hand washing
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Hand Hygiene in NICUDr Manan Parikh
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• Bacteria that cause hospital-acquired infections most commonly transmitted via HCW’s hands
• Studies have shown that washing hands between patients reduces spread of bacteria in health care
• HCW handwashing compliance rate 40%
Improving Hand Hygiene PracticeWhy?
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Minor Action _ Major Outcome
• Simple tasks can contaminate hands:
– Taking a patient’s vital signs– Touching the patient’s clothing or linens– Touching equipment and furniture nearby
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“Hand Hygiene
is the SINGLE
most important practice
to prevent
nosocomial infections”
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Benefits of Hand Hygiene
Reduced number of deaths Reduced number of infections:
Decreased antibiotic usage Decreased patient length of stay Decreased use of resources
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Definitions Hand Hygiene
a general term that applies to either handwashing, antiseptic hand wash, antiseptic hand rub or surgical hand antisepsis.
Handwashingwashing hands with plain soap and water.
• Antiseptic Hand Washwashing hands with water and soap or other detergents containing an antiseptic agent.
• Alcohol-based Hand Rub the alcohol-containing preparation applied to the hands to reduce the number of viable microorganisms.
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When To Perform Hand Hygiene?
“High Risk” for Contamination Activities
“Low Risk” for Contamination Activities
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Immediately before and after patient contact Immediately before and after a procedure Before and after touching any devices/equipment
directly connected to the patient e.g. IV Lines, Umbilical Lines, PICC Lines, Central Lines External Ventricular Drains Urinary Catheters Ventilation Equipment
“High Risk” for Contamination
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Moving from contaminated to a clean body site
After contact with body fluids
After coming from washroom
After taking food
“High Risk” for Contamination
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“Low Risk” for Contamination
After contact with equipmente.g. patients charts, monitors
After removing gloves
After contact with own nose/mouth/hair
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BEFORE Hand Wash
• Nails should be kept short / No Nail Polish
• Artificial nails should not be worn• Remove your footwear, take NICU slippers• Remove all your ornaments (rings, bracelet, bangles etc),
wristwatch before entering NICU• Roll over your sleeves up to elbow• Wear ICU Gown, Apron (even if you are not touching the
baby)• Use antiseptic solution for Hand rub (even if you are not
touching the baby)• Wear face mask, if you have common cold, cough, URTI
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How to do Hand Wash?
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Alcohol at EVERY bed helps increase compliance
0
5
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Pe
rce
nt
Co
mp
lia
nc
e
Baseline 1 Dispenser per4 Beds
1 Dispenser forEvery Bed
Biscoff WE et al 1998: Abstract K132
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Ensure that hands have no visible contamination
Apply product to palm of one hand and rub hands together covering all surfaces and fingers
Allow to air dry
The process takes about 15 seconds
How to do Hand Rub ?
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Continue rubbing hands together until alcohol is dry (should take 10-15 sec).
After using an alcohol based product, you will feel a “build up” on your hands. To remove this, wash your hands with soap and water as often as necessary.
A few tips when using the hand rub
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Before & After EVERY ACT
related to patient care
When to follow Hand Hygiene?
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Before Entering NICU
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When Hands are Visibly Soiled
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Before examining the Patient
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Before Touching the Patient
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In between 2 Patients
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Before VF Insertion
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Before Procedure
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Before - After IV Injections
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After Waste Disposal
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Before – After touching Infusion Pump
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Before – After touching Monitor
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Before – After touching Trolley
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Before – After Nappy Change
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After Handling Body Fluids / Secretions
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After Touching Files / Papers
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After removing gloves
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After touching the Mobile
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WHO should follow Hand Hygiene?• Consultants• Outside consultants visiting NICU
(Superspecialist, Radiologist, Neurologist, Physiotherapist etc)• In-House Paediatrician• Resident Doctors• Nurses• Health care assistant• Support staff• X-ray Technician• Lab Assistant• Mothers / Relatives / Visitors• Cleaning Staff• Hospital Management Staff• Maintenance people of different NICU instruments • WHO SO EVER ENTERS THE NICU ---- MUST FOLLOW HAND HYGIENE
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Nurse’s Role
• Follow the Hand Hygiene Guidelines– For every patient– For every act– In every shift
• Observe others…. If somebody is not following Hand Hygiene… Even if CONSULTANTS… You have right to tell them to follow Hand Hygiene Guidelines
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Single Step to Prevent Infection
Hand washing
Hand washing
Hand washingHand washing
Hand washing
Hand washing
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Questions ?