Every year, more than 3.5 million children do not live to celebrate their fifth birthday because of diarrhea and pneumonia.
Handwashing with soap is among the most effective and inexpensive ways to prevent diarrheal diseases and pneumonia,despite its lifesaving potential, handwashing with soap is seldom practiced and not always easy to promote.
Micro-organisms found on hands are all capable of colonising susceptible sites on an individual patient. Such sites generally involve a break in the skin’s protective barrier, through which micro-organisms invade and then multiply. Micro-organisms are either transient, and easily removed by handwashing or resident, requiring higher levels of hand disinfection to reduce the number of organisms present. Micro-organisms usually thrive and multiply in warm, moist conditions. In such circumstances - and given a susceptible host - either local or systemic infection can result. It is essential that HCW’s wash hands: before contact with a susceptible site after activities which may contaminate hands
Resident micro-organisms survive and multiply on the skin. They are usually of low virulence and rarely cause infections except when introduced into the body as a result of an invasive procedure e.g. surgery, insertion of intravascular lines, catheterisation or trauma. In these instances, their pathogenicity can increase rapidly. In addition, resident micro-organisms protect the body against invasion by more virulent microbes and thus are a factor in maintaining the skin’s ecologic and microbiologic balance. Repeated use of systemic antimicrobial agents may destroy many of the normal resident flora, allowing colonisation with other micro-organisms. Resident micro-organisms are not easily removed by simple handwashing or scrubbing, but they can be inactivated by topical antimicrobial agents.
The choice of handwashing agents available for use by HCW’s should be made following careful consideration of a number of key issues. Ideally, the infection control team should be involved in developing a comprehensive Trust-wide hand hygiene protocol which includes the provision of a range of products appropriate for all tasks and which are acceptable to the user. Ideally, products should be evaluated in use prior to large scale contracting.
Handwashing Agents Handwashing agents fall into 3 categories depending on their active ingredients and their composition ie aqueous (requiring water) or alcoholic (used without water). Active Ingredients There are 6 antimicrobial ingredients commercially available in the US, UK and Europe that are designed for handwashing, hand antisepsis and surgical hand scrubbing. Only four of these ingredients are commonly used in health care settings in the UK.
The use of alcohol as a hand rub is currently far more widespread in Europe than in the UK. Such products are inexpensive and provide the most rapid and greatest reduction in microbial counts on the skin. A vigorous, 1-minute rubbing with enough alcohol to wet the hands completely has been shown to be the most effective method of hand antisepsis (Larson 1995). It must be remembered however, that alcohols are not good cleaning agents and are not recommended in the presence of physical dirt. They can, however, be preceded in use by a handwash using plain soap to produce a high level of decontamination. Alcohol is often combined with antiseptic products e.g. chlorhexidine which provide the advantages of rapid microbial kill together with residual activity thus enhancing efficacy.
Triclosan Triclosan-based products have increased in use in the UK during the last few years, especially in the management of MRSA. It is often anecdotedly reported as being kinder on the skin when used as a body wash, however this has not been substantiated by clinical studies. Indeed, there is a need for additional safety and efficacy data to determine the usefulness of Triclosan-based products in health care. Triclosan has a wide range of bacterial activity but little information is currently available regarding its activity against viruses, and it appears to be a poor fungicide. Triclosan has excellent residual activity on the skin and is minimally affected by organic material. It is widely used in commercial soaps to reduce body odour by inhibiting the growth of skin bacteria over time. Triclosan is used in a formulation of 2% as an aqueous skin cleanser and 0.5% as an alcohol-based hand rub.
Hand hygiene can be accomplished by both mechanical and chemical means. Mechanical cleansing uses friction to physically remove soil, debris, transient and a few resident micro-organisms. It is an abrasive action. Handwashing and scrubbing are examples of mechanical cleansing. Chemical cleansing action utilises antimicrobial agents to destroy or interfere with the growth of micro-organisms. Cidal agents (e.g. bactericidal) destroy micro-organisms. Static agents (e.g. bacteriostatic) suppress micro-organism growth.
There are generally considered to be 3 types of handwashing techniques. Each technique has a slightly different objective and method. The type of cleansing agent also differs depending on which type of micro-organisms are to be removed. What is almost universal, however, is the recommendation to use a six stage handwashing procedure in order to thoroughly cleanse all surfaces of the hands. Refer to the diagram on slide 14.
What is now regarded as a seminal work on hand decontamination, was undertaken by an ICN, Lynda Taylor in 1978. Using a red food dye, volunteers were blindfolded and their hands were “painted” with the dye. They were then asked to wash their hands as they would normally do. After washing, hands were examined to see how effective such washing had been in removing the dye. Any dye left in situ, implied that maybe that area had not been thoroughly washed. The diagram shows those areas most frequently missed. Most importantly, it is worth remembering that the majority of tasks are carried out using the fingertips - one of the areas most frequently missed in this study. Just worthy of a note: It is also likely that the dominant hand - usually the right - will more thoroughly wash the non-dominant hand. However, most care will be undertaken by the dominant hand! Beware!
Handwashing ( global handwashing day )
Dirty HANDS !!(see the germs in your
Can you imagine ?: Hand is the
perfect germ farm .
Handwashing with soap works by interrupting the transmission of disease.
• All micro-organisms found on hands are
capable of colonising susceptible sites e.g.
wounds, intravascular devices
• Multiplication of micro-organisms at susceptible
sites may lead to local/systemic infection
• protective function
• survive & multiply on skin
• not easily removed by mechanical
• inactivated by topical antimicrobial
As per necessity to remove / reduce:
• soil / dirt / debris
• transient micro-organisms
• resident flora?
Keep in mind that antibacterial soap is no more
effective at killing germs than is regular soap. Using
antibacterial soap may even lead to the development of
bacteria that are resistant to the product's
antimicrobial agents — making it harder to kill these
germs in the future.
I. before/after routine
II. before handling/
III. before aseptic
IV. after bed-making
V. after glove removal
VI. after using toilet
VII. after contact with :
I. before invasive
II. before care of
III.before leaving source
IV. before care of
V. when persistent
antimicrobial activity is
necessary e.g. ITU
I. prior to any
Hand antisepsis Remove or destroy Antimicrobial
(hygienic) transient soap/detergent
micro-organisms or alcohol based
hand-rub for at least
TYPE OBJECTIVE METHOD
Handwash Removal of soil/dirt Soap or detergent
(social/routine) and transient micro-
Surgical hand scrub Remove or destroy Antimicrobial soap/
transient micro- detergent with brush
organisms to achieve friction
Reduce resident flora for at least 120 seconds
hand-rub for at least
• After using the bathroom
• After changing a diaper — wash the diaper-wearer's hands, too
• After touching animals or animal waste
• Before and after preparing food, especially raw meat, poultry or
• Before eating
• After blowing your nose
• After coughing or sneezing into your hands
• Before and after treating wounds or cuts
• Before and after touching a sick or injured person
• After handling garbage
• Before inserting or removing contact lenses
• When using public restrooms, such as those in airports, train
stations, bus stations and restaurants
MIND . If you could
see the germs you’d
wash your hands.
Stage 1. Palm to palm Stage 2. Backs of hands Stage 3. Between the fingers
Stage 4. Fingertips Stage 5. Thumbs and wrists Stage 6. Nails in the
palm of the hand
Alcohol based – need at least 60% ethanol
Useful in health care settings between patients
Useful on CLEAN HANDS not on DIRTY HANDS
NOT USEFUL FOR KILLING ALL MICROBES .
Must remain in contact for 15 – 20 seconds
A word on Hand Sanitizers
5 Facts Everyone Should Know about Handwashing with Soap