Saturday, May 5, 2018

Hand hygiene is the fundamental principle to prevent infection

Hand hygiene is the fundamental principle to prevent infection. It is also the single most important, simplest, effective and least expensive intervention to prevent and control the spread of infections in hospital and other healthcare settings.

Hands of the healthcare workers are among the most common routes of transmission of pathogens. Lack of or inadequate adherence to hand hygiene means the hands remain contaminated and result in either between-patient or within-patient cross-transmission, occurrence of infection and spread of antimicrobial resistance. It is the transient flora of the hand, which is responsible for cross transmission of pathogens and spread of infection, through contaminated hands. The transient flora is also more amenable to removal by hand hygiene unlike the true resident flora of the hand.

Hand hygiene reduces the risk of healthcare associated infections (HCAIs) and reduces the associated morbidity and mortality.

The WHO has devised ‘My 5 Moments for Hand Hygiene’, which defines the key moments during patient care, when hand hygiene should be done.

·         Before touching a patient
·         Before clean/aseptic procedures
·         After body fluid exposure/risk
·         After touching a patient
·         After touching patient surroundings

Hand hygiene is handwashing with soap and water or the use of alcohol-based hand disinfection with an alcohol-based hand rub.

Handrubbing with alcohol-based rub is mostly recommended as it is faster and easier and should be done whenever you enter and exit a room and prior to any procedure. Soap and water should be used when hands are visibly dirty or visibly soiled with blood or other body fluids or after using the toilet or if exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of Clostridium difficile. Handwashing with soap and water should also be done in patients with known or suspected norovirus infection. Alcohol does not kill norovirus or the spores of C. difficile.

The WHO recommends that handwashing with soap and water should be done for 15-20 seconds, and hand rubbing with alcohol-based rubs should be done as per the six steps described in its guidelines for about 20 seconds. The Centers for Disease Control and Prevention (CDC) recommends three steps for hand rubbing with alcohol.

It is important to remember that wearing gloves does not preclude the need for hand hygiene by either handrubbing or handwashing. 

All this is well-known to us all; nevertheless, let us take a few minutes to reaffirm our commitment to these guidelines, today being World Hand Hygiene Day and adhere to its theme “It’s in your hands – prevent sepsis in health care” in letter and spirit. This is the need of the hour.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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