hand washing technique - (2014 - 2015)

History of Hand Washing

1st Year MB;BS( 2014 – 2015 )

BMS Block

Hand Washing

Message

Clean Hands Saves Lives

Clean care is safe Care

WHO

WHO - Five MomentsRemember always…..

• Before patient care• After environmental contact• After contact with blood / body fluids• Before an aseptic task• After patient care

….points to note….• What is hand washing• The importance of hand washing• Brief history of hand washing….. the time• Role of Moses bin Maimon and

Semmelweis• Micro-organisms on the hands / palms• Types of hand washing• How to wash hands – paying particular

attention to specific areas


Hand Washing Is The Single

Most Important Means Of Preventing The Spread

Of Diseases

Checks the spread of Diseases

• minimize spread of influenza• diarrhea prevention – 3.5 million • avoiding respiratory infections – 1.8 million• preventive infant deaths in home-deliveries• checks the diseases spread by virus (SARS)

Moses bin Maimon (1135 – 1204)

“Never to forget to wash your hands after touching a sick patient”• the history of hand washing went through a painfully slow pace stretched over 700 years Moses bin Maimon• familiar with the works of Hippocrates and Galen• practiced and taught medicine in Egypt• contributed to the principles of hygiene

container – water for washing

Before seeing patients•Maimonides strictly followed the principles of hygiene by observing cleanliness •Cleanliness is the physician’s best friend

“ I dismount from my animal, Wash my hands Go forth to my patients”.

History of Hand Washing• Maimon’s observations and teachings on

cleanliness were ignored by the medical profession• No progress from 1204 – 1843

Oliver Wendell Holmes• (1809 -1894)• Harvard Professor of Anatomy

• Anatomy in 1843 published

• “Puerperal Fever, as a Private Pestilence”


“From one person to another…”•puerperal fever (child-bed fever)•transmitted from patient to patient by none other than the doctors and nurses attending them •he preached the doctrine of child-bed cleanliness “To guard is better than to heal” was ignored. His views were not accepted.


• Hungarian-born physician• worked in 3 institutions 15 years working experience• 1846 -- Vienna Lying – in Hospital• observed that puerperal fever was more common in women after childbirth when assisted by medical students than in women when Semmelweis assisted by midwives


• patient afflicted in rows• primiparae worse women delivered enroute to hospital less likely to develop fever• appeared that students/physician who conducted autopsy carried the infection to women in the First Clinic Ward


Two clinics• First Clinic Wards - student doctors = 11.25 mortality• Second Clinic Wards – midwives = 2.85 mortality(within 7 months mortality rate dropped to 3%)


1847 mandate•Semmelweis issued orders•students and physicians who •performed postmortem •examinations have to wash their hands•chlorine water / chlorinated lime solution before seeing patients (the reward - he was fired from this job)

History of Hand WashingDisbelief and Reluctance – greeted •his findings and recommendations•in 1850 he left Vienna•returned to Hungary•in 1861 he published (The Etiology, the concept and Prophylaxis of Childbed Fever)•died in 1865 •from Pyopneumothorax after suffering from a wound •sustained in an insane asylum


• only in the 20th Century was hand washing finally accepted as a procedure

• now considered the single most important procedure • prevent nosocomial infection• over 2 million of these infections occur annually in American hospitals

Hand Washing Technique

MBBS Year 1 (2014-2015) Semester 1

September 2014Dr. P Y Lee

Hand Washing Technique

Soap and WaterCheap and Effective: Soap and water are more effective than hand sanitizers at removing or inactivating certain microbes Using soap is more effective than using water alone because the surfactants in soap lift soil and microbes from skin

Hand Washing technique

Why do you think you have to learn how to wash your hands?• hand-mediated transmission

– one of the major contributing factors• reduces or even cut off the chain of

transmission• reduces complication of wounds / surgical

wounds**• directly cuts down length of hospital stay**• cuts down cost in the care of patient


What is good to avoid and to follow?•avoid the use of soap unless it is “one cake for each person”•avoid using the blower / dryer•wash hands before and after examining the next patient, •some surgeons do it before patients leave the consultation


Micro-organismsResident – normal flora (commensals)• deeper in the epidermis (difficult to remove)

– skin crevices– nails, sweat glands, hair follicles

Transient– located on the surface of the skin– poses a problem– direct contact causes transfer of these micro-organisms


Levels of decontamination•social •hygiene•surgical hand washing

Surgical hand washing•most important•detergent and time of scrubbing**•(second washing, shorter time needed)•wrist and forearms•sterile brush•towel


Important to note the following:

• observe time taken for washing • variable, depending on level of importance

– the detergent applied– plain soap and water, antiseptic detergent– chlorhexadine, povidine-iodine, – alcoholic rub–gel**

• can be anything from 30 sec. up to 3 min. or even 10 min.

– follow the SOP and your Study Guide

October 15

hand washing technique - (2014 - 2015)

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