. After removal of gloves 9. At the start of a shift and at the end of a shift 10. After completing a task i.e. cleaning equipment Points to be in consideration: Open cuts or sore hands should be covered with a water proof plaster. Keep nails short and clean. Do not wear false nails or nail polish. Avoid wearing rings, watches or bracelets. Always keep hands & uniform away from the sink during hand washing. Take care of your hands by regularly using a protective hand cream or lotion, at least daily. Do not routinely wash hands with soap and water immediately before or after using an alcohol-based hand rub. Do not use hot water to rinse your hands. Dry completely before putting on gloves. 7 Steps of Soap and Water Hand Hygiene 1. Ensure jewellery has been removed 2. Wet hands thoroughly and lather vigorously using a neutral pH liquid soap for 15-30 seconds 3. Rub hands palm to palm 4. Right palm over left dorsum with interlaced fingers and vice versa 5. Palm to palm with fingers interlaced 6. Backs of fingers to opposing palms with fingers interlocked 7. Rotational rubbing of left thumb clasped in right palm and vice versa 8. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa 9. Rinse under running water Do not touch taps with clean hands – if elbow or foot controls are not available, use paper towel to turn off taps 10. Pat hands dry using paper towel 0 2. Alcohol-based hand (ABH): ABHPs are more effective against most bacteria and many viruses than either plain liquid soap or antimicrobial soap. If hands are visibly soiled they must be washed with soap and water. 1. Ensure jewellery has been removed 2. Apply quantity of alcohol-based hand hygiene product as per manufacturer‘s recommendations into cupped hand 3. Rub hands palm to palm 4. Right palm over left dorsum with interlaced fingers and vice versa 5. Palm to palm with fingers interlaced 6. Backs of fingers to opposing palms with fingers interlaced 7. Rotational rubbing of left thumb clasped in right palm and vice versa 8. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa 9. Rubbing hands together until hands are dry before continuing with patient care, do not rub off excess product Benefits of Alcohol-based hand: 1. Require less time than hand washing 2. Act quickly to kill microorganisms on hands 3. More accessible than sinks 4. Reduce bacterial counts on hands 5. Do not promote antimicrobial resistance 6. Less irritating to skin than soap and water 7. Some can even improve condition of skin 9 3. Aseptic/Clinical Hand Hygiene Aseptic/clinical hand hygiene is undertaken to remove transient micro-organisms and inhibit the growth of resident micro-organisms prior to any care activity that implies a direct or indirect contact with a mucous membrane, non-intact skin or an invasive medical device. During such a procedure no micro-organisms should be transmitted. 1. Ensure jewellery has been removed 2. Wash hands thoroughly using an antimicrobial soap (e.g. chlorhexidine gluconate 2% soap) for one minute using the technique outlined in Routine/Social Hand Hygiene 3. Rinse carefully 4. Do not touch taps with clean hands – if elbow or foot controls are not available, use paper towel to turn off taps 5. Pat dry hands using clean paper towels 10 4. Surgical hand antisepsis (scrubbing): Surgical hand antisepsis – refers to the antiseptic surgical scrub or antiseptic hand rub that is performed prior to donning surgical dress preoperatively. The surgical scrub serves to minimize the number of pathogens. Process of removing as many microorganisms as possible from the hands and arms by mechanical washing (friction) and chemical antisepsis before participating in a surgical procedure. Method of scrubbing: Points to remember Keep hands higher than elbow after scrub procedure. Avoid splash back of water on the scrub site. Use the recommended antimicrobial agent only. Wear mask during scrub procedure. Steps of surgical hand scrub: (2-5 minutes) 1. Wet hands and forearms and, according to the manufacturer’s instructions regarding amount, apply the solution from a dispenser. Rub solution into the hands palm to palm and then work upwards until all areas to just below the elbow are covered in solution. 2. Using the right palm spread product over the back of the left hand with interlaced fingers. Repeat with the left palm on the back of the right hand. 3. With fingers interlaced, rub palm to palm. 11 4. Clasp the fingers of the right hand into the left palm and rotate hands. Repeat with the opposite hand. 5. Hold the right thumb in the left hand and rotate to cover in scrub solution. Repeat with the opposing thumb. 6. For both hands, rub the fingertips on the palm (steps 1-6 for 2 minutes). 7. Working only in the direction towards the elbows, use a rotating action to move one hand around the arm to just below the elbow to avoid recontamination of the hands by water from the elbows and prevents bacteria-laden soap and water from contaminating the hands. Repeat on the other arm for 1 minute. 8. Rinse. Repeat above steps. Ensure hands are kept higher than elbows throughout the process. 9. Allow water to run off skin. Take a sterile single-use towel and pat dry left hand down to the elbow, discard the towel and repeat with the right hand. 12 Step:1 Step:2 Step:3 Step:4 Step:5 Step:6 Step:7 Step:8 Step:9 Step:10 Step:11 Step:12 Step:13 Step:14 Step:15 Step:16 13  Gloving Indication Latex-free gloves are available for all staff and must be worn for the following situations: 1. Before an aseptic procedure. 2. Before contact with blood or another body fluid, regardless of the existence of sterile conditions 3. Contact with non-intact skin and mucous membrane. 4. When anticipating contact with chemical hazards such as disinfectants or preserving agents. Note: any cuts or abrasions present on hands should be covered (eg plaster) prior to donning gloves. The keys to wearing gloves properly are: 1. Washing hands prior to wearing gloves- removing jewelry prior to washing hands is highly recommended. 2. Wear fresh pair of gloves before each procedure. NEVER REUSE GLOVES. 3. Remove gloves using proper technique and dispose of them properly. 4. Wash hands after removing gloves. NB. Gloves are not a substitute for hand hygiene and do not provide a safe method of preventing hand contamination Putting on Gloves: 1. Wash hands with soap and water, and dry thoroughly- removing jewelry prior to washing hands is highly recommended. 2. Before putting gloves on, be sure to examine for dirt or damage (tears or holes). Replace gloves if necessary. 3. Replace gloves before dealing with another patient or if they become heavily soiled. 14 Removing Gloves: Then, perform hand hygiene by rubbing with an alcohol based hand rub or by washing with soap and water To reduce hand irritation related to gloves: a) Wear gloves for as short a time as possible b) Clean and dry hands before donning gloves and after glove removal; and c) Wear gloves that are clean and dry inside HAND HYGIENE AND MEDICAL GLOVE USE The use of gloves does not replace the need for cleaning your hands. Hand hygiene must be performed when appropriate regardless of the indications for glove use. Remove gloves to perform hand hygiene, when an indication occurs while wearing gloves. 15  Discard gloves after each task and clean your hands – gloves may carry germs. Wear gloves only when indicated according to Standard and Contact Precautions (see examples in the pyramid below) – otherwise they become a major risk for germ transmission. Summary of the indications for gloving and for glove removal: Indication Gloves on 1) Before a sterile procedure 2) When anticipating contact with blood or another body fluid, regardless of the existence of sterile conditions and including contact with non-intact skin and mucous membrane 3) Contact with a patient (and his/her immediate surroundings) during contact precautions. Gloves off 1) As soon as gloves are damaged (or non-integrity suspected) 2) When contact with blood, another body fluid, non-intact skin and mucous membrane has occurred and has ended 3) When contact with a single patient and his/her surroundings, or a contaminated body site on a patient has ended 4) When there is an indication for hand hygiene 16  Personal Protective Equipment (PPE) Personal Protective Equipment (PPE) is special equipment for both patients and medical staff prevents exposure to disease and is a concern for all healthcare facilities. 5 practice points 1. Health professionals must use personal protective equipment (PPE) when undertaking any procedure that carries an infection risk 2. PPE is only as effective as the user‘s skill in use and removal 3. PPE can protect staff from infection risks, and vulnerable patients from acquiring infections from staff 4. PPE must be assessed for each procedure 5. Change PPE whenever it is heavily splashed and between procedures with different patients. 17 18 19 20