HAND HYGIENE
Hands have been known to be involved in many infectious disease outbreaks especially in nurseries, neonatal units, intensive care units and other hospital settings. This happens because hands of medical personnel may be transiently infected with pathogenic organisms from infected patients or environment, and thus these can be transmitted to other patients. Therefore, hand hygiene is very important in keeping the health care associated infections at minimum.
Types of Hand Hygiene Techniques-
1. Routine hand washing
2. Hygienic hand care
3. Surgical hand washing or hand scrub
1. Routine Hand Washing
It involves washing of hands with soap and water. It removes most transient microorganisms from the hands. Routine hand washing should be performed in the following conditions:
· Before and after contact with patients,
· Before wearing and after removing gloves,
· After wound dressing,
· After contact with body fluids of patients,
· After handling devices for patient care or having contact with inanimate objects in and around patient.
2. Hygiene Hand Care
· Wash hands with soap and water by rubbing hands in the six movements by covering all surfaces of hands.
· Rinse hands with water.
· Dry hands with single-use towel.
Alcohol based method
· When alcohol-based hand rub solution instead of soap, dry hands are required.
· Wash hands with soap and water by rubbing hands in the six movements by covering all surfaces of hands.
· Rinse hands with water.
No towel is required for drying as alcohol evaporates in the environment.
3. Surgical Hand Washing or Hand Scrub
· It requires more time for washing than hygiene hand care.
· Besides hands, wrists and forearms are also included for washing.
· For drying, sterile towels are used.
Indian scenario
In India, the quality of healthcare is governed by various factors, the principal amongst these being whether the health care organization is government or private-sector run. There is also an economic and regional disparity throughout the country. About 75 per cent of health infrastructure, medical manpower and other health resources are concentrated in urban areas, where 27 per cent of the population lives. There is a lack of availability of clean water for drinking and washing. Like in other developing countries, the priority given to prevention and control of HCAI is minimal. This is primarily due to lack of infrastructure, trained manpower, surveillance systems, poor sanitation, overcrowding and understaffing of hospitals, unfavorable social background of population, lack of legislations mandating accreditation of hospitals and a general attitude of non-compliance amongst health care providers towards even basic procedures of infection control. In India, although hand hygiene is imbibed as a custom and promoted at school and community levels to reduce the burden of diarrhea, there is a paucity of information on activities to promote hand hygiene in HCFs. Sporadic reports document the role of hands in spreading infection and isolated efforts at improving hand hygiene across the country.
The practice of compulsory training on standard precautions, safe hospital practices and infection control for all postgraduates upon course-induction, as is being done in a few Delhi medical colleges seems very promising for our country. Such an exercise may be made mandatory across all medical and nursing colleges of India, especially since the “patient safety” is increasingly being prioritized by the Government of India and the country being one of the 120 signatories pledging support to the WHO launched world alliance (available
at http://www.who.int/patientsafery/events/06/statememts/India_pledge.pdf).
Conclusion
Hand washing should become an educational priority. Educational interventions for medical students should provide clear evidence that HCWs hands become grossly contaminated with pathogens upon patient contact and that alcohol hand rubs are the easiest and most effective means of decontaminating hands and thereby reducing the rates of HAIs. Increasing the emphasis on infection control, giving the charge of infection control to senior organizational members, changing the paradigm of surveillance to continuous monitoring and effective data feedback are some of the important measures which need to be initiated in Indian hospitals.
One of the reasons microbes have survived in nature is probably their simplicity: a simple genomic framework with genetic encryption of basic survival strategies. To tackle these microbes, human beings will have to follow basic and simple protocols of infection prevention. The health care practitioners in our country need to brace themselves to inculcate the simple, basic and effective practice of hand hygiene in their daily patient care activities and serve as a role model for future generations of doctors, nurses and paramedical personnel.
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