Hand hygiene is therefore the most important measure to avoid the transmission of harmful germs and prevent health care-associated infections. • This brochure. HAND WASHING TECHNIQUES. WHEN SCRUBBING. Remove jewellery and trim the nails. Use soap, a brush (on the nails and fingertips) and running water to . Wash hands with soap and water for seconds immediately after taking off PPE. If hands are soiled, wash hands with soap and water for seconds.

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PDF | ARTICLE INFO ABSTRACT Unclean or soiled hands transmit infections in a community as Children are more prone to infection/infestation as they play. Importance of Hand Washing. • Keeping hands clean through improved hand hygiene is one of the most important ways to prevent sickness and spreading. Hand washing with soap and water has been considered a measure of .. Morb Mortal Wkly Rep Recomm 25; beijuaganette.ga

The highest rates of hand contamination are reported from critical care areas, which also report most cases of cross-transmission. Importance of hand hygiene Proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of HAIs and the spread of antimicrobial resistance 1 — 3 , 20 — An increase in handwashing compliance has been found to be accompanied by a fall in MRSA rates The hand hygiene liason group identified nine controlled studies, all of which showed significant reductions in infection related outcomes, even in settings with a high infection rates in critically ill patients 14 , 27 , Transmission of Health-care-associated Klebsiella sp.

The evidence suggests that adherence to hand hygiene practices has significantly reduced the rates of acquisition of pathogens on hands and has ultimately reduced the rates of HAIs in a hospital 22 , 23 , 26 , 29 — Indications for hand hygiene during patient care Wash hands with soap and water when i visibly dirty or contaminated with proteinaceous material, blood, or other body fluids and if exposure to Bacillus anthracis is suspected or proven since the physical action of washing and rinsing hands in such circumstances is recommended because alcohols, chlorhexidine, iodophors, and other antiseptic agents have poor activity against spores ; ii After using a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water; and iii before and after having food 1 — 3 , 21 — 23 , In all other clinical situations described below, when hands are not visibly soiled, an alcohol-based hand rub should be used routinely for decontaminating hands 1 — 3 , 21 — 23 , Other precautions in relation to hand sanitation Avoid unnecessary touching of surfaces in close proximity to the patient.

Infection prevention and control

Although rings harbour a high count of pathogens, they have not been found to be associated with transmission of infections Method of hand washing 1 , 2 , 21 For handwashing, remove the jewelry and rinse hands under running water preferably warm.

Lather with soap and using friction, cover all surfaces of hands and fingers. Wash thoroughly under running water. Dry hands with a single use towel or by using forced air drying.

Hand Hygiene Print Materials

Pat skin rather than rubbing to avoid cracking. If disposable towels are used, throw in trash immediately. Skin excoriation may lead to bacteria colonizing the skin and the possible spread of blood borne viruses as well as other microorganisms.

Sore hands may also lead to decreased compliance with hand washing protocols 1 , 2 , If using antiseptic rub, take an adequate amount and rub on all surfaces for the recommended time. Let the antiseptic dry on its own. Agents used for hand hygiene Table I lists the properties, advantages and disadvantages of the commonly used agents for hand hygiene 1 — 4 , 21 , Table I Open in a separate window Selecting hand hygiene products for health set-ups The major determinants for product selection are antimicrobial profile, user acceptance, and cost 2 , 4 , Post-contamination hand hygiene products must have at least bactericidal, fungicidal yeasts , and virucidal coated viruses activity.

Since hands of HCWs are frequently contaminated with blood during routine patient care, activity against coated viruses should be included in the minimum spectrum of activity of an agent for hand hygiene 4.

Additional activity against fungi including molds , mycobacteria, and bacterial spores may be relevant in high risk wards or during outbreaks. Pre-operative hand hygiene should be at least bactericidal and fungicidal yeasts , since the hands of most HCWs carry yeasts and surgical- site infections have also been associated with hand carriage of yeasts during an outbreak 4.

Hospital administrators should also take into account the acceptability of product smell, feel, skin irritation by the users and its allergenic potential 1 — 4 , When comparing the cost of hand hygiene products, it has been found that the excess hospital cost associated with only HAIs of average severity may equal the entire annual budget for hand hygiene products used for in-patient care areas 3 , One of the key elements in improving hand hygiene practice is the use of an alcohol based hand rub instead of washing with soap and water.

An alcohol-based hand rub requires less time, is microbiologically more effective and is less irritating to skin than traditional hand washing with soap and water 2 , 3 , In the ICUs, switching to alcohol hand disinfection would decrease the time necessary for hand hygiene from 1.

Reasons for poor hand hygiene practices In most health care institutions, adherence to recommended hand-washing practices remains unacceptably low, rarely exceeding 40 per cent of situations in which hand hygiene is indicated 35 , Hand hygiene reflects attitudes, behaviours and beliefs. Table II Open in a separate window Methods used to improve hand hygiene compliance Multimodal strategies have been shown to be more successful in improving rates of adherence with hand hygiene in HCWs than single interventions Targeted, multi-faceted approaches focusing on system change, administrative support, motivation, availability of alcohol-based hand rubs, training and intensive education of HCWs and reminders in the workplace have been recommended for improvement in hand hygiene Recent studies support the fact that interactive educational programmes combined with free availability of hand disinfectants significantly increased the hand hygiene compliance 42 , A single lecture on basic hand hygiene protocols had a significant and sustained effect in enhancing hand hygiene compliance in a Swedish hospital The four member States of the European Union, which implemented National Hand Hygiene Campaigns found the following strategies to be extremely useful in their countries: Governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol based hand rub consumption and auditing hand hygiene compliance Trampuz et al 35 advocated simple training sessions for HCWs to be held in each ward to introduce the advantage of alcohol hand rubs over hand washing.

Other factors like positive role modeling hand hygiene behaviour of senior practitioners and the use of performance indicators also remarkably improve adherence to hand hygiene 40 , There should be adequate supply of hand hygiene products, lotions and creams, disposable towels and facilities for hand washing, where necessary 2 — 4 , 35 , 40 , Alcohol hand rubs should be available at the point of care in sufficient quantities. It needs to be emphasized that wearing gloves does not replace the need for hand hygiene and that contamination may occur during glove removal.

Studies by Pitet 26 , 45 showed a remarkable and long lasting improvement in hand hygiene compliance using a multimodal strategy, which has been adopted by the first Global Patient Safety Challenge of WHO to develop hand hygiene strategies.

The availability of individual, pocket carried bottles also increased compliance 38 — 40 , 46 — Apart from this, all hospitals should have a dynamic infection control team, robust surveillance system, adequate staff to disseminate evidence-based knowledge in an easily comprehensible way to all cadres of staff. At a more local or regional level, there is a need for institutional frameworks or programmes to deal with HAIs The Institute for Healthcare Improvement www.

Research and education To develop successful interventions, more research into behavioural determinants is needed, in particular, how these determinants can be applied to improve hand hygiene 51 , Process indicators are vital and an understanding of why some interventions succeed and others fail is needed.

Since hand hygiene is more of a behavioural practice, the first step towards the development of interventions should be to identify the prevalence of risk behaviours i.

Since the reasons for non-compliance vary among countries, large scale systematic studies are needed to identify the reasons thereof and plan remedial strategies. An expert panel has recommended that measuring hand hygiene compliance is essential to understand the current situation, facilitate change and to measure the impact of interventions This can be done by direct observation, automated electronic monitoring, product consumption and self reporting by HCW The important aspect of role models for students, whose adherence is strongly influenced by their mentor's attitude at bed side should be exploited in moulding the behaviour of young medical students.

Hand Hygiene

A few lectures in the undergraduate curriculum may prime the medical students to this basic necessity. The Hand Hygiene Liason Group strongly advocates teaching of elementary hygiene practices at medical schools In an elaborate study focusing on MBBS students, it was noted that assessing the knowledge, attitude and practices of final year MBBS students and providing a positive role modeling at undergraduate level is a good initiative Indian scenario In India, the quality of healthcare is governed by various factors, the principal amongst these being whether the health care organization is government or private-sector run.

There is also an economic and regional disparity throughout the country. About 75 per cent of health infrastructure, medical manpower and other health resources are concentrated in urban areas, where 27 per cent of the population lives There is a lack of availability of clean water for drinking and washing.

Like in other developing countries, the priority given to prevention and control of HCAI is minimal. This is primarily due to lack of infrastructure, trained manpower, surveillance systems, poor sanitation, overcrowding and understaffing of hospitals, unfavourable social background of population, lack of legislations mandating accreditation of hospitals and a general attitude of non-compliance amongst health care providers towards even basic procedures of infection control. In India, although hand hygiene is imbibed as a custom and promoted at school and community levels to reduce the burden of diarrhoea, there is a paucity of information on activities to promote hand hygiene in HCFs.

Sporadic reports document the role of hands in spreading infection and isolated efforts at improving hand hygiene across the country 54 , 58 — The practice of compulsory training on standard precautions, safe hospital practices and infection control for all postgraduates upon course-induction, as is being done in a few Delhi medical colleges seems very promising for our country.

Challenges ahead Although evidence based guidelines are increasingly being implemented in the developed countries, the developing countries still lack basic health care facilities, surveillance networks and resources to curtail HAIs 61 — Lack of hand washing facilities e. The use of WHO advocated alcohol based hand rubs is a practical solution to overcome these constraints, because these can be distributed individually to staff for pocket carriage and placed at the point of care.

The major advantage is that its use is well applicable to situations typical of developing countries, such as two patients sharing the same bed, or patient's relatives being requested to help in care provision.

Several hospitals are now reporting increased compliance after implementation of CCiSC However, global Healthcare Infection Prevention programmes can only be successful, if these populous developing nations are able to control the menace by formulation of national or local policies and strictly implementing the guidelines.

Conclusion Hand washing should become an educational priority. Educational interventions for medical students should provide clear evidence that HCWs hands become grossly contaminated with pathogens upon patient contact and that alcohol hand rubs are the easiest and most effective means of decontaminating hands and thereby reducing the rates of HAIs. Increasing the emphasis on infection control, giving the charge of infection control to senior organizational members, changing the paradigm of surveillance to continuous monitoring and effective data feedback are some of the important measures which need to be initiated in Indian hospitals.

One of the reasons microbes have survived in nature is probably their simplicity: a simple genomic framework with genetic encryptation of basic survival strategies. To tackle these microbes, human beings will have to follow basic and simple protocols of infection prevention. The health care practitioners in our country need to brace themselves to inculcate the simple, basic and effective practice of hand hygiene in their daily patient care activities and serve as a role model for future generations of doctors, nurses and paramedical personnels.

References 1. Guide to implementation of the WHO multimodal hand hygiene improvement strategy. First Global Patient Safety Challenge. Clean Care is Safer Care. Boyce JM, Pittet D.

Morb Mortal Wkly Rep. Kampf G, Kramer A. Epidemiologic background of Hand Hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev. Handwashing: simple, but effective. Ann R Coll Surg Engl. Labarraque AG. Instructions and observations regarding the use of the chlorides of soda and lime. In: Porter J, editor.

Hand Hygiene

Semmelweis I. Etiology, concept, and prophylaxis of childbed fever. In: Carter KC, editor. Rotter ML. Hyg Med. Role of airborne transmission in Staphylococcal infections. Handwashing practices for the prevention of nosocomial infections.

Ann Intern Med. CDC guideline for handwashing and hospital environmental control, Infect Control.

Infect Control Hosp Epidemiol. The EPIC project: developing national evidence- based guidelines for preventing healthcare associated infections. J Hosp Infect. Wash Your Hands Posters These simple posters remind people to wash their hands. Alcohol based handrubs: Easy as 1, 2, 3 MDH poster about alcohol based hand rubs. Cleaning Hands with Hand Sanitizer Components to cleaning hands with alcohol-based hand sanitizers also known as handrubs , the proper technique, and how hand sanitizers work.

Clean Your Hands: It is as Easy as Poster Flyer showing three steps to using alcohol hand sanitizers and washing with soap and water. Hand Hygiene How-To Poster This letter sized poster shows the six steps for washing hands with soap and water or two for cleaning with alcohol-based hand sanitizers.

Localised tools

Clean Your Hands! Poster This 11x17 poster shows the six steps for washing hands with soap and water or two for cleaning with alcohol-based hand sanitizers.

Which Soap is Best? Antibacterial soap vs. Which is better? Liquid soap or bar soap? What about alcohol-based hand sanitizers?

Germs Are Tough This poster teaches about germs. Teaching handwashing: Hand Washing: Hand Sanitizers: Handwashing with a Nail Brush Eight steps to washing hands using a nail brush poster that could be hung in restrooms.

Cover your Cough:Hand Hygiene How-To Poster This letter sized poster shows the six steps for washing hands with soap and water or two for cleaning with alcohol-based hand sanitizers.

Historical background The significance of hand washing in patient care was conceptualized in the early 19th century 6 — 8. Additional Resources.

In: Carter KC, editor. The best way to wash your hands is to use warm water and soap to lather up your hands and fingers.