Hand Hygiene

Hand Hygiene

“Clean care for all - it's in your hands” –WHO (2019)

  • Hand hygiene is a critical component of infection prevention and control.
  • Most health care-associated infections are preventable through good hand hygiene i.e. cleaning hands at the right times and in the right way.
  • Hand hygiene reduces the transmission of microorganisms (including those that are antibiotic-resistant), increases patient safety, and decreases health care-associated infection (HAI) -WHO
  • Effective, timely hand hygiene is a cornerstone of infection prevention and control.

What are your hands carrying

Micro-organisms found on the skin include two categories

Resident
Micro-Organisms

(normal flora)

These are usually deep seated in the epidermis, are not readily removed and do not readily cause infections.

Transient
Micro-Organisms

Ex.COVID-19 Virus

These are organisms that are not part of the normal flora and represent recent contamination that usually survives for a limited period of time. They are easily removed by a good hand washing technique.

Hand Hygiene

Hand hygiene is a general term that applies to either hand washing, hand rubbing (e.g.,using an alcohol-based hand rub), or surgical hand antisepsis and protecting hands from contamination by using gloves.

Purpose of hand hygiene

In the health care environment microorganisms, such as bacteria, viruses and fungi are transmitted through various routes.

  • Prevent spreading of microorganisms between patients.
  • Prevent contamination of the health care environment (e.g., linens, surfaces, patient care devices).
  • Protect patients by preventing infections from happening in the first place, and from spreading if they are already present
  • Reduce the number of patients acquiring a health care-associated infection (HAI), less morbidity and death.
  • Reduce the antibiotic use, which contributes to decreased antibiotic resistance.
  • Remove soil, organic material, and transient microorganisms from the hands.

Moments
for hand hygiene

The 5 Moments for Hand Hygiene focuses on contact occurring within the patient zone during the delivery of patient care.

Patient zone Includes the patient and all inanimate surfaces that are touched by or in direct physical contact with the patient, such as the bed rails, bedside table, bed linen, infusion tubing and other medical equipment. It further contains surfaces frequently touched by health care workers while caring for the patient, such as monitors, knobs and buttons, and other touch surfaces.

Step 1 Step 2 Step 3 Step 4 Step 5

Clean your hands before touching a patient when approaching him/her to protect the patient against harmful germs carried on your hands.

Clean your hands immediately before accessing a critical site with infectious risk for the patient to protect the patient against harmful germs, including the patient’s own, entering his/her body.

Clean your hands immediately after an exposure risk to body fluids (and after glove removal). This will protect both you and the health care environment from pathogens in blood and body fluids.

Clean your hands after touching a patient and his/her immediate surroundings, and when leaving the patient’s side, to protect yourself and the health care environment from harmful microorganisms.

Clean your hands after touching any object or furniture in the patient’s immediate surroundings when leaving – even if the patient has not been touched – to prevent the spread of harmful microorganisms from inside the patient zone to the rest of the health care environment.

Gloves and hand
hygiene

Glove use is an important part of protecting hands from contamination. If an HCW is wearing gloves, it does NOT mean that hand hygiene can be skipped. In other words, glove use does NOT replace the need for hand hygiene. Considerations for hand hygiene and glove use include:

  • Gloves are worn when contact is anticipated with blood or other body fluids, mucous membranes, non-intact skin, potentially infectious material, or chemicals (such as cleaning solutions).
  • Hand hygiene is performed before putting on gloves.
  • Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient.
  • Perform hand hygiene after glove removal. It is important to know that hand contamination often occurs during glove removal due to poor technique and also, possibly, as a result of small, undetected holes in gloves.
  • Perform hand hygiene after glove removal. It is important to know that hand contamination often occurs during glove removal due to poor technique and also, possibly, as a result of small, undetected holes in gloves.
  • Hands that are not clean when reaching into a box of gloves can spread microorganisms throughout the glove box. This is one reason why hand hygiene should always be performed before putting on and after taking off gloves.

Drying hands

Drying hands after using soap and water is an important step of hand hygiene after using soap and water, because the transmission of microorganisms is more likely to occur with wet skin than with dry skin.

Dry hands thoroughly with a method that does not re-contaminate or irritate the hands, such as:

Air-drying

(manual drying by movement of hands)

Note: Warm-air dryers for drying hands are not recommended in health facilities, as forced air can result in the spread of pathogens through water droplets.

Using a single use towel

Using a paper towel or single-use cloth to pat hands dry. Towels should not be used multiple times or by multiple individuals because shared towels quickly become contaminated

Hand washing with Soap and water demonstration

Hand Hygiene with Soap and water-WHO

Hand hygiene demonstration using soap and water

Now that you have learned about the proper way to wash your hands, practice this technique. Have a co-worker look at the hand hygiene compliance poster for Hand washing using Soap and Water and observe as you wash your hands. Ask him or her to give you feedback

Hand Hygiene Technique with Soap and Water (40-60 Sec)

Hand Hygiene Technique with ABHR

Hand hygiene demonstration using Alcohol- Based Hand Rub(ABHR)

Now that you’ve learned about proper ABHR application, practice this technique. Have a co-worker look at the Compliance poster for Hand Hygiene Using Alcohol-Based Hand Rub, and observe you as you apply ABHR to your hands. Ask him or her to give you feedback

Facilities without running water

Value added considerations of Hand hygiene

Don’ts of Hand washing:

  • DON’T use hot water to wash hands. Hot water has not been proven to remove more germs and tends to promote chapping of the skin, making it more susceptible to bacteria.
  • DON’T allow water to run over hands while lathering. This washes soap away and makes hand washing less effective.
  • DON’T touch the sink surface after washing your hands. It is contaminated with microbes.
  • DON’T skip hand washing if soap and running water are not available. Instead, use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Additional considerations of hand hygiene

Lesions and Skin Breaks

To reduce the risks of skin reaction caused by frequent use of soap (such as contact dermatitis) and other skin damage, it is important to promote good skin-care practices that help to maintain skin integrity, such as

  • Discouraging concurrent use of soap and ABHR
  • Promoting ABHR to protect skin integrity (frequent hand washing with soap can lead to contact dermatitis)
  • Providing alternative hand hygiene products for HCWs who have confirmed allergies or adverse reactions to standard products used in the health care facility

Fingernails, nail polish and jewellery

Ensure that fingernails are kept short and clean. Wrist watches and jewellery MUST be removed before surgical hand disinfection Long fingernails, nail polish, and jewellery are impediments to hand hygiene and can promote bacterial growth on hands. Spaces or crevices under artificial or long nails and jewellery are hard to clean, and limit access to those areas. Natural fingernails should be kept short, ideally not extending 0.5 cm (less than 1/4 inch) beyond the fingertips.

  • Artificial nails or extenders are discouraged while working in clinical areas.
  • If nail polish is worn, it should not be chipped.
  • Wearing jewellery, including rings, is strongly discouraged. As an alternative, rings can be placed on a necklace around the neck.
  • Surgical teams should remove jewellery, including rings, bracelets and watches prior to performing surgical hand scrub.

Hand lotions and creams

Hand lotions and creams should be used with caution. If used as a shared product, lotion and cream tubes can lead to cross- contamination. Hand lotions, creams, or moisturizing skin care products are used to minimize hand hygiene-related dryness and contact dermatitis due to frequent hand washing. Oil-based hand creams that contain petroleum jelly should not be used, because they may damage latex rubber gloves.

Religious and cultural considerations

The health care facility’s IPC team should have discussions with staff to identify and address any religious concerns regarding hand hygiene and the products used for hand hygiene. The IPC team should seek advice from religious leaders and provide alternatives that are religiously acceptable to the staff.