Hand Washing

Hand Washing

Why Bother? THINK!

Would you want to ….

Be examined by a doctor who had just been to the bathroom and not washed their hands ..
Have stitches removed by a nurse who had just dressed the infected wound of the patient in the next bed without washing their hands….
Of course not…..
Even if you would wash your hands in such circumstances any surface touched by others will contain germs that will transfer over to you

Micro organsims

We cannot see or feel micro organisms
Some micro organisms are harmful
Some only become harmful when they are in the wrong place.
Such as in the blood stream, in an open wound, or mucous membrane
Sick patients may have a lowered immunity and are at greater risk than healthy individuals

Why wash our hands

We cannot clean all surfaces between contact with patients and health care workers (e.g. such as door handles, table tops)
We cannot completely remove microorganisms from health care workers and patient’s skin
What we can do is minimise transfer of micro organisms by washing our hands between contacts

Hand washing Procedure

Soap and water hand wash

Using soap and water – dirt and transient micro-organisms are removed from the skin.
Done thoroughly (ie by a method such as Ayliffe technique) removes 99 per cent of transient flora
Suffices for most wards, kitchens and clinical areas.
Liquid soaps usually contain a preservative or bacteriostatic agent which prevents microbial growth
Soft absorbent paper towels should be used to dry thoroughly

Alcohol/Non alcohol hand-rub

Hand disinfection with an alcohol/non alcohol hand-rub: transient micro-organisms are largely destroyed on the skin, dirt is not removed
In a solution, or as a gel or foam does not remove micro-organisms but rapidly destroys them on the skin surface
Studies have shown that they are even more effective than the better aqueous antiseptic soaps and detergents
Hand-rubs are particularly valuable in areas devoid of wash basins or where return to a wash basin is impractical e.g., in the community or during a ward round
A hand cream is necessary to prevent hands drying and chapping
Alcohol hand wash does not destroy C-difficile, use of soap and water is advised if infection is known

Types of Skin Flora

Residents normal skin flora
Mainly of Gram-positive coagulase negative cocci, e.g. Staph. epidermidis, other staph., and diptheroids
Rarely cause infection apart from contamination during invasive procedures e.g., surgery or insertion of IV lines.
Difficult to remove by normal hand washing techniques.
Staph. Aureus and Gram -ve bacilli, (generally responsible for hospital-acquired infection) rarely found as residents
Transients acquired from staff, patients or the environment
Do not normally grow on skin
Readily removed/destroyed by thorough and frequent hand washing or disinfection.
Include most organisms responsible for cross infection e.g., Stapb. aureus, Salmonella spp, Esch. Coli, P. aeruginosa, Klebsiella spp
Up to 1/3rd of nursing staff carrying transient micro-organisms on their hands at any one time

Equipment (hand hygiene)

Hand washing – Ayeliffe method

1. Palm to palm

2. Backs of hands