Infection Control 2: Hand Hygiene with Alcohol-Based Hand Sanitizer | Clinical

introduction

Healthcare-badociated infections (HCAI) pose a serious risk to patients, staff and visitors and would cost the NHS £ 1 billion a year. National surveys have identified a prevalence of HCAI in hospitalized patients of 6.4% in England in 2011 (Health Protection Agency, 2012), 4.6% in Scotland in 2016 (NHS Scotland, 2017), 4.0 % in Wales in 2011 (Public Health Wales, 2012) and 4.2% in Northern Ireland in 2011/12 (Public Health Agency, 2012).

Both resident and transient bacteria will be present on the hands; transferred from the hands of a health professional to sensitive sites such as wounds or invasive devices, they can cause life-threatening infections, while transfer to non-susceptible sites may leave patients colonized with a bacterium that may lead to future infection of the patient or expose staff and visitors to the risk of infection (Loveday et al, 2014).

Why is hand hygiene important?

The most common mode of transmission of HCAI-badociated pathogens in health facilities is via contaminated hands of health professionals (World Health Organization, 2009). Transmission of the hands of a health professional to a patient is done in stages:

• The organisms are transferred from the patient or the environment to the health professional;
• The health professional does not provide effective hand hygiene;
• The health professional's hands come into contact with a patient or a vulnerable site such as the entry point of an invasive device.

Hand hygiene is the main measure that has been shown to be effective in preventing CRPD and is the cornerstone of good infection prevention and control (IPC) practice (WHO, 2009). . Current national and international guidelines have consistently shown that effective decontamination of the hands results in a significant reduction of potential pathogens on the hands. Loveday et al. (2014) state that it is therefore logical that effective decontamination decreases the incidence of preventable IPSCs, resulting in reduced morbidity and mortality of patients.

Hand decontamination can be performed with the help of an alcohol-based alcohol-based solution or a liquid soap and water. Staff should receive regular training on how to become familiar with the proper hand hygiene technique.

This article, the second in a series of six articles on the prevention and control of infections, discusses when hand hygiene should be performed, the hand hygiene procedure to use in different situations and the procedure of cleaning hands with ABHR.

The sixth part of this series explains how to clean the hands with water and soap and protect the integrity of the skin.

When to practice hand hygiene

WHO (2009) recommends decontaminating the hands of health professionals at five critical moments before, during and after patient care activities; These are called My Five Moments of Hand Hygiene:

• Before touching a patient
• Before clean / aseptic procedure;
• After exposure / risk to body fluids;
• After touching a patient
• After touching the patient's environment.

Hand hygiene resources and adherence to health professional guidelines by health professionals should be audited on a regular basis and the results communicated to health professionals to improve and maintain levels of compliance. compliance (Loveday et al, 2014).

Which cleaning agent to use

The choice of the appropriate hand decontamination method depends on the badessment of a number of factors:

• The nature of the care intervention provided;
• Resource availability at or near the point of service
• What is practically possible
• The acceptability of preparations or materials in terms of ease of use, time and access, as well as dermatological effects (Loveday et al, 2014).

Although handwashing or effective use of the ABHR system will eliminate transient microorganisms to make the hands socially clean, the ABHR system will also substantially reduce resident microorganisms. It is therefore recommended for routine use because of its increased efficacy, easy availability at the treatment site and general acceptability for health professionals (Loveday et al, 2014).

However, although ABHR reduces some resident microorganisms, it is not effective against all species (eg some viruses, especially noroviruses and sporulated microorganisms such as Clostridium difficile). In addition, it will not remove dirt and organic matter and may not be effective in certain epidemic situations; in such situations, it is necessary to wash your hands with soap and water.

Loveday et al. (2014) recommend using the ABHR method to decontaminate hands before and after direct patient contact and clinical care, except in the following situations, when water and soap should be used:

• When hands are visibly soiled or potentially contaminated with body fluids;
• When treating patients with vomiting or diarrheal diseases, whether you wear gloves or not.

The procedure

The handwash must be available at the health care site. For staff working in community settings, they should have their own human impregnated treatment center to ensure that they have access to them when they go to patients' homes or to their homes. other establishments other than health care.

Before you wash your hands, you should:

• Expose your forearms (bare under the elbows);
• Make sure all hand / wrist jewels are removed (staff members must be naked under their elbows at all times when they work.) Therefore, do not wear jewelry other than one. simple metal ring, which should be removed or moved to the top of the finger to wash below hand hygiene if this is required by local politics);
• Make sure nails are clean and short, and artificial nails or nail products are not worn.
• Cover cuts or abrasions with an impervious dressing.

To decontaminate hands with ABHR:

1. Make sure your hands are free of dirt and organic matter.
2. Apply a handshake in one hand in section and cover all surfaces (Fig 1).
3. Rub your hands palm against palm (Fig 2).
4. Rub the back of each hand with the palm of the other hand with intertwined fingers (Fig. 3).
5. Rub hands with intertwined fingers (Fig. 4).
6. Rub with the back of the fingers on the opposite palms with the nested fingers (Fig 5).
7. Rub each thumb tight in the opposite hand using a rotational motion (Fig 6).
8. Rub the ends of the fingers in the opposite palm in a circular motion (Fig 7).
9. Rub each wrist with the opposite hand (Fig 8).
10. Once dry, your hands are safe (20-30 seconds).

• Professional Responsibilities – These procedures should be undertaken only after approved training, supervised practice, and competency badessment, and conducted in accordance with local policies and protocols.