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Hand Hyegiene
Hand Hyegiene
10
hours:
8
medical students 4
2
• Second Clinic: Midwives 0
FIRST CLINIC SECOND CLINIC
THE INTERVENTION:
HAND SCRUB WITH CHLORINATED LIME SOLUTION
Ignaz Semmelweis Hand hygiene basin at the Lying-In Women’s Hospital in Vienna, 1847.
HAND HYGIENE: NOT A NEW CONCEPT
Maternal Mortality due to Postpartum Infection General
Hospital, Vienna, Austria, 1841-1850
16 Semmelweis’ Hand
Maternal Mortality (%)
Hygiene Intervention
11
9 9
8 8
7.5
7
6
3.5
2.3 2.6 2.5 2.2
2 2
1 1.4
1.3
1841 1842 1843 1844 1845 1946 1847 1848 1849 1850
MDs Midwives
STANDARD PRECAUTIONS:
FIVE
MOMENTS
FOR HAND
HYGIENE”
Ability of Hand Hygiene
Agents to Reduce Bacteria on
HAND HYEGIENE- WITH WHAT? Hands
Time After Disinfection
% log
99.9 3.0 0 60 180 minutes
Bacterial Reduction
99.0 2.0 Alcohol-based handrub
(70% Isopropanol)
90.0 1.0
Antimicrobial soap
(4% Chlorhexidine)
0.0 0.0
Plain soap
Baseline
HAND HYEGIENE-WITH WHAT?
HAND HYEGIENE-WITH WHAT?
• Handrubbing with alcohol-based handrub is the
preferred routine method of hand hygiene if hands
are not visibly soiled.
• Handwashing with soap and water – essential when
when hands are visibly dirty or visibly soiled (following
visible exposure to body fluids)1
1 If
exposure to spore forming organisms e.g. Clostridium difficile is strongly suspected
or proven, including during outbreaks – clean hands using soap and water
WHY THESE
STEPS ONLY
To effectively reduce
germs on hands,
HANDWASHING
must last
40-60 secs
and should be
performed by
following all steps
illustrated in figure.
To effectively reduce
germs on hands,
ALCOHAL
HANDRUBBING
must last for 20-30
secs & should be
performed by
following all steps
illustrated in figure.
HAND HYGIENE AND GLOVE USE
POSTERS
handwash/hand HH champion of
rub/moments of month
hand hygiene CUE REWARD
Financial reward
Hand rub solution at
entry gate HABIT LOOP Punishment –
Adapted from “The Power of Habit” by Charles Duhigg fine/career
Perceived danger of
HANG HYEGIENE ALSO NEEDS BOOSTER DOSES
self infection
A CONSENSUS-BASED, TESTED
IMPROVEMENT STRATEGY NOW EXISTS
• WHO Multimodal Hand Hygiene Improvement Strategy
• Field tested in eight pilot centres and over 350 additional
health-care facilities worldwide
• Based on the recommendations of the WHO Guidelines
for Hand Hygiene in Health Care
• 5 core components; 5 indications (moments) for hand
hygiene
WHAT IS THE WHO MULTIMODAL HAND HYGIENE
IMPROVEMENT STRATEGY?
• Based on the ONE System change
Access to a safe, continuous water supply as well as
evidence and to soap and towels; readily accessible alcohol-based hand
recommendations rub at the point of care
from the WHO TWO Training / Education
Guidelines on Hand Providing regular training to all health-care workers
Hygiene in Health THREE Evaluation and feedback
Care (2009), a Monitoring hand hygiene practices, infrastructure,
number of perceptions and knowledge, while providing results
feedback to health-care workers
components make
FOUR Reminders in the workplace
up an effective Prompting and reminding health-care workers
multimodal strategy
FIVE Institutional safety climate
for hand hygiene
Creating an environment and the perceptions that
facilitate awareness-raising about patient safety issues
EDUCATION:
• Doctor touches infant two times a day
,nurse touches infant 200 times a day .
• Your infection prevention is as good as
your nursing staff.
• Educating them so that they believe in
practices and then reinforcing practices
is the key.
CHANGING CULTURE
FOSTER/SUPPORT CULTURE IN
WHICH INFECTION IS CONSIDERED
A PREVENTABLE COMPLICATION
• In NICUs with low nosocomial infection rates, the staff belief was that
infections were preventable and represented a breakdown in care
• NICUs with high rates, staff belief is that infections are inevitable and
unavoidable complications of intensive care.
• A belief among staff that nosocomial sepsis is preventable leads to a
motivation to improve.
35
TOOLKIT FOR IMPROVING HAND HYEGIENE
COMPLIANCE
• WHO Guidelines on Hand Hygiene in Health Care (2009):
• Present the evidence for hand hygiene improvement
• CDC guideline on hand hygiene
• Hand Hygiene Why, How and When Brochure
• Education Sessions and Training Films
• WHO template action plan
• Glove Use Information Leaflet
• Posters displayed throughout the facility
• Your 5 Moments for Hand Hygiene
• How to Handrub
• How to Handwash
HOW TO OBSERVE HAND HYGIENE
X100
CALCULATING COMPLIANCE RATES
DEFINITIONS
• Cleaning—Removal of contamination from an item to the extent necessary for
further processing or for intended use.
• “Cleaning is the initial and most critical steps in breaking the chain of
disease transmission”
• Anything that can be disassembled must be disassembled for cleaning,
decontamination, and sterilization
DEFINITIONS
• Disinfection—The process of destroying all possible
live organisms[excluding spores]
• Low
• Intermediate
• High Level
• Sterilization—Process of effectively killing all possible
form of microorganisms [including spore] from surface
equipment food medication or biological culture
medium.
GOOD OLD DR. EARLE SPAULDING
• The selection of a disinfection or sterilization method depends
on the intended use of the item.
1.AUTOCLAVING
a. 20 seconds
b. 3 seconds
c. 1 minute
d. 10 seconds
WHICH HAND HYGIENE METHOD
IS BEST AT KILLING BACTERIA?
1. 15 minutes
2. 30 minutes
3. 1 hour
4. 2.5 hours
Healthcare-associated organisms are commonly
resistant to alcohol.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
A co-worker who examines a patient with
VRE, then borrows my pen without
cleaning his/her hands is likely to
contaminate my pen with VRE.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Which is world hand hygiene day ?
1. 5 Dec
2. 2 Nov
3. 5 May
4. 22 Jan
GLOVE GAME
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