Hands Hygiene PDF

 HANDS Are a source of infection Entire surface of the human body is colonized by micro- organisms Skin below waist, particularly in the warm moist perineal and inguinal regions Most people shed about a million skin scales (squames) per day A...

 HANDS Are a source of infection Entire surface of the human body is colonized by micro- organisms Skin below waist, particularly in the warm moist perineal and inguinal regions Most people shed about a million skin scales (squames) per day Attached to these shed skin scales are microorganisms  HANDS Staphylococci and enterococci Shed bacteria are deposited on clothes, uniforms, masks and surrounding local environment  The skin of the hands harbor 2 types of bacteria Resident Gram positive, low virulence that are not easily transmitted by hand contact Are not easily removed by hand hygiene Transient Gram negative bacteria Important causes of nosocomial infections They can be removed by hand hygiene  Resident Make up the persistent ora of the hands Live on the surface, without causing infection If the intact skin is breached, resident species can become opportunistic pathogens causing wound Or deep seated infections Staphylococcus epidermidis fl  Resident Shaking hands, touching a patient’s face Hundreds even thousands of bacteria are transferred onto the dentist’s hands  HANDS About 5-10% of patients during their hospital stay will pick up a healthcare associated infection 2M patients become infected as a result of an infection from a hospital 80,000 deaths per year 600,000 (HCAIs) are due to failure of HCW to wash their hands after every patient When to clean your hands WHO Five moments for hand hygiene Based on the evidence for the transmission of microbes When to clean your hands 1. Before touching a patient 2. Before clean/aseptic procedures 3. After body uid exposure (saliva, blood) 4. After touching a patient 5. After touching patient surroundings fl Choosing the correct hand hygiene product  Handwashing Traditional hand washing with soap Antiseptic hand washes Alcohol based hand rubs  Handwashing Not all forms are e ective The choice will depend upon the reason for cleaning the hands ff Alcohol based hand rubs Active ingredient is an alcoholic solution Ranging from 65 - 70 percent alcohol With low or high concentrations of detergents Surfactants such as biguanides, quaternary ammonium or peroxides Alcohol based hand rubs Products that contain ethanol are diluted from 10 to 40 percent by weight with water To enhance the denaturation of microbial proteins Alcohol based hand rubs Ethanol or isopropyl Demonstrate rapid action against a wide variety of gram negative and gram positive species Including MRSA, vancomycin resistant enterococci Alcohol based hand rubs (-OH) group readily forms hydrogen bonds with protein Leading to loss of structure and function Causing protein and other macromolecules to precipitate  Alcohol Lyses the bacterial cytoplasmic membrane Leading to bacterial inactivation As little as 15 seconds of vigorous alcohol-based hand rubbing has been show to be e ective in preventing transmission of GNB Wash the hands for 30 seconds to allow alcohol to evaporate from the skin ff  Alcohol As alcohols evaporate, no antiseptic residue is left on the skin that could contribute to the development of microbial resistance  Limitation of alcohol based hand rubs Only use ALC based hand rubs on visibly clean hands When hands are soiled with blood and dirt Ine ective against Clostridium di cile Spore forming Watery diarrhea ff ffi  Limitation of alcohol based hand rubs Action is short lived Alcohol component evaporates rapidly even before user was able to spread it  Systemic effects of hand rubs Repetitive long term use can cause alterations in thyroid and reproductive systems of neonates and adolescent animals Studies in humans revealed detectable levels of alcohol in the blood Hand hygiene technique Remove rings and watches S aureus Fewer bacteria are found under silver than gold and platinum rings Silver inhibits the growth of bacteria  Hand hygiene technique Gloves are more prone to tearing when rings are worn on the hand Arti cial nails also harbor bacteria fi  Standard hand hygiene technique Versatile Can be used with water and soap, ABHR 1st step is to hand wash Followed by a hand rub  Standard hand hygiene technique Sequence is used to target the areas of the hand that are commonly missed Finger, thumb wbs Cuticles Wrists Back of the hands QUIZ # 2 MIDTERMS 15 ITEMS  Quiz 1.-2 Give good practices for hand hygiene 3. These are peelings of the skin that can latch onto clothes, gadgets, uniforms and instruments 4.-5 These are the bacteria that are present in these sheddings 6. Type of bacteria of the hands that are important causes of nosocomial infections  Quiz 7. One of the limitations of alcohol based hand rub is that it is ine ective against _______________ (microorganism) 8-13. What are the ve moments of hand hygiene (when to clean your hands) ff fi  Quiz: True or False 14. As alcohols evaporate, no antiseptic residue is left on the skin that could contribute to the development of microbial resistance  Quiz 15. What is the action of alcohol on the bacterial cell membrane?  Surgical hand hygiene For surgical procedures (perio, implant surgery, oral surg) More extensive disinfection referred to as antisepsis Surgical scrub of the hands and arms To reduce the number of resident bacteria to a minimum It is not possible to sterilize the skin Surgical hand hygiene The basic principle is to wash from a clean area to a less clean area (arm) 2 methods Numbered stroke method - for each nger, palm, back of the hand, arm Alternative method - timed scrub should last 5 mins fi  Surgical hand hygiene Wash the hands, nails and forearms with antimicrobial disinfectant (antimicrobial soap) for 2 mins Cold water prevents soap from lathering, soil and germs may not be washed away Clean subungal areas, les are not necessary Scrub each nger, between the ngers, back and front of the hand fi fi fi  Surgical hand hygiene Proceed to scrub the arms, keeping the hand higher than the arm at all times using a rotational action (1 min) Wash the soap from your hands and forearms by holding up your arms with the hands elevated under the tap Water running runs o into the sink from the elbows ff  Surgical hand hygiene Proceed to scrub the arms, keeping the hand higher than the arm at all times using a rotational action (1 min) Wash the soap from your hands and forearms by holding up your arms with the hands elevated under the tap Water running runs o into the sink from the elbows This prevents bacteria laden soap and water from contaminating the hand ff  Surgical hand hygiene Repeat the procedure on the other hand If any of the hands touches anything except the brush Scrub must be lengthened by one minute for that area  Surgical hand hygiene Repeat the procedure further three times this time around initially down to the mid forearm To the wrists (1 min)  Surgical hand hygiene Keep your arms elevated Dry your hands and forearms with sterile towels in the gowning pack Using a dabbing motion instead of a wiping motion  Some pointers.. Avoid vigorous scrubbing that causes the skin to become abraded Scrubbing should not splash water onto surgical attire Scrubbing precedes donning and do ng ffi  References Health Protection Scotland (2015) National Infection Prevention and Control Manual. Available at: www.hps.scot.nhs.uk/haiic/ic/guidelinedetail.aspx?id=49785# (accessed 30 October 2016). Loveday HP, Wilson JA, Pratta RJ et al. (2014) Epic3: national evidence‐based guide- lines for preventing healthcare‐associated infections in NHS hospitals in England. Journal of Hospital Infection, 86(Suppl. 1), S1–S70. Pittet D, Hugonnet S, Mourouga P et al. (2000) E ectiveness of a hospital‐wide pro- gramme to improve compliance with hand hygiene. Lancet, 356, 1307–12. World Health Organization (2009) WHO Guidelines on Hand Hygiene in Healthcare. Available at: www.who.int/gpsc/5may/tools/9789241597906/en/(accessed 30 October 2016). ff  Final course output Submit a laboratory infection control manual that provides instructions and protocols for the : Disinfection of dental environment Hand hygiene Scrub technique Donning and do ng of ppe ffi ff  Contents: Goals of infection control program (objectives) Personal hygiene Respiratory/ cough etiquette Protective attire (ppe)  Barrier techniques Gloves / overgloves Mask and face protection Eyewear Headwear Preparation of the DTR Safety needles Preparing the DTR between patients Securing the DTR at the end of the day  Sterilization Designated work areas Flow of sterilization process Receiving and cleaning Sterile storage Sterilization process Methods Drying and packaging  https://dentistry.ucla.edu/sites/default/ les/2021-01/UCLA School of Dentistry Infection Control Manual_03.2018.pdf fi