who handrub ppt

8/3/2019 WHO Handrub Ppt.

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Health Care-Associated Infectionand Hand Hygiene Improvement

Calixto T. Chan Jr. M.D. FPCSSurgical Infection

Philippine Heart Center CV Surgery


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Overview of the Session

This session will: Set the scene for the continued

need to advocate for goodhand hygiene in health care

HCAI places a seriousdisease burden andsignificant economic impacton patients and health-caresystems

Good hand hygiene thesimple task of cleaninghands at the right timesand in the right way saveslives

Explain the My 5 Moments forHand Hygiene approach

There are 5 Moments forHand Hygiene in health care

Global compliance with My 5Moments for Hand Hygieneapproach is universally sub-optimal

Outline the Action PlanPHC is preparing to implement an

Action Plan for improved hand

hygiene and reduction of HCAI


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Definition

Health Care-associated Infection (HCAI) Also referred to as nosocomial or hospital infection

An infection occurring in a patient during the process of care in a hospital or other health-care

facility which was not present or incubating at the timeof admission. This includes infections acquired in thehealth-care facility but appearing after discharge, and also occupational infections among health-care

workers of the facility


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HCAI: The worldwide burden

Estimates are hampered by limited availabilityof reliable data

The burden of disease both outside and insidehealth-care facilities is unknown in many countries

No health-care facility, no country, no health-caresystem in the world can claim to have solved the problem


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Estimated rates of HCAI worldwide

At any time, over 1.4 million people worldwide aresuffering from infections acquired in health-care facilities

In modern health-care facilities in the developed world:5 10% of patients acquire one or more infections

In developing countries the risk of HCAI is 2 20 timeshigher than in developed countries and the proportionof patients affected by HCAI can exceed 25%

In intensive care units, HCAI affects about 30% of

patients and the attributable mortality may reach 44%


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The impact of HCAI

HCAI can cause: more serious illness prolongation of stay in a

health-care facility long-term disability excess deaths high additional

financial burden high personal costs on

patients and their families


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Most frequent sites of infectionand their risk factors

LOWER RESPIRATORY TRACT INFECTIONSMechanical ventilationAspirationNasogastric tubeCentral nervous system depressantsAntibiotics and anti-acidsProlonged health-care facilities stayMalnutritionAdvanced age

SurgeryImmunodeficiency

13%

BLOOD INFECTIONSVascular catheter Neonatal ageCritical care Severe underlying diseaseNeutropenia

ImmunodeficiencyNew invasive technologiesLack of training and supervision

14%

SURGICAL SITE INFECTIONSInadequate antibiotic prophylaxis

Incorrect surgical skin preparationInappropriate wound care

Surgical intervention durationType of wound

Poor surgical asepsisDiabetesNutritional state

ImmunodeficiencyLack of training and supervision 17%

URINARY TRACT INFECTIONSUrinary catheter Urinary invasive procedures

Advanced ageSevere underlying disease

UrolitiasisPregnancy

Diabetes

34%

Most commonsites of health care-

associated infectionand the risk factors

underlying theoccurrence of

infections

LACK OFHANDHYGIENE


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Prevention of health care-associated infection

Validated and standardized prevention strategies havebeen shown to reduce HCAI

At least 50% of HCAI could be prevented Most solutions are simple and not resource-demanding

and can be implemented in developed, as well as intransitional and developing countries


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SENIC study: Study on the Efficacy of Nosocomial Infection Control

>30% of HCAI are preventable

With infectioncontrol

-31% -35%-35%-27%

-32%

Withoutinfectioncontrol

14%

9%

19%26%

18%

LRTI SSI UTI BSI Total

Relative change in NI in a 5 year period (1970 1975)

0

10

20

30

-40

-30

-20

-10

%

Haley RW et al. Am J Epidemiol 1985


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Hand transmission

Hands are the mostcommon vehicle totransmit health care-associated pathogens

Transmission ofhealth care-associatedpathogens from onepatient to another viahealth- care workershands requires5 sequential steps


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5 stages of hand transmission

Germs present on patient skinand immediateenvironment

surfaces

Germ transfer onto health-care workershands

Germs survive on hands forseveralminutes

Suboptimal oromitted handcleansingresults in

handsremainingcontaminated

Contaminatedhands transmit germs viadirect contact

with patient orpatientsimmediateenvironment

one two three four five


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Why should you clean your hands?

Any health-care worker, caregiver or person involved inpatient care needs to be concerned about hand hygiene

Therefore hand hygiene concerns you ! You must perform hand hygiene to:

protect the patient against harmful germs carried onyour hands or present on his/her own skin

protect yourself and the health-care environmentfrom harmful germs


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The My 5 Moments for Hand Hygieneapproach


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How to clean your hands

Handrubbing with alcohol-based handrub is thepreferred routine method of hand hygiene if handsare not visibly soiled

Handwashing with soap and water essential when

when hands are visibly dirty or visibly soiled (followingvisible exposure to body fluids) 1

1 If exposure to spore forming organisms e.g. Clostridium difficile is strongly suspectedor proven, including during outbreaks clean hands using soap and water


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To effectively reduce thegrowth of germs on hands,handrubbing must beperformed by following all ofthe illustrated steps.This takes only 20 30seconds!

How to handrub


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How to handwash

To effectively reduce thegrowth of germs on hands,handwashingmust last 40 60 secsand should be performed byfollowing all of the illustratedsteps


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Hand hygiene and glove use

The use of gloves does not replace the need to cleanyour hands!

You should remove gloves to perform hand hygiene,when an indication occurs while wearing gloves

You should wear gloves only when indicated (see thePyramid in the Hand Hygiene Why, How and WhenBrochure and in the Glove Use Information Leaflet) otherwise they become a major risk for germ

transmission


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Compliance with hand hygiene

Compliance with hand hygiene differs across facilitiesand countries, but is globally


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Adequate handwashing withwater and soap requires40 60 seconds

Average time usuallyadopted by health-careworkers:


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A consensus-based, testedimprovement strategy now exists

WHO Multimodal Hand Hygiene Improvement Strategy Field tested in eight pilot centres and over 350 additional

health-care facilities worldwide Based on the recommendations of the WHO Guidelines

for Hand Hygiene in Health Care 5 core components; 5 Moments for Hand Hygiene


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Based on theevidence andrecommendationsfrom the WHOGuidelines on Hand

Hygiene in HealthCare (2009), anumber ofcomponents make upan effectivemultimodal strategyfor hand hygiene

What is the WHO Multimodal Hand HygieneImprovement Strategy?

ONE System changeAccess to a safe, continuous water supply as well asto soap and towels; readily accessible alcohol-basedhandrub at the point of care

TWO Training / EducationProviding regular training to all health-care workers

THREE Evaluation and feedbackMonitoring hand hygiene practices, infrastructure,perceptions and knowledge, while providing resultsfeedback to health-care workers

FOUR Reminders in the workplacePrompting and reminding health-care workers

FIVE Institutional safety climateCreating an environment and the perceptions thatfacilitate awareness-raising about patient safety issues


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Realistic targets for improvement (1)

e.g.

Improve compliance by x% in Year 1 Improve compliance by y% during Years 1 5 Increase compliance by z% by 2020 Reduce infection rates by x% over a z-year period

Targets will be influenced by baseline data


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Realistic targets for improvement (2)

Targets should be realisticIf baseline compliance is 20%, it is unrealistic to set atarget of 60% after 1 year of an intervention

Targets are dependent upon the necessary hand hygiene

infrastructures being in place


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Tools available to help you improve handhygiene at PHC (1)

WHO Guidelines on Hand Hygiene in Health Care

(2009):Present the evidence for hand hygiene improvement

Facility/Country-specific Guidelines Hand Hygiene Technical Reference Manual

Hand Hygiene Why, How and When Brochure Education Sessions and Training Films Hand Hygiene: When and How Leaflet


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Tools available to help you improve handhygiene at PHC (2)

Glove Use Information Leaflet Posters displayed throughout the facility

Your 5 Moments for Hand HygieneHow to Handrub

How to Handwash SAVE LIVES : Clean Your Hands Screensaver A Frequently Asked Questions document Key Scientific Publications


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Many countries worldwide are committedto improve hand hygiene

Current status, March 2009

You are part

of a globalmovement!Countries committed in 2005, 2006, 2007 and 2008

Countries planning to commit in 2009


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Summary

HCAI places a serious disease burden and significanteconomic impact on patients and health-care systems

Good hand hygiene the simple task of cleaning handsat the right times and in the right way saves lives

There are 5 Moments for Hand Hygiene in Health Care Global compliance with the My 5 Moments for Hand

Hygiene approach is universally sub-optimal PHC has implemented an Action Plan to improve hand

hygiene and reduce infection Your support and compliance with the initiatives is

essential to save lives in our facility


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Further information

Contact Visit the SAVE LIVES : Clean Your Hands website at:

www.who.int/gpsc/5may/en/
http://www.who.int/gpsc/5may/en/http://www.who.int/gpsc/5may/en/

who handrub ppt

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