Hand Hygiene NEJM english subtitles

Hand Hygiene NEJM english subtitles



this is a video in clinical medicine from the New England Journal of Medicine infection associated with healthcare is the most common adverse event affecting hospitalized patients hand hygiene is the most important preventive measure against these infections but compliance with this simple procedure among healthcare providers is often below 40 percent hand hygiene is an essential procedure for all healthcare providers it serves four different purposes in the healthcare setting hand hygiene prevents nosocomial infection in patients and the cross transmission of microorganisms between patients hand hygiene prevents contamination of the hospital environment with potential pathogens finally it helps protect healthcare workers from occupational infectious diseases such as infection with the human immunodeficiency virus and hepatitis C virus this video will demonstrate the various indications to perform hand hygiene as well as to different hand hygiene techniques hand rubbing with an alcohol based hand rub formulation and hand washing with soap and water this video will also review and hygiene equipment the appropriate use of gloves and policies on jewelry and fingernail hygiene we will also review selected complications associated with hand hygiene and make suggestions about how to avoid them finally we will comment on religious and cultural issues concerning hand hygiene and hygiene to prepare for surgical procedures will not be addressed in this video to perform adequate hand hygiene you will need an alcohol-based hand rub formulation or soap water and drying agents such as disposable paper or cloth towels use alcohol-based hand rubs with proven antimicrobial efficacy these usually contains 60 to 80 percent ethanol isopropanol or n-propanol or a combination of these products these hand rubs are supplemented with emollients to protect the skin they are available as liquid solutions or gels sprays or foams containers with these products should be easily available within arm's reach either at the point of care that is within three feet of the most likely use or should be carried in small bottles by healthcare providers for their own personal use soaps are detergents that can remove lipids and dirt the antibacterial effect of soaps results from their capacity to dislodge bacteria from the skin when combined with the rinsing effect of running water the indications for the use of hand hygiene by health care workers have been clearly defined by numerous organizations including the Centers for Disease Control and Prevention and the World Health Organization we will now review these indications we will first review some of the basic principles of cross transmission of microbial pathogens the skin and mucous membranes of every human being are colonized by various microbial species when hospitalized patients gradually shed these microorganisms onto inanimate objects and their immediate surroundings for example on to bed linens gowns and bedside furniture hospitals contain a multitude of environments some of these dubbed patient zones consist of a patient and his or her immediate surroundings as a result of contamination by both healthcare workers and patients other areas of the healthcare settings such as corridors and public areas are also colonized with microorganisms though to a lesser extent than patient rooms cross transmission of potential pathogens from one environment to another occurs through healthcare workers hands hand hygiene greatly reduces the risk of cross transmission by this route health care workers must perform hand hygiene immediately before touching a patient or when entering a patient zone this will prevent cross transmission of microbes from one patient to another the correct moment to perform hand hygiene before touching a patient is critical hand hygiene should be performed close to the site of care in order to avoid recontamination should your hands inadvertently come into contact with an object distant from the patient the door knob for example perform hand hygiene between the last hand to service contact with an object located outside the patient zone and the first within the patient zone you should also perform hand hygiene just after touching a patient and before touching any object located outside the patient zone this will limit the risk of germ dissemination to the healthcare environment even if you did not touch the patient perform hand hygiene after touching objects located in the vicinity of the patient for example perform hand hygiene after touching a monitor bedside table or bed rail since these may also be contaminated by the patient's microbial flora there are body regions that must be kept as free of microorganisms as possible these include zones of impaired host defense such as breaks in skin and mucous membranes surgical wounds for example or sites of invasive device insertion such as vascular or urinary catheters and endotracheal tubes microorganisms that colonize the healthcare workers hands the patient's skin or immediate surroundings must not be introduced into these zones of lowered immune protection for these reasons perform hand hygiene immediately before touching non-intact skin and before manipulating invasive devices this will prevent colonization which may subsequently lead to infection examples of critical procedures include wound care tracheal suctioning removing the dressing of a central venous line giving an injection and lumbar puncture finally hand hygiene helps to protect the healthcare worker some patient care activities may expose healthcare workers to potentially infectious pathogens in consequence perform hand hygiene after contact with body fluids mucous membranes non-intact skin or wound dressings even in the absence of visible soiling and even when gloves have been used there are two recognized techniques for performing hand hygiene hand rubbing with an alcohol-based formulation and hand washing with soap and water to perform hand rubbing apply a palm full of hand rub formulation to a cupped hand and rub your hands together to cover all surfaces then rub your hands again palm to palm to reach the dorsal interdigital area of your hand rub the fingers of one hand over the dorsum of the other and interlace your fingers repeat the procedure on the palmar side of your hands to reach the palmer into digital area to cleanse the dorsal aspect of the distal phalanges rub the back of your fingers across the palm of the other hand with fingers interlocked to cleanse the base of the thumb clasp it in the palm of your other hand and rotate your thumb finally decontaminate the tip of your fingers and the sub angle region by rotating them on the palm of the other hand once dry your hands are safe and you are ready to work the entire procedure should take you 20 to 30 seconds to perform hand hygiene with soap and water wet your hands with water and apply the amount of soap necessary to cover all surfaces avoid using hot water as it may increase the risk of dermatitis rub your hands vigorously to cover all surfaces then complete the hand washing procedure by following the steps previously described for the hand rubbing procedure once your hands have been thoroughly decontaminated rinse them with water use a disposable paper towel to dry your hands gently pat your skin rather than rubbing it hands may also be dried using cloth towels or hot air dryers however avoid reusable towels turn off the faucet using a paper towel to prevent recontamination your hands are now safe and you are ready to work the entire procedure should take 40 to 60 seconds hand rubbing with an alcohol-based formulation is the preferred hand cleansing procedure in most clinical situations the main advantages of alcohol-based hand rubs as opposed to soap and water include availability at the point of care greater antimicrobial efficacy faster use and better tolerability by the skin there are a few specific indications for which hand-washing should be performed instead of hand rubbing hand-washing must be conducted when the hands are visibly contaminated with blood or body fluids and when the hands are visibly contaminated with proteinaceous material and washing must also be performed after exposure to spore-forming organisms for example after caring for patients with diarrhea associated with Clostridium difficile or after exposure to bacillus anthracis finally hand-washing should be performed after using the restroom gloves serve two different purposes they prevent transmission of microorganisms from the healthcare workers hands to the patient and they reduce the risk of health care workers acquiring infections from patients sterile gloves are not necessary during retain patient care clean non sterile examination gloves must be worn during patient care activities that may involve exposure to potentially infectious material this includes exposure to blood body fluids mucous membranes and non-intact skin and also manipulation of invasive devices close to their insertion site or when visibly soiled gloves must also be worn when caring for patients who are colonized or infected with pathogens transmitted by the contact root for example Clostridium difficile methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci ace limit unnecessary use of gloves for example gloves are not indicated when taking a patient's temperature placing oxygen cannula or manipulating vascular lines in the absence of leakage you must always perform hand hygiene after removing gloves as the gloves may have defects and hand contamination may occur during removal alcohol made the grade glove material and lead to holes and leakage for this reason do not disinfect or reuse gloves and remember glove use does not replace the need to perform hand hygiene when an indication for hand hygiene occurs while you are wearing gloves you must remove the gloves perform hand hygiene and put on another pair if the use of gloves is still indicated wearing jewelry such as rings increases the bacterial load of the skin do not wear rings and bracelets during patient care if you have a wedding ring a simple alternative is to wear it on a chain around your neck in some settings wedding rings may be tolerated review and comply with the policy in place at your health care facility long fingernails have been associated with infection outbreaks of resistant pathogens and healthcare settings as a result you must keep your fingernails short less than 0.2 inches or half a centimeter in length and refrain from wearing artificial nails use of these products in health care settings has been associated with outbreaks of infection with resistant pathogens nail polish is acceptable providing its integrity is preserved however finger nail diseases such as onychomycosis should be promptly treated as they may reduce the efficacy of hand hygiene there are some common problems associated with hand hygiene irritation dermatitis can occur after repeated use of hand hygiene products common symptoms include dryness itching and sometimes cracking and bleeding in rare cases allergic dermatitis can occur damage skin is more difficult to disinfect and may be more susceptible to skin colonization leading to transmission to prevent skin irritation use skin care products frequently during work shifts these products should be freely and widely available in your health care facility you should also use alcohol-based hand rubs avoid the use of hot water when washing hands refrain from using gloves unless specifically needed and dry your hands completely before donning gloves alcohols are flammable although exceedingly rare flash fires involving the hands of health care workers can occur if caregivers touch open flames or if a static spark occurs when hands are still coated with alcohol to prevent such events it is important to ensure that hands are thoroughly dry before touching objects although some religions prohibit the use of alcohol all except its use as a medical agent and recognize the value of using alcohol-based hand rubs to perform hand hygiene for example the Islamic religion permits the use of alcohol as a medicinal agent hand hygiene is a procedure to be mastered by every healthcare worker hand hygiene is not optional it is mandatory it must be used conscientiously to increase patient safety today patients are very aware of the infection risks associated with healthcare and expect you to cleanse your hands as frequently as necessary this is a sign of competency professionalism and respect you

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2 thoughts on “Hand Hygiene NEJM english subtitles

  1. Very good video. It's good to empower the patient/family, so they can feel save. I'm all for promoting this in healthcare.

    Tida Peterson, Aruba DWI

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