Handwashing and Infection Control

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Handwashing and Infection Control

• Dr Merri Paech
• School of Nursing and Midwifery

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Content

• Chain of infection
• Infections caused by healthcare
• Iatrogenic and nosocomial infections
• Infection Control in the Healthcare Sector
• Principles of Infection Control
• Standard and Additional Precautions
• Handwashing and hand care
• Aseptic technique
• Current handwashing research

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The Chain of Infection Etiologic
agent (microorganism)
Reservoir (source)
Susceptible host
Portal of exit from reservoir
Portal of entry to the susceptible host
Method of transmission
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Crisis over SARS infection chain broken

• Headline in 2003
• Worldwide, SARS infected approx 8,500 and 800
  people died.
• (Treccasi L 2003 The Advertiser, July 24th)
• People wore ineffective paper face masks.
• The best defense is frequent, thorough
  handwashing
• (Mary Beers-Deeble 2003, Director, Master of
  Applied Epidemiology, ANU. Reported in The
  Australian 20/8/03)

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Methods of transmission

• Excretions and secretions
• Personal contacts
• Equipment and supplies

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Transmission Barriers

• Handwashing
• Barrier techniques
• Isolation (can create ethical dilemmas for
  staff)
• Personal protective equipment
• Gloves
• Masks
• Protective eyewear
• Gowns

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Infections Caused by Healthcare

• Iatrogenic Infection caused by treatment or
  diagnostic procedures
• Nosocomial Infection acquired at least 72 hours
  after hospitalisation hospital-acquired
  infection

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Nosocomial infections result in

• Pain and suffering (clients and families)
• Longer stays in hospital
• Increased health care costs
• Increased use of antibiotics
• Loss of income for clients
• Death

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How big is the problem?

• Human and financial cost
• 10 of in-patients in the UK develop nosocomial
  infections each year
• costing 1000 Million pounds)
• resulting in 5,000 deaths
• (Nicolay C 2006 Hand Hygiene An evidence-based
  review for surgeons. International Journal of
  Surgery, Vol 4 53-65)
• In 1999 in Australia, infected wounds cost approx
  140 million (Australian Patient Safety
  Foundation)

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Infection Control in the Australian Healthcare
Sector
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Infection control guidelines for the prevention
of transmission of infectious diseases in the
health care setting (ICG), 2004

• Australian Government
• Department of Health and Ageing
• http//www.health.gov.au

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Principles of Infection Control

• Appreciation of basic microbiology and modes of
  disease transmission
• Implementation of work practices which prevent
  transmission of infection (Standard and
  Additional Precautions)
• Conscientious hygiene, including handwashing
  regular cleaning of work areas
• Contd . . . . . /

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Principles of Infection Control

• Adoption of nationally recommended procedures for
  sterilisation and disinfection
• Use of single-use equipment
• Support for OHS policies and practices,
  including vaccinations
• Surveillance of nosocomial and iatrogenic
  infections quality improvement activities
• On-going education training for staff

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Standard Precautions for every patient

• Basic risk-minimisation strategy for healthcare
  work practices
• Aseptic technique, including appropriate use of
  skin disinfectants
• Personal hygiene practices, particularly
  handwashing before and after all significant
  patient contacts
• Personal protective equipment (PPE) - gloves,
  impermeable gowns, plastic aprons, masks/face
  shields, eye protection
• Careful handling disposal of ALL sharps
  clinical waste
• (ICG 2004)

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Basic Precautions contd . . . .

• Appropriate reprocessing of reusable equipment
  and instruments
• Environmental controls, including design
  maintenance of premises, cleaning spills
  management
• Appropriate provision of support services such as
  laundry and food services
• (ICG 2004)

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Additional Precautions

• For patients known or suspected to be infected
  or colonised with infectious agents that may not
  be contained with standard precautions (e.g.
  measles, rubella, influenza)
• Tailored to a particular infectious agent
• Single room with ensuite facilities
• Dedicated toilet
• Special ventilation (negative pressure)
• Additional PPE
• Rostering of immune healthcare workers
• Dedicated patient equipment
• Restricted movement of patients and healthcare
  workers
• ICG 2004

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Handwashing and hand care

• Hands have resident and transient micro-organisms
• AIMS of HANDWASHING
• To remove soil transient micro-organisms
• To reduce the total microbial counts over time

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When should healthcare professionals wash their
hands?

• When hands are visibly soiled
• Before and after client contact
• After contact with a source of micro-organisms
  (blood, body fluids, inanimate objects that are
  contaminated)
• Before performing invasive procedures
  (antimicrobial soap is recommended)
• After removing gloves
• (Infection Control Guidelines 2004)

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Aseptic Technique

• ASEPSIS
• absence of pathogenic micro-organisms
• ASEPTIC TECHNIQUE
• Practices that keep a patient as free from
  micro-organisms as possible

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Types of aseptic techniques

• Handwashing is different (see ICG handout)
• Medical asepsis (clean technique)
• Procedures in wards and clinics to reduce
  prevent the spread of micro-organisms among
  patients and staff
• Surgical asepsis (sterile technique)
• Invasive or operating room procedures

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Cleansing Agents

• Plain soap and water physically removes most
  transient micro-organisms
• Antiseptic agents kill/inhibit micro-organisms,
  reducing the level further

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Routine/social handwash

• Nails should be clean and short
• Remove jewellery
• Wet hands thoroughly
• Lather vigorously, particularly your dominant
  hand
• Use warm water if possible
• Rinse hands
• Dry with a single-use towel or hand drier

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Maintain your hands in good condition

• Assess hands for skin damage (can change resident
  microbial flora)
• Use hand lotions and protectants
• Prudent use of disposable gloves (should be
  powder-free and non-latex)

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Current handwashing research
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Handwashing and students health

• Investigation of the effectiveness of increased
  hand hygiene (gel handwashing) in decreasing
  the incidence of upper-respiratory illness
  (symptoms, illness rates and absenteeism) among
  450 students (average age 18 years) living in 4
  halls of residence in Ohio.
• Control group and study group . . . . . . . .
  contd
• White C, Kolble R, Carlson R, Lipson N, Dolan M,
  Ali Y Cline M 2003 The effect of hand hygiene
  on illness rate among students in university
  residence halls. AJIC, 31(6) 364-370

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• RESULTS
• 14.8 39.9 decrease in symptoms
• 20 improvement in illness rates
• 43 less missed school/work days
• White C, Kolble R, Carlson R, Lipson N, Dolan M,
  Ali Y Cline M 2003 The effect of hand hygiene
  on illness rate among students in university
  residence halls. AJIC, 31(6) 364-370

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Alcohol-based disinfection

• Hand hygiene compliance 50.4 - performed
  adequately in 20.8 of cases.
• Took hand samples for bacteriological examination
• Alcohol-based disinfection was less sensitive to
  individual performance and therefore a more
  robust hand hygiene method
• (Tvedt C, Bukholm G 2005 Alcohol-based hand
  disinfection a more robust hand-hygiene method
  in an ICU. Journal of Hospital Infection, 59(3)
  229-234)

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A study of various handwashing methods concludes
. . . .

• For removing viruses from hands, physical removal
  with soap and water is the most effective method
  since viruses are hardy and relatively resistant
  to disinfection
• Sickbert-Bennett E et al 2005 AJIC, March.
• Accessed on-line http//www.news-medical.net/?id
  8368

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Hand hygiene simple and complex

• Compliance with hand hygiene recommendations is
  poor worldwide. . . Input from behavioural and
  social sciences is essential when designing
  studies to investigate compliance. Interventions
  to increase compliance . . . must be appropriate
  for different cultural and social needs.
• Jumas P 2005 Hand Hygiene simple and complex.
  International Journal of Infectious Diseases,
  9(1) 3-14

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Key points

• Handwashing is the most important hygiene measure
  in preventing the spread of infection.
• Gloves are not a substitute for handwashing.
• Hands should be washed before and after
  significant contact with any patient, and after
  removing gloves.
• A mild liquid handwash should be used for routine
  handwashing. Skin disinfectants formulated for
  use without water may be used in certain limited
  circumstances.
• (Infection Control Guidelines 2004 pp12.1)

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Wash your hands thoroughly and often!