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If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2  l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0 ` www3ff` 3fff` ___>?" dF@,?nAfd@ K " @ `"  n?" dd@   @@``PR    @ ` ` p>> ~8t(  8 8 Ngֳgֳ ?"  P  T Click to edit Master title style! !< 8 Hgֳgֳ ?"    RClick to edit Master text styles Second Level Third Level Fourth Level Fifth Level!     S 8 A޽h? ?C:\Documents and Settings\bzw8\Desktop\CDC logo template 1new.jpg www3ff DHQPmaster 0 |:(  | | 0  P   \*  | 0\    ^* d | c $ ?/   | 0d  @  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     S | 6( {P   \*  | 6 {   ^* H | 0޽h/. ? ̙33@ ,(  , , 0Dϧ P!   X*  , 0  !  Z*  , 6  vP   X*  , 6 v   Z* H , 0޽h/. ? ̙33/ F> (    <(Ϡ ?\` This slide set  Hand Hygiene in Healthcare Settings_Core and accompanying speaker notes provide an overview of the Guideline for Hand Hygiene in Health-care Settings published in 2002. A second slide set  Hand Hygiene in Healthcare Settings_Supplemental which can be obtained at www.cdc.gov/handhygiene provides additional slides that may be used in conjunction with the core slide set. The target audience for this slide set is healthcare personnel in acute care hospitals.B0 U2fffb  JA޽h ?zz1 www3ffd   (  r  S 8    0  P  ? "(   < ?` SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 (   H\ ?"PI PBackground Definitions Indications Selection of Agents Techniques Surgical Other$Q0fU2Q  nnH  0޽h ? ̙33  >(    08 8H,$  0 Most common mode of transmission of pathogens is via hands! Infections acquired in healthcare Spread of antimicrobial resistanceD=0U2F0fU2=$|F r  S 8  P   H  0޽h ? ̙33  _(  ~  s *8Wg   ~  s *\8'@    < ?;EN SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33 YQ0(    6  PH8  {#Hand Hygiene Adherence in Hospitals $P$,  0D p@ `   F&~Z  0<4 1. Gould D, J Hosp Infect 1994;28:15-30. 2. Larson E, J Hosp Infect 1995;30:88-106. 3. Slaughter S, Ann Intern Med 1996;3:360-365. 4. Watanakunakorn C, Infect Control Hosp Epidemiol 1998;19:858-860. 5. Pittet D, Lancet 2000:356;1307-1312.P   "(! =J  0%  ` TLD___PPT9&  Year of Study Adherence Rate Hospital Area 1994 (1) 29% General and ICU 1995 (2) 41% General 1996 (3) 41% ICU 1998 (4) 30% General (5) 48% General0U20U20  "H 4 IiILB  c $D0P00H  0޽h ? ̙33! , a(  x  c $«80   r  S ë88H  /  <ī ?p EAdapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.@F P 3H  0޽h ? ̙33   t`(  t~ t s *Ϋ8`0   ~ t s *hϫ80   t <4ӫ ?r#] TGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@U P5 H t 0޽h ? ̙33  _(  ~  s * 8P   ~  s * 8     <  ?X( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33  _(  ~  s *@ 8H8   ~  s *, 8`\$y      <`  ?bX( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33   ,_(  ,~ , s *80PP   ~ , s *8@X(@   , < ?bX( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H , 0޽h ? ̙33  910 D(  D~ D s *! 8p   |R D T3d?Ht   D B'  ?\f @Good 0 K2 D BD+  ?u@ ? \ BBetter 0 K2f D Bp$  ?[w @Best 0 K23 D B2  ? "  F Plain Soap 0 K2   D B5  ? p =  NAntimicrobial soap 0 K2f  D B8  ? J  QAlcohol-based handrub 0 K23H D 0޽h ? ̙33    @0m  (    0> P :Ability of Hand Hygiene Agents to Reduce Bacteria on Hands ;P;(  <PG AAdapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999. JB 8 $ m$HB  C foz N  S oz HB  C oHB % C oz  , BCDE FfԔH@  - BC(DE FfԔ(K @f  . B CDE FfԔ;K @S  0  B$C%DEFff5%$% @`  1  B$C%DEFff5%$% @` ? d  9 <O  A0.0" : <dT!   A1.0" ; <WH  A2.0" < <<[v6 A3.0"HB E C 1  HB F C 1G H HB G C 1   L <_ 1  ?0" M <c   @60" O <hR ]  A180" R  B$C%DEFff5%$% @` `  S  B$C%DEFff5%$% @`   T  B$C%DEFff5%$% @`Q  v  U  B$C%DEFff5%$% @`A  f B VB NDo?"B WB NDo?"  B XB NDo?"B YB NDo?"B ZB NDo?"  B [B NDo?"F F B \B NDo?"ll ^ <m~  Cminutes  _ <rg E A0.0" ` <$v! E  B90.0" a <lyHE  B99.0" b <}vE6 B99.9" c <g Elog& d <fg C%& e B}A[  UBacterial Reduction&  f <4   'Alcohol-based handrub (70% Isopropanol) (',  g < 1  %Antimicrobial soap (4% Chlorhexidine) &%  h < {}; < Plain soap  i <$  {Time After Disinfection&  j <D  :Baseline B k TDjJ?"P$H  0޽h ? ̙33    P (  l  0A i??jp@  il  0A c??dE p  c  BP !p IEpidermal water content  B̬P p JSelf-reported skin score  <lf5` 7Dry  <   ;HealthydB  <DԔuu    < K  9Dry   <ff` =Healthy   6LPJ6 n2Effect of Alcohol-Based Handrubs on Skin Condition 3P3(   0˧>0 6~ Alcohol-based handrub is less damaging to the skin ~87$8 P26ffHH   <Ч :Boyce J, Infect Control Hosp Epidemiol 2000;21(7):438-441.F;$ P dB  <DԔ   H  0޽h ? ̙33 $ @$Q(  $x $ c $L> 8P`   x $ c $? 8     $ <@  DVoss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.<E  $ 6xD  %[` C~ Alcohol-based handrubs reduce time needed for hand disinfection ~DD8U2 | |+ |H $ 0޽h ? ̙33   P`(  ~  s *P 8H8   ~  s *Q 8v@@`     <R  ?r(X TGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@U P5 H  0޽h ? ̙33 ! `xN(  xr x S \ 8P   x x c $P] 8 `    x <^  ?b(X TGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@U P5 H x 0޽h ? ̙33M " p|(  |x | c $\u 8P    | <ĉ  ?``  p, P2 Test of Class of No. SSI/No. Operations (%) Equivalence Contamination Handscrub Handrub (p-value) Clean 29/1485 (1.9) 32/1520 (2.1) 16.0 (<0.001) Clean- Contaminated 24/650 (3.7) 23/732 (3.1) 1.9 (0.09) All 53/2135 (2.5) 55/2252 (2.4) 19.5 (<0.001)  0    >M_8 }  | <  ? )Parienti et al. JAMA 2002: 288(6);722-27.@* PH | 0޽h ? ̙33   T`(  T~ T s *ȕ 8P   ~ T s * 8@h     T <  ?(XN TGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@U P5 H T 0޽h ? ̙33    `(  ~  s *T 8|L   ~  s * 8       <D  ?0S-~ TGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@U P5 H  0޽h ? ̙33 & S(  x  c $8 8P   x  c $ 8p      <(  ?X(P SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33   _(  ~  s * 8P0   ~  s *T 8Wxp     <ܾ  ?2X( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33  l_(  l~ l s *\ 8P   ~ l s * 8h    l <  ?2X( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H l 0޽h ? ̙33  d_(  d~ d s * 8P   ~ d s * 8@     d <  ?X( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H d 0޽h ? ̙33 + _(  ~  s *H 8  P   ~  s * 8P0@     <L  ?2 u SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33 ) tS(  tx t c $ 8  P   x t c $D 8    t <T  ?2X( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H t 0޽h ? ̙33 * <*(  <r < S 8H8   x < c $8)}p  H < 0޽h ? ̙330  `$(  $ $ # l ۧ3d1?P0  PPREVENTION IS PRIMARY!<\ $ N ߧ ?" h  Protect patients& protect healthcare personnel& promote quality healthcare! K 2Kb $ JA޽h ?zz1 www3ff80___PPT10.3,J 0 JB0(  d  c $|*   6  s *| @   J There is substantial evidence that hand hygiene reduces the incidence of infections. Semmelweis demonstrated that the mortality rate among mothers who delivered in the First Obstetrics Clinic at the General Hospital of Vienna was significantly lower when hospital staff cleaned their hands with an antiseptic agent than when they washed their hands with plain soap and water. In more recent studies healthcare-associated infection rates were lower when antiseptic handwashing was performed by personnel and went down when adherence to recommended hand hygiene practices improved. ^I! BHBfBH  0޽h/. ? ̙33L 0 p!(  d  c $|*   S}  S S| @  S  Healthcare workers should wash hands with soap and water when hands are visibly dirty, contaminated or soiled and use an alcohol-based handrub when hands are not visibly soiled to reduce bacterial counts..!fBH  0޽h/. ? ̙33M 0 ^V(  d  c $|*   SJ  s *S| @T  S<4___PPT9 . Hand hygiene is indicated before: patient contact, donning gloves when inserting a central venous catheter (CVC), and inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery. Hand hygiene is also indicated after contact with a patient s intact skin, contact with body fluids or excretions, non-intact skin, or wound dressings, and after removing gloves. Gloves should be used when a HCW has contact with blood or other body fluids in accordance with universal precautions. J" BwfBH  0޽h/. ? ̙33WZ 0 @(  d  c $|*     s *@r| @   ' Wearing gloves reduces the risk of healthcare workers acquiring infections from patients, prevents flora from being transmitted from healthcare workers to patients, and reduces contamination of the hands of healthcare workers by flora that can be transmitted from one patient to another. Gloves should be used when HCWs have contact with blood or other body fluids. Gloves should be removed after caring for a patient. The same pair of gloves should not be worn for the care of more than one patient. Gloves should not be washed or reused. N'!"BOfBH  0޽h/. ? ̙33[ 0 JB (  d  c $|*   6  s *l | @   j Nail length is important because even after careful handwashing, HCWs often harbor substantial numbers of potential pathogens in the subungual spaces. Numerous studies have documented that subungual areas of the hand harbor high concentrations of bacteria, most frequently coagulase-negative staphylococci, gram-negative rods (including Pseudomonas spp.), corynebacteria, and yeasts. Natural nail tips should be kept to inch in length. A growing body of evidence suggests that wearing artificial nails may contribute to transmission of certain healthcare-associated pathogens. Healthcare workers who wear artificial nails are more likely to harbor gram-negative pathogens on their fingertips than are those who have natural nails, both before and after handwashing. Therefore, artificial nails should not be worn when having direct contact with high risk patients. >j! T  H  0޽h/. ? ̙33` 0 h` (   d   c $|*   T   S xj| @    These recommendations will improve hand hygiene practices of HCWs and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings. When decontaminating hands with an alcohol-based handrub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. When washing hands with soap and water, wet hands first with water, apply the amount of soap recommended by the manufacturer, and rub hands together for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water dry thoroughly with a disposable towel, and use the towel to turn off the faucet. $!H   0޽h/. ? ̙33b 0 06(  0d 0 c $|*   T 0 s *p!T| @  T  When evaluating hand hygiene products for potential use in health care facilities, administrators or product selection committees should consider the relative efficacy of antiseptic agents against various pathogens and the acceptability of hand hygiene products by personnel. Product acceptance can be affected by characteristics of the product such as its smell, consistency, color and the effect of skin irritation and dryness on hands. Easy access to hand hygiene supplies is essential for acceptance and use of products. Dispenser systems should function adequately and deliver an appropriate volume of product. Soap should not be added to a partially empty soap dispenser because of potential bacterial contamination of the soap.!H 0 0޽h/. ? ̙33Q 0 @<L(  <^ < S |/   S < c $#S| @  S B In general, adherence of healthcare workers to recommended hand hygiene procedures has been poor. Studies shown here are representative of the overall adherence rates which averaged about 40%. Adherence rates do vary by occupation. :!H < 0޽h/. ? ̙33xd 0 80H(  Hd H c $|*   T$ H s *xTT| @  T | Plain soap is good at reducing bacterial counts but antimicrobial soap is better, and alcohol-based handrubs are the best. }!}H H 0޽h/. ? ̙33:f 0 X(  Xd X c $|*    X s *| @   tB Provide healthcare workers with hand lotions or creams in order to minimize the occurrence of irritant contact dermatitis associated with handwashing. Because soaps and detergents can damage skin when applied on a regular basis, HCWs must be better informed regarding adverse effects associated with hand hygiene agents. Information regarding adverse effects can be obtained from manufacturers. Information should be obtained from manufacturers regarding the effect that hand lotions, creams, or alcohol-based handrubs have on the effectiveness of antimicrobial soaps. CCH X 0޽h/. ? ̙33h 0 `h(  hd h c $|*   z h s *hȩ| @    Make improved hand hygiene an institutional priority and provide appropriate administrative support and financial resources. Several administrative measures may help improve hand hygiene adherence among personnel who work in areas where high workloads and high intensity of patient care are anticipated. These include placing alcohol-based handrubs at the entrance to patients rooms, or at the bedside and providing healthcare workers with individual pocket-sized containers. (! H h 0޽h/. ? ̙33i 0 PpN(  pd p c $|*    p s * | @   8 One strategy to promote improved hand hygiene behavior is to monitor healthcare worker adherence with recommended hand hygiene practices and to give feedback. Strategies to improve adherence to hand hygiene practices should be both multimodal (i.e. use several different methods or strategies) and multidisciplinary (i.e. involve several different areas of the institution, and types of HCWs). Patients and their families can be involved in reminding HCWs to wash their hands. :!H p 0޽h/. ? ̙33F 0 (  ^  S |/   H  0޽h/. ? ̙33U1 0   (  ^  S |/     < ?W 6p  P* Kf C  c $| @T  <4___PPT9 ' Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings. Hand hygiene reduces the incidence of health-care associated infections. ǿֹ estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection. More widespread use of hand hygiene products that improve adherence to recommended hand hygiene practices will promote patient safety and prevent infections. P' " f&fBH  0޽h/. ? ̙33H 0 `R(  ^  S |/   S  c $S| @  S H| Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, alcohol-based handrub, or surgical hand hygiene/antisepsis. Handwashing refers to washing hands with plain soap and water. Handwashing with soap and water remains a sensible strategy for hand hygiene in non-healthcare settings and is recommended by ǿֹ and other experts. Antiseptic handwash refers to washing hands with water and soap or other detergents containing an antiseptic agent. Alcohol-based handrub refers to the alcohol-containing preparation applied to the hands to reduce the number of viable microorganisms. Surgical hand hygiene/antisepsis refers to an antiseptic handwash or antiseptic handrub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. Antiseptic detergent preparations often have persistent antimicrobial activity. !" ff'|H  0޽h/. ? ̙33NR 0 (  ^  S |/   T  c $T| @  T ^ This graph shows that alcohol-based handrub is better than handwashing at killing bacteria. Shown across the top of this graph is the amount of time after disinfection with the hand hygiene agent. The left axis shows the percent reduction in bacterial counts. The three lines represent alcohol-based handrub, antimicrobial soap, and plain soap._!_H  0޽h/. ? ̙33S 0 7(  ^  S |/     c $| @`   - Alcohol-based handrubs are less damaging to the skin than soap and water. In the graph on the left the blue bar shows self-reported skin health scores for persons using soap and water, and persons using alcohol-based handrubs are depicted by the green bar. Self-reported studies indicate participants using soap and water reported a significant increase in dryness, cracking, and irritation after 2 weeks, whereas those that used the alcohol-based handrub reported improvement in skin dryness. Epidermal water content shows the same results as the self reported scores, after 2 weeks of use, the skin water content decreased for those that used soap and water (resulting in dryer skin) as compared with those who used an alcohol-based handrub. $!H  0޽h/. ? ̙33k 0 |(  ^  S |/   v  c $$| @0    Surgical hand hygiene (or antisepsis) can be performed by using either an antimicrobial soap OR an alcohol-based handrub with persistent activity. When an antimicrobial soap is used, the hands and forearms should be scrubbed for the length of time recommended by the product s manufacturer, usually 2-6 minutes. Longer scrub times (e.g. 10 minutes) are usually not necessary. When an alcohol-based handrub with persistent activity is used, follow the manufacturer s instructions on the amount of product to use. Pre-wash hands and forearms with a non-antimicrobial soap and allow them to dry completely. After application of the alcohol-based product as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves. H  0޽h/. ? ̙337l 0 (  ^  S |/     c $XԨ| @   }= Parienti et al. compared 30-day surgical site infection rates among clean and clean-contaminated procedures where either a traditional surgical handscrub (using soap and water) or an alcohol-based handrub were used. The chi-square test for equivalence shows that SSI rates were comparable for the two forms of hand antisepsis. That is the handrubs were not associated with an increased risk of SSIs compared with traditional handscrubs. Moreover, the alcohol-based handrub was better tolerated by the surgical teams, and improved compliance with hand hygiene guidelines.$>zfH  0޽h/. ? ̙337 0 ld(  ^  S |/   ^  S d?| @    The time required for nurses to leave a patient s bedside, go to a sink, and wash and dry their hands before attending the next patient is a deterrent to frequent handwashing or hand antisepsis. More rapid access to hand hygiene materials could help improve adherence. Alcohol-based handrubs may be a better option than traditional handwashing with plain soap and water or antiseptic handwash because they require less time, act faster, and irritate hands less often. $!H  0޽h/. ? ̙33m 0 y0(  ^  S |/   s  S S| @   No recommendation can be made regarding the routine use of nonalcohol-based handrubs for hand hygiene in healthcare settings. Whether the wearing of rings results in greater transmission of pathogens is unknown. !H  0޽h/. ? ̙33j 0 IA(  ^  S |/   ;  S 01| @   u These performance indicators are recommended for measuring improvements in HCWs hand-hygiene adherence. Monitor and record adherence to hand hygiene by ward or service. Provide feedback to healthcare workers about their performance. Monitor the volume of alcohol-based handrub used per 1,000 patient days. Monitor adherence to policies on wearing artificial nails. Ds! rH  0޽h/. ? ̙33  0 jb(  ^  S |/   \  S dW| @    In summary, alcohol-based handrubs provide several advantages compared with handwashing with soap and water, because they not only require less time, they also act faster. In addition, alcohol-based handrubs are more effective for standard handwashing than soap, are more accessible than sinks, are the most efficacious agents for reducing the number of bacteria on the hands of healthcare workers, and can even provide improved skin condition. !H  0޽h/. ? ̙33o 0 ~vp(  d  c $|*   j  s *| P    Alcohol-based handrubs should be stored away from high temperatures or flames, in accordance with National Fire Protection Agency recommendations. In Europe, where alcohol-based handrubs have been used extensively for many years, the reported incidence of fires related to such products has been extremely low. In the U.S., there has been report of a flash fire that occurred as a result of an unusual series of events, which included a healthcare worker applying an alcohol gel to her hands, then immediately removing a polyester isolation gown, and touching a metal door before the alcohol had evaporated. Removing the polyester gown created a large amount of static electricity that generated an audible static spark when she touched the metal door, igniting the unevaporated alcohol on her hands. Following application of alcohol-based handrubs, hands should be rubbed together until all the alcohol has evaporated. In other words, Let It Dry! H  0޽h/. ? ̙33p 0 P7(  ^  S |/   S  c $$QS| @  S - Healthcare workers have reported several factors that may negatively impact their adherence with recommended practices including; handwashing agents cause irritation and dryness, sinks are inconveniently located, lack of soap and paper towels, not enough time, understaffing or overcrowding, and patient needs taking priority. Lack of knowledge of guidelines/protocols, forgetfulness, and disagreement with the recommendations were also self reported factors for poor adherence with hand hygiene. Perceived barriers to hand hygiene are linked to the institution and HCWs colleagues. Therefore, both institutional and small-group dynamics need to be considered when implementing a system change to secure and improve HCWs hand hygiene practice. $!H  0޽h/. ? ̙33$t 0 p 4(   d   c $|*      s **| @    H   0޽h/. ? ̙3380___PPT10.3"$u 0 (4(  (d ( c $|*    ( s *t| @    H ( 0޽h/. ? ̙3380___PPT10.3" (xZ]L\>sw5 1,`c;p: 'Jel8vlALҢHR&/Q䡕Z+u+F͋J}hҾTú6;s޻{],yޙ3gΜ3gf.[?~PA9B> S'b}/@ʇ~yRxJԷՀ+h+V=,^9Mxf)N)Z V-[_Ȑ%'^a[i甓4Eɲt:K ᴧT:? _yzl9m*U?ӏ9hOEf?\/_~Uk(Ys8&4l4v1@ HZ6.n@;``/`1zg6k_i'O xbps, N^HMLƟM^wuvvzr|!hjIZ{_Ǵ\8dR"@ך>  aO iX1hL&ZkipoF7r:9U7Qcޙ'tAvc$ )']D#5pRl#wX{f*8sȭ[Cѣycp( 8`(], &iy[N]^DYuQ{ޮ!M3ϔZJ;E3B3C# [#zCà'Wr#JQ'ĕ%477Gԝ$xR^ e2\8*N[Hdr t/,wu ><?@7n܀q^ /f5f#66~6$ | 2 !Ψfu_~OzGgS~PK&/+N%M]aVϭׁ^ L~$Kcd퉩-%{΄ lk8pRB|)&/̿|R\qM0ͼt%C콉;Ș56_ȁ" Wen^ 8L 0L)% aM}^}Na#rA赽gBop\ uVxx4\[vKb/K9fq"M91ְFh+[Cͧ@DId{0vk/\.ۭlc{s̆Ub7BvH3&gIoA1%ni|= x%9WTYj2 'rcȍ+ya/@=WCl[uD)' 5.;o[ڣeG~n;N?.ΉYR:jQ",EEEkܼƍiܘk\4gΞ %/?B)KFQC)TM%ymÿiI&DfɿCWEv2 g,AIȢm.-LȐE=+۶Vr+󞄬mMGf *xZ]lT>swmﮱ}a1]6cC0(vLRS&5qҪ/K TUڪ"mڼTTUЪ*YjRܟz$$rΜ9s~93sǿ_}BYe~&L MdL&cЙ'*x3T PԨՀ5}RrLR9'bv*(X1@Ȓy/';ߎԓ&1.ID^{WKFs5:=Nѫ%_٦b3]',d>|,>8&><XXhl46b&@466ZmIY"6^|󳺜?/@D^X84zzbxj2XG{{ FSnCd_s#Cmig%iYpȦ2Qů]ƥa41O+g@%)Aoye[qt"Js,sT2[a+hoxZF/[kŷ6ARZouBע}C(k.8rp)\̙yXi˽~w-흐|\ sLB[=5צ$-ǦP61eE(+=INcdw]sp3n\;~pp 7xp88J_/w$_?4#cfS4η2^bv/n'j]ɆɆ!_an>Wq{X,߽4!G_ZXOήGۘo!:h`$w#Ҭ3֞/_ISV\IܓB>fi@6eE#)MW̶-.SRtyX?o=~_ߗt]+§Վȟ}Rn3.qq5c;np.nyd58)c%ؙ s=Qi%e&1WS|*FSY9/ՔjvDӕmL vܹ Թ`gGu# ]C绨K!m%eW6߮eUJd0VDgkj ,0BYJwF?mI G L :p ܲ> nq*  # ',- ^03@7`g=P IVBD8jPteZOh+'0U hp  8 D P\d)Hand Hygiene in Healthcare Settings Coreft ǿֹGC:\Documents and Settings\rjl2\Application Data\Desktop\DHQPmaster.potǿֹ218Microsoft PowerPointing@5߭@G{@P+C GSg  )'    """)))UUUMMMBBB999|PP3f333f3333f3ffffff3f̙3ff333f333333333f33333333f33f3ff3f3f3f3333f33̙33333f333333f3333f3ffffff3f33ff3f3f3f3fff3ffffffffff3ffff̙fff3fffff3fff333f3f3ff3ff33f̙̙3̙ff̙̙̙3f̙3f333f3333f3ffffff3f̙3f3f3f333f3333f3ffffff3f̙3f3ffffffffff!___wwwa6804'A x(xKʦ """)))UUUMMMBBB999|PP3f3333f333ff3fffff3f3f̙f3333f3333333333f3333333f3f33ff3f3f3f3333f3333333f3̙33333f333ff3ffffff3f33f3ff3f3f3ffff3fffffffff3fffffff3f̙ffff3ff333f3ff33fff33f3ff̙3f3f3333f333ff3fffff̙̙3̙f̙̙̙3f̙3f3f3333f333ff3fffff3f3f̙3ffffffffff!___www!!<!"gsD!CD "4a=gɝtS8wιߜs*AԣSP1Xу 4dQ#Ho?"(w=t/T=u1-@o[wp?AGpJJ9X5 5 v1ދ)E E1SmQ8 i/ܽP\N|~* uwP emw}7(1H?eaZH erʉYY܏QWF)E>~3pىӸ=G4!2WI#>R+'%34dc΍˼֖GԿH`cN>b0۫Gࣃ&Yί$S$Ygqn8O4|ۼB?ni~P}ϻxڇq=;Fg=8uu ]g7-B Ч>%MTe#ߡڶɐ%#7?ͷF' Ƭ91{d-o^ 6Pshh\),\s)ۺwΣtLfŽĸ_Yp/MXqO3E lc7-}p۬kknbnJ~yyEWA|}40'5l`{Z*Y1cVaaޝ‡#~c=k8s_gO7wF}' D~OLxGͽ[HZ~*}|aeg ﷗/eoMTf;Gqd۶)9oܧ}a/āp# 'PF[2Msa55, 9J ke5ftL0~0+r}W-Zt~~yO3?=Z>0p #?M fB-1|+EcmI9T_ݎu_fL~oZ^cP?H'formance Indicators?Summary Alcohol-Based Handrubs: What benefits do they provide?Powe  d i Chart MSGraph.Chart.804Microsoft Graph 2000 Chart0\ Chart MSGraph.Chart.804Microsoft Graph 2000 ChartF/ 0|DTimes New Romant\d 0t & 0XDArial Narrowant\d 0t & 0X" DArialNarrowant\d 0t & 0X"0DWingdingsowant\d 0t & 0X@DWP Greek Centuryt\d 0t & 0X ` .  @n?" dd@  @@``   H9    #Z      h  'n/3/*(-((,  )54 %*+,-, %4  '* 55539 _"$7%( YR$'2]'µi"$HB˦Ϙ>s#i$b$4Q&Jmĩu 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@f܉ʚ;%<&ʚ;g43d3dd 0hrppp@ <4KdKdg? 0$<4ddddg? 0$ <4BdBd@ 0$g42d2dd 0hpK pp___PPT9zJpL70? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPS(Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;(Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients 0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !V  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root EntrydO)@+Pictures_Current User)SummaryInformation([DUPowerPoint Document( DocumentSummaryInformation88(  d i Chart MSGraph.Chart.804Microsoft Graph 2000 Chart0c\ Chart MSGraph.Chart.804Microsoft Graph 2000 ChartF/ 0|DTimes New Romant\d 0t & 0XDArial Narrowant\d 0t & 0X" DArialNarrowant\d 0t & 0X"0DWingdingsowant\d 0t & 0X@DWP Greek Centuryt\d 0t & 0X ` .  @n?" dd@  @@``   H9    #Z      h  'n/3/*(-((,  )54 %*+,-, %4  '* 55539 _$R$'2]'µi"$HB˦Ϙ>s#i"$[lMAe{[ ob$4Q&Jmĩu 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@f܉ʚ;%<&ʚ;g43d3dd 0hrppp@ <4KdKdg? 0$<4ddddg? 0$ <4BdBd@ 0$g42d2dd 0hpK pp___PPT9zJpL70? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPSSubstantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2 ^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients 0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !VLIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2  l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0/ NF (    <(  ?#&  This slide set  Hand Hygiene in Healthcare Settings-Core and accompanying speaker notes provide an overview of the Guideline for Hand Hygiene in Health-care Settings published in 2002. A second slide set  Hand Hygiene in Healthcare Settings-Supplemental which can be obtained at www.cdc.gov/handhygiene provides additional slides that may be used in conjunction with the core slide set. The target audience for this slide set is healthcare personnel in acute care hospitals.J0 U2fb  JA޽h ?zz1 www3ffd   (  r  S S8    0HU  P  ? "(   <Y ?` SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 (   H^ ?"P  PBackground Definitions Indications Selection of Agents Techniques Surgical Other$Q0fU2Q nnH  0޽h ? ̙33T1 0  (  ^  S |/     <h  ?W 6p  P* Kf B  c $| @T  <4___PPT9 & Clean hands are the single most important factor in preventing the spread of pathogens and antibiotic resistance in healthcare settings. Hand hygiene reduces the incidence of healthcare associated infections. ǿֹ estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection. More widespread use of hand hygiene products that improve adherence to recommended hand hygiene practices will promote patient safety and prevent infections. P& " f%fBH  0޽h/. ? ̙33r [™.1[8( ՜.+,D՜.+,H    On-screen Show0ǿֹ { "Times New Roman Arial NarrowArial WingdingsWP Greek Century DHQPmasterMicrosoft Graph 2000 ChartSlide 12Hand Hygiene in Healthcare Settings: An Overview(So Why All the Fuss About Hand Hygiene?SEvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSlide 5;Self-Reported Factors for Poor Adherence with Hand Hygiene DefinitionsIndications for Hand Hygiene&Specific Indications for Hand Hygiene6Selection of Hand Hygiene Agents: Factors to Consider:Efficacy of Hand Hygiene Preparations in Killing Bacteria Slide 12 Slide 137Time Spent Cleansing Hands: one nurse per 8 hour shift#Recommended Hand Hygiene Technique!Surgical Hand Hygiene/Antisepsis0Infection Rates: Surgical Handscrub vs. Handrub Skin Care!Fingernails and Artificial NailsUnresolved IssuesGlovingEducation/Motivation Programs0Administrative Measures to Improve Hand HygieneAlcohol and FlammabilityPerformance Indicators?Summary Alcohol-Based Handrubs: What benefits do they provide? Slide 27  Fonts UsedDesign Template LIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2  l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0  _(  ~  s *83   ~  s *8'@    < ?;EN SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33! , a(  x  c $,80n   r  S 88H  /  < ?p EAdapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.@F P 3H  0޽h ? ̙33  _(  ~  s *d8P   ~  s *J8>    < ?X( SGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@T P5 H  0޽h ? ̙33  i a @0m (    0t  P :Ability of Hand Hygiene Agents to Reduce Bacteria on Hands ;P;(  <T  AAdapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999. JB 8 $ m$HB  C foz N  S oz HB  C oHB % C oz  , BCDE FfԔH@  - BC(DE FfԔ(K @f  . B CDE FfԔ;K @S  0  B$C%DEFff5%$% @`  1  B$C%DEFff5%$% @` ? d  9 <$   A0.0" : <|# !   A1.0" ; < H  A2.0" < < v6 A3.0"HB E C 1  HB F C 1G H HB G C 1   L <\  1  ?0" M <(    @60" O < R ]  A180" R  B$C%DEFff5%$% @` `  S  B$C%DEFff5%$% @`   T  B$C%DEFff5%$% @`Q  v  U  B$C%DEFff5%$% @`A  f B VB NDo?"B WB NDo?"  B XB NDo?"B YB NDo?"B ZB NDo?"  B [B NDo?"F F B \B NDo?"ll ^ <TD ~  Cminutes  _ <H g E A0.0" ` <L ! E  B90.0" a <P HE  B99.0" b <T vE6 B99.9" c <X g Elog& d <\ fg C%& e B` }A[  UBacterial Reduction& f <le    'Alcohol-based handrub (70% Isopropanol) ('  g <j  1  %Antimicrobial soap (4% Chlorhexidine) &%  h <p  {}; < Plain soap  i <8s $  YTime After Disinfection& j < x D  :Baseline B k TDjJ?"P$H  0޽h ? ̙33    P (  l  0A i??jp@  il  0A ??dE p    B P !p IEpidermal water content  B P p JSelf-reported skin score  <@ f5` 7Dry  <ċ    ;HealthydB  <DԔuu    <  K  9Dry   <̒ ff` =Healthy   6@ PJ6 n2Effect of Alcohol-Based Handrubs on Skin Condition 3P3(   0Ģ >0 6~ Alcohol-based handrub is less damaging to the skin ~87$8 P26ffHH   <@  :Boyce J, Infect Control Hosp Epidemiol 2000;21(7):438-441.F;$ P dB  <DԔ   H  0޽h ? ̙33b 0 05(  0d 0 c $|*    0 s *(o| @    When evaluating hand hygiene products for potential use in healthcare facilities, administrators or product selection committees should consider the relative efficacy of antiseptic agents against various pathogens and the acceptability of hand hygiene products by personnel. Product acceptance can be affected by characteristics of the product such as its smell, consistency, color and the effect of skin irritation and dryness on hands. Easy access to hand hygiene supplies is essential for acceptance and use of products. Dispenser systems should function adequately and deliver an appropriate volume of product. Soap should not be added to a partially empty soap dispenser because of potential bacterial contamination of the soap.!H 0 0޽h/. ? ̙33S 0 8(  ^  S |/     c $ (| @`   . Alcohol-based handrubs are less damaging to the skin than soap and water. In the graph on the left the blue bar shows self-reported skin health scores for persons using soap and water, and persons using alcohol-based handrubs are depicted by the orange bar. Self-reported studies indicate participants using soap and water reported a significant increase in dryness, cracking, and irritation after 2 weeks, whereas those that used the alcohol-based handrub reported improvement in skin dryness. Epidermal water content shows the same results as the self reported scores, after 2 weeks of use, the skin water content decreased for those that used soap and water (resulting in dryer skin) as compared with those who used an alcohol-based handrub. $!H  0޽h/. ? ̙33 *xY]l\G>sw]M6&miܪx:mS) @ r+8q]V0r_>!TE(H@y %J򝙹"Ed{9s~93sv޹QV^&De. Id{LBg>g@V!; u}! 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If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2  l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0    P (  l  0A i??jp@  il  0A ??dE p    B P !p IEpidermal water content  B P p JSelf-reported skin score  <@ f5` 7Dry  <ċ    ;HealthydB  <DԔuu    <  K  9Dry   <̒ ff` =Healthy   6@ PJ6 n2Effect of Alcohol-Based Handrubs on Skin Condition 3P3(   0Ģ >0 6~ Alcohol-based handrub is less damaging to the skin ~87$8 P26ffHH   <@  :Boyce J, Infect Control Hosp Epidemiol 2000;21(7):438-441.F;$ P dB  <DԔ   H  0޽h ? ̙33` 0 ia (   d   c $|*   U   S (| @    These recommendations will improve hand hygiene practices of HCWs and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings. When decontaminating hands with an alcohol-based handrub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. When washing hands with soap and water, wet hands first with water, apply the amount of soap recommended by the manufacturer, and rub hands together for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water, dry thoroughly with a disposable towel, and use the towel to turn off the faucet. $!H   0޽h/. ? ̙33 *xY]L\>s`õ( Y/$'Ƙ8JYđS6iC ظYm}hFBE^CȪ\Q݇>UU>TKqT?~g~ϲlɒrΜ9s~93s 7/鯔SH6F҇dq,ݾf :@󐝢 $X ZFVol>±%:$%a7ʱٱL>҇;>MD66pٓ(9f m9+vq-x쭇'Q YS\X}ݼ?A'pbL`'WqaJ)n em]DݜSԱ r9>CTuf HʈS")chX$/)V vKbYb44NS>k e$VF-جQˬDDIa{%$};}αMJm-j}dIZX90I@0E= c?#QY-<"ƾqM>)8-hlCqLkY*ş fbX]:y :Mʹc ֹ`NQWS<qQ?E2 gS/>xu9f̽;vcJ~ϐ>|`lj>Qxl(F@ELl=Gcb)u "{ve}BNMS%]f9'?,cITļ7y&޸+*rb\ϦKf[שB9+ < zYjw_]]5<.h\.%Uxި,1j5;6&ځ'yQ:Ws}l`D[}b/~) Q(xv $p@(/Z'!D|oFkq9<Tv=WxbM~q -ڻ7eKU w+/PV*)!˥~!]r}n2BOv׬6/(еR#Er $+\fj`#t8(  d i Chart MSGraph.Chart.804Microsoft Graph 2000 Chart0\ Chart MSGraph.Chart.804Microsoft Graph 2000 ChartF/ 0|DTimes New Romant\d 0t & 0XDArial Narrowant\d 0t & 0X" DArialNarrowant\d 0t & 0X"0DWingdingsowant\d 0t & 0X@DWP Greek Centuryt\d 0t & 0X ` .  @n?" dd@  @@``   H9    #Z      h  'n/3/*(-((,  )54 %*+,-, %4  '* 55539 _"$7%( YR$'2]'µi"$HB˦Ϙ>s#i$b$4Q&Jmĩu 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@f܉ʚ;%<&ʚ;g43d3dd 0hrppp@ <4KdKdg? 0$<4ddddg? 0$ <4BdBd@ 0$g42d2dd 0hpK pp___PPT9zJpL70? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPS(Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;(Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients 0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !VLIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2 l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0 ! PxN(  xr x S  8P   x x c $dH 8 `    x <LS  ?b(X TGuideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.@U P5 H x 0޽h ? ̙33   pT`(  T~ T s *f 8B   ~ T s *}3ԠP ԛ!@;AE@\LN_l g 䳮G=bsyNc3f#݀@+ < "(q^@Izcsw`9a$Gj3>ɳlpoww O&2Ⱦ&S]O^ߠtC~G 0]OD"Hh{1A_98U7Q:刺|fX2|exHhŐ:  ٭-qw^<{`ja9/G!H7v`L.,>^kn^8LUaR(Jk4뺪WnSCbTtf'8Hʀ`FRƢa=Zi;4f/?_q* j8hX#l9kL#U5Jx~ƚaD4 1iBrgs9$xkkwZtl2%v+x{~`/ |R` /vq8jG79'>G]d \˺hO.5KkƲG}/4#Ή_?W:I9uEj\@ h:DjkHO=9/ C2nXqT&[(jm>V'5ms#_T_w|3ڡ}E!!yS2UZ@cNٷ>^1{#gn?q;,U\Ӭꚺ.A3 ?fpp'Jouy{!TZ|AC ZeVMȘ暇eq}hc ߕ9"C)t.Wā>lG6J|AחwS+O"Z03nǔ!;+(-: |hl+>A*xPއ-\npڏ3 {hC廥욖 (#D/LO;;P_ι5ӒDEN@̻ -lE׹MW̶_N ]7>o=x_oʿ ]+§?_Q=ݰpOpoYp/[Xw9d4Z8)cK愊s7(Ę$T+zw)*M0GE:AEyfG9]YcuS8׼N9Jh~>/|6}7Rh/u6Glm(&&2(;&e] 58/ʿ; "㯆vHj#+][¶x{}\ 綜/mUT\VwAq V2V_ٻUq˷I/l۶w!U}w{ -rP u kC ռ J- #e-ot8(  d i Chart MSGraph.Chart.804Microsoft Graph 2000 Chart0\ Chart MSGraph.Chart.804Microsoft Graph 2000 ChartF/ 0|DTimes New Romant\d 0t & 0XDArial Narrowant\d 0t & 0X" DArialNarrowant\d 0t & 0X"0DWingdingsowant\d 0t & 0X@DWP Greek Centuryt\d 0t & 0X ` .  @n?" dd@  @@``   H9    #Z      h  'n/3/*(-((,  )54 %*+,-, %4  '* 55539 _"$7%( YR$'2]'µi"$HB˦Ϙ>s#i$b$4Q&Jmĩu 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@f܉ʚ;%<&ʚ;g43d3dd 0hrppp@ <4KdKdg? 0$<4ddddg? 0$ <4BdBd@ 0$g42d2dd 0hpK pp___PPT9zJpL70? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPS(Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;(Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients 0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !VLIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2 l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0 * <*(  <r < S ܮ 8H8   x < c $ 8)}p   H < 0޽h ? ̙330  `$(  $ $ # lT 3d1?P0  PPREVENTION IS PRIMARY!<\ $ N@  ?"4 h Protect patients& protect healthcare personnel& promote quality healthcare! K 2Kb $ JA޽h ?zz1 www3ff80___PPT10.3, *xZ]l\G>sDZ}t6v8NViJIJ P#Ive'kWVBQQ,$ܗ6<,V9Ixf)LG) JFDŋ$~~I_:j+)JT$Y =厫'Ks<]٦r3YUSt6$z*Ϻ4ߊ LZ9m v-V@Q@D:}'OE۸\ #Y<_ &ϤgR'½2^8Ő:" ٭-qw^<{bj`Y/G~!H7v`L.,^cn^38LuaR(Jk4뺪WnSCbT:t%e7#)cưI{DRp/ 8iYHSku5ܪ[sf%:)~0uSps;8b 5[#VTP8幖uў\)JzYk.֌eT+^@AWid;'?~^X+' u\qF=*̣I16@ jWᑞZ{]s^Xwwd*/GݰjjM6P| Vk/%|G{Rm|fCxK_MTk:iezA_@GFE:GTsMk2]f~/MO3_1- ˗62C .B܇<_ZdVMȘ暇eq}:+[;+ks8ERS\wWԁ>m6J|AחwS+O,13nǔ!;+EZ(St@8PW|B񶳡[:-͵g eK9AoІfowK )5-P6G^:(*N{4w99vsOk2%wZ ϋsQ!mSRx:7*eo&/}z&/*wrV{&_{a޶p9%^pshpRƖ ?7loHک1I;F>>s#i"$"b$4Q&Jmĩu" 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@f܉ʚ;%<&ʚ;g43d3dd 0hrppp@ <4KdKdg? 0$0\<4ddddg? 0$0\ <4BdBd@ 0$g42d2dd 0h      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~pK pp___PPT9zJpL7*? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPS(Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;(Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !VLIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2 l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0/ JB0(    < ?#&  This slide set  Hand Hygiene in Healthcare Settings-Core and accompanying speaker notes provide an overview of the Guideline for Hand Hygiene in Health-care Settings published in 2002. A second slide set  Hand Hygiene in Healthcare Settings-Supplemental which can be obtained at www.cdc.gov/handhygiene provides additional slides that may be used in conjunction with the core slide set. The target audience for this slide set is healthcare workers in acute care hospitals.J0 U2fb  JA޽h ?zz1 www3ffr'!@Yt!^G8(  d i Chart MSGraph.Chart.804Microsoft Graph 2000 Chart Chart MSGraph.Chart.804Microsoft Graph 2000 ChartD/ 0|DTimes New Roman0:A 0DArial Narrowan0:A 0X" DArialNarrowan0:A 00DWingdingsowan0:A 0X@DWP Greek Century0:A 0X@ .  @n?" dd@  @@``   H9E E #Z   D  <hD<''n/42*?B??,D *>1C4=>@!&*A/B-> 84  '* 5553;9 _"$7%( YR$'2]'µi"$HB˦Ϙ>s#i$b$4Q&Jmĩu 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@fFlO ʚ;Sk8ʚ;g4RdRd :A 0^ppp@ <4KdKdL$ 0 <4ddddL$ 0  <4BdBdL # 0g42d2d :A 0pK pp&0___PPT10 ___PPT9zJpL7*? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPS(Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;(Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !VLIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2 l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0r_tm^mG8(  d kkkelkeelfeefefkkkelkeelfeeeelkkleefefekfeeelkkleefefei Chart MSGraph.Chart.804Microsoft Graph 2000 Chart Chart MSGraph.Chart.804Microsoft Graph 2000 ChartD/ 0|DTimes New Roman0:A 0DArial Narrowan0:A 0X" DArialNarrowan0:A 00DWingdingsowan0:A 0X@DWP Greek Century0:A 0X@ .  @n?" dd@  @@``   H9GP   #Z   F  Hh ''n/42*?N(?,$ *1O4JLL&*+/0N 84  '* 5553G9 _"$7%( YR$'2]'µi"$HB˦Ϙ>s#i$b$4Q&Jmĩu 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@fFlO ʚ;Sk8ʚ;g4RdRd :A 0^ppp@ <4KdKdL$ 0w<4ddddL$ 0w <4BdBdL # 0g42d2d :A 0hpK pp&0___PPT10 ___PPT9zJpL7*? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPS(Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;(Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !VLIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2 l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0Al 0 (  ^  S |/   P  c $XP| @  P = Parienti et al. compared 30-day surgical site infection rates among clean and clean-contaminated procedures where either a traditional surgical handscrub (using soap and water) or an alcohol-based handrub were used. The chi-square test for equivalence shows that SSI rates were comparable for the two forms of hand antisepsis. That is the handrubs were not associated with an increased risk of SSIs compared with traditional handscrubs. Moreover, the alcohol-based handrub was better tolerated by the surgical teams, and improved compliance with hand hygiene guidelines..>yfH  0޽h/. ? ̙33rlm}9G8(  d i Chart MSGraph.Chart.804Microsoft Graph 2000 Chart Chart MSGraph.Chart.804Microsoft Graph 2000 ChartD/ 0|DTimes New Roman0:A 0DArial Narrowan0:A 0X" DArialNarrowan0:A 00DWingdingsowan0:A 0X@DWP Greek Century0:A 0X@ .  @n?" dd@  @@``   H9GP   #Z   F  Hh ''n/42*?N(?,$ *1O4JLL&*+/0N 84  '* 5553G9 _"$7%( YR$'2]'µi"$HB˦Ϙ>s#i$b$4Q&Jmĩu 0e0e     A@ A 8c8c     ?1 d0u0@Ty2 NP'p<'pA)BCD|E||S" f3f|@fFlO ʚ;Sk8ʚ;g4RdRd :A 0^ppp@ <4KdKdL$ 0w<4ddddL$ 0w <4BdBdL # 0g42d2d :A 0hpK pp&0___PPT10 ___PPT9zJpL7*? %O ="t1Hand Hygiene in Healthcare Settings: An Overview2P2 [1'So Why All the Fuss About Hand Hygiene?(P(JREvidence of Relationship Between Hand Hygiene and Healthcare-Associated InfectionsSPS(Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed 0dU2^ MQp:Self-Reported Factors for Poor Adherence with Hand Hygiene;P;(Handwashing agents cause irritation and dryness Sinks are inconveniently located/lack of sinks Lack of soap and paper towels Too busy/insufficient time Understaffing/overcrowding Patient needs take priority Low risk of acquiring infection from patients0dU2H Definitions  Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel 0Ue0U 0U(0U0UU0U0U50U!0UV0U e (U  5  !VLIndications for Hand HygienePWhen hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. 0dU2 M%Specific Indications for Hand Hygiene&P&XBefore: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don t require surgery After: Contact with a patient s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves`0U0U0Ux0U  xb5Selection of Hand Hygiene Agents: Factors to Consider6P6Efficacy of antiseptic agent Acceptance of product by healthcare personnel Characteristics of product Skin irritation and dryness Accessibility of product Dispenser systemsFL0U270U2+0U2L 7+ d9Efficacy of Hand Hygiene Preparations in Killing Bacteria:P:RSk76Time Spent Cleansing Hands: one nurse per 8 hour shift"7P$Hand washing with soap and water: 56 minutes Based on seven (60 second) handwashing episodes per hour Alcohol-based handrub: 18 minutes Based on seven (20 second) handrub episodes per hour.0dU290 AU2"0dU250 AU2. 9" 5`"Recommended Hand Hygiene Technique#P#Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucetn 0U2m0U20U20U2  m  k Surgical Hand Hygiene/Antisepsis!P!>Use either an antimicrobial soap or alcohol-based handrub Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer Alcohol-based handrub: follow manufacturer s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap 0U2 l/Infection Rates: Surgical Handscrub vs. Handrub0P0f Skin Care P Provide healthcare workers with hand lotions or creams Get information from manufacturers regarding effects that hand lotions, creams, or alcohol-based handrubs may have on the effectiveness of antimicrobial soaps0U2 [ Fingernails and Artificial Nails!P!Natural nail tips should be kept to inch in length Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)0U2 mUnresolved IssuesPMRoutine use of nonalcohol-based handrubs Wearing rings in healthcare settings<)0U2%0P2  < ZGlovingPWear gloves when contact with blood or other potentially infectious materials is possible Remove gloves after caring for a patient Do not wear the same pair of gloves for the care of more than one patient Do not wash gloves0U2 iEducation/Motivation ProgramsP Monitor healthcare workers (HCWs) adherence with recommended hand hygiene practices and give feedback Implement a multidisciplinary program to improve adherence to recommended practices Encourage patients and their families to remind HCWs to practice hand hygiene 0U2  h/Administrative Measures to Improve Hand Hygiene0P0Make improved hand hygiene an institutional priority Place alcohol-based handrubs at entrance to patient room, or at bedside Provide HCWs with pocket-sized containers0U2 oAlcohol and FlammabilityPAlcohols are flammable Alcohol-based handrubs should be stored away from high temperatures or flames Europe: fire incidence low U.S.: one report of flash fire Application is key: Let It Dry!0U2 jPerformance IndicatorsPMonitor and record adherence to hand hygiene by ward or service Provide feedback to healthcare workers about their performance Monitor the volume of alcohol-based handrub used per 1,000 patient days Monitor adherence to policies on wearing artificial nails0U2  >Summary Alcohol-Based Handrubs: What benefits do they provide? ?P $Require less time More effective for standard handwashing than soap More accessible than sinks Reduce bacterial counts on hands Improve skin condition0U2 u/  !"$&)*+,/0rutmQ