Importance of Hand Washing and Hygiene in Healthcare Settings

Ashish sharma

Deputy Director Six Sigma Healthcare, Delhi

Handwashing practices in the patient care setting began in the early 19th century. The practice evolved over the years with evidential proof of its vast importance and coupled with other hand-hygienic practices, decreased pathogens responsible for nosocomial or hospital-acquired infections (HAI). contaminated hands of healthcare providers are a primary source of pathogenic spread. Keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others. many diseases and conditions are spread by not washing hands with soap and clean, running water. Proper hand hygiene decreases the proliferation of microorganisms, thus reducing infection risk and overall healthcare costs, length of stays, and ultimately, reimbursement. According to the centres for Disease control and Prevention (cDc), hand hygiene is the single most important practice in the reduction of the transmission of infection in healthcare settings. This activity illustrates the importance of handwashing and highlights the importance of the interprofessional team in educating patients about preventing infections and improving outcomes by remembering to wash hands frequently.

Objectives:

• Identify the indications for handwashing:

When, Why and How to Hand wash and sanitize? • Importance of Handwashing and Hand

Hygiene in Healthcare Institutions. • Explain how handwashing decreases risk of infection transmission.

• Outline interprofessional team strategies for enhancing care coordination and communication to advance the prevention of infections and improve patient outcomes.

intrOductiOn

Handwashing practices in the patient care setting began in the early 19th century. The practice evolved over the years with evidential proof of its vast importance and coupled with other hand-hygienic practices, decreased pathogens responsible for nosocomial or hospital-acquired infections (HAI). contaminated hands of healthcare providers are a primary source of pathogenic spread. Proper hand hygiene decreases the proliferation of microorganisms, thus reducing infection risk and overall healthcare costs, length of stays, and ultimately, reimbursement.

According to the centers for Disease control and Prevention (cDc), hand hygiene is the single most important practice in the reduction of the transmission of infection in the healthcare setting. Despite this evidence, studies have repeatedly shown that the importance of hygiene has not been adequately recognised amongst healthcare professionals and compliance remains low.

HOw Germs spreAd

Washing hands can keep us healthy and prevent the spread of respiratory and diarrheal infections. Germs can spread from person to person or from surfaces to people when we: • Touch the eyes, nose, and mouth with unwashed hands • Prepare or eat food and drinks with unwashed hands • Touch surfaces or objects that have germs on them • Blow the nose, cough, or sneeze into hands and then touch other peoples' hands or common objects

Key times tO wAsH HAnds

• Before, during, and after preparing food • Before and after eating food • Before and after caring for someone at home who is sick with vomiting or diarrhea • Before and after treating a cut or wound • After using the toilet • After changing diapers or cleaning up a child who has used the toilet • After blowing your nose, coughing, or sneezing • After touching an animal, animal feed, or animal waste • After handling pet food or pet treats • After touching garbage

HAndwAsHinG tecHnique:

• Begin by standing in front of the sink and taking care not to touch sink surfaces with hands or uniform/lab coat. • If hands touch sinks at any time during this process, they are considered contaminated, and you must start the process over. • Turn on the warm water. Allow water to wet hands and wrists thoroughly. • Remember to keep hands and forearms lower than your elbows, so cross-contamination from water running back does not occur. • Water should flow in a manner from least to most contaminated areas such as the hands. microorganisms get washed down the sink. • Apply approximately 3 ml to 5 ml of an antiseptic soapy solution. Soap requires even distribution with a nice lather making sure all areas of hands receive covering in soap. • Next, use friction or rubbing of hands and wrists for no less than 15-20 seconds to ensure the removal of germs. • Use a timer or timed sink if available. • This vigorous rubbing of hands and wrists will

include anterior and posterior surfaces, cuticle area, underneath nails, and in between each finger. • Leave no part of the hand or wrist untouched. • Interlace fingers, rub palms and backs of hands at least five times each to ensure all areas have coverage. • The World Health Organisation (WHO) recommends six steps in hand hygiene. This includes palm to palm, right palm over the left dorsum and vice versa, palm to palm with fingers interlaced, backs of fingers to opposing palms, rubbing of thumbs and fingertips. • Rinse hands and wrists making sure all soap has been successfully washed off. • When rinsing off water remember to keep hands down and elbows up, then dry hands and wrists entirely with clean or disposable towels. • Throw towels away if disposable or place in the appropriate place/ hamper/ bin without coming into contact with these objects. • The end of handwashing will involve making sure you do not recontaminate your hands by touching the sink or faucet handles to turn the water off. Once hands are washed and dried, use a towel to turn off the water and then dispose of it in the appropriate container. • Surgical sinks/handwashing stations have timers such as in trauma bays that automatically shut off at specific time intervals. These guard against recontamination of hands/wrists by ensuring there is no need to turn the water off manually.

mAnpOwer

Healthcare professionals caring for high-risk patients that are immuno compromised must take great care in performing proper hand hygiene as this patient population is at high risk for opportunistic infections. Handwashing with soap and water will remove nearly all transient gramnegative bacilli in ten seconds while chlorhexidine may be more appropriate than soap and water for the removal of transient gram-positive bacteria.

Handwashing is a requirement if potential there was potential exposure to clostridium difficile, Norovirus, or Bacillus anthracis. Clostridium difficile and bacillus anthracis contain spores, and none of the agents used in antiseptic handwash or hand-rub preparations are reliably sporicidal. In these cases, vigorous handwashing with soap will assist in the removal of the spores from the skin.

According to the cDc, established guidelines recommend that agents used for surgical hand scrubs should reduce microorganisms on intact skin in a substantial manner, contain a nonirritating antimicrobial preparation, have broadspectrum activity, and be fast-acting and persistent. Studies have demonstrated that formulations containing 60% to 95% alcohol alone or 50% to 95% in combination with other products lower bacterial counts on the skin immediately post-

The World Health Organization (WHO) recommends 6 steps in hand hygiene. This includes palm to palm, right palm over the left dorsum and vice versa, palm to palm with fingers interlaced, backs of fingers to opposing palms, rubbing of thumbs and fingertips.

scrub more effectively than other agents.

tecHnique

Surgical hand antiseptic practices began in the late 1800s and remain vital to the prevention of infection today. Surgical hand antisepsis or hand hygiene for surgery requires a different set of skills than regular handwashing techniques. The inadvertent transfer of micro organisms to a patient's surgical site can result in a surgical site infection, these are one of the most common forms of hospital-associated infections for surgical patients. carrying out the correct hand hygiene steps prior to surgery can help reduce the risk of surgical site infections.

According to the cDc, 'Hand Hygiene in the Healthcare Settings,' hand hygiene for surgery follows specific vital steps using either an anti microbial soap or an alcohol-based hand sanitiser before donning sterile gloves for surgical procedures. In contrast to hygienic handwashing, surgical hand preparation must remove the transient flora and reduce the presence of resident flora.

surGicAl HAnd Antisepsis steps

• Remove all jewellery such as rings, watches, and bracelets before beginning the surgical hand scrub. • Inspect hands for cuts, cuticle damage, open lesions, or abrasions. • Apply surgical shoe covers, hats, caps, masks, and eye protection next. • Turn on water using foot/ knee controls to the desired warm temperature. • Perform a pre-rinse ensuring soap gets to about two inches above the elbows remembering the hands must be always kept above the elbows during this process as well as during the rinse. • Begin debris removal from underneath fingernails using a nail pick while the water is running. • When performing surgical hand antisepsis using an antimicrobial agent, scrub hands, fingers, and forearms for two to six minutes typically, but follow manufacturer guidelines and facility-specific policies and procedures.

Some institutions suggest a certain number of strokes when cleansing the nails, palms, hands, and forearms. According to the CDC, 'Hand Hygiene in the Healthcare Settings,' hand hygiene for surgery follows specific vital steps using either an antimicrobial soap or an alcohol-based hand sanitizer before donning sterile gloves for surgical procedures.

• Brush methods may be used and are facilityspecific. Long scrub times (e.g., 10 minutes) are not a recommendation due to the potential to irritate hands and nonsupporting evidence of its benefit versus risk. • Shorter scrub times with a two-stage surgical scrub technique may be standard in some institutions. • Remember, when rinsing soap/ agent off, allow water to run off at the elbows, ensuring the hands remain clean and free of microbes. • Foot or knee controls are used to turn the water off. • Hands always stay elevated and away from the body. • Approach sterile field, grasp towel, avoid dripping excess water on your sterile field, and dry one hand. • Obtain a new sterile towel or reverse the first towel and dry the other hand. • Drop towel into a nearby linen hamper or carefully handoff to another member of the healthcare team. • After application of the alcohol-based product or antiseptic hand rub as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves.

enHAncinG HeAltHcAre teAm OutcOmes

All healthcare workers should regularly wash hands as this is the most cost-effective way to prevent transmission of infections. While compliance with handwashing is high among healthcare workers, the same is not true of the public. Thus, the nurse, pharmacist and physician should educate the patient on the benefits of handwashing at every clinic visit. sshc

ARMED FORCES BOOK OF RECORDS

• We do the things that makes India Proud. We want to record their activities from ground to top and this brings little more enthusiasm to our Defence personnel when their name listed nationally. We are planning the launching of this book in a big way through Defence Ministers, CDS & DGs of All Forces @ Golden Jubilee of 1971 War. The book will be authored by the veterans of Indo-Pak War and eminent personalities of forces. • Who dares - Wins, Who sweats - Wins, Who plans – Wins. The brave die never, though they sleep in dust. Their courage nerves a thousand living men. The Forces have numerous talents and extraordinary works which we want to club under one roof. In view of this, we have decided to include the work/talent of Military and Para Military forces in the concerned field.

FORCES TO BE COVERED IN AFBR

OTHER DEPARTMENTS TO BE COVERED IN AFBR

• Indian Army • Indian Air Force • Indian Navy • ITBP • CRPF • RAF • Assam Rifles • SSB • BRO • Indian Coast Guard • CISF • BSF • Special Frontier Force • Police • NSG • RPF • WAR Veteran • NDRF

• Aeronautical Development Agency • Defence Exhibition Organisation • Defence Intelligence Agency (India) • Defence Planning Committee • Defence Research and Development Organisation • Marine Commando Force (MCF) • Military Engineer Services • Associate Armed Forces Organizations • Directorate of Air Intelligence • Directorate of Military Intelligence (India) • Directorate of Naval Intelligence (India) • Indigenous Defence Equipment Exporters Association • MARCOS • National Defence Academy (India) • Ordnance Factory Board • Samtel Avionics • Ex Servicemen