importance of hand hygiene in icu : dr devawrat buche

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Dr. Rajesh PandeDr. Devawrat Buche

HAND HYGIENE PRACTICES

BASIC QUESTIONS ???

• WHO started it ?? – A Brief history.• WHY TO PRACTICE ?• WHEN TO PRACTICE ? • WHAT TO PRACTICE WITH ?• HOW TO PRACTICE ?

• Ignaz Philipp Semmelweis (July 1, 1818 – August 13, 1865)

• A Hungarian physician , in Vienna General Hospital, now known as the "savior of mothers“

• Puerperal fever was common in mid-19th-century hospitals and often fatal, with mortality at 10%–35%.

• Semmelweis discovered that the incidence of puerperal fever could be drastically reduced with the use of chlorinated lime solutions in obstretic clinics ( 1847 )

Milestones in Hand Hygiene• 1980: First hand hygiene guidelines published in

English literature• 1995-96: CDC recommended use of antimicrobial

soap or a waterless antiseptic agent for cleaning hands upon leaving patient rooms.

• 2002: Healthcare Infection Control Practices Advisory Committee Guidelines defined alcohol-based handrub as the standard of care for hand hygiene in healthcare settings.

1.WHY TO PRACTICE HAND HYGIENE ??

WHY TO PRACTICE HAND HYGIENE

• The burden of HCAI is greatly increased in the ICU• Prevalence rates of infection

– In Europe: 9.7% to 31.8%– US: 9% to 37%– Crude mortality rates: 12-80%

• The use of invasive devices (e.g., CVC, MV or urinary catheters) is one of the most important risk factors for acquiring HCAIs.

• Not only the morbidity and mortality is high, but multidrug-resistant pathogens are commonly involved in such infections and render effective treatment challenging

• Most common mode of transmission of pathogens is via hands

• Hands of HCWs may become persistently colonized by pathogenic flora– S. aureus, Gram-negative bacilli, or yeast– The bacterial density of transient and resident flora, usually

between 3.9 x 104 colony-forming units (CFU)/cm2 and 4.6 x 106 CFU/cm2 and is relatively constant for any given individual.

• Hands can be contaminated with GNB, S. aureus, enterococci, or C. difficile by performing “clean procedures,” such as lifting a patient or taking the patient’s pulse, blood pressure, or temperature, or by touching intact areas of a hospitalized patient’s skin

• Both Enterococcus faecalis and E. faecium survived for at least 60 mins on fingertips.

• Pseudomonas aeruginosa and Burkholderia cepacia were transmissible by handshake for up to 30 mins when the organisms were suspended in saline and for up to 180 mins when they were suspended in sputum.

• People suffering from dermatitis commonly remain colonized for prolonged time periods

• "Proper handwashing with soap and water is an important barrier to many infectious diseases and promotes better health and well-being…handwashing is one of the most practical and effective ways of preventing the spread of disease."

World Health Organization (WHO)

2.WHEN TO PRACTICE HAND HYGIENE

3.WHAT TO PRACTICE WITH ??

*Plain or antimicrobial soap & water better than alcohol-based hand rub if hands visibly soiled, or for spore-forming organisms (e.g. C. difficile, anthrax),

Antimicrobial soap recommended over plain soap in health care settings.

GOOD BETTER BEST

PLAIN SOAP & WATER

ANTIMICROBIAL SOAP & WATER

ALCOHOL-BASED HAND

RUB*

1. Soap; bar, liquid or foam dispenser• Anti-microbial soaps are slightly more effective than regular soaps.• When hands are visibly dirty, soiled with blood or other body fluids, or

after using the toilet.• But, frequent handwashing often causes skin irritation and dryness.

2. Hand Sanitizer; gels, rinses, or foams• Less time, fast action, more effective, more accesible and most

efficacious antimicrobial agents• 60 – 80% alcohol (Dix, 2010) and Chlorhexidine ( 0.5 – 4 %) - rapid and

optimal antimicrobial spectrum; bacteria, viruses, yeasts, and fungi • Hypoallergenic • Odorless• Colorless

4. HOW TO PRACTICE HAND HYGIENE?

• Hands must be washed for atleast 20-25 seconds.

• Even intact skin of patients and healthcare workers can be colonised with disease causing bacteria!

ELBOW HEEL OF YOUR PALM

Proper Ways of Using Hand Sanitizer

• Keep your natural fingernails short to about ¼ inch.

• Do not wear artificial nails when having direct contact with high-risk patients (e.g., ICU, OR).

• Recommendations on rings, jewellery is unresolved

FINGERNAIL HYGIENE

• Handwashing with soap and water. Available at: http://www.youtube.com/watch?v=WYj2kkSIsOc&feature=related

• Handwashing with Hand rub. Available at: http://www.youtube.com/watch?v=JHoPQTTfCv0

• Recommendations from the CDC Guideline for Hand Hygiene in Healthcare Settings. Available at: http://solutions.3m.com/3MContentRetrievalAPI/BlobServlet?locale=en_US&lmd=1145337135000&assetId=1114284208573&assetType=MMM_Image&blobAttribute=ImageFile

PREVENTIONIS PRIMARY!

Protect patients…protect healthcare personnel…

promote quality healthcare!

THANK YOU !!!!