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)

  • 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