Infection Control

Week 2

 Context

Healthcare Associated Infections (HCAI) are infections that are acquired as a result of healthcare interventions. There are a number of factors that can increase the risk of acquiring an infection, but high standards of infection control practice minimise the risk of occurrence.

A recent report from the Health Protection Agency (2012) highlighted:

• The prevalence of healthcare-associated infections (HCAI) was 6.4% in 2011 compared to 8.2% in 2006.
• The most frequent HCAIs detected were respiratory tract, urinary tract and surgical site infections.
• The prevalence of antimicrobial use (AMU) was 34.7%. This is the first time AMU was measured nationally. This provides a baseline for future monitoring.
• The prevalence of HCAIs, AMU and device use was highest in intensive care units, which relates in part to the complexity and vulnerability of patients in this setting.

 

 Content

Why hand hygiene?

There is a lot of evidence that effective hand hygiene has a huge effect on HCAI rates in almost all health care settings. This evidence is both historical, as well as more recent controlled trials scientific testing. The World Health Organisation produced Guidelines on Hand Hygiene in Health Care Download Guidelines on Hand Hygiene in Health Care

in 2009, which contain a wealth of information on the issues related to hand hygiene, the types of infections transmitted in this way, and also the impact on both patients and health services more generally.

Following on from this the World Health Organisation promoted a '5 moments for Hand Hygiene' campaign. Their poster is below and can also be downloaded Download downloaded

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This approach recommends health-care workers to clean their hands:

1. before touching a patient,
2. before clean/aseptic procedures,
3. after body fluid exposure/risk,
4. after touching a patient, and
5. after touching patient surroundings.

Cleaning hands can either be by hand washing or by using handrub.

Handwashing

The hands normally have a "resident" population of micro-organisms. Other micro-organisms are picked up during every-day activities, and these are termed "transient" organisms. It is important that hand washing is carried out correctly to prevent the spread of infection. Many infection control problems are caused by these transient organisms. Hand washing with soap & warm water should remove these transient organisms before they are transferred to surfaces, another patient or to a susceptible area on the same patient (Health Protection Agency (HPA), 2014).

Three Stages of handwashing

• Preparation- wetting hands under warm running water before applying soap
• Washing and rinsing – hands to be rubbed together vigorously for 10-15 seconds, attention to tips of fingers, in between finger and thumbs
• Drying – after thorough rinsing, dry with clean disposable hand towels

Video courtesy of Clinical Skills Forum

Use of Handrub

Alcohol handrub works very well, and is more effective than soap and water at disinfecting physically clean hands. However, it is not effective when hands are dirty or soiled and against some organisms.

The evidence very clearly supports the view that it is perfectly acceptable to use alcohol handrub on its own provided none of the indicators for handwashing occur. There are a large number of studies that have looked at alcohol and antimicrobial soap and water and compared the two. In 90% of the studies, alcohol handrubs reduced bacterial counts on the hands to a greater degree than the antimicrobial soaps (National Patient Safety Agency, 2011) .

There has been discussion about muslim healthcare workers using alcohol-based handrubs.  You can read a good summary of the issues here Links to an external site..

Video courtesy of the University of Leicester

References and Further Reading

Health Protection Agency. (2012) English National Point Prevalence Survey on Healthcare Associated Infections and Antimicrobial Use, 2011: Preliminary data Download English National Point Prevalence Survey on Healthcare Associated Infections and Antimicrobial Use, 2011: Preliminary data

. Health Protection Agency: London.

National Patient Safety Agency (2011) Alcohol handrub [WWW] http://www.npsa.nhs.uk/cleanyourhands/resource-area/nhs-resources/faqs-for-coordinators/faqs-alcohol-handrub Links to an external site.