Improving
Hand Hygiene
in Health Care
Best Practices for Breaking the
Chain of Infection Transmission
Program Overview
• Historical Background
• Rationale for Hand Hygiene
• Indications for Hand Hygiene
• Hand Hygiene Technique
• Other
Historical Background
• Ignaz Semmelweiss 1815-1865
• In the 1840’s at the General Hospital in Vienna discovered high
mortality rates due to Childbed Fever (Strep) among obstetrical
patients
• Forced doctors under his supervision to wash their hands
before touching patients
Semmelweiss on the Obstetrics Ward
From: Bender, George A., “Great moments in medicine; the stories
And paintings in the series: A history of medicine in pictures”,
Detroit: Northwood Institute Press, 1966 [c1965] p.199.
Hand Hygiene
Guideline Development
• 1980 CDC began developing guidelines for prevention
and control of Nosocomial Infections
• 1988 & 1995 APIC Guidelines for Handwashing and
Hand Antisepsis
• 2002 CDC Advisory Committee published current
Guidelines: Guideline for Hand Hygiene in Health-Care
Settings
A Forgotten Lesson
• Over 150 years since Semmelweiss and hand hygiene
continues to be a challenge
• One out of three people do not wash hands after using
the restroom
• Adherence of health care workers to recommended hand
hygiene practice remain low
Hand Hygiene Adherence in
Hospitals – Avg. 40%
Year of Study Adherence Rate Hospital Area
1994 (1) 29% General and ICU
1995 (2) 41% General
1996 (3) 41% ICU
1998 (4) 30% General
2000 (5) 48% General
1. Gould D, J Hosp Infect 1994;28:15-30. 2. Larson E, J Hosp Infect 1995;30:88-106. 3. Slaughter S, Ann Intern Med
1996;3:360-365. 4. Watanakunakorn C, Infect Control Hosp Epidemiol 1998;19:858-860. 5. Pittet D, Lancet
2000:356;1307-1312.
Why the Increased Focus
on Hand Hygiene ?
• Most pathogens are transmitted via hands
Inadequate hand hygiene practices have been implicated in transmission
of microorganisms from patient to patient and patient to health care worker
Spread of antimicrobial resistance
• Evidence shown that hand hygiene reduces the incidences of
infections
• Patient Safety Focus
JCAHO Patient Safety Goals
• 2004 the Joint Commission Accreditation of Healthcare
Organizations issued Patient Safety Goals
• Goal #7: Reduce the risk of healthcare-acquired infections
Requirement 7a: Comply with WHO or CDC Hand Hygiene
Guidelines
• JCAHO visits – will cite facility if observe hand hygiene
non-compliance
• Goal #13: Involve the patients and their families in their care
(using hand hygiene is a great technique)
Healthcare Workers
Are Vehicles for Infection
Transmission
HCWs can get 100s to 1000s of pathogens
on their hands by doing simple tasks:
• Pulling patients up in bed
• Taking blood pressure or pulse
• Touching a patient’s hand
• Rolling patients over in bed
• Touching patients gown or bed sheets
• Touching equipment like bedrails, IV pumps
over-bed tables
Colonized or Infected
What is the difference?
• Colonized or colonization occurs when people
carry bacteria without evidence of infection
• Infected or infection develops usually from
bacteria that colonize patients
• Bacteria that colonize patients can be transmitted
from one patient to another by hands of HCW
CDC, Hand Hygiene Core-Supplemental Slides, February, 2005
The Iceberg Effect
Infected
Colonized
CDC, Hand Hygiene Core-Supplemental Slides, February, 2005
Microbial Skin Flora
Normal human skin harbors bacteria which
are divided into two groups:
• Transient Flora
• Resident Flora
Transient Flora
• Found on and within the superficial layers of the skin
• They are frequently picked up by healthcare workers through
contact with patients or contaminated surfaces near patients
• These microorganisms are easily removed by mechanical
means such as hand washing
• Transient Flora is most frequently associated with infection
transmission
Resident Flora
• Considered “permanent” inhabitants of the skin
• Found in the deeper layers of the skin– the cracks and crevices
• More difficult to remove than transient flora
• Examples of resident flora are diphtheroids
(not frequently associated with healthcare
–associated infections) and CNS –
coagulase-negative Staphylococcus
(CNS can be pathogenic)
Concepts of Hand Hygiene
• Hand washing with plain or
antimicrobial soap and water
• Alcohol-based hand product
What Do The
CDC Guidelines
for Hand Hygiene say?
2002 CDC
Guideline Recommendations
• Use of Alcohol hand products
• Antimicrobial activity of alcohols is based
on protein denaturation
• Excellent and rapid (within seconds)
germicidal activity against vegetative
bacteria, fungi, and many viruses
• Alcohol concentrations of 60% to 95%
(vol/vol) have better antibacterial activity
Indications for Using
Alcohol-based Hand Products
• When hands are NOT visibly soiled or contaminated with blood or body fluids
• Before having direct contact with patients
• After having direct contact with a patients skin
• After contact with body fluids or excretions, mucous membranes, nonintact
skin, or wound dressings
• If moving from contaminated to clean body site
• After contact with inanimate environment (equipment or furniture near patient)
• After removing gloves
• Emergency situations where sinks are not available
(EMS, Police, Fire Rescue) and hands visibly soiled
Hand Hygiene Technique
Hand Hygiene Technique
Hand Hygiene Technique
When Using Soap & Water
• Wet hands first (avoid hot water)
• Apply 3 to 5 ml of soap to hands (avoid bar soap)
• Rub hands together for at least 15 seconds
• Cover all surfaces of hands and fingers
• Rinse hands with water and dry thoroughly
• Use paper towel to turn off faucet
Hand Hygiene Technique
Using Alcohol Based Product
• When using gels or foams, apply enough product
(at least 1.5 to 3 ml) to palm of hand
• Alcohol gel wipe – use single wipe
• Cover all surfaces of hands and fingers
• Include areas around/under finger nails
• Rub 10-15 seconds and allow to dry
Other Best Practices
in Hand Hygiene
• Skin Care – Provide HCWs with lotions or creams
• No artificial nails for HCWs with direct patient contact
• Proper use of gloves
• Monitor adherence to hand hygiene and report results
• Educate and motivate employees
SUMMARY
• Use of Alcohol-based hand products contribute to
improved hand hygiene practices
• Alcohol-based hand products reduce bacterial counts
on hands
• Hand Hygiene programs must be ongoing; personal
accountability necessary
• Management support and endorsement is necessary
THANK YOU