Hand hygiene.pdf

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9.10 Other agents .......................................38 9.11 Activity of antiseptic agents against spore-forming bacteria ....38 9.12 Reduced susceptibility of microorganisms to antiseptics .......39 9.13 Relative efficacy of plain soap, antiseptic soap and detergents, and alcohols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39 9.14 Safety issues related to alcohol-based preparations ..........41 10. A WHO alcohol-based formulation .......................42 10.1 General remarks ....................................42 11. Surgical hand preparation ..............................46 11.1 Evidence for surgical hand preparation ...................46 11.2 Objectives of surgical hand preparation ...................47 11.3 Selection of products for surgical hand preparation ..........48 11.4 Surgical hand antisepsis using medicated soap ..............48 11.5 Surgical hand preparation with waterless, alcohol-based handrub ...........................................50 11.6 Steps for surgical hand preparation ......................51 11.7 Surgical hand scrub with medicated soap or surgical handrub with alcohol-based formulations ..................52 12 Skin reactions related to hand hygiene .....................52 12.1 Frequency and pathophysiology of irritant contact dermatitis . . .53 12.2 Allergic contact dermatitis related to hand hygiene products . . .54 12.3 Methods to reduce adverse effects of agents ...............54 13. Factors to consider when selecting hand hygiene products .....56 13.1 Pilot testing ........................................56 13.2 Selection factors ....................................57 14. Hand hygiene practices among health-care workers and adherence to recommended practices ..................... 60 14.1 Hand hygiene practices among health-care workers .........60 14.2 Observed adherence to hand cleansing ...................61 14.3 Factors affecting adherence. . . . . . . . . . . . . . . . . . . . . . . . . . . .61 15. Religious and cultural aspects of hand hygiene ..............62 15.1 Hand hygiene in different religions ......................63 15.2 The concept of “visibly dirty” hands .....................66 15.3 Hand gestures ......................................66 15.4 Prohibition of alcohol use .............................67 16. Behavioural considerations .............................70 16.1 Social sciences and health behaviour ....................70 16.2 Behavioural aspects of hand hygiene ....................71
17. Organizing an education programme to promote hand hygiene . .75 17.1 Implementation process ...............................76 17.2 Reviewing the guideline for implementation ...............76 17.3 Steps in guideline implementation .......................78 17.4 The infection control link health-care worker ...............79 18. Formulating strategies for hand hygiene promotion ...........80 18.1 Elements of promotion strategies ........................80 18.2 Developing a strategy for guideline implementation .........82 19. Impact of improved hand hygiene ........................83 20. Other policies related to hand hygiene ....................84 20.1 Gloving policies ....................................84 20.2 Glove use in settings with limited resources ...............87 20.3 Importance of hand hygiene for safe blood and blood products .....................................91 20.4 Jewellery .........................................92 20.5 Fingernails and artificial nails ..........................93 21. Hand hygiene research agenda . ..........................94 PART II. CONSENSUS RECOMMENDATIONS .........................95 1. Indications for handwashing and hand antisepsis . .............95 2. Hand hygiene technique ................................96 3. Recommendations for surgical hand preparation ..............96 4. Selection and handling of hand hygiene agents ...............97 5. Skin care ............................................98 6. Use of gloves .........................................98 7. Other aspects of hand hygiene ............................98 8. Educational and motivational programmes for health-care workers ....................................99 9. Governmental and institutional responsibilities ...............99 9.1 For hospital administrators .............................99 9.2 For national governments ..............................99 PART III. OUTCOME MEASUREMENTS .............................103 1. Monitoring hand hygiene compliance .....................103 1.1 Direct observation ..................................103 1.2 Indirect monitoring ..................................104 1.3 Electronic monitoring ................................104
Page 2 and 3: The WHO Guidelines on Hand Hygiene
Page 5: CONTENTS INTRODUCTION . ...........
Page 11: INTRODUCTION The WHO Advanced Draft
Page 14 and 15: Handwashing. Washing hands with pla
Page 16 and 17: 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
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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
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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
Page 211 and 212:
AUTHORS: John Boyce Saint Raphael H
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Garance Upham People’s Health Mov
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