HAND HYGIENE TUMINAH BINTI JANTAN (Consultant)

Outline The hand of the HCW Transmission of HC associated organisms Hand cleansing methods Reviewing the 5 moments HH technique Improving HH practice Hand care

Hand Hygiene HW practice - long history (1800) Accepted as the simplest and most economical procedure for reduction of HAI. Numerous studies proved HW effective in reduction of HAI Low compliance rate Various reported factors for low compliance rate. Introduction of ABHR improve compliance.

The hands • Resident flora: 80% of resident flora reside in the first 5 layers of stratum corneum 20% in the hair follicles and sebaceous glands • Transient flora: Organism that are temporarily lodged on the skin. Can easily be removed

Hand transmission •Hands are the most common vehicle to transmit health care associated organisms. • Transmission of health care associated organisms from one patient to another via health care provider hands requires five sequential steps

Hand transmission Organisms present on patient skin and environment surfaces Organisms transfer on health care providers’ hands – eg: touching pt, environment, equipment, linen lifting, etc. Organisms survival on hands Defective hand hygiene results in hands remaining contaminated (technique, HH agent) Contaminated hands cross-transmit organisms

How to clean hands Alcohol-based hand rub is the preferred method for cleaning hands. It is better than washing hands (even with antibacterial soap) when hands are not visibly soiled. Handwashing with soap and running water must be done when hands are visibly soiled. If running water is not available, use moistened towelettes to remove the visible soil, followed by alcohol-based hand rub. 1 2

5 moments for HH Some examples may be: shaking hands, stroking an arm helping a patient to move around, get washed, giving a massage taking pulse, blood pressure, chest auscultation, abdominal palpation before adjusting an IV rate

5 moments for HH Some examples may be: oral/dental care, giving eye drops, secretion aspiration skin lesion care, wound dressing, subcutaneous injection catheter insertion, opening a vascular access system or a draining system preparation of medication, dressing sets

5 moments for HH Some examples may be: oral/dental care, giving eye drops, secretion aspiration skin lesion care, wound dressing, subcutaneous injection drawing and manipulating any fluid sample, opening a draining system, endotracheal tube insertion and removal clearing up urine, faeces, vomit, handling waste (bandages, napkin, incontinence pads), cleaning of contaminated and visibly soiled material or areas (bathroom, medical instruments)

5 moments for HH

5 moments for HH

Frequently missed…. L.J.Taylor, “An Evaluation of handwashing techniques – 1” Nursing Times (1978)

KKM P&P

WHO Guidelines

WHO & KKM HW

WHO & KKM HR

Improving HH Practice. • Administrative support and Financial resources. • Ensure HCW, understand key elements of HH practice (demonstrate knowledge). (Educational activities) • HCW, (all cat) demonstrates competence in hh technique. (live demo, training video etc) & Emphasize on product volume, correct technique. • Availability of HH facilities (enable staff to practice). Eg ABHR at the point of care. Conveniently located sinks. • Initiating a multi-component publicity campaign (e.g. posters, drawing, screen saver with targeted messaging) • Periodic auditing

Skin condition related to HH There are two major types of skin reactions • Contact dermatitis : most common type includes symptoms which can vary from quite mild to debilitating, including dryness, irritation, itching, and even cracking and bleeding. • Allergic contact dermatitis: is rare and represents an allergy to some ingredient in a hand hygiene product. Symptoms range from mild and localized to severe and generalized. In its most serious form, may be associated with respiratory distress and other symptoms of anaphylaxis. WHO HH Guidelines

Hand Care • Important to look after the skin & fingernails • Damaged skin leads to loss of a smooth skin surface & increases the risk of skin colonisation with resistant micro organisms • Continuing to work with damaged, cracked or weeping skin may expose the healthcare worker to increased infection risk, which could ultimately lead to dermatitis

Recommendations • To provide HCWs with moisturizing skin-care products* • Hand lotions will prevent dry skin and reduce the risk of developing skin irritations and dermatitis. • Frequent and consistent use of an appropriate lotions* is an integral component of a hand hygiene regime * compatible with both Chlorhexidine and latex gloves

Hand Care Strategies for HCWs Keep your hands moisturised while you are working Moisturise and Restore (repair) your skin barrier while you are at home or sleeping

Conclusion The hand of the HCW Transmission of HC associated organisms Hand cleansing methods Reviewing the 5 moments HH technique Improving HH practice Hand care

11th ASM of ICAM

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