http://www.ific.narod.ru/Manual/Hands.htm
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Hand Hygiene
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Introduction
The natural flora of the mouth and
the bowel has bacterial concentrations up to 10^10 per ml and are significant
reservoirs of nosocomial or hospital pathogens. In hospitalised patients, the
skin may become colonised with multidrug resistant (MDR) pathogens, and
infected wounds and other lesions are also potential sources of
cross-infecting organisms.
Pathogenic organisms from colonized and infected
patients (and sometimes from the environment) transiently contaminate the
hands of staff during normal clinical activities and can then be transferred
to other patients. Hand transmission is one of the most important methods of
spread of infectious agents in health care facilities. Proper hand hygiene is
an effective method for preventing the transfer of microbes between staff and
patients.
The microbial flora of the skin
consists of resident and transient microorganisms. Resident organisms (e.g.,
coagulase negative staphylococci, diphtheroids) survive and multiply in the
superficial skin layers. The transient microbial flora of the skin consists
of recent contaminants that survive only for a limited period of time. These
microorganisms (e.g., S. aureus, E. coli,
enterococci) may be acquired by contact with the normal flora or colonised or
infected sites of the patient or from the inanimate hospital environment. If
the skin of staff members' hands is damaged, the bacterial count on the skin
becomes higher. There is also a risk for colonisation with bacteria not
normally belonging to the hand flora.
Three levels of decontamination of
hands are recognized.
Social handwashing with plain soap and water removes most transient
microorganisms from moderately soiled hands.
Hygienic handwashing or
disinfection is a
procedure where an antiseptic detergent preparation is used for washing or
hands are disinfected with alcohol (alcoholic rub). This is a more effective
method to remove and kill transient microorganisms.
The distinction between the need
for social handwashing and hygienic hand washing may not always be clear. A
thorough social hand wash may be appropriate if disinfectants are not
available.
Surgical handwashing is performed with the aim of removing and killing the
transient flora and decreasing the resident flora in order to reduce the risk
of wound contamination if surgical gloves become damaged. Agents are the same
as for the hygienic hand wash.
A
defined technique for decontamination of hands is probably of
greater importance than the agent used. The technique presented in Figure
4.1 is recommended.
When to wash hands
Social handwashing
Hygienic handwashing or alcoholic
rub
An alcoholic hand rub, ideally
from a dispenser at the patient's bedside is the most efficient and least
time consuming procedure for hand decontamination.
Surgical handwashing
Methods
Watches and rings reduce hand
washing/disinfection effectiveness and should be removed during hand hygiene.
Some suggest that they not be worn in patient care.
Social hand washing
In social hand washing, vigorous
and mechanical friction is applied to all surfaces of lathered hands using
plain soap and water for at least 10 seconds using a defined technique (Fig.
4.1). The hands are rinsed under a stream of water and dried with
paper towel. In the absence of running water, a clean bowl of water
should be used. The bowl should be cleaned and water changed between each
use. Alternatively, a drum with a drain spout could be elevated to serve as
running water. Similarly, in the absence of paper towels, a small clean cloth
could be used, but the towel should not be used for extended communal use and
should be discarded after each use into a bag designated for laundering and
reuse.
In places where there is frequent
disruption of water supply, water should be stored in large receptacles
whenever water is available. The water should be free from infectious agents.
Recommended hand
wash agents
Hygienic hand washing/disinfection
Aqueous
Wet hands with clean (running)
water or, if not available, from water in a bowl. Apply cleanser (3-5 ml)
depending on the product or thoroughly lather with soap. Wash the hands
for 10-15 seconds, applying friction over all hand surfaces, rinse and dry as
described above.
Alcoholic
Apply not less than 3ml of the
preparation to the hands and rub to dryness (approximately 30 seconds).
Alcohol is more effective than aqueous antiseptic solutions, but a
preliminary wash may be needed for physically soiled hands. Alcohol is an
effective alternative when there is no water or towels readily available and
there is need for rapid hand disinfection. Alcohol products with emollients
added will cause less skin irritation and drying to hands (1-3% glycerol).
Surgical hand washing/disinfection
Agents for surgical hand washing
are the same as for the hygienic hand wash. The difference is the time of
scrub that is increased to 2-3 min and should include wrists and forearms. If
an alcoholic preparation is used, two applications of 5ml each rubbed to
dryness are suggested.
Important Points to
Note
In areas where gloves are not
readily available, latex gloves can be washed with soap and water, dried,
powdered, sterilized or high level disinfected and reused. Sterilisation is
preferable for surgical procedures.
Minimal requirements
Bibliography
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Monrovia — The U.S. Government has donated another supply of Personal Protective Equipment (PPE) to the World Health Organization to support the international response to the Ebola outbreak which is affecting Liberia, Guinea, and Sierra Leone.
The donation, including aprons, face masks, gowns, caps and cadaver bags, are in addition to a previous donation by the U.S. Government. Last week, the U.S. Government made a similar donation, including rubber boots, coveralls and gloves, which will protect health workers who are at the forefront of providing essential care to patients who are suspected or confirmed to have the Ebola virus. Health workers who use the protective equipment as recommended are protected from exposure to blood or body fluids from infected patients.
In presenting the items, the U.S. Agency for International Development (USAID) Liberia Mission Director, John Mark Winfield, said the U.S. Government is committed to helping in the fight against the spread of the Ebola virus.
In presenting the items, the U.S. Agency for International Development (USAID) Liberia Mission Director, John Mark Winfield, said the U.S. Government is committed to helping in the fight against the spread of the Ebola virus.
World Health Organization Representative to Liberia Dr. Nestor Ndayimirije, who received the donations, immediately passed the essential equipment to the Ministry of Health and Social Welfare, and thanked the U.S. Government for the donations, which he said will help boost Liberia’s response to the Ebola virus.
Dr. Ndayimirije said partnership was important in the fight against the outbreak, and urged stakeholders to unite to improve the response by making sure no health worker is infected and dies because of the lack of protective gear.
In receiving the PPE, Liberia’s Chief Medical Officer, Dr. Bernice Dahn, warned that communities and religious institutions should not try to serve as health facilities. She said Liberians are still in the denial stage, which is fuelling a deterioration of the situation. “At this point, you do not know what you are dealing with,” Dr. Dahn said. “So, don’t keep sick people in your homes or facilities. “
Three weeks ago, Liberia experienced a second wave of the outbreak. Since that time, more than 30 persons have died of the disease.
Three weeks ago, Liberia experienced a second wave of the outbreak. Since that time, more than 30 persons have died of the disease.
The U.S. Government has provided additional support to Liberia, Guinea and Sierra Leone to mitigate the Ebola outbreak, which includes supplying materials and messaging in communities to prevent the spread of Ebola, training environmental health technicians, financial support for deployment of field teams to the WHO Africa Regional Office and WHO's Global Outbreak Alert and Response Network (GOARN), training of health workers in contact tracing, and the provision of essential supplies for collection, preservation, transport and analysis of blood specimens.