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Hand washing

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The need and importance of hand washing in healthcare system and for people involved in patient care. When and how to wash hands? Differences between alcohol based hand rubs and hand washing.
WHO and CDC guidelines on hand washing.

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Hand washing

  1. 1. Hand Washing Dr. Mohammad Amir MS. (General Surgery) Department of General Surgery Era’s Lucknow Medical College, Lucknow.
  2. 2. HAND WASHING • A solution to many problem. • Reason to Save Many. • HCAI- Health Care Acquired Infections. • CR-UTI • CR- BSI
  3. 3. CLEAND HANDS COUNT …
  4. 4. Prevalence • In developed countries, HCAI concerns 5–15% of hospitalized patients. • Affects 9–37% of those admitted to intensive ICUs. • Recent studies conducted in Europe reported hospital-wide prevalence rates of patients affected by HCAI ranging from 4.6% to 9.3%.
  5. 5. HCAI related Morbidity Mortality • In general, attributable mortality due to HCAI in Europe is estimated to be 1% (50 000deaths per year). • HCAI contributes to death in at least 2.7% of cases (135 000 deaths per year).
  6. 6. Hand Hygiene and Health • Hand washing is like a "do- it- yourself" vaccine. • Reduce the spread of diarrheal and respiratory illness in children and adults. • Early training of children in hand washing improves their health and hygiene. • More important for doctors, medical students and healthcare workers.
  7. 7. Historical Perspective • In the mid-1800s- Ignaz Semmelweis in Vienna, Austria. • “Saviour of Mothers" • Oliver Wendell Holmes in Boston, USA. • Hospital-acquired diseases were transmitted via the hands of HCWs. • In 1847, Semmelweiss was appointed as a house officer in one of the two obstetric clinics at the University of Vienna Allgemeine Krankenhaus (General Hospital).
  8. 8. Historical Perspective • He observed that maternal mortality rates, mostly attributable to puerperal fever, were substantially higher in one clinic compared with the other (16% versus 7%). • He also noted that doctors and medical students often went directly to the delivery room after performing autopsies and had a disagreeable odour on their hands despite handwashing with soap and water before entering the clinic. • He hypothesized therefore that “cadaverous particles” were transmitted via the hands of doctors and students from the autopsy room to the delivery theatre and caused the puerperal fever.
  9. 9. Historical Perspective • As a consequence, Semmelweis recommended that hands be scrubbed in a chlorinated lime solution before every patient contact and particularly after leaving the autopsy room. • Following the implementation of this measure, the mortality rate fell dramatically to 3% in the clinic most affected and remained low thereafter.
  10. 10. Normal Bacterial Flora on Hands • In 1938, Price established that bacteria- Two categories- • Resident or Transient. • Staphylococcus epidermidis is the dominant species and oxacillin resistance is extraordinarily high, particularly among HCWs. • S. hominis and other coagulase-negative staphylococci, coryneform bacteria (propionibacteria, corynebacteria, dermobacteria, and micrococci). • Fungi, the most common genus of the resident skin flora, when present, is Pityrosporum (Malassezia).
  11. 11. • Resident flora has two main functions.  Protective functions  Microbial antagonism and the competition for nutrients. • Resident flora is less likely to be associated with infections, but may cause infections in sterile body cavities, the eyes, or on non-intact skin.
  12. 12. • The Global Hand washing Day- October 15, 2008. • By UN General Assembly in accordance with year 2008 as the International Year of Sanitation
  13. 13. • Normal human skin- Total aerobic bacterial counts ranging from more than 1 x 106 CFU/cm2 on the scalp, 5 x 105 CFUs/cm2 in the axilla, and 4 x 104 CFU/cm2 on the abdomen to 1 x 104 CFU/cm2 on the forearm. • Total bacterial counts on the hands of HCWs have ranged from 3.9 x 104 to 4.6 x 106 CFU/cm.
  14. 14. Transmission of Pathogens • Organisms present on patient skin or in the inanimate environment. • Organism transfer to health-care workers’ hands. • Defective hand cleansing, resulting in hands remaining contaminated • Organism survival on hands. • Cross-transmission of organisms by contaminated hands.
  15. 15. Antiseptic Spectrum of Action
  16. 16. Comparison of Antiseptics
  17. 17. Device-associated Infection
  18. 18. Surgical Hand Preparation
  19. 19. Protocol for Surgical Scrub
  20. 20. Avoid the Embarrassment!
  21. 21. My Five Moments for Hand Hygiene
  22. 22. How Long to Wash? • Hand Hygiene Technique with Alcohol-Based Formulation- Duration of the entire procedure: 20-30 seconds • CDC- Till dry. • Hand Hygiene Technique with Soap and Water- Duration of the entire procedure: 40-60 seconds
  23. 23. Cost Burden of HCAI
  24. 24. REFERENCES • WHO Guidelines on Hand Hygiene in Health Care- 2009 • Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis, Allegranzi, Benedetta et al. The Lancet , Volume 377 , Issue 9761 , 228 – 241. • CDC Guideline for Hand Hygiene in Health-Care Settings- Recommendations of the Healthcare Infection Control Practices, Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
  25. 25. NEJM- Hand Hygiene
  26. 26. Thank You … and wash your hands!

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