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

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APPENDICES • Health-care workers should wear gloves and aprons when providing care for patients with C. difficile and should discard them immediately after they have been worn for a patient-care activity. Hand hygiene must then be performed. There is evidence that wearing gloves significantly reduces C. difficile infection and is therefore crucial, even though handwashing reduces spores and alcohol-based handrubs are effective against non-spore forms of C. difficile. Washing of clothing (including staff uniforms), bed linen, etc. – both in health-care settings using industrial processes and in the home – is also important when someone has C. difficile infection. Careful handling of contaminated clothing is essential in order to prevent the spread of any of the bacteria or its spores to hands or other items. Key points to consider for laundering include: • always hold laundry away from yourself; • do not sort through laundry unless absolutely necessary and do not shake it; Summary Preventing and controlling the spread of all diarrhoeal diseases is important. The main message is that hands should be washed thoroughly with soap and water when they are: visibly dirty or visibly soiled with blood or other body fluids; after using the toilet; or when exposure to potential spore-forming pathogens is strongly suspected or proven, including during outbreaks of C. difficile. Performing hand hygiene using an alcohol-based handrub is the recommended and most effective method to clean hands in most patient-care situations. According to recent evidence, alcohol-based handrubs have been a major factor in the reduction of serious infections such as MRSA, for example in the United Kingdom. It is important that the correct technique for hand hygiene is always applied. • perform hand hygiene after handling laundry; • use normal detergent to wash the laundry; • dry laundry either in a tumble dryer or on a washing line; • iron clothes according to their instructions, using a hot steam iron if possible; • keep clean the machines or sink areas where laundry has been washed. Organizational steps are also important in aiding prevention and control. An adequate health-care infrastructure should be in place, including: • a functioning and effective infection prevention and control team; • functioning and effective communication strategies and information available for patients and visitors; • written guidance that sets standards and assigns responsibilities, including monitoring of recommended practices against the standards; • surveillance and education programmes, with multidisciplinary teams working to ensure targeted management and control. There are also other specific measures that are recommended during outbreaks of C. difficile (http://www.cdc.gov/ncidod/ dhqp/id_Cdiff.html) 1 1 Vonberg RP et al. Infection control measures to limit the spread of Clostridium difficile. Clinical Microbiology and Infection, 2008, 14(Suppl. 5):2-20. 245
<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE Appendix 3. Hand and skin self-assessment tool Rate the current condition of the skin on your hands on a scale of 1–7 Appearance Abnormal: 1 2 3 4 5 6 7 Normal: red, blotchy, rash no redness, blotching, or rash Intactness Many abrasions 1 2 3 4 5 6 7 Completely intact: or fissures no abrasions or fissures Moisture content Extremely dry 1 2 3 4 5 6 7 Normal amount of moisture Sensation Extreme itching, 1 2 3 4 5 6 7 No itching, burning, or soreness burning, or soreness Sources: adapted from Larson E et al. Physiologic and microbiologic changes in skin related to frequent handwashing. Infection Control, 1986, 7:59-63 and Larson E et al. Prevalence and correlates of skin damage on the hands of nurses. Heart & Lung, 1997, 26:404-412. 246
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