Hand Hygiene in Clinical Context

Introduction

The spread of infection via the hands is well established and hand hygiene is one of the most important procedures for preventing the spread of disease. There is extensive evidence that clearly demonstrates that contaminated hands are responsible for transmitting infections (Pittet 234- 238). Pressures on the clinical environment, the greater use of antibiotic therapy and the increase in invasive treatments have also contributed to the origin and spread of opportunistic and multi-resistant bacteria. The spread of these organisms can also be attributed, at least in part, to a failure of Health Care Workers to perform hand hygiene either as often, or as efficiently as the situations requires (Pittet 234- 238).

The Point Of Care As The Crucial Moment For Hand Hygiene

The point of care represents the time and place at which there is the highest likelihood of transmission of infection via healthcare staff whose hands act as mediators in the transfer of microorganisms (Pittet 234- 238).

To help staff understand the precise moments when they need to clean their hands and why, the National Patient Safety Agency (NPSA) endorses the World Health Organization (WHO) five moments for hand hygiene, which is reproduced below:

1

BEFORE PATIENT CONTACT

When? Clean your hands before touching a patient when approaching him/her

Why? To protect the patient against harmful germs carried on your hands

2

BEFORE ASEPTIC TASK

When? Clean your hands immediately before any aseptic task

Why? To protect the patient against harmful germs, including the patient's own, from entering his/her body

3

AFTER BODY FLUID EXPOSURE RISK

When? Clean your hands immediately after an exposure risk to body fluids (and after glove removal)

Why? To protect yourself and the healthcare environment from harmful patient germs

4

AFTER PATIENT CONTACT

When? Clean your hands after touching a patient her/his immediate surroundings when leaving the patient's surroundings

Why? To protect yourself and the healthcare environment from harmful patient germs

5

AFTER CONTACT WITH PATIENT SURROUNDINGS

When? Clean your hands after touching any object or furniture in the patient's immediate surroundings when leaving - even if the patient has not been touched.

Why? To protect yourself and the healthcare environment from harmful patient germs

Health care workers must wash their hands before and after all patient contact and whenever hands are visibly soiled, as well as: (this list is not exhaustive) (Pittet 234- 238)

Before:

Each shift;

Eating, drinking or handling food;

Performing a clinical procedure;

Giving care to a patient;

Before performing an aseptic technique.

After:

Each shift;

Direct contact with any blood and/or body fluids;

Using the toilet;

blowing your nose, coughing or sneezing;

Giving personal care;

Bed making;

Removing protective clothing;

Performing a clinical procedure;

Any cleaning of the environment or equipment.

Hand washing agents:

All hand washing and disinfection agents used in health care should be dispensed from a sealed dispenser which delivers a measured amount of liquid soap or antiseptic. The nozzle must be cleaned regularly to prevent clogging and contamination. Containers that are left open without a cover or dispenser should not be used as they can become dry and contaminated.

Liquid Soap

Soap and water hand washing will remove most organic contamination and is acceptable for a social hand wash. Bars of soap must be ...