○ Microorganisms can survive on

HANDWASHING hands for differing lengths of time

(2–60 minutes

ROLE OF HAND HYGIENE TO REDUCE THE

Many studies have documented that HCWs can
BURDEN OF HEALTH CARE-ASSOCIATED contaminate their hands or gloves with pathogens
INFECTION such as Gram-negative bacilli, S. aureus, enterococci
or C. difficile by performing “clean procedures” or
touching intact areas of skin of hospitalized patients
TRANSMISSION OF HEALTHCARE ASSOCIATED
PATHOGENS THROUGH HANDS Defective hand cleansing (e.g. use of an insufficient
amount of product and/or an insufficient duration of
hand hygiene action) leads to poor hand
TRANSMISSION OF HEALTHCARE ASSOCIATED decontamination.
PATHOGENS THROUGH HANDS
● Transmission of healthcare-associated Contaminated HCWs’ hands have been associated with
pathogens takes place through: endemic HCAIs and also with several HCAI outbreaks
○ Direct and indirect contact
○ Droplets
○ Air HAND HYGIENE COMPLIANCE AMONG HCWS
○ Common vehicle
● Transmission through contaminated HCWs’ HAND HYGIENE COMPLIANCE AMONG HCWS
hands→ most common pattern in most ● Hand hygiene:
settings ○ Primary measure proven to be
○ Require five sequential steps: effective in preventing HCAI and the
■ Organisms are present on spread of antimicrobial resistance.
the patient’s skin, or have ● Shown that HCWs encounter difficulties in
been shed onto inanimate complying with hand hygiene indications at
objects immediately different levels
surrounding the patient ● Adherence of HCWs to recommended hand
■ Organisms must be hygiene procedures has been reported as
transferred to the hands of variable, with mean baseline rates ranging
HCWs from 5% to 89% and an overall average of
■ Organisms must be capable 38.7%.
of surviving for at least ● In observational studies conducted in
several minutes on HCWs’ hospitals:
hands ○ HCWs cleaned their hands on
■ Handwashing or hand average from 5 to as many as 42
antisepsis by the HCWs must times per shift and 1.7–15.2 times per
be inadequate or omitted hour.
entirely, or the agent used ○ Duration of hand cleansing
for hand hygiene episodes ranged on average from
inappropriate as short as 6.6 seconds to 30
■ Contaminated hand or seconds.
hands of the caregiver must ● Main factors that may determine poor
come into direct contact hand hygiene:
with another patient or with ○ Risk factors for non-adherence
an inanimate object that will observed in epidemiological studies
come into direct contact as well as reasons given by HCWs
with the patient. themselves for lack of adherence to
● Health care-associated pathogen can be hand hygiene recommendations
recovered not only from infected or
draining wounds but also from frequently
colonized areas of normal, intact patient
STRATEGIES TO IMPROVE HAND HYGIENE
skin COMPLIANCE
○ Nearly 106 skin squames containing
viable microorganisms are shed STRATEGIES TO IMPROVE HAND HYGIENE
daily from normal skin COMPLIANCE
● Following contact with patients and/or a ● Most studies used multimodal strategies
contaminated environment: which include:

BACTE | ASHERAH D. 1
 PRELIM | EXERCISE 4: HAND HYGIENE

○ HCWs’ education ○ If alcohol-based handrub is not

○ Audits of hand hygiene practices obtainable, wash hands with soap
and performance feedback and water
○ Reminders ● Perform hand hygiene:
○ Improvement of water and soap ○ Before and after touching the
availability patient
○ use of automated sinks, ○ Before handling an invasive device
○ Introduction of an alcohol-based for patient care, regardless of
handrub whether or not gloves are used
○ Improvement of the institutional ○ After contact with body fluids or
safety climate with participation at excretions, mucous membranes,
the institutional, HCW and patient non-intact skin, or wound dressings
levels. ○ If moving from a contaminated body
site to another body site during
IMPACT OF HAND HYGIENE PROMOTION ON care of the same patient
HCAI ○ After contact with inanimate
surfaces and objects (including
medical equipment) in the
IMPACT OF HAND HYGIENE PROMOTION ON HCAI immediate vicinity of the patient
● Improved hand hygiene through multimodal ○ After removing sterile or non-sterile
implementation strategies can reduce HCAI gloves
rates ○ Before handling medication or
● Several studies showed a sustained preparing food perform hand
decrease of the incidence of hygiene using an alcohol-based
multidrug-resistant bacterial isolates and handrub or wash hands with either
patient colonization following the plain or antimicrobial soap and
implementation of hand hygiene water
improvement strategies ● Soap and alcohol-based handrub should
not be used concomitantly
WHY, WHEN & HOW OF HANDWASHING
FIVE MOMENTS FOR HAND HYGIENE

INDICATIONS FOR HAND HYGIENE

INDICATIONS FOR HAND HYGIENE

● Wash hands with soap and water when
visibly dirty or visibly soiled with blood or BEFORE TOUCHING THE PATIENT
other body fluids or after using the toilet ● Why:
● If exposure to potential spore-forming ○ To protect the patient against
pathogens is strongly suspected or proven, colonization and, in some cases,
including outbreaks of C. difficile, hand against exogenous infection, by
washing with soap and water is the harmful germs carried on your
preferred means hands
● Use an alcohol-based handrub as the ● When:
preferred means for routine hand ○ Clean your hands before touching a
antisepsis in all other clinical situations if patient when approaching him/her
hands are not visibly soiled
Situations when Moment 1 applies

BACTE | ASHERAH D. 2
 PRELIM | EXERCISE 4: HAND HYGIENE

● Before shaking hands, before stroking a child’s lavatories, etc)

forehead
● Before assisting a patient in personal care
activities: to move, to take a bath, to eat, to get AFTER TOUCHING A PATIENT
dressed, etc ● Why?
● Before delivering care and other non-invasive ○ To protect you from colonization
treatment: applying oxygen mask, giving a with patient germs
massage ○ To protect the health-care
● Before performing a physical non-invasive
environment from germ spread
examination: taking pulse, blood pressure,
chest auscultation, recording ECG ● When?
○ Clean your hands when leaving the
patient’s side, after having touched
BEFORE CLEAN/ASEPTIC PROCEDURE the patient
● Why?
○ To protect the patient against
Situations when Moment 4 applies if they correspond
infection with harmful germs,
to the last contact with the patient before leaving him /
including his/her own germs, her:
entering his/her body ● After shaking hands, stroking a child’s
● When? forehead
○ Clean your hands immediately ● After you have assisted the patient in personal
before accessing a critical site with care activities: to move, to bath, to eat, to
infectious risk for the patient (e.g. a dress, etc
mucous membrane, non-intact skin, ● After delivering care and other non-invasive
an invasive medical device) treatment: changing bed linen as the patient is
in, applying oxygen mask, giving a massage
● After performing a physical non-invasive
Situations when Moment 2 applies: examination: taking pulse, blood pressure,
● Before brushing the patient’s teeth, instilling chest auscultation, recording ECG
eye drops, performing a digital vaginal or
rectal examination, examining mouth, nose, ear
with or without an instrument, inserting a AFTER TOUCHING PATIENT SURROUNDINGS
suppository / pessary, suctioning mucous ● Why?
● Before dressing a wound with or without ○ To protect you from colonization
instrument, applying ointment on vesicle, with patient germs that may be
making a percutaneous injection / puncture present on surfaces / objects in
● Before inserting an invasive medical device patient surroundings and to protect
(nasal cannula, nasogastric tube, endotracheal the health-care environment against
tube, urinary probe, percutaneous catheter,
drainage), disrupting / opening any circuit of
germ spread
an invasive medical device (for food, ● When?
medication, draining, suctioning, monitoring ○ Clean your hands after touching
purposes) any object or furniture when living
● Before preparing food, medications, the patient surroundings, without
pharmaceutical products, sterile material having touched the patient

AFTER BODY FLUID EXPOSURE RISK This Moment 5 applies in the following situations if they
● Why? correspond to the last contact with the patient
○ To protect you from colonization or surroundings, without having touched the patient:
infection with patient’s harmful ● After an activity involving physical contact with
germs and to protect the the patient's immediate environment:
○ changing bed linen with the patient
health-care environment from germ
out of the bed
spread ○ holding a bed trail
● When? ○ clearing a bedside table
○ Clean your hands as soon as the ● After a care activity:
task involving an exposure risk to ○ adjusting perfusion speed
body fluids has ended (and after ○ clearing a monitoring alarm
glove removal) ● After other contacts with surfaces or
inanimate objects (note – ideally try to avoid
these unnecessary activities): leaning against a
Situations when Moment 3 applies: bed, leaning against a night table / bedside
● When the contact with a mucous membrane table
and with non-intact skin ends
● After a percutaneous injection or puncture;
after inserting an invasive medical device
(vascular access, catheter, tube, drain, etc);
after disrupting and opening an invasive
circuit
● After removing an invasive medical device
● After removing any form of material offering
protection (napkin, dressing, gauze, sanitary
towel, etc)
● After handling a sample containing organic
matter, after clearing excreta and any other
body fluid, after cleaning any contaminated
surface and soiled material (soiled bed linen,
dentures, instruments, urinal, bedpan,

BACTE | ASHERAH D. 3
 PRELIM | EXERCISE 4: HAND HYGIENE

THE GLOVE PYRAMID

MOST FREQUENTLY MISSED, LESS FREQUENTLY

MISSED DURING HAND HYGIENE

HAND HYGIENE STEPS

BACTE | ASHERAH D. 4