Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
The link between hand washing and contact transmission of infection was first established by Oliver Wendell Holmes in the US (1843) and in Europe by Semmelweiss (1861) (Horton, 2002). It was again well supported by Larson (1981). They both showed a drop in the rate of puerperal sepsis and its associated mortality when medical staff washed their hands between examining women during childbirth. Hands are the principle route by which cross infection occurs (Elliot, 1992). The Strategy for the Control of Antimicrobial Resistance in Ireland (SARI) was launched in 2001 and is available in the Mercy University Hospital Library and the Health Protection Surveillance Centre (01) 876 5300 Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
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Micro-organisms found on the skin include two categories:
These are usually deep seated in the epidermis, are not readily removed and do not readily cause infections. However, during surgery/invasive procedures, they may enter deep tissues and establish an infection.Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
These are organisms that are not part of the normal flora and represent recent contamination, that usually survives for a limited period of time. They are easily removed by a good hand washing technique. They include most of the organisms responsible for cross infection, e.g. Gram-negative bacilli (E.coli, Klebsiella, Pseudomonas spp, Salmonella spp.), Staph aureus, MRSA and viruses e.g. rotaviruses (Damani, N.N. (1997)).Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
There are three recommended levels of Hand Hygiene to ensure that the hand hygiene performed is suitable for the task being undertaken. The efficacy of hand hygiene will depend on application of an adequate volume of a suitable hand hygiene agent with good technique for the correct duration of time, and finally ensuring that hands are dried properly.Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
The aim of social (routine) hand washing with soap and warm water is to remove dirt and organic material, dead skin and most transient organisms. On visibly clean hands it can be undertaken using an alcohol hand rub, and this will remove transient organisms.Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
Antiseptic hand disinfection with an antiseptic hand wash agent i.e. Hydrex is generally carried out for aseptic procedures on the ward and for areas of Isolation. Hygienic hand disinfection will remove and kill most transient micro- organisms- indications for use
Surgical hand washing requires the removal and killing of transient micro-organisms and substantial reduction and suppuration of the resident flora of the surgical team for the duration of the operation, in case a surgical glove is punctured/torn. Ensure that fingernails are kept short and clean. Wrist watches and jewellery MUST be removed before surgical hand disinfection (Bernthal E, 1997). Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
Hand washing with a good technique covering all surfaces of the hands at the right time is more important than the agent used or the length of time of hand washing. Do not use nail-brushes on the wards. Nail-brushes (soft, sterile) used only for Surgical Scrub.
Each step consists of five strokes forward and five backward.
Follow the six steps already described except instead of using water dispense 3mls of the gel into the palm of the hand. Remember to rub the wrists of both hands. Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
Alcohol Gels
These are alternative methods of hand disinfection as already described (section 4.5) They do not cleanse and, therefore it is important that hands should first be cleaned with soap and water, in the presence of visible contamination. They are particularly useful in areas where a wash hand basin is not readily available, or when return to a wash hand basin is impractical e.g. during a ward round, in between bed making ,during a dressing procedure or if the previously washed hands touch the curtain trolley etc. They are also particularly useful outside the door of an isolation room/area and for individual patient bed space in “high” risk areas and during outbreaks on the advice of infection control. Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
The use of Prometics XL Cream available from the Pharmacy Department (project of the Microbiology Laboratory) is also encouraged in the hospital. This cream can be used for the same purposes as alcohol rub and as it contains natural emollients which help to moisturise the skin staff are encouraged to use it 3-4 times daily.
The main active ingredient is a natural fatty acid present in small amounts in the skin. This is particularly active against VRE and MRSA and a protective shield against the organisms remains in the skin when Prometics is used unlike alcohol based products where the protective effect evaporates within seconds.
NB: Only a very minute amount is required to be efficient. Surplus may cause the hands to become greasy. Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.
Surgical Hand antisepsis should be performed prior to all surgical procedures. It involves thorough washing and disinfection of hands, subungual areas and forearms. The agent used must have broad spectrum microbial activity, act rapidly and persist on the skin over several hours Betadine is the agent used in the MUH- See Theatre Policies for full guidelines – available in the theatre and on the H Drive of the hospital network. Comparison of Different Hand Washing Techniques to Control Transmission of Microorganisms.