Hand Hygiene

Hands- the most common way transporting microorganisms, & subsequently causing infection in patients seeking medical advice/care in health care facilities.

Hand Hygiene

Hand washing , also known as hand hygiene, is the act of cleaning the hands with water and liquid handwash or soap for the purpose of removing soil, dirt and micro-organisms.

Handwashing -

Washing hands with plain soap and water.
Remove soil/dirt

Antiseptic handwash-

Washing hands with water and an antiseptic soap or detergents.
Remove soil/dirt and transient micro-organisms.

Alcohol-based handrub

Rubbing hands with an alcohol-containing preparation.
Remove transient microorganisms.

Purpose

To remove bacteria from fingers, hands and forearms.
To prevent the risk of transmission of infection to client.
To prevent cross infection among clients.
To remove dirt.
To reduce the risk of transmission of infection to oneself.

Important of Hand Hygiene

Most common mode of transmission.
Most important factor in preventing spread of organisms.
Reduce number of infections.
Decrease patient length of stay.
Decrease use of resources.
Reduce number of deaths.

5 Moments for Hand Hygiene

5 Moments for Hand Hygiene approach defines the key moments when health-care workers should perform hand hygiene.

1. Before Touching a Patient	Clean your hands before touching a patient when approaching him/her. To protect the patient against harmful germs carried on your hands.
2. Before clean/Aseptic procedure.	Clean your hands immediately before performing a clean/aseptic procedure. To protect the patient against harmful germs, including the patient's own,from entering his/her body.
3. After body fluid Exposure risk.	Clean your hands immediately after an exposure risk. To body fluids (And after glove removal). To protect yourself and the health-care environment from harmful patient germs.
4. After Touching a Patient.	Clean your hands after touching a patient and her/his. Immediate surroundings, when leaving the patient's side. To protect yourself and the health-care environment from harmful patient germs.
5. After Touching Patient Surroundings	Clean your hands after touching any object or furniture in the patient's immediate surrounding, when leaving even if the patient has not been touched. To protect yourself and the health-care environment from harmful patient germs.

Types of Handwashing -

Types of handwashing are two types -

Medical Handwashing
Surgical Handwashing

Medical Handwashing -

Is the act of cleaning hands for the purpose of removing soil, dirt, and microorganisms.It is done by 2 minute.
The main medical purpose of washing hands is to cleanse the hands of pathogens (like bacteria or viruses) and chemicals which can cause harm or disease.

Surgical Handwashing - Surgical handwashing is a procedure by which dirt and microorganism are destroyed. It is done by 5 minute.

Articles Required

Articles	Purpose
Sink with running water	To rinse the hands
Soap and soap dish or liquid hand wash	To remove the dirt and bacteria
Nail brush	To clean nails
Airdryer	To dry hands

Steps of Handwashing

Steps	Purpose
Cut the nail short and ensure that nails are free of nails polish.	Short nails are less likely to harbour resident and transient micro-organisms
Gather the necessary supplies. stand in front of the sink Remove all Jewellery and wrist watch.	For easy access and conveniently. Removal of Jewellery proper cleansing.
You have wear full. Sleeve apron then fold her elbow.
Turn on water using elbow control.	Knee prevent contaminated of hands after rub
Wet the hands and wrist area with running water. Keep hands lower than elbows to allow water to flow toward fingertips.	Water should flow from the cleaner area toward the more contaminated area.
Apply enough soap or handwash solution.	Clean the dirt and remove the Bacteria.
Cover all areas of hands with the soap product or liquid hand wash.
Wash hands thoroughly using a firm, circular motion and friction and follow the 6 steps of hand washing. Rub hands palm to palm. Rub the back of both hands. Rub the back of fingers of both hands. Rub thumb in a rotating manner of both hands. Rub fingers on palm for both hands. Rub both wrists in a rotating manner.
Hand washing procedure should be complete in 2 minutes
Continue this friction motion for at least 10 seconds each steps (10 × 6 = 60 second X Both hands = 120 seconds)	Length of handwashing is determined by degree of contamination.
Tum on water using elbows and rinse thoroughly. Tum on water using elbows control.	Elbow prevent contamination of hands after rub. Keeps hands free of microorganisms.
Air dry both hands.

Surgical hand wash

Performing surgical hand antisepsis using either an antimicrobial soap or an alcohol- based hand sanitizer with persistent activity is recommended before donning sterile gloves when performing surgical procedures.

Objectives of Surgical hand wash

To remove debris and dart.
Reduce the resident bacterial flora on the surface of the skin of the hand to the minimum possible limit.
Prevent rapid re-growth of bacterial flora under gloves.
In addition, there is a risk of a glove breaking for any reason: from manufacturing defects to accidental cuts with sharp material.

Prior to Hand wash

Remove rings, watches, and bracelets before beginning the surgical hand wash.
Remove debris from underneath fingernails using a nail cleaner under running water. ( Nailbrushes should not be used as they may damage the skin and encourage shedding of cells. If used, nailbrushes must be sterile, once only (single use).
Keep nails short as far as possible.
Germs can live under artificial fingernails both before and after using an alcohol-based hand sanitizer and hand washing.
It is recommended that healthcare providers do not wear artificial fingernails or extensions when having direct contact with patients at high risk (e.g., those in intensive- care units or operating rooms)

Wash your Hands

FIVE STEPS

Wet your hands with clean, running water (warm or cold), turn off the tap, and apply soap.
Lather your hands by rubbing them together with the soap. Be sure to lather the backs of your hands, between your fingers, and under your nails.
Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
Rinse your hands well under clean, running water.
Dry your hands using a clean towel or air dry them.

Six steps of hand wash

Palm to palm.
Right palm over left dorsum & left palm over right dorsum.
Palm to palm fingers interlaced.
Back of fingers to opposite palms with fingers interlocked.
Rotational rubbing of right thumb clasped in left palm and vice versa.
Rotational rubbing backwards and forwards with clasped fingers of right hand in left palm and vice versa.

Each step consists of five strokes forward and five backward.

The procedure for the timed five minute scrub consists of

Wash hands and arms with antimicrobial soap.
Clean subungual areas with a nail file.

Start timing

Scrub each side of each finger, between the fingers, and the back and front of the hand.( for two minutes).
Proceed to scrub the arms, keeping the hand higher than the arm at all times. This prevents bacteria-laden soap and water from contaminating the hand.
Wash each side of the arm to three inches above the elbow for one minute.
Repeat the process on the other hand and arm, keeping hands above elbows at all times.
If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for the area that has been contaminated.

Timing of Handwash

Institutions opting to use the WHO-recommended formulations for surgical hand preparation should ensure that a minimum of three applications are used, if not more, for a period of 3 to 5 minutes.
For surgical procedures of more than a two hours’ duration, ideally surgeons should practice a second hand rub of approximately 1 minute, even though more research is needed on this aspect.
Long scrub times (e.g., 10 minutes) are not necessary, as do not offer any extra advantage.

Alcohol-based hand rub is preferred over soap and water

Is more effective than soap at killing potentially deadly germs on hands.
Requires less time.
Is more accessible than handwashing sinks.
Produces reduced bacterial counts on hands.
Improves skin condition with less irritation and dryness than soap and water.