Hand hygiene.pdf

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According to behavioural theories (see Part I, Section 16), hand cleansing patterns are most likely to be established in the first ten years of life. This imprinting subsequently affects the attitude to hand cleansing throughout life, in particular regarding the practice called “inherent hand hygiene” 542 which reflects the instinctive need to remove dirt from the skin. The attitude to handwashing in more specific opportunities is called “elective handwashing practice” 542 and may much more frequently correspond to some of the indications for hand hygiene during health-care delivery. In some populations, both inherent and elective hand hygiene practices are deeply influenced by cultural and religious factors. Even though it is very difficult to establish whether a strong inherent attitude towards hand hygiene directly determines an increased elective behaviour, the potential impact of some religious habits is worth considering. When considering behaviour related to personal hygiene, religious affiliations can be classified into three categories: (i) those where norms governing hand hygiene are detailed precisely in several moments throughout daily and ritual life; (ii) those where hand aspersion is indicated only on the occasion of ritual events; and (iii) those where no explicit attention is paid to personal or hand hygiene. Hand hygiene can therefore be practised for hygienic reasons, regardless of whether dirt is actually present or visible; for ritual reasons, as part of the gestures during religious ceremonies; and for symbolic reasons, in specific everyday life situations.This kind of classification is identified in Table I.15.1. Judaism, Islam and Sikhism, for example, have precise rules for handwashing included in the holy texts and this practice punctuates several crucial moments of the day. Therefore, a serious practising believer is a careful observer of these indications. Nevertheless, it is well known that in some cases, such as with Judaism, religion underlies the very culture of the population in such a way that the two concepts become almost indistinguishable. As a consequence of this, even those who do not consider themselves strong believers behave according to religious principles in everyday life. However, it is very difficult to establish if inherent 542 and elective 542 behaviour in hand hygiene, deep-seated in some communities, may influence HCWs’ attitude towards hand cleansing during health-care delivery. It is likely that those who are used to caring about hand hygiene in their personal lives are more likely to be careful in their professional lives as well, and to consider hand hygiene as a duty to guarantee patient safety. In the Sikh culture for instance, hand hygiene, besides being a holy act, is also an essential element of daily life. Sikh people would always wash their hands properly with soap and water before dressing a cut or a wound. This behaviour is obviously expected to be adopted by HCWs during patient care. A natural expectation, such as this one, could also facilitate patients’ ability to remind the HCW to clean their hands without creating the risk of compromising their mutual relationship. Of the five basic tenets of Islam, observing regular prayer five times daily is one of the most important. Personal cleanliness is paramount to worship in Islam. Muslims must perform methodical ablutions before praying and explicit instructions are given in the Qu’ran as to precisely how washing should be carried out. Ablutions must be made in freely running (not stagnant) water and involve washing the hands, face, forearms, ears, nose, mouth and feet, three times each. Additionally, hair must be dampened with water. Thus, every observant Muslim is required to maintain scrupulous personal hygiene at five intervals throughout the day, aside from his/her usual routine of bathing as specified in the Qu’ran. These habits transcend Muslims of all races, cultures and ages, emphasizing the importance ascribed to correct ablutions. “O you, who believe! When you intend to offer As-salat (the prayer), wash your face and your hands (forearm) up to the elbows, rub (by passing wet hands over) your heads
and (wash) your feet up to the ankles … then make ablution at the time of each prayer” (chapter 6, Almaidah, verse 6). Apart from the Qu’ran, other references also exist to guide Muslims. The way in which the Prophet Mohammed conducted his life is documented in a body of literature, the Hadith and the Sunna, and provide additional observations regarding both the emphasis given to personal hygiene within Islam, and the specific prominence of hand hygiene. The Prophet Mohammed always urged Muslims to wash hands frequently and especially after some clearly defined tasks (Table I.15.1) 549 . Hence, from the dawn of Islam, strict observation of hand hygiene with freely running water has been advocated for all Muslims, whatever their occupation. Unfortunately, the above-mentioned hypothesis that community behaviour influences HCWs’ professional behaviour has been corroborated by scanty scientific evidence until now (see also Part I, Section 16). In particular, no data are available on the impact of religious norms on hand hygiene compliance in health-care settings where religion is very deep-seated. This is a very interesting area for research in a global perspective, because this kind of information could be very useful in identifying the best components of a programme for hand hygiene promotion. It could be established that in some contexts emphasizing the link between religious and health issues may be very advantageous. An assessment survey, moreover, may also show that in populations with a high religious observance of hand hygiene, compliance with hand hygiene in health care will be higher than in other settings and, therefore, does not need to be further strengthened or, at least, education strategies should be oriented towards different aspects of hand hygiene and patient care. With the exceptions of ritual hand aspersion before the consecration of bread and wine, and of the cleansing of hands after touching the holy oil (the latter only in the Catholic Church), the Christian faith seems to belong to the third category of the above classification regarding hand hygiene behaviour. It must be highlighted that there are some episodes of Christ’s life where the act of hand cleansing apparently had negative connotations. Jesus criticized the Pharisees and scribes for their strict compliance with the ritual of washing hands before meals (Matthew 15:2, 20). It is important to understand that this is a symbolic criticism, in order to refer to the priority given to interior purity as opposed to exterior appearance. Similarly, the negative meaning given to Pilate’s act of washing hands to refer to his innocence has to be interpreted in a symbolic manner (Matthew 27:24). In general, the indications given by Christ’s example refer more to behaviour in a Christian’s spiritual life than in everyday life and are aimed to free believers from those formal and repetitive acts that do not always reflect interior purity. The emphasis on this specific point of view does not imply, though, that personal hygiene and body care are not important in the Christian way of life. Similarly, specific indications regarding hand hygiene are nonexistent in the Buddhist faith. No mention is made of hand cleansing in everyday life, nor during ritual occasions. According to Buddhist habits, only two examples of pouring water over hands can be given, both with symbolic meaning. The first is the act of pouring water on the hands of the dead before cremation in order to demonstrate forgiveness to each other, between the dead and the living. The second, on the occasion of the New Year, is the young person’s gesture of pouring some water over the hands of elders to wish them good health and a long life. In some African countries (e.g. Ghana and some other West African countries) hand hygiene is commonly practised in specific situations of daily life according to some ancient traditions. For instance, hands must always be washed before raising anything to one’s lips. In this regard, there is a local proverb: “when a young person washes well his hands, he eats with the elders”. Furthermore, it is customary to provide facilities for hand aspersion (a bowl
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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
Page 18 and 19: treatment selectively removes glyce
Page 20 and 21: of the organism on their hands. Mak
Page 22 and 23: 6. MODELS OF HAND TRANSMISSION 6.1
Page 24 and 25: In the 1960s, a prospective, contro
Page 26 and 27: for its ability to reduce the relea
Page 28 and 29: 8.2 SHORTCOMINGS OF TRADITIONAL TES
Page 30 and 31: tions of short-chain aliphatic alco
Page 32 and 33: 9.1.3 WATER QUALITY The physical, c
Page 34 and 35: Case study: experience of Egypt The
Page 36 and 37: and both reduced viral counts on ha
Page 38 and 39: activity of chlorhexidine is not se
Page 40 and 41: protein synthesis and alteration of
Page 42 and 43: in micelle structures formed by sur
Page 44 and 45: In all the studies that included pl
Page 46 and 47: isopropyl alcohol) were applied to
Page 48 and 49: 3) Glycerol is added using a measur
Page 50 and 51: in 2005 the costs of an alcohol-bas
Page 52 and 53: infection, risk factors that are la
Page 54 and 55: 11.4.4 SIDE-EFFECTS OF THE SURGICAL
Page 56 and 57: • Repeat the process on the other
Page 58 and 59: 12.2 ALLERGIC CONTACT DERMATITIS RE
Page 60 and 61: particularly when resources are lim
Page 62 and 63: Handrubs are available as gels, sol
Page 64 and 65: 14. HAND HYGIENE PRACTICES AMONG HE
Page 66 and 67: quantified in observational studies
Page 70 and 71: of water with special leaves) outsi
Page 72 and 73: Furthermore, according to Phra Depv
Page 74 and 75: 16. BEHAVIOURAL CONSIDERATIONS 16.1
Page 76 and 77: and community factors must be consi
Page 78 and 79: i. ii. iii. iv. v. vi. a) b) Educat
Page 80 and 81: tion precautions 580 . There are al
Page 82 and 83: follow the intent 588 . Studies hav
Page 84 and 85: 18. FORMULATING STRATEGIES FOR HAND
Page 86 and 87: 18.2 DEVELOPING A STRATEGY FOR GUID
Page 88 and 89: 1998 (P
Page 90 and 91: HCWs routinely to wear vinyl gloves
Page 92 and 93: quality gloves, reuse, shortage of
Page 94 and 95: • To test for holes, gloves shoul
Page 96 and 97: Figure l.20.2: Blood safety: crucia
Page 98 and 99: Consensus recommendations are that
Page 100 and 101: D. Wash hands with either plain or
Page 102 and 103: 5. SKIN CARE A. B. C. Include infor
Page 107 and 108: PART III. OUTCOME MEASUREMENTS 1. M
Page 109 and 110: 2. HAND HYGIENE AS A QUALITY INDICA
Page 111 and 112: can be seen during routine work. Da
Page 113 and 114: Case study: United Kingdom national
Page 115 and 116: PART IV. PROMOTING HAND HYGIENE ON
Page 117 and 118: 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
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23. Lee YL et al. Colonization by S
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Interscience Conference on Antimicr
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122. Vicca AF. Nursing staff worklo
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171. Kauppinen J et al. Hospital wa
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224. Krilov LR et al. Inactivation
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276. Thomas L et al. Development of
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326. Johnson S et al. Prospective,
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34th Interscience Conference on Ant
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423. Kampf G, et al. Influence of a
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474. West DP et al. Evaluation of a
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524. Muto C et al. Hand hygiene rat
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578. Babcock HM et al. An education
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Interscience Conference on Antimicr
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679. Hirschmann H et al. The influe
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729. Martin LS, McDougal JS, Loskos
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Table I.8.1: Basic experimental des
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Table I.9.1: Waterborne pathogens a
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Table I.9.3: Virucidal activity of
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Table I.9.4: Studies comparing the
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Table I.9.6: Studies comparing the
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Table I.14.1: Hand hygiene frequenc
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Table I.14.2: Hand hygiene adherenc
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Table I.15.1: Hand hygiene indicati
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Table I.18.1: Strategies for succes
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Table l.20.1: Possible problems and
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Table I.21.1. Hand hygiene research
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Table I.21.1: Hand hygiene research
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Table I.21.2: Unsolved issues for r
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Table III.2.1: Quality indicators r
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Table V.3.1: Examples of public inf
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Table V.4.1: Examples of national p
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Table V.5.1: The public information
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APPENDIX 1. DEFINITIONS OF HEALTH-C
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APPENDIX 2. HAND AND SKIN SELF-ASSE
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Data in coloured cells can be chang
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NHS NICU n-P NPSA NA NS OPD PACU PA
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AUTHORS: John Boyce Saint Raphael H
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Garance Upham People’s Health Mov
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