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Hand Hygiene in Healthcare Settings. Hospital Acquired Infections. 7 -10% of patients acquire an infection 7,000 death per year The federal government spend > $950 million annually Source: Australian Council for Quality and Safety in Healthcare July 2003. Paediatric Nosocomial Infections.
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Hospital Acquired Infections • 7-10% of patients acquire an infection • 7,000 death per year • The federal government spend > $950 million annually Source:Australian Council for Quality and Safety in Healthcare July 2003
Paediatric Nosocomial Infections • MORE Viral respiratory infections • MORE Gastrointestinal infections • MORE BACTEREMIAS • All children are exposed to maternal infections/siblings • HIGH RISK PATIENT GROUPS: • Newborns and premature infants • Children with congenital abnormalities
Obstetric Nosocomial Infections • Minimal invasive diagnostic procedures • Surgery not prolonged • Short hospital stay • Intact host defenses • Not subject to as many hospital pathogens • Not exposed to prolonged antibiotic courses
Obstetric Nosocomial Infections- Risks Increase With: • Urinary catheterisation • Intravenous therapy • Intra-uterine and foetal monitoring • PV examinations
“Hand Hygiene is the SINGLE most important practice to preventing nosocomial infections” Rotter ML 1997
Benefits of Hand Hygiene • Reduced number of deaths • Reduced number of infections: • Decreased antibiotic usage • Decreased patient length of stay • Decreased use of resources
Compliance with hand hygiene? Table 2. Distribution of factors associated with non-compliance with hand hygiene Table 1. Compliance with hand hygiene in different hospital settings before intervention Source: Pittet D, Boyce JM LANCET Infect Dis 2001
An overview • Definitions • Guidelines for hand hygiene • Soap versus Alcohol solution • Healthy Hands
Definition of Terms • Hand Hygienea general term that applies to either handwashing, antiseptic handwash, antiseptic hand rub or surgical hand antisepsis. • Handwashingwashing hands with plain ( ie. non-antimicrobial) soap and water. • Decontaminationto reduce bacterial counts on the hands by performing antiseptic hand rub or antiseptic handwash. Guide for Hand Hygiene in Healthcare Settings: MMWR 2002; vol.51, no. RR-16
When To Perform Hand Hygiene? • “High Risk” for Contamination Activities • “Low Risk” for Contamination Activities
“High Risk” for Contamination • Immediately before and after patient contact • Immediately before and after a procedure
“High Risk” for Contamination • Before and after touching any devices/equipment directly connected to the patient e.g. • Indwelling catheter • External Ventricular Drains • Redivacs • Ventilation Equipment
“High Risk” for Contamination • Moving from contaminated to a clean body site • After contact with body fluids
“Low Risk” for Contamination • After contact with equipmente.g.patients charts, monitors • After removing gloves • After contact with own nose/mouth/hair
A quick and easy solution An alcohol gel!
Alcohol at EVERY bed helps increase compliance Biscoff WE et al 1998: Abstract K132
Place gel/rinse at each: • Bed / cot • Trolley • Entrance to room
Alcohol is more effective in reducing the number of bacteria Mean change (log10 CFU) Pittet D, Boyce JM. Lancet Infect Dis 2001
Alcohol has persistent activity • Reduction in resident flora Rotter ML. Chapter 87 in Mayhall CG 1999
A quick and easy solution :An alcohol gel! • Less drying than soap and water
When can you use an alcohol-based hand gel? • In all clinical situations EXCEPT: • When your hands are visibly soiled • When a surgical scrub is required
How to use an alcohol hand gel? • Ensure that hands have no visible contamination • Apply product to palm of one hand and rub hands together covering all surfaces and fingers • Allow to air dry • The process takes about 15 seconds
A few tips when using the gel… • Continue rubbing hands together until alcohol is dry (should take 10-15 sec). • After using an alcohol based product, you will feel a “build up” on your hands. To remove this, wash your hands with soap and water as often as necessary.
When should you handwash? • when hands are visibly contaminated with blood/body fluids • to remove “build-up” from the alcohol gel/rinse • before eating • after using the restroom
How to wash your hands? 1 2 Apply solution and scrub for at least 15 seconds Wet your hands
How to wash your hands? 3 4 Rinse your hands Scrub back of hands, wrists, between fingers and under fingernails
How to wash your hands? 5 6 Dry with paper towel Turn off water lever using your elbows
Visitors and Relatives • Instruct them to EITHER wash their hands or apply the gel: • Before holding the baby/child • Before feeding the baby/child • After nappy change
Summary of Recommendations • Hands visibly soiled Soap and water or antimicrobial soap • Hands not soiled Alcohol hand rub for all routine hand hygiene
Healthy Hands: • Use warm water, not hot • Wet hands before applying soap • Rinse hands well and pat dry • Moisturise 3-4 times daily
Healthy Hands: • Select a moisturiser compatible with Chlorhexidine gluconate • Nails should be kept short (< ¼ inch) • Artificial nails should not be worn in high risk areas e.g. ICU, NICU
Any Questions? For more information visit www.washup.org.au