Surgical

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Surgical Hygienic Hand Disinfection and
nosocomial infections
Anna Ahmad
M.Radwan Khaiata
Nazem Al-Kilany
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Terms

• Guidance?
• APIC ?
• CDC ?
• Infection control program ?

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Introduction

• Nosocomial infections (NIs) remain a major global
  concern. Approximately 2 million NIs occur
  annually in the United States. Overall national
  prevalence rates have been described as ranging
  between 3.5 and 9.9 , but they vary
  significantly between departments, patient
  groups, types of surgical procedures, and the use
  of medical indwelling devices, etc . The most
  common NIs are urinary tract infections, lower
  respiratory tract infections, surgical site
  infections, and primary septicemia. They lead to
  additional days of treatment, increase the risk
  of death , and increase treatment costs.
• In 2002, a new CDC guideline for hand hygiene in
  health-care settings was published, entitled
  Recommendations of the Healthcare Infection
  Control Practices Advisory Committee and the
  HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force .
  It provides healthcare workers with a review of
  data on hand washing and hand antisepsis in
  healthcare settings and provides specific
  recommendations to promote improved hand-hygiene
  practices and reduce transmission of pathogenic
  microorganisms to patients and personnel in
  health-care setting.

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• How could hands participate as an important
  factor in hospital infection?

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Infection Chain
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Microbial and Viral Flora of Hands

• Gram-positive Bacteria
• S. aurcus can survive on hands for at least 150
  min VRE survives on hands or gloves for up to 60
  min . On inanimate surfaces, S. aurcus and MRSA
  may survive for 7 months, with wild strains
  surviving longer than laboratory strains. VRE may
  survive on surfaces for 4 months. The tong
  survival on surfaces together with the relatively
  short survival on hands suggests that
  contaminated surfaces may well be the source for
  transient colonization despite negative hand
  cuttures.

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Patients Often Carry Resistant Bacteria on Their
Skin

• Patients often carry resistant bacteria on many
  areas of their skin, even when they have no
  wounds or broken skin
• The Figure shows the percent of patients with
  methicillin-resistant S. aureus (MRSA) who carry
  the organism on the skin under their arms, on
  their hands or wrists, or in the groin area.

Percent of Patients with MRSA Who Carry the
Organism on Their Skin
13-25 40 30-39
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• Gram-negative Bacteria
• Escherichia coil is the most common gram-negative
  bacterium, causing mainly urinary tract
  infections. Pseudomonas aeruginosa is also very
  common, chiefly causing lower respiratory tract
  infections. In the majority of cases, both types
  of infection are device-associated, and often
  found among patients in ICUs. Manual handling of
  devices such as urinary catheters, ventilation
  equipment, or suction tubes emphasizes the
  importance of healthcare workers hands in
  possible cross transmission of gram-negative
  bacteria. Overall, gram-negative bacteria are
  found in up to 64 of all NI .
• Spore-forming Bacteria
• The main spore-forming bacterium causing NI is
  Clostridium difficilo. It is estimated that
  between 15 and 55 of all cases of nosocomial
  antibiotic-associated diarrhea are caused by C.
  difficile . Patients with diarrhea caused by C.
  difficile have on average 3.6 additional hospital
  days attributable to the NI, which in the US
  costs approximately 3,669 per case or 1.1
  billion per year (289). The overall mortality is
  15 . Extra-intestinal manifestations are very
  uncommon (1) . Patients can be contaminated
  from, for instance, hospital personnels hands
  and from inanimate surfaces .

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Healthcare workers can get 100s to 1000s of
bacteria on their hands by touching any of the
following
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Hands

• Most common mode of transmission of pathogens is
  via hands!
• CDC estimates that each year nearly 2 million
  patients in the United States get an infection in
  hospitals, and about 90,000 of these patients die
  as a result of their infection
• 80 of the nosocomial infections is due to hand
  washing
• Germs in hospitals kill more Americans every
  year than car accidents, fires and drownings
  combined, the Chicago Tribune reports.

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Definitions

• Handwashing
• Washing hands with plain soap and water
• Hand Hygeine
• Washing hands with water and soap containing an
  antiseptic agent (scrub)or alcohol based hand rub
• Surgical hand hygiene
• Washing hands with antimicrobial soap and water
  (scrub)or alcohol based rub before operations by
  surgical personnel
• Guideline for Hand Hygiene in Health-care
  Settings. MMWR 2002 vol. 51, no. RR-16.

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Antiperspirant efficacy
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Why Is Adherence of Personnel toRecommended
Handwashing So Poor?

• Factors responsible for poor handwashing
  adherence rates include
• heavy workloads (too busy)
• sinks are poorly located
• skin irritation caused by frequent exposure to
  soap and water
• hands dont look dirty
• handwashing takes too long

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Skin Irritation and Dryness of HandsIs Another
Deterrent to Frequent Handwashing

• Frequent handwashing with soap and water often
  causes skin irritation and dryness
• In winter months, the skin on the hands of some
  personnel may become so dry and cracked that
  bleeding occurs
• When this occurs, personnel avoid washing their
  hands because it is painful to do so

Larson E et al. Heart Lung 199726404 Pittet D
et al. Lancet Infectious Dis April 20019
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Advantages of Cleaning Hands with Alcohol-Based
Hand Rubs

• When compared to soap and water handwashing,
  alcohol-based hand rubs have the following
  advantages
• take less time to use
• can be made more accessible than sinks
• cause less skin irritation and dryness (due to
  emoliunts)
• are more effective in reducing the number of
  bacteria on hands
• making alcohol-based handrubs readily available
  to personnel has led to improved hand hygiene
  practices

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Using an Alcohol-Based Hand Rub Takes Less Time
than Handwashing

• Time required for ICU nurses to go to a sink,
  wash and dry their hands, and return to patient
  care activities average 62 seconds
• Estimated time required to clean hands with an
  alcohol-based hand rub available at patients
  bedside average 15 seconds

Voss A Widmer A Infect Control Hosp Epidemiol
199718205
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• Ideal disinfectant
• Be fast acting even in the presence of organic
  substances .
• Be effective against all types of infectious
  agents without destroying tissues or acting as
  poison if ingested .
• Easily penetrate material to be disinfected
  without damaging or discoloring it .
• Be easy to prepare and stable even when exposed
  to light,heat, having a pleasant odor.

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How Can We Overcome Problems Associated with
Handwashing?

• We need to make cleaning your hands faster, more
  convenient and less irritating
• Experts now recommend that healthcare workers
  routinely clean their hands with an alcohol-based
  hand rub (rinse)

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Disinfection and Sterilization?

• Sterilzation killing all MicroOrganism including
  Spores
• Disinfection High level Killing all
  MicroOrganism excluding Spores
• Cleaning is removing dirts only.

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Thank You