II. Background

  1. Semmelweis in 1847 Austria identified the importance of Hand Washing in reducing perinatal mortality
    1. https://www.npr.org/sections/health-shots/2015/01/12/375663920/the-doctor-who-championed-hand-washing-and-saved-women-s-lives
  2. Despite the clear benefits of Hand Washing in Prevention of Healthcare Associated Infection, medical staff compliance is low

III. Epidemiology

  1. Healthcare Associated Infection affects 1.7 Million patients per year in U.S. (10% of inpatients)
    1. Kills 90,000 patients per year

IV. Approach: Hand Hygiene

  1. General Measures
    1. Perform Hand Hygiene between every patient (make it a habit)
    2. Include Fingernails, palms, and the back of the hand
    3. Also foam over and around rings, watches as well as stethoscopes
    4. Keep Fingernails trimmed
    5. Avoid wearing shirt sleeves below the elbows
  2. Preparations
    1. Alcohol-based foams
      1. Effective and preferred in most instances
    2. Soap and Water
      1. Indicated when visible dirt is present, as well as after caring for patients with Diarrhea (esp. Clostridium difficile)

V. Approach: Clothing and other Worn Items

  1. White coats
    1. White coats harber Bacteria, especially resistant Bacteria (esp. at the cuffs) and even with frequent washing
    2. Banu (2012) J Clin Diagn Res 6(8): 1381-4 [PubMed]
  2. Neck ties
    1. Neckties frequently culture positive and easily transmit Bacteria to patients
    2. McGovern (2010) J Hosp Infect 75(2): 138-9 [PubMed]
    3. Weber (2012) J Hosp Infect 80(3): 252-4 [PubMed]
  3. Stethoscope
    1. Uniformly culture positive (clean them with foam or Alcohol wipes)
    2. Merlin (2009) Prehosp Emerg Care 13(1): 71-4 [PubMed]
    3. Lecat (2009) Am J Infect Control 37(3): 241-3 [PubMed]
  4. Rings
    1. Smooth rings are not typically a source of infection
    2. Al-Allak (2008) Ann R Coll Surg Engl 90(2): 133-5 [PubMed]
  5. Surgical Scrubs
    1. Easy to clean and typically washed after every use
    2. Patients do not perceive scrubs as unprofessional (preferred by patients over white coat, business clothing)
      1. Petrilli (2018) BMJ Open 8(5): e021239 [PubMed]
    3. Home washing surgical scrubs does not appear to increase infection risk
      1. https://pdfs.semanticscholar.org/5bc6/c4979fceccfe55fa639d69195e39dea405ed.pdf

VI. Pearls: Cleaning Tips in Medical Care

  1. Clothing stains from blood
    1. Hydrogen Peroxide removes
  2. Bubble Gum in hair
    1. Peanut butter removes
  3. Corrosion metal contacts (battery compartments, connectors)
    1. Vinegar on cotton swab removes corrosive material

VII. Resources

  1. WHO Guidelines on Hand Hygiene in Health Care
    1. https://www.ncbi.nlm.nih.gov/books/NBK144018/

VIII. References

  1. McCullum in Herbert (2019) EM:Rap 19(10):11-3

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Ontology: Hand Disinfection (C0018570)

Definition (MSH) The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of destroying infectious microorganisms.
Concepts Health Care Activity (T058)
MSH D006235
English Disinfection, Hand, DISINFECT HAND, HAND DISINFECT, hand disinfection, Hand Disinfection
Czech dezinfekce rukou
French Désinfection des mains
German Desinfektion, Hände-
Italian Disinfezione delle mani
Spanish Desinfección de las Manos, Desinfección de Manos
Polish Dezynfekcja rąk, Odkażanie rąk
Russian RUK SANITARNAIA OBRABOTKA, РУК САНИТАРНАЯ ОБРАБОТКА, OBRABOTKA RUK KHIRURGICHESKAIA, RUK MYT'E, ОБРАБОТКА РУК ХИРУРГИЧЕСКАЯ, RUK DEZINFEKTSIIA, РУК МЫТЬЕ, ДЕЗИНФЕКЦИЯ РУК, DEZINFEKTSIIA RUK, РУК ДЕЗИНФЕКЦИЯ
Portuguese Desinfecção das Mãos, Higienização de Mãos Pré-Cirúrgica, Desinfecção de Mãos
Norwegian Hånddesinfeksjon, Handdesinfeksjon
Dutch Desinfectie, hand-

Ontology: Handwashing (C0018581)

Definition (MSH) The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms.
Concepts Activity (T052)
MSH D006235
Swedish Handtvättning
Finnish Käsienpesu
Japanese 術前手洗い, 手の消毒, 手指消毒, 手洗い
English handwash, handwashing, Hand Washing, Washing, Hand, Hand Washings, Washings, Hand, Handwashing, Hand washing
Czech mytí rukou
French Lavage des mains
German Händewaschen
Italian Lavaggio delle mani
Spanish Lavado de Manos
Portuguese Lavagem de Mãos
Norwegian Handvask, Håndvask
Dutch Handen wassen, Wassen, handen

Ontology: Hand Hygiene (C3494474)

Definition (MSH) Practices involved in preventing the transmission of diseases by hand.
Concepts Individual Behavior (T055)
MSH D063373
English Hygiene, Hand, Hand Hygiene
Czech ruce - hygiena, hygiena rukou
French Hygiène des mains
German Handhygiene
Italian Igiene delle mani
Spanish Higiene de las Manos
Polish Higiena rąk
Russian РУК ГИГИЕНА, RUK GIGIENA
Portuguese Higiene das Mãos
Norwegian Håndhygiene, Handhygiene

Ontology: Hand washing education (C3697311)

Concepts Educational Activity (T065)
SnomedCT 698608004
English Hand washing education, Hand washing education (procedure)
Spanish educación sobre lavado de manos (procedimiento), educación sobre lavado de manos