_______________________________________________________________ Healthcare-Associated Infections
should be evaluated in relation to regional and national norms, and temporal trends should also be noted. Continuing analysis of the data allows the infection control team to evaluate the efficacy of programs designed to enhance compliance with hospital-wide strategies to prevent HAIs. HAND HYGIENE Hand hygiene is the most important preventive measure in hospitals, and the Joint Commission mandates that hospitals and other healthcare facilities comply with the Level I recom- mendations in the CDC guidelines for hand hygiene [29]. The CDC guidelines state the specific indications for washing hands, the recommended hand hygiene techniques, and recom- mendations about fingernails and the use of gloves ( Table 18 ) [29]. The guidelines also provide recommendations for surgical hand antisepsis, selection of hand-hygiene agents, skin care, educational and motivational programs for healthcare workers, and administrative measures. Despite the simplicity of the intervention, its substantial impact, and wide dissemination of the guidelines, compliance with recommended hand hygiene has ranged from 16% to
81%, with an average of 30% to 50% [29; 42; 43; 44; 45]. A 2010 systematic review of studies on compliance with hand- hygiene guidelines in hospital care found an overall median compliance rate of 40%, with lower rates in ICUs (30% to 40%) than in other settings (50% to 60%), lower rates among physicians than among nurses (32% and 49%, respectively), and lower rates before (21%) rather than after (47%) patient contact [295]. Among the reasons given for the lack of compli- ance are inconvenience, understaffing, and damage to skin [29; 43; 89]. The development of effective alcohol-based handrub solutions addresses these concerns, and studies have demon- strated that these solutions, as well as performance feedback and accessibility of materials, have increased compliance [44; 295; 296; 297]. The CDC guidelines recommend the use of handrub solutions on the basis of several advantages, includ- ing [29]: • Better efficacy against both gram-negative and gram-
positive bacteria, mycobacteria, fungi, and viruses than either soap and water or antimicrobial soaps (such as chlorhexidine)
SUMMARY OF CDC RECOMMENDATIONS FOR HAND HYGIENE
Indications for Hand Hygiene Wash hands with nonantimicrobial or antimicrobial soap and water when they are visibly dirty, contaminated, or soiled. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. Specific Indications Wash hands before patient contact, before putting on gloves for insertion of invasive devices that do not require surgery (e.g., urinary catheters or intravascular devices), before moving from work on a soiled body site to a clean body site on the same patient; and after touching a patient or patient’s surroundings. Wash hands after: • Contact with a patient’s skin • Contact with body fluids or excretions, nonintact skin, or wound dressings • Removing gloves Recommended Handrub Technique Apply to palm of one hand, rub hands together, covering all surfaces until dry (approximately 20 seconds). Pay attention to frequently missed areas (e.g., thumbs, fingertips, between fingers). Recommended Handwashing Techniques • Wet hands with water, apply the manufacturer recommended amount of product, and rub hands together for at least 15 seconds, covering all surfaces of the hands and fingers. • Rinse and dry with disposable towel. • Use towel to turn off faucet. • Avoid using hot water to prevent drying of the skin. Fingernails, Artificial Nails, and Jewelry • Keep tips of natural nails to a length of the fingertip. Do not wear artificial nails during direct contact with high-risk patients (e.g., patients in intensive care unit or operating room). • Some studies have shown that the skin underneath rings contains more germs than fingers without rings. Further studies should determine if wearing rings increases the spread of deadly germs. Use of Gloves Use gloves when there is potential for contact with blood or other potentially infectious materials, mucous membranes, or nonintact skin. Change gloves after use for each patient and if gloves become damaged or soiled. Change gloves before exiting a patient’s room. Source: [29; 294] Table 18
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