Washing hands reduces

hospital-acquired
infection

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
 How disease spreads

Infectious diseases can spread in a

variety of ways.
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
Why is Hand washing
Important?

Routine Hand washing prevents the

spread of disease!
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
Few Infectious Places

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
 Hand hygiene products
 Alcohol-based (hand)rub : An alcohol-containing preparation
(liquid, gel or foam).
 Antimicrobial (medicated) soap : Soap (detergent)
containing an antiseptic agent at a concentration
 Antiseptic agent : An antimicrobial substance which reduces or
inhibits the growth of microorganisms on living tissues.
 Detergent (surfactant) : They are composed of a hydrophilic
and a lipophilic part and can be divided into four groups: anionic,
cationic, amphoteric, and non-ionic.
 Plain soap : Detergents that do not contain antimicrobial
agents, or that contain very low concentrations of antimicrobial
agents effective solely as preservatives.
 Waterless antiseptic agent : An antiseptic agent that does
not require the use of exogenous water. After application, the
individual rubs the hands together until the agent has dried. The
term includes different types of handrubs (liquid formulations,
Vijay Pratap Raghuvanshi
gels, foams). M.Phil & MHA
( Hospital & Health
 Why is compliance with
recommended handwashing
so poor?
Here are some reasons
why healthcare workers
do not wash their hands
as often as they should:
•Heavy workloads
(too busy)
•Sinks are poorly
located
•Skin irritation
caused by frequent
exposure to soap and
water Vijay Pratap Raghuvanshi
M.Phil & MHA
•Hands don’t look ( Hospital & Health
 Proper hand washing with
soap and water
Follow these instructions for
washing with soap and
water:
 Wet your hands with warm,
running water and apply liquid or
clean bar soap. Lather well.
 Rub your hands vigorously together
for at least 15 seconds.
 Scrub all surfaces, including the
backs of your hands, wrists,
between your fingers and under
your fingernails.
 Rinse well.
 Dry your hands with a clean or
disposable towel. Vijay Pratap Raghuvanshi
M.Phil & MHA
 Use a towel to turn off the tap. ( Hospital & Health
When should you wash
your hands?

Although it's impossible to keep your

hands germ-free, times exist when it's
critical to wash your handsVijay
to Pratap
limitRaghuvanshi
the
transfer of bacteria, viruses and other
M.Phil & MHA
( Hospital & Health
 Health care workers
Nurses, doctors
and other
healthcare
workers can get
100s or 1000s
of bacteria on Culture plate showing
their hands by growth of bacteria 24
hours after a nurse
doing simple placed her hand on the
plate
tasks

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
 What is the single most
important reason for
healthcare workers to
practice good hand
 hygiene?
To remove visible soiling from hands
 To prevent transfer of bacteria from the
home to the hospital
 To prevent transfer of bacteria from the
hospital to the home
 To prevent infections that patients
acquire in the hospital

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
 Colonized or
Infected:
What is the
Difference?
 People who carry bacteria without evidence
of infection (fever, increased white blood
cell count) are colonized
 Ifan infection develops, it is usually from
bacteria that colonize patients
 Bacteria that colonize patients can be
transmitted from one patient to another by
the hands of healthcare workers
~ Bacteria can be transmitted even
if the patient is not infected ~
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
The Iceberg
Effect
Infected

Colonized

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
How often do you clean your
hands after touching a
PATIENT’S INTACT SKIN

1. Always
2. Often
3. Sometim
es
4. Never
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
 Which method do you use
to clean your hands at
work?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
Efficacy of Hand Hygiene
Preparations in Killing
Bacteria
Good Better Best

Plain Soap Antimicrobial Alcohol-based

soap handrub

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
 Ability of Hand Hygiene
Agents to Reduce Bacteria on
Hands
Time After Disinfection
% log
0 60 180 minutes
99.9 3.0

99.0 2.0 Alcohol-based handrub

Reduction
Bacterial

(70% Isopropanol)

90.0 1.0
Antimicrobial soap
(4% Chlorhexidine)

0.0 0.0
Plain soap
Baseline
Vijay
Adapted Pratap
from: Hosp Raghuvanshi
Epidemiol Infect Control, 2nd Edition, 1999.
M.Phil & MHA
( Hospital & Health
How much time would an ICU
nurse save during an 8 hour
shift by using an alcohol-
based handrub instead of
soap and water?
1. 15 minutes
2. 30 minutes
3. 1 hour
4. 2.5 hours

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
How often do you clean your
hands after touching an
ENVIRONMENTAL SURFACE
near a patient?

1. Always
2. Often
3. Sometime
4. Never

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
 Use of artificial nails by
healthcare workers poses
no risk to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
 Glove use for all patient
care contacts is a useful
strategy for reducing risk
of transmission of
organisms.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly
disagree Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
 The following list gives some
examples when hands should be
washed
 Before preparing, handling or eating food
 After visiting the toilet
 Whenever hands are visibly dirty
 After bed making
 After Removing Gloves
 Before wearing sterile gloves.
 Before and after administering medication
 After any possible microbial contamination
 Any situation which involves direct patient/client contact e.g.
bathing, assisting to move
 Before and after handling wounds, urethral catheters
 After handling contaminated laundry and waste.
 Before and after emptying urine drainage bags for susceptible
patients Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
 How to wash
Hands
 Handwashing
 Remove jewelry before hand wash procedure
 Rinse hands under running water.
 Lather with soap and, using friction, cover all
surfaces of the hands and fingers.
 Rinse and dry with disposable towel
 Use towel to turn off taps (if not elbow)
 Handrubs
 Applyto palm of one hand, rub hands together
covering all surfaces until dry
 Application is key: Let It Dry!
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
 Education/Motivation
Programs
 Monitor
healthcare workers (HCWs)
adherence with recommended hand
hygiene practices and give feedback
 Implement a multidisciplinary program
to improve adherence to
recommended practices
 Encourage patients and their families
to remind HCWs to practice hand
hygiene
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Vijay Pratap Raghuvanshi
M.Phil & MHA
( Hospital & Health
 Proposed Strategies to Improve Hand Washing
Technique and Compliance
Obstacle Strategy

Lack of Education with supportive literature, videotaped instructions, hand washing

knowledge demonstrations; frequent refreshers; involvement of personnel in education
and feedback
Lack of Direct observation and feedback on regular basis; role models; involvement of
motivation staff in studies; application of new technologies
Programs on hand hygiene for patients and families

Availability Hand washing facilities conveniently located throughout the health care setting
of hand A sink accessible to personnel in or just outside every room; more than one sink
washing per room may be necessary if a large room is used for several individuals.
facilities Hand washing facilities in or adjacent to rooms where health care procedures
are performed
Accessible, adequately supplied and proper functioning soap and towel
dispensers or hand dryers
Faucets with foot, wrist or knee operated handles; faucets with an electric eye
arealso desirable.
Hand Waterless antiseptic
Hand washing agents
products that readily
have a available
high levelinofwall mounted dispensers,
acceptability to staff, withor
washing insmall containerscost,
appropriateness, for mobile
supply,care
etc.,such astaken
being homeintocareconsideration
and for emergency
product responders.
Dermatitis Lotions to prevent skin dryness
Lotion supplied in small, non-refillable containers
Compatibility between lotion and antiseptic products and effect on glove
integrity Vijay Pratap Raghuvanshi
Lotions approved by personnel in infection control M.Phil & MHA health
and occupational
( Hospital & Health
 PREVENTION
IS PRIMARY!
Protect patients…protect healthcare personnel…
promote quality healthcare!

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health
How clean are
you???

Vijay Pratap Raghuvanshi

M.Phil & MHA
( Hospital & Health