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Table I.17.1: Elements of educational and motivational programmes for health-care workers 1. Rationale for hand hygiene, including: a) potential risks of transmission of microorganisms to patients b) potential risks of health-care worker colonization or infection caused by organisms acquired from the patient c) morbidity, mortality, and costs associated with health care-associated infections 2. Indications for hand hygiene, including those patient contacts for which potential contamination is not readily apparent to the health-care worker, such as: a) contact with a patient’s intact skin (e.g. taking a pulse or blood pressure, performing physical examinations, lifting the patient in bed) 28,44,45,63,67,71 b) contact with environmental surfaces in the immediate vicinity of patients 28,64,71,74 c) following glove removal 69,85,500 3. Techniques for hand hygiene, including: a) amount of hand hygiene solution b) duration of hand hygiene procedure c) selection of hand hygiene agents 1) alcohol-based handrubs are the most efficacious agents for reducing the number of bacteria on the hands of personnel. Antiseptic soaps and detergents are the next most effective, and non-antimicrobial soaps are the least effective 1,361 2) soap and water are recommended for visibly soiled hands 3) alcohol-based handrubs are recommended for routine decontamination of hands for all clinical indications (except when hands are visibly soiled) and as one of the options for surgical hand hygiene 4. Methods to maintain hand skin health: a) lotions and creams are acceptable and can prevent or minimize skin dryness and irritation due to irritant contact dermatitis b) lotions or creams must be applied according to a recommended schedule c) lotions or creams should be provided free of charge to the health-care worker 5. Expectations of patient-care managers/administrators as evidenced by: a) written statements regarding the value of, and support for, adherence to recommended hand hygiene practices b) role models demonstrating adherence to recommended hand hygiene practices 559 6. Indications for, and limitations of, glove use: a) hand contamination may occur as a result of small, undetected holes in examination gloves 377,615 b) contamination may occur during glove removal 69 c) wearing gloves does not replace the need for hand hygiene 85 d) failure to remove gloves after caring for a patient may lead to transmission of microorganisms from one patient to another 634
Table I.18.1: Strategies for successful promotion of hand hygiene in hospitals Strategy Selected references* 1. Education 2. Routine observation and feedback 261,262,507,518,526,528-531,536,591,592,746 261,262,506,518,526,528-530,746 3. Engineering control 4. Patient education Make hand hygiene possible, easy, convenient Make alcohol-based handrub available 261,262,506,518,526,528-530,746 261,262,506,518,526,528-530,746 261,262,506,518,526,528-530,746 5. Reminders in the workplace 6. Administrative sanction/rewarding 7. Change in hand hygiene agent 8. Promote/facilitate skin care for HCW hands 9. Active participation at individual and institutional level 10. Improve institutional safety climate 11. Enhance individual and institutional self-efficacy 12. Avoid overcrowding, understaffing, excessive workload 13. Combine several of above strategies 261,262,506,518,526,528-530,746 261,262,506,518,526,528-530,746 261,262,506,518,526,528-530,746 261,262,506,518,526,528-530,746 261,262,506,518,526,528-530,746 261,262,506,518,526,528-530,746 262,535,541,530,592 262,535,541 530,592 262,535,541 530,592 *Only selected references have been listed; readers should refer to more extensive reviews for exhaustive reference lists 1,13,541,561,749 .
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The WHO Guidelines on Hand Hygiene
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CONTENTS INTRODUCTION . ...........
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17. Organizing an education program
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INTRODUCTION The WHO Advanced Draft
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Handwashing. Washing hands with pla
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still considered the standard of ca
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treatment selectively removes glyce
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of the organism on their hands. Mak
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6. MODELS OF HAND TRANSMISSION 6.1
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In the 1960s, a prospective, contro
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for its ability to reduce the relea
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8.2 SHORTCOMINGS OF TRADITIONAL TES
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tions of short-chain aliphatic alco
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9.1.3 WATER QUALITY The physical, c
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Case study: experience of Egypt The
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and both reduced viral counts on ha
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activity of chlorhexidine is not se
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protein synthesis and alteration of
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in micelle structures formed by sur
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In all the studies that included pl
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isopropyl alcohol) were applied to
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3) Glycerol is added using a measur
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in 2005 the costs of an alcohol-bas
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infection, risk factors that are la
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11.4.4 SIDE-EFFECTS OF THE SURGICAL
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• Repeat the process on the other
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12.2 ALLERGIC CONTACT DERMATITIS RE
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particularly when resources are lim
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Handrubs are available as gels, sol
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14. HAND HYGIENE PRACTICES AMONG HE
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quantified in observational studies
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According to behavioural theories (
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of water with special leaves) outsi
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Furthermore, according to Phra Depv
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16. BEHAVIOURAL CONSIDERATIONS 16.1
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and community factors must be consi
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i. ii. iii. iv. v. vi. a) b) Educat
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tion precautions 580 . There are al
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follow the intent 588 . Studies hav
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18. FORMULATING STRATEGIES FOR HAND
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18.2 DEVELOPING A STRATEGY FOR GUID
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1998 (P
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HCWs routinely to wear vinyl gloves
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quality gloves, reuse, shortage of
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• To test for holes, gloves shoul
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Figure l.20.2: Blood safety: crucia
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Consensus recommendations are that
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D. Wash hands with either plain or
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5. SKIN CARE A. B. C. Include infor
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PART III. OUTCOME MEASUREMENTS 1. M
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2. HAND HYGIENE AS A QUALITY INDICA
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can be seen during routine work. Da
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Case study: United Kingdom national
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PART IV. PROMOTING HAND HYGIENE ON
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ated to reinforce its principles (t
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6. PRINCIPLES OF COUNTRYWIDE HAND H
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As many international and national
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debate that resulted in increasing
Page 128 and 129: 23. Lee YL et al. Colonization by S
Page 130 and 131: Interscience Conference on Antimicr
Page 132 and 133: 122. Vicca AF. Nursing staff worklo
Page 134 and 135: 171. Kauppinen J et al. Hospital wa
Page 136 and 137: 224. Krilov LR et al. Inactivation
Page 138 and 139: 276. Thomas L et al. Development of
Page 140 and 141: 326. Johnson S et al. Prospective,
Page 142 and 143: 34th Interscience Conference on Ant
Page 144 and 145: 423. Kampf G, et al. Influence of a
Page 146 and 147: 474. West DP et al. Evaluation of a
Page 148 and 149: 524. Muto C et al. Hand hygiene rat
Page 150 and 151: 578. Babcock HM et al. An education
Page 152 and 153: Interscience Conference on Antimicr
Page 154 and 155: 679. Hirschmann H et al. The influe
Page 156: 729. Martin LS, McDougal JS, Loskos
Page 161 and 162: Table I.8.1: Basic experimental des
Page 163 and 164: Table I.9.1: Waterborne pathogens a
Page 165 and 166: Table I.9.3: Virucidal activity of
Page 167 and 168: Table I.9.4: Studies comparing the
Page 169 and 170: Table I.9.6: Studies comparing the
Page 171 and 172: Table I.14.1: Hand hygiene frequenc
Page 173 and 174: Table I.14.2: Hand hygiene adherenc
Page 175: Table I.15.1: Hand hygiene indicati
Page 179 and 180: Table l.20.1: Possible problems and
Page 181 and 182: Table I.21.1. Hand hygiene research
Page 183 and 184: Table I.21.1: Hand hygiene research
Page 185 and 186: Table I.21.2: Unsolved issues for r
Page 187 and 188: Table III.2.1: Quality indicators r
Page 189 and 190: Table V.3.1: Examples of public inf
Page 191 and 192: Table V.4.1: Examples of national p
Page 193: Table V.5.1: The public information
Page 197 and 198: APPENDIX 1. DEFINITIONS OF HEALTH-C
Page 199: APPENDIX 2. HAND AND SKIN SELF-ASSE
Page 202: Data in coloured cells can be chang
Page 206: NHS NICU n-P NPSA NA NS OPD PACU PA
Page 211 and 212: AUTHORS: John Boyce Saint Raphael H
Page 213 and 214: Garance Upham People’s Health Mov
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