Hand washing

For many healthcare workers, hand washing has become automatic since we know that maintaining proper hand hygiene is important to preventing the spread of infectious. It has long been known that hand hygiene among health care workers plays a central role in preventing the transmission of infectious agents. Improving Hand Hygiene among healthcare workers is currently the single most effective intervention to reduce the risk of hospital. HAND are the largest transmitters of pathogens in the health!care setting making hand hygiene the most important modifiable risk factor to a successful infection

Improving Hand Hygiene Among HealthCare Professionals

In health-care settings, hand hygiene is the single most important way to prevent infection From Dialogue, July 2009 Health!care associated infections affect hundreds of millions of patients worldwide every year. As an unintended result of seeking care, these infections lead to more serious illness, prolonged hospital stays, and induce long!term disability. Not only do they inflict une"pected high costs on patients and their families, they also lead to a massive additional financial burden on the health!care system and # last but not least # contribute to unnecessary patient deaths. $ost patient deaths and suffering attributable to health!care associated infections can be prevented. %ow!cost and simple practices already e"ist to prevent these infections. Hand hygiene, a very simple action, remains the primary measure to reduce health!care associated infection and the spread of antimicrobial resistance, enhancing patient safety across all settings. &et compliance with hand hygiene is very low throughout the world. Failure to apply infection control measures favours the spread of pathogens. 'his spread may be particularly important during outbreaks, and health!care settings can act as multipliers of disease, with an impact on both hospital and community health. 'he emergence of life!threatening infections such as severe acute respiratory syndrome ( A) *, viral haemorrhagic fevers (+bola and $arburg viral infections* and the risk of a new influen,a pandemic highlight the urgent need for efficient infection control practices in health care. $aking matters more difficult is that most health!care providers believe they are already practicing good hand hygiene, states information from the -ntario government.s Just Clean Your Hands campaign. -bservational audits from an -ntario study, however, showed a baseline general compliance rate of less than /01. And yet an increase in hand hygiene adherence of only 201 results in a /01 reduction in the rate of HAIs. 3hy does perception and practice differ4 Health!care providers generally clean their hands when they are visibly soiled, sticky or gritty or for personal hygiene purposes (i.e. after using the toilet*. 'his habit is fre5uently learned in early childhood. -ther hand hygiene indications uni5ue to health!care settings are not triggered by the 6habit7 to clean the hands. Highlighting these indications in health care are needed to create new habits. +"amples of actions in health care that do not naturally trigger a need

to clean hands include touching a patient, taking a pulse or blood pressure or touching the environment. 3hile all indications for hand hygiene are important, there are some essential moments in health!care settings where the risk of transmission is greatest and hand hygiene must be performed. 'he following are 3H-.s recommendations8

Indications for handwashing and hand antisepsis

3ash hands with soap and water when visibly dirty or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids, or if e"posure to potential spore!forming organisms is strongly suspected or proven or after using the restroom. 9referably use an alcohol!based hand rub for routine hand antisepsis in all other clinical situations described in items listed below if hands are not visibly soiled. Alternatively, wash hands with soap and water. Perform hand hygiene: a* before and after having direct contact with patients8 b* after removing gloves: c* before handling an invasive device (regardless of whether or not gloves are used* for patient care: d* after contact with body fluids or e"cretions, mucous membranes, non!intact skin, or wound dressings: e* if moving from a contaminated body site to a clean body site during patient care: f* after contact with inanimate ob;ects (including medical e5uipment* in the immediate vicinity of the patient. 3ash hands with either plain or antimicrobial soap and water or rub hands with an alcohol!based formulation before handling medication and preparing food. 3hen alcohol!based hand rub is already used, do not use antimicrobial soap concomitantly.

Technique matters
'o clean hands properly8

)ub all parts of the hand with an alcohol!based hand rub or soap and running water. 9ay special attention to fingertips, between fingers, backs of hands and the base of thumbs. <eep nails short and clean. )emove rings and bracelets. Do not wear artificial nails. )emove chipped nail polish. $ake sure that sleeves are pushed up and do not get wet. =lean hands for a minimum of >? seconds. Dry hands thoroughly. Apply lotion to hands fre5uently.

se of !loves
'he use of gloves does not replace the need for hand cleansing by either handrubbing or handwashing. 3ear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, and non!intact skin will occur. )emove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient. 3hen wearing gloves, change or remove gloves during patient care if moving from a contaminated body site to a clean body site within the same patient or to the environment.

"actors influencing adherence to recommended hand hygiene practices

#$served ris% factors for poor adherence

&elf-reported factors for poor adherence

3orking in intensive care 3orking during the week (vs. week!end* 3earing gowns@gloves Automated sink Activities with high risk of cross!transmission Anderstaffing or overcrowding

Hand!washing agents cause irritations and dryness inks are inconveniently located or shortage of sinks %ack of soap, paper towel -ften too busy or insufficient time 9atient needs take priority Hand hygiene interferes with health!care workerBpatient relationship %ow risk of ac5uiring infection from

High number of opportunities for hand hygiene per hour of patient care Nursing assistant status (rather than a nurse* 9hysician status (rather than a nurse*

patients 3earing of gloves or belief that glove use obviates the need for hand hygiene %ack of knowledge of guidelines and protocols Not thinking about it, forgetfulness No role model from colleagues or superiors cepticism about the value of hand hygiene Disagreement with the recommendations %ack of scientific information of definitive impact of improved hand hygiene on health care!associated infection rates