WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

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<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE Table I.3.1 Device-associated infection rates in ICUs in developing countries compared with NNIS rates Surveillance network, study period, country Setting No. of patients CR-BSI* VAP* CR-UTI* INICC, 2003–2005, PICU 1,529 16.1 10.6 5.3 5 developing countries† 41 NNIS, 2002–2004, USA 20 PICU — 6.6 2.9 4.0 INICC, 2002–2005, 8 developing countries‡* Adult ICU 21,069 12.5 24.1 8.9 NNIS, 2002–2004, USA 20 Adult ICU — 4.0 5.4 3.9 * Overall (pooled mean) infection rates/1000 device-days. INICC = International Nosocomial Infection Control Consortium; NNIS = National Nosocomial Infection Surveillance system; PICU = paediatric intensive care unit; CR-BSI = cather-related bloodstream infection; VAP = ventilator-associated pneumonia; CR-UTI = catheter-related urinary tract infection. †Argentina, Colombia, Mexico, Peru, Turkey ‡Argentina, Brazil, Colombia, India, Mexico, Morocco, Peru, Turkey Reproduced from Pittet, 2008 25 with permission from Elsevier. 8
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE 4. Historical perspective on hand hygiene in health care Handwashing with soap and water has been considered a measure of personal hygiene for centuries 48,49 and has been generally embedded in religious and cultural habits (see Part I, Section 17). Nevertheless, the link between handwashing and the spread of disease was established only two centuries ago, although this can be considered as relatively early with respect to the discoveries of Pasteur and Lister that occurred decades later. In the mid-1800s, studies by Ignaz Semmelweis in Vienna, Austria, and Oliver Wendell Holmes in Boston, USA, established that hospital-acquired diseases were transmitted via the hands of HCWs. In 1847, Semmelweiss was appointed as a house officer in one of the two obstetric clinics at the University of Vienna Allgemeine Krankenhaus (General Hospital). He observed that maternal mortality rates, mostly attributable to puerperal fever, were substantially higher in one clinic compared with the other (16% versus 7%). 50 He also noted that doctors and medical students often went directly to the delivery suite after performing autopsies and had a disagreeable odour on their hands despite handwashing with soap and water before entering the clinic. He hypothesized therefore that “cadaverous particles” were transmitted via the hands of doctors and students from the autopsy room to the delivery theatre and caused the puerperal fever. As a consequence, Semmelweis recommended that hands be scrubbed in a chlorinated lime solution before every patient contact and particularly after leaving the autopsy room. Following the implementation of this measure, the mortality rate fell dramatically to 3% in the clinic most affected and remained low thereafter. Apart from providing the first evidence that cleansing heavily contaminated hands with an antiseptic agent can reduce nosocomial transmission of germs more effectively than handwashing with plain soap and water, this approach includes all the essential elements for a successful infection control intervention: “recognize-explain-act”. 51 Unfortunately, both Holmes and Semmelweis failed to observe a sustained change in their colleagues’ behaviour. In particular, Semmelweis experienced great difficulties in convincing his colleagues and administrators of the benefits of this procedure. In the light of the principles of social marketing today, his major error was that he imposed a system change (the use of the chlorinated lime solution) without consulting the opinion of his collaborators. Despite these drawbacks, many lessons have been learnt from the Semmelweis intervention; the “recognize-explainact” approach has driven many investigators and practitioners since then and has also been replicated in different fields and settings. Semmelweis is considered not only the father of hand hygiene, but his intervention is also a model of epidemiologically driven strategies to prevent infection. The 1980s represented a landmark in the evolution of concepts of hand hygiene in health care. The first national hand hygiene guidelines were published in the 1980s, 53-55 followed by several others in more recent years in different countries. In 1995 and 1996, the CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) in the USA recommended that either antimicrobial soap or a waterless antiseptic agent be used 56,57 for cleansing hands upon leaving the rooms of patients with multidrug-resistant pathogens. More recently, the HICPAC guidelines issued in 2002 58 defined alcohol-based handrubbing, where available, as the standard of care for hand hygiene practices in health-care settings, whereas handwashing is reserved for particular situations only. 59 The present guidelines are based on this previous document and represent the most extensive review of the evidence related to hand hygiene in the literature. They aim to expand the scope of recommendations to a global perspective, foster discussion and expert consultation on controversial issues related to hand hygiene in health care, and to propose a practical approach for successful implementation (see also Part VI). As far as the implementation of recommendations on hand hygiene improvement is concerned, very significant progress has been achieved since the introduction and validation of the concept that promotional strategies must be multimodal to achieve any degree of success. In 2000, Pittet et al. reported the experience of the Geneva’s University Hospitals with the implementation of a strategy based on several essential components and not only the introduction of an alcohol-based handrub. The study showed remarkable results in terms of an improvement in hand hygiene compliance improvement and HCAI reduction. 60 Taking inspiration from this innovative approach, the results of which were also demonstrated to be long-lasting, 61 many other studies including further original aspects have enriched the scientific literature (see Table I.22.1). Given its very solid evidence base, this model has been adopted by the First Global Patient Safety Challenge to develop the <strong>WHO</strong> Hand Hygiene Improvement Strategy aimed at translating into practice the recommendations included in the present guidelines. In this final version of the guidelines, evidence generated from the pilot testing of the strategy during 2007– 2008 is included (see also Part I, Section 21.5). 62 A prospective controlled trial conducted in a hospital nursery 52 and many other investigations conducted over the past 40 years have confirmed the important role that contaminated HCWs’ hands play in the transmission of health care-associated pathogens (see Part I, Sections 7–9). 9
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PART V. PATIENT INVOLVEMENT IN HAND
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PART VI. COMPARISON OF NATIONAL AND
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REFERENCES 35. Jroundi I et al. Pre
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REFERENCES 841. Gillet P. Construir
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REFERENCES 986. Kinsella G, Thomas
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REFERENCES 1138. Chen YC, Chiang LC
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