# Presentation: 065659

## Hand Hygiene 

**Hand Hygiene**

- Edna Barbee, RN
- Regional Nurse Consultant
- Chicago Region

- Hands: Some of the most used limbs
- in the human body.
- 				Anonymous

## Picked up a television remote
Drove a car 
Scratched our body 
Picked up a book
Used the restroom

- Drove a car
- Scratched our body
- Picked up a book
- Used the restroom

**Chances are, before this day is over, most of us will have:**

**Notes:**
Chances are before this day is over you will have picked up a television remote, gotten behind the wheel of a car and driven somewhere, scratched your body somewhere, picked up a book and used the restroom.

- Shook someone’s hand
- Ate a meal
- All of which could have been done
- without giving a thought to cleansing
- our hands.

## Preventable Deaths

- Nearly 2 million children die annually from diarrheal disease.

**Notes:**
Nearly 2-million deaths occur annually among children around the world as a result of diarrheal disease according to the Journal of American Medical Association.  

## JAMA Pakistan Study Vol. 291 No. 21 6/2/2004

- Handwashing with plain soap resulted in 53% lower incidence of diarrhea
- Neighborhoods with less intervention resulted in 41% fewer incidence of diarrhea
- Handwashing households reduced the incidence of diarrhea among children

**Notes:**
In a study conducted in Karachi Pakistan paid weekly visits to 25 neighborhoods to promote handwashing with soap after defecation and before preparing food, eating, and feeding a child.  Within the intervention neighborhoods 300 households were approximately 1523 children in the control group.  The study was designed to measure the incidence of diarrhea among children.  The results among children 15 years of age or younger.  Handwashing promotion with plain soap had a 53% lower incidence of diarrhea compared with a minus 41% incidence for children and families not using handsoap.  The study concluded that in a setting in which diarrhea is a leading cause of child death, improvement in handwashing in the household reduced the incidence of diarrhea among children at high risk of death from diarrhea.  

## Hospital Settings

**Serious Nosocomial Infections result in 90,000 deaths annually**
**$4.5-Billion Costs for Treatment**
**Handwashing compliance 40% average**

**Notes:**
In the United States hospital settings approximately 90-thousand deaths per year occur where serious nosocomial infections are the culprit.  The costs of treatment 4.5 Billion dollars per year.  It’s estimated that Hand washing compliance rates are on average 40 percent.

## In 1846, Ignaz Semmelweis 

- In 1846, Ignaz Semmelweis
- provided evidence that cleansing
- contaminated hands with antiseptic
- reduced health care associated
- transmission of contagious disease.

- Ignaz Semmelweis

**Notes:**
In 1846, Ignaz Semmelweis observed that women whose babies were delivered by students and physicians in the First clinic at the General Hospital in Vienna consistently had a higher mortality rate than those whose babies were delivered by midwives in the second clinic.  He noted that physicians who went directly from the autopsy suite to the obstetrics ward had a disagreeable odor on their hands despite washing with soap and water.  The physicians were passing on the cadaverous particles via the hands of students and physicians.  Semmelweis insisted that the physicians hands be cleaned with chlorine solution.  This discovery is the forerunner of antiseptics which resulted in a dramatic reduction in the maternal mortality rate.

## Made the 

- Made the
- connection
- between fever and
- negligence of
- hand washing.

**Notes:**
In 1843 the famed poet, Oliver Wendell Holmes was one of the first to conclude that puerperal fever was spread by the hands of health personnel.  He described methods that could be taken to limit its spread.  Because of the work of Oliver Wendell Holmes and Ignaz Semmelweis, hand washing techniques became the most important measures for preventing transmission of pathogens in health-care facilities.

## Hospital Nurseries

- Babies acquired staphylococci more frequently when nurses failed to wash their hands!

**Notes:**
A scientific study performed in a hospital nursery found that babies acquired staphylococci more frequently when cared for by nurses who didn’t wash their hands than babies cared for by nurses who washed their hands between patient contacts with an anti-microbial soap.  

## Hand Rub Dispensers

**2002- CDC recommends alcohol based hand-rubs in patient rooms**
**2005- CMS adopted amendment allowing for the installation of alcohol hand-rub dispensers**

**Notes:**
In October 2002 the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee published the Guideline for Hand Hygiene in Health-Care Setings in which alcohol hand-rubs were recommended for use in healthcare facilities.  However the recommendation stopped short of placing the same in egress or corridors.  In March 2005 the Centers for Medicare and Medicaid Services issued an interim final rule adopting an alcohol hand-rub dispensers in egress corridors.

## Slide 11

**Notes:**
Hand washing is a simple habit that can help keep you healthy.  One that requires minimal training and no special equipment.  Yet it’s one of the best ways to avoid getting sick.  This simple habit requires only soap and warm water or an alcohol-based hand sanitizer.  The dangers of not washing are numerous.  Throughout the day each person accumulates germs on our hands from a variety of sources, such as direct contact with peopoe, contaminated surfaces, foods, even animals and animal waste.  Inadequate hand hygiene also contributes to food-related illnesses, such as salmonella and E. coli infection.  76-million Americans contract a food-borne illness each year.  Of these 5,000 die as a result of their illness.  Others experience the annoying symptoms of nausea, vomiting and diarrhea.  

## Tips on Hand-Washing with Soap

- Wet hands first
- with water
- Apply 3 to 5 ml
- of soap
- Rub hands
- together
- 15-seconds
- Rinse hands
- with water
- Dry thoroughly and
- use paper towel
-  to turn off water facet

**Notes:**
Here are some tips on how to wash your hands effectively with soap and water.  Wet hands first with water and avoid hot water; apply 3 to 5 ml of soap to hands; rub hands together for at least 15 seconds; cover all surfaces of the hands and fingers; rinse hands and fingers with water and dry thoroughly; and use paper towel to turn off water facet.  Even if alcohol cleaner is available, when hands are visibly contaminated with blood or body fluids wash with soap and water or antimicrobial soap.

## Apply 1.5 to 3 ml 
about the size of a
 quarter

Cover all surfaces 
of your hands 
and fingers

Rub hands together
 until alcohol dries 
15-25 seconds

Make sure hands are 
completely dry before
 putting on gloves

- about the size of a
-  quarter
- Cover all surfaces
- of your hands
- and fingers
- Rub hands together
-  until alcohol dries
- 15-25 seconds
- Make sure hands are
- completely dry before
-  putting on gloves

**Tips on Alcohol-Based Hand Rub**

**Notes:**
Apply 1.5 to 3 milliliters (about the size of a quarter) of an alcohol gel or rinse to the palm of one hand, and rub hands together;  Cover all surfaces of your hands and fingers, including areas around/under fingernails; and continue rubbing hands together until alcohol dries (about 15-25 seconds).  Make sure hands are completely dry prior to putting on gloves.  Again, wash your hands with soap and water when you feel a build up of emollients.  

## When?

- Before patient contact
- After patient contact
- Before donning sterile gloves
- After removing gloves
- After contact with objects and equipment in patient’s environment

**Notes:**
Now that you know how to use proper hygiene, the question remains when should you use it in a health care setting.  Before contact with each patient; After contact with each patient; Before donning sterile gloves; Before inserting invasive devices; after removing gloves and After contact with objects and equipment in the patient’s environment.

## Your patients depend on you! 

- Your patients depend on you!
- Your health and theirs depend on good 	hand hygiene!
- Wash your hands before and after contact 	with patients!

**Notes:**
Do your health a favor and you will reward your patients in the process.  Be guilty of washing your hands with Soap and Water and alcohol rub, consistently.  Remember your health depends on it!