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
- 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)
- Wash basins (turned on without the use of hands)
- Clinical staff only basins
- No plugs or overflows
- Mixer type taps
- Liquid soap dispensers close by
- Paper towel dispenser close by
- Pedal operated bin
- Alcohol-based handrub at the point of care
Hand washing – Ayeliffe method
- Hands are moistened
- 3-5mL of soap or gel are applied to hands
- EACH STEP IS REPEATED 5 TIMES
- IN THE FOLLOWING ORDER
1. Palm to palm
- Palm to palm
- Distributes soap / gel
2. Backs of hands
- Right palm over left dorsum
- Fingers interlaced
- Thumb on outer aspect of palm
- Movement should cover entire finger lengths
- Repeat on other hand