Germs are present on patient skin and surfaces in the patient surroundings

• Germs present on intact areas of patients' skin.
• Nearly 1 million skin cells containing viable germs are shed daily from normal skin
• Patient surroundings (bed linen, furniture, objects) become contaminated by patient germs

By direct and indirect contact, patient germs contaminate health-care workers' hands

• Nurses could contaminate their hands during “clean” activities (lifting patients, taking the patient's pulse, blood pressure, or oral temperature)
• 15% of nurses working in an isolation unit large colonies of S. aureus on their hands
• In a general health-care facility, 29% nurses carried S. aureus on their hands and 17–30% carried Gram negative bacilli in large quantities.
• Vancomycin Resistant Enterococci (VRE's) have been known to remain on countertops for up to 7 days.

Germs survive and multiply on health-care workers' hands

• Following contact with patients and/or contaminated environment, germs can survive on hands for differing lengths of time (2–60 minutes).
• In the absence of hand hygiene action, the longer the duration of care, the higher the degree of hand contamination.

Defective hand cleansing results in hands remaining contaminated

• Insufficient amount of product and/or insufficient duration of hand hygiene action lead to poor hand decontamination
• Transient microorganisms are still recovered on hands following hand washing with soap and water, whereas hand rubbing with an alcohol-based solution has been proven significantly more effective

Transfer of pathogens from one source to another.

• Manipulation of invasive devices with contaminated hands determines transmission of patient's germs to sites at risk of infection – portals of entry.
• Contact with areas where there is a portal of entry.

“But my patient isn't infected!”

• People who carry bacteria without evidence of infection (fever, elevated white blood count) are colonized.
• If an infection develops, it is usually from bacteria that colonize patients.
• Bacteria that colonize patients can be transmitted from one Patient to another by the hands of healthcare workers.
• Bacteria can be transmitted even in the absence of an infection.

So Why All the Fuss About Hand Hygiene?

• Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings.
• Hand hygiene reduces the incidence of healthcare associated infections.
• More widespread use of hand hygiene products that improve adherence to recommended hand hygiene practices will promote patient safety and prevent infections.
• Validated and standardized prevention strategies have been shown to reduce HCAI
• At least 50% of HCAI could be prevented
• Most solutions are simple and not resource-demanding and can be implemented in developed, as well as in transitional and developing countries

Self-Reported Factors for Poor Adherence with Hand Hygiene

Consider:

• Adequate handwashing with water and soap requires 40-60 seconds
  Average time usually adopted by health-care workers: <10 seconds
• Time Constraints for Hand Hygiene
  • Handwashing: 40-60 seconds
  • Alcohol-based handrubbing: 20–30 seconds
• For an 8 hour Shift
  • Hand washing with soap and water: 56 minutes
    Based on seven (60 second) handwashing episodes per hour
  • Alcohol-based handrub: 18 minutes
    Based on seven (20 second) handrub episodes per hour
• Alcohol Based Hand Sanitizer
  • Is easier to use, more convenient
  • Can be used at the point of care
  • Is better for your skin
  • Is more effective in reducing the number of pathogens on your hands
  • Lasts longer
  • Is quicker than hand washing
  • Reduces the number of infections related to healthcare contacts.

• The concept embraces the need to perform hand hygiene at recommended moments exactly where care delivery takes place
• This requires that a hand hygiene product (e.g. alcohol-based handrub, if available) be easily accessible and as close as possible (e.g. within arm's reach), where patient care or treatment is taking place. Point-of-care products should be accessible without having to leave the patient zone of Care.
• This enables health-care workers to quickly and easily fulfil the 5 indications (moments) for hand hygiene (explained above)
• Availability of alcohol-based hand-rubs in point-of-care is usually achieved through health-care worker-carried hand-rubs (pocket bottles), wall-mounted dispensers, containers fixed to the patient's bed or bedside table or hand-rubs affixed to the patient's bed or bedside table or to dressing or medicine trolleys that are taken into the point-of-care

THE 5 ESSENTIAL MOMENTS

There are 5 essential moments where the healthcare worker is to use hand hygiene. Following are those 5 moments, the rationale and examples of each.

• BEFORE TOUCHING A PATIENT: To protect the patient against harmful germs carried on your haps

• Shaking hands, stroking a child's forehead
• Helping a patient to move around, get washed
• Applying oxygen mask, giving physiotherapy
• Taking pulse, blood pressure, chest auscultation, abdominal palpation, recording EKG.

• BEFORE PERFORMING A CLEAN OR ASEPTIC PROCEDURE -To protect the patient against harmful germs, including the patient's own, from entering his/her bodp

  • Before handling an invasive device for patient care, regardless of whether or not gloves are used
  • If moving from a contaminated body site to another body site during care of the same patient
  • Brushing the patient's teeth, instilling eye drops
  • Skin lesion care, wound dressing, subcutaneous injection
  • Catheter insertion, opening a vascular access system or a draining system, secretion aspiration
  • Preparation of food, medication, pharmaceutical products, sterile material.

• AFTER BODY FLUID EXPOSURE RISK - To protect yourself and the health-care environment from harmful patient germs.

• Gloves should be used when a HCW has contact with blood or other body fluids in accordance with universal precautions.
• After contact with body fluids or excretions, mucous membrane, non-intact skin or wound dressing
• If moving from a contaminated body site to another body site during care of the same patient
• After removing sterile or non-sterile gloves
• Brushing the patient's teeth, instilling eye drops, secretion aspiration
• Skin lesion care, wound dressing, subcutaneous injection, drawing and manipulating any fluid sample, opening a draining system, endotracheal tube insertion and removal
• Cleaning up urines, faeces, vomit, handling waste (bandages, napkin, incontinence pads), cleaning of contaminated and visibly soiled material or areas (soiled bed linen lavatories, urinal, bedpan, medical instruments)

• AFTER TOUCHING A PATIENT – To protect yourself and the health-care environment from harmful patient germs.

• Before and after touching the patient
• After removing sterile or non-sterile gloves
• Shaking hands, stroking a child forehead
• Helping a patient to move around, get washed
• Applying oxygen mask, giving physiotherapy
• Taking pulse, blood pressure, chest auscultation, abdominal palpation, recording ECG

• AFTER TOUCHING A PATIENT'S SURROUNDINGS –To protect yourself and the health-care environment from harmful patient germs.

• After contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient
• After removing sterile gloves or non-sterile gloves
• Changing bed linen, with the patient out of the bed
• Monitoring alarm
• Holding a bed rail, leaning against a bed, a night table
• Clearing the bedside table

STERILE GLOVES INDICATED

Any surgical procedure; vaginal delivery; invasive radiological procedures; performing vascular access and procedures (central lines); preparing total parental nutrition and chemotherapeutic agents.

GLOVES NOT INDICATED (except for CONTACT precautions)

No potential for exposure to blood or body fluids, or contaminated environment

DIRECT PATIENT EXPOSURE: Taking blood pressure, temperature and pulse; bathing and dressing the patient; transporting patient; caring for eyes and ears (without secretions); any vascular line manipulation in absence of blood leakage.