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hand hygiene

Indications: - hand hygiene is the cornerstone of any infection-control program - increasing hand hygiene compliance in associated with fewer nocosomial infections [4] Procedure: - hands must be decontaminated immediately before direct patient contact & after any contact that could potentially result in hands becoming contaminated - hands that are visibly soiled, or potentially grossly contaminated with dirt or organic material, must be washed with liquid soap & water - hand antiseptic is generally superior to handwashing unless hands are visibly soiled or patient has C difficile - alcohol-based antiseptics for hand hygiene are insufficient for infection control associated with C difficile - it does not eradicate C difficile spores [5,6] - all wrist & hand jewelry should be removed prior to hand decontamination - cuts & abrasions must be covered with waterproof dressings - fingernails should be kept short, clean, & free from nail polish - an emollient hand cream should be applied regularly to protect skin from the drying effects of regular hand decontamination - additional specific recommendations [3] - soap & alcohol-based hand rubs should be conveniently located for routine hand hygiene in all areas where patients are seen - healthcare workers should wash their hands with soap & water or use alcohol-based hand rubs - before direct patient contact (WHO) - preparing or handling patients' medications - moving from a contaminated body site to a clean body site - before clean or aseptic procedure (WHO) - before & after using an invasive device - after contact with bodily fluids (WHO_ - after direct contact with a patient (WHO) - after contact with a patient's surroundings (WHO) - hand washing with soap & water is recommended - after toileting - when hands are visibly soiled with feces or other bodily fluids (even if gloves are worn) - possible contact with C difficile [6] - soaps containing triclosan should be avoided due to risk for antimicrobial resistance. - adherence to hand hygiene should be monitored [3] Notes: - video cameras improve compliance [2]

Related

infection control

Specific

hand antiseptic; hand sanitzer (alcohol-based hand rub) handwashing

General

hygiene

References

  1. Harris BD et al Strict Hand Hygiene And Other Practices Shortened Stays And Cut Costs And Mortality In A Pediatric Intensive Care Unit Health Aff September 2011 vol. 30 no. 9 1751-1761 PMID: 21900667 http://content.healthaffairs.org/content/30/9/1751.abstract
  2. Armellino D et al. Using high-technology to enforce low-technology safety measures: The use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis 2012 Jan 1; 54:1. PMID: 22109950 - Palmore TN and Henderson DK. Big brother is washing . . . video surveillance for hand hygiene adherence, through the lenses of efficacy and privacy. Clin Infect Dis 2012 Jan 1; 54:8 PMID: 22109949
  3. Ellingson K et al SHEA/IDSA Practice Recommendation. Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infection Control and Hospital Epidemiology. July 16, 2014 PMID: 25026608 http://www.jstor.org/stable/10.1086/677145
  4. Sickbert-Bennett EE, DiBiase LM, Schade Willis TM et al Reduction in healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerg Infect Dis. 2016 Sep PMID: 27131129 http://wwwnc.cdc.gov/eid/article/22/9/15-1440_article
  5. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Leffler DA, Lamont T. Clostridium difficile infection N Engl J Med 2015;372(16):1539-1548 PMID: 25875259
  6. McDonald LC, Gerding DN, Johnson S et al Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):987-994. PMID: 29562266