Relationship of Hand Hygiene and Hospital-

Acquired Infections (HAIs)

HAI source – hands of health care workers Discovered in 1961 with 1 clone 5 clones identified in 2002 Divided into HAIs and CAIs CAIs initially found in drug addicts, but now

in healthy people Found in almost every HAI because of

biofilm Examples: MRSA, VRSA, C-diff,

Legionnaires’ Disease, UTI, pneumonia

Introduction

MRSA – infectious pathogen, resistant to B-lactams antibiotics

Nosocomial Infection – infection received in hospital as a result of being treated for a separate condition (HAIs).

Staphylococcus aureus (s. Aureus) – common cause of MRSA

DEFINITIONS

Non-compliance to hand washing guidelines by medical personnel

Cost per patient = $8,832.00 85% of invasive MRSA related to health care 33% developed during hospital stay Community Acquired Infections (CAIs) in

gyms, prison and day care

PROBLEMS:

Many pathogens are now resistant to antibiotics

Hand washing is most effective way to prevent infections

Staff are reluctant to wash hands

SIGNIFICANCE:

Reduce water loss    Protection from germs and abrasions     Barrier from unfriendly environmental

influences Everybody sheds skin cells – use caution

around patient’s environment (clothing, linen, furniture, etc).

Skin Functions:

Taking vital signs Transferring a patient Touching linens or equipment that comes in

contact with the patient Touching body secretions, excretions Touching skin – whether intact or not intact,

wounds

YOUR HANDS BECOME CONTAMINATED WHEN:

When handling food After sneezing or using bathroom After handling animals After handling any type of waste When your hands are dirty

WHEN TO CLEAN YOUR HANDS:

Hands are visibly dirty (blood and body fluids)

Before eating Before and after using the bathroom Patient has diarrhea - more efficient at

destroying C-Difficile

USE SOAP AND WATER WHEN…

Use warm, running water and soap Lather all areas of hands away from running

water Rub all areas of hands – fingers, underneath

fingernails, back of hands, palms Soap and running water removes germs Rub for at least 15 - 20 seconds – use friction! Rinse Dry with paper towel or one-time cloth Use paper towel to turn off spigots

WASHING HANDS

Available in gels, foam or rinse More effective at killing germs than soap

and water Does not irritate skin Easier to locate at point of care Requires less time to use than soap and

water

ALCOHOL-BASED HAND RUBS ARE:

Between patients if hands are not visibly dirty. Before having direct contact with the patient Before using sterile gloves to insert invasive devices

such as central intravascular catheter, indwelling urinary catheters, peripheral vascular catheters

After having direct contact with mucous membranes, wound or wound dressings, body fluids, broken skin

After touching equipment or furniture that the patient uses

After taking off your gloves When moving from contaminated site on body to

clean site on body

WHEN TO USE ALCOHOL-BASED RUBS:

Use 1 ½ to 3 ml of gel – about the size of a quarter

Apply to palm of hand Rub hands together and include fingers,

fingernails, palms, back of hands Rub until completely dry – 15-25 seconds

DIRECTIONS

Protects patient and HCW Can become contaminated during patient care Should be changed when moving from an infected

site to a clean site (along with hand-gel) Should be changed between patients Can develop tiny holes during use Does not replace hand hygiene Wash hands when you take off the gloves Use when coming in contact with blood or infectious

body fluids, excretions, secretions, mucous membranes and non-intact skin

Do not need gloves for touching patients’ sweat

GLOVES

Intensive Care Unit Diabetics, dialysis patients and chronic dermatitis

may have intact skin that is colonized with S. aureus (staphalacoccus aureus).

Excess antibiotics, long hospitalizations, history of MRSA, exposure to MRSA patients

Touch, ingestion, contaminated medical equipment

New colonized patients – no symptoms but carry germ

Infected/draining wounds or intact skin with colonized areas.

Risk factors

Skin to skin contact, activities that damage skin, contaminated towels and sports equipment

Often will affect healthy people

CAI Risk Factors

Compliance rates estimated to be below 50%

Lack of supplies, irritation to skin, insufficient evidence, heavy workload

Compliance with Hand Hygiene

Each year there are over 2M HAIs 30,000 resulted in death 70,000 = contributed to death Colonized patients have a 10-30% chance of

infection. 80% of tested stethoscope ear tips

contaminated Cost $20B a year

Statistics

Laws require hospitals to do more HAI screening Monitor and report HAI’s Public disclosure laws leading to

compliance MRSA Surveillance swabbing Copper – pathogens can not grow on copper Wash your hands!!

Prevention

You should clean your hands before entering a patients room

The patient may not have any visible signs of infection Germs can live over 2 hours on surfaces such as tables,

door knobs, desks Coughing and sneezing sends droplets throughout the air

as far as 3 feet. You can pick these germs up on your hands

When warm water is not available, you can use rubbing alcohol

You should never share a towel You should not touch surfaces that other people are

constantly touching – door knobs, computer keyboards, faucets, toilet handles, etc.

DID YOU KNOW…

The U.S. Public Health Service recommended washing hands for 1 – 2 minutes before and after patient care

Some germs can last for several minutes on HCW’s hands.

Improper hygiene fails to kill the germs – do it right!!

Fast Facts

Bacteria cut by up to 95% in copper trial. Health Estate Journal. 58-59 Bonnuel, N., Byers, P., Gray-Beckness, T. (2009).

Methicillin resistant staphylococcus aureus (MRSA) prevention through facility-wide culture

change. Critical Care Nursing Quarterly, 144-149 Boyce, J. S. (2009). Epidemiology of methicilin-resistant staphylococcus aureus infections in adults. UptoDate Online Data Base. Retrieved on September 3, 2009 from www.utdol.com/online/index.do

References:

Camins, B., & Fraser, V. (2005). Reducing the risk of health care- associated infections

by complying with CDC hand hygiene guidelines. Journal on Quality and

Patient Safety, 331 (3), 173-179. Klevins, R., Morrison, M., Nadle, J., Petit, S., Gershman,

K., Ray, S., et al. (2007). Invasive Methicillin-resistant staphylococcus aureus infections

in the United States. Journal of American Medical Association. 1763-1771 Leapfrog Group (2008) retrieved from internet on 7/18/10

from: www.leapfroggroup.org

References

Sprague, I. (2009). Health care-associated infections: Is there an end in sight? Issue

Brief/National Health/Policy Forum Weber, S., Huang, S., Oriola, S., Huskins, W., Noskin, G., Harriman, K., et al. (2007). Legislative mandates for use of active surveillance cultures to

screen for methicillin-resistant staphylococcus aureus and vancomycin-

resistant enterococci: Position statement from the joint SHEA and APIC task force. 35 (2), 73-85. Wolfe, A. (2009). Infection correction: Hospital-acquired infections can be

reduced significantly Or even eliminated with sound prevention procedures. States

Legislatures.    

References