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HAND

H Y GIEN E

Jerome H.
Mamaril RN

OBJECTIVES

OUTLINE

HISTORY OF
HANDWASHING

A French Pharmacist
demonstrated that
solutions containing
chloride of lime or soda
could eradicate the foul
odor associated with
human corpses and be
used as disinfectants
and antiseptics

182

HISTORY OF
HANDWASHING
Ignaz Philipp
Semmelweis insisted
that physicians cleanse
their hands with chlorine
solution between
patients. Thereafter, the
maternal mortality rate
in the First Clinic
dropped dramatically.

184

(CDC,

HISTORY OF
HANDWASHING
The U.S. Public Health Service
recommendations directed
personnel to wash their
hands with soap and water for
1 to 2 minutes before and
after patient
contact. Rinsing hands with an
antiseptic agent was believed to
be less effective than hand
washing with plain soap and
was recommended only in
emergencies or in areas where
sinks were not available.

196

HISTORY OF
HANDWASHING
Guidelines on hand washing
practices in hospitals were published
by CDC. They recommended hand
washing with plain soap between
patients and
washing with antimicrobial
products before and after
performing invasive procedures.
Waterless antiseptic agents such as
alcohol-based solutions were
recommended only in situations
where sinks were not
available.

1975 &
1985

HISTORY OF
HANDWASHING
Healthcare Infection Control
Practices Advisory Committee
(HICPAC) recommended that upon
leaving the rooms of patients with
multi-drug resistant pathogens
such as methicillin-resistant
Staphylococcus aureus (MRSA),
caregivers use either antimicrobial
soap or a waterless antiseptic
agent to cleanse their hands. These
guidelines also recommended
hand washing and hand antisepsis
for routine patient care.

1995 &

HISTORY OF
HANDWASHING

Guideline for Hand Hygiene in


Health-Care Settings was
published as the
recommendations of the
Healthcare Infection Control
Practices Advisory Committee
and the
HICPAC/SHEA/APIC/IDSA Hand
Hygiene Task Force. In 2010,
the 2002 Guideline continued
to be available on the CDC
website (CDC, 2002).

200

HISTORY OF
HANDWASHING
World Health Organization (WHO)
reaffirmed the recommendation to
wash hands with soap and water
when visibly dirty, soiled with blood
or other body fluids, or exposed to
potential spore-forming
pathogens, such as Clostridium
difficile.
When hands are not visibly soiled,
the WHO recommended the use of
alcohol-based hand rubs as the
preferred means for routine
hand antisepsis

200

(WHO,

HISTORY OF
HANDWASHING
Although the guidelines of all these
healthcare organizations have been
adopted by the majority of
hospitals, adherence by healthcare
providers to recommended hand
washing protocols remains low. For
this reason, various professional
groups have undertaken studies to
identify factors that improve
adherence to hand hygiene
protocols.

201

Categories of skin flora


Resident
Transient
Flora
Flora

Deep seated Superficial


Difficult to
Transferred
remove
with ease to
and from
hands
Part of the
Deactivated
bodys
through
natural
Hygienic
defense
hand

SOURCES &TRANSMISSION OF
PATHOGENS

SOURCES &TRANSMISSION OF
PATHOGENS

Patient

Inanimate
Objects

SOURCES &TRANSMISSION OF
PATHOGENS

HAND HYGIENE
PRODUCTS

HAND HYGIENE
PRODUCTS
IODINE AND
IODOPHORS

Iodine and iodophors have bactericidal


activity against
gram-positive, gram-negative, and
certain spore-forming bacteria (e.g.,
clostridia, Bacillus spp.) and are active
against mycobacteria, viruses, and fungi.
However, in concentrations used in
antiseptics, iodophors are not usually
sporicidal. The majority of iodophor
preparations used for hand hygiene
contain 7.5%10% povidone- iodine.

When to perform hand


hygiene?

FIVE MOMENTS FOR HAND


HYGIENE

WHO,
2012

Missed Spots in
Washing Hands

Webs of
fingers
Thumbs
Palms
Nails
Backs of
fingers &
hands

Running
Water

Soa
p

Liqui
d
Soap

Sanitiz
er
1

Palm to palm

Base of thumbs

Paper
Towel
2

Back of hands

Between fingers

Fingernails

Wrists

Towel

Sink
WASTE BIN

Back of fingers

Rinse & wipe dry

1. Remove
hand /wrist
jewelries, watch

2. Keep
your nails
short
X

3. Avoid nail
polish and
artificial nails

HAND HYGIENE
PROCEDURE

HAND HYGIENE
PROCEDURE

1 ) PALM TO PALM

2 ) R i g h t Palm over
dorsum and vice
versa

3 ) Palm t o palm,
fingers
interlaced

4 ) Back of fingers t o
opposing Palms, fingers
interlocked

5 ) Rotational r u b b i n g of r i g h t t h u m b
clasped i n l e f t p alm and vice
versa

6 ) Rotational rubbing, backwards


and f o r w a r d s w i t h clasped fingers
of r i g h t hand i n l e f t p alm & vice
versa

BARRIERS TO HAND
HYGIENE
Inaccessible hand hygiene supplies
Skin irritation caused by hand hygiene agents
Hand washing and hygiene products thought to
be harmful to the skin
Priority of care (the patients need takes
priority over hand
hygiene)
Lack of knowledge of the guidelines
Lack of feedback to encourage compliance
Insufficient time for hand hygiene
Forgetfulness
High workload and understaffing
Lack of scientific information about healthcare-

REFEREN
CES