[STUDY] Hand hygiene

Types of microorganisms on hands

Transient organisms (high yield)

• Live in superficial skin layers

• Acquired from patient contact

• Remove w/ soap & water

• Responsible for MOST HAIs

  • Blood/ OPIM/ mucous/ patients

Resident organisms

• Live in deeper skin layers

• Difficult to remove

• Less associated with HAIs

How infection spreads via hands

1. Organism → HCP hands

2. Organism survives on hands

3. Hand hygiene missing/ incorrect

4. Contaminated hands → patient/ object

Transfer → survive → no hygiene. → contact

Gloves does not substitute hand hygiene

• Reduce risk

• But hands contaminated during glvoe removal

When to do hand hygiene?

• Visibly soiled

• Touching contaminated surfaces

• Before and after each patient

• Before and after gloves

Types of hand hygiene

1. Handwashing

• Soap + water

1. Antiseptic handwash/ handrub

• Antimicrobial agents

1. Surgical hand antisepsis

• Surgical level cleaning

Handwashing

• Detergents or soaps

• Removes dirt, soil, organic substances

• Wet hands = More organisms transferred

• Dry hands = less

Antiseptic agents

• Broad spectrum (capable of killing range of microorganisms)

• Fast acting

  • Reduce microbes significantly

  • Prevent infection

  • ETHANOL (fast/ strongest)

• Persistent (long lasting effect)

Antiseptic handwash

• Povidone iodine (5—10%)

  • 2—5 mins

• Helps rerduce transient organisms

• Visible soiled hands = Good alternative to handwashing

  • Antiseptic handwash is an acceptable alternative to handwashing when the hands are visibly soiled.

• Not visibly soiled = Use alcohol handrub

• Antimicrobial impregnated wipes = not acceptable for antiseptic handwash

Cannot use alcohol based hand rub and antiseptic handwash at same time

Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an acceptable alternative to handwashing.

but wipes not acceptable alternative to antiseptic handwashing

Antiseptic handrub

• Ethanol 60—95% best

• More effective than soap when not visibly dirty

  • Routine clinical cleaning

  • Before and after patient care

• 20—30 secs

• Fast, more effective

Surgical hand antisepsis

• Scrubbing hands/ forearms with brush for 10 mins = damage skin + shedding

• Scrubbing for 5 mins = effective as 10

• Scrubbing 2—3 minutes = reduce microbials to acceptable levels

  • Brush / sponge not necessary

antisepsis — process of destroying microorganism on living tissue

antiseptic — the actual product to perform that action

Surgical hand antisepsis (2 options)

1. Two stage method

2. Antiseptic handwash

• Povidone iodine (5—10%)

Two stage method (surgical hand antisepsis)

1. Soap + water

AND

2. Alcohol based rub

Containing 0.5—1% chlorhexidine gluconate

• Remove fake nails

• Short nails (<0.5cm)

• Remove jewelry

• No brushes

Considerations when selecting hand hygiene products

• Cost NOT main factor

  • Alcohol based handrub — most cost effective

• Dispensers must be reliable

• Don’t top off soap dispensers (contamination)

• Hand lotions = interact with gloves or contact dermititis

Irritant contact dermatitis

Caused by

• Frequent washing

• Gloves

• Hot water

= dry, itching, burning, CRACKED skin

—> Alcohol hand rub = less irritating than soap

Allergic contact dermatitis (ACD)

• Immune reaction (Type IV)

Caused by

• Fragrances

• Preservatives

• Emulsifiers (less common)

• Iodophors (antiseptic handwash) — common