In Spain, between 5-10% of patients will get an infection related to healthcare, according to the Epine study

The doctor of the Preventive Medicine Service of the Hospital Quirónsalud Infanta Luisa, Sacred Heart and Field of Gibraltar Nuria López Ruiz points out, in the framework of the World Hand Hygiene Day that is celebrated on May 5, the importance of hand hygiene when it comes to preventing the transmission of infections in health care.

And it is that the specialist says that “washing hands saves lives”, since the hands are “the main route of transmission of germs during health care.” In Spain, as extracted from the Prevalence Study of Nosocomial Infections in Spain (Epine), between 5-10% of patients will get an infection related to healthcare and thousands of people die daily worldwide because of infections acquired while receiving health care, as highlighted by WHO.

As indicated in a statement, some examples of diseases in which transmission can be reduced by hand washing are common colds, the flu, hepatitis A, some gastroenteritis, infections with microorganisms resistant and not resistant to antibiotics, herpes Whooping cough, among others.

Specifically, this year, World Hand Hygiene Day is celebrated under the slogan ‘Prevent septicemia is in your hands’. Sepsis arises when an infection disrupts the normal response of the body and damage to organs and tissues.

Thus, each hospital in Quirónsalud periodically performs an observation of hand hygiene according to the five moments of the World Health Organization (WHO) – before contact with the patient, before aseptic tasks, after aseptic tasks, after contact with patient and after patient environment.

As for the general population, López highlights the importance of raising public awareness of hand washing whenever they are visibly dirty, after using the bathroom, after eating, before preparing food, among other times. He also states that “it is very important to have respiratory hygiene”, that is, to sneeze in tissues and never in the palms of your hands, cough towards the elbow, cover your mouth when coughing, among other measures to take.

“All populations must have good hand hygiene, although more vulnerable populations must, in general, be especially careful, such as children, the elderly and immunocompromised people,” he adds.

To do this, he explains the benefits of the hydroalcoholic solution (alcohol-based disinfectant), in the hospital setting, as a usual preferred means to disinfect the hands when they are not visibly dirty. “It is faster, more effective and better tolerated by the hands than washing them with soap and water,” says the preventive doctor, who indicates that, at home, “soap and water can be used, but remember that for washing be effective, you have to take the right time, about 40 or 60 seconds in total. ”

In addition, in the facilities of the Quirónsalud Infanta Luisa, Sagrado Corazón and Campo de Gibraltar hospitals, Dr. López is going to carry out activities, from this Thursday until next Monday, May 7, for the World Hand Hygiene Day aimed at sensitize health professionals and the general population that “good hand hygiene saves lives”.

Some of these activities will consist of giving information and carrying out practical exercises to learn to wash your hands correctly, using a black box with ultraviolet light to see if the hand hygiene technique is done correctly, training health professionals in hospitalization plants and ICU or the visit to the area of ​​Pediatrics to also raise awareness among children through games.

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41% of hand cultures of health workers were positive for EVR (after patient care and before hand washing)

Hayden M, Clin infect diseases 2000: 31 1058-1065

EVR can be recovered from numerous patient unit sites
Hayden M ICAAC, 2001 Chicago

EVR survives on surfaces for more than 7 days

Noskin G Infect. Control and epidemiol 1995: 16 577-581

Studies conducted with cultures of different sites of the Unit – patient as shown in Figure (X), determined how multiresistant germs such as EVR, Klebsiella spp MR were found persistently, thus favoring the transmission of bacterial resistance to other nosocomial germs that were not .

WHAT ARE THE MOST IMPORTANT REASONS FOR THE PRACTICE OF A GOOD WASHING OF HANDS?

Remove visible dirt from hands

Decrease colonization of patients with nosocomial germs

Prevent infections that patients acquire in the hospital.

Prevent bacterial transfer from home to hospital and from hospital to home.

Decrease hospital costs.

WHY HAND HYGIENE?

HAND HYGIENE IS THE GREATEST FACTOR IN REDUCING THE TRANSMISSION OF MICROORGANISM

NOSOCOMIAL INFECTIONS ARE THE GREATEST CAUSE OF MORBI-MORTALITY: 5 TO 25%

Most frequent germs: Cocos Gram +, Candida sp, Bacilos Gram -.

BACTERIAL RESISTANCE HAS BEEN TRANSFORMED IN A SERIOUS PUBLIC HEALTH PROBLEM

HAND HYGIENE is the key in the infection control program, together with the isolates and the proper use of antibiotics.

There are multiple works that confirm how through different hand hygiene techniques it is possible to reduce their colonization.

So also works that compare different antiseptics and their residual effect

Hand hygiene is a simple and effective measure to prevent nosocomial infections.

The average compliance of this measure varies in the pavilions of the hospitals and the different professional categories of health personnel and according to the working conditions, but is usually <50%

With the improvement of hand hygiene, the transmission of antimicrobial resistant pathogens can be prevented and the rates of nosocomial infections reduced.

An example of this are the following works:

REDUCTION OF THE BACTERIAL COLONIZATION WITH HAND HYGIENE

Hosp Epidemiol Infect Control, 2nd Edition, 1999

EFFECT OF HAND HYGIENE ON RESISTANT MICROORGANISMS

Source: Pittet D: Emerg Infect Dis 2001; 7: 234-240

IMPLEMENTATION OF BEST PRACTICES FOR THE DECREASE OF EVIDENCE-BASED NOSOCOMIAL INFECTIONS
Collaborative work in 7 UTINs in the United States showed a decrease in the incidence of bacteremia associated with staphylococcus coagulase negative, from 24.6% in 1997 to 16.4% in 2000.

Pediatrics vol 11 April 2003 Author: Howard W. Kilbride et al.

HAND HYGIENE IN NEONATAL THERAPY: MULTIMODAL INTERVENTION AND IMPACT ON NOSOCOMIAL INFECTION

The evaluation of an educational program on protocolized hand hygiene, reduction of the opportunity for contact with patients and facilitation of adherence showed:

Pediatrics vol 114 November 2004 Author: Barbara CC et al

As will be observed, there is no doubt about the impact that HAND HYGIENE has on the daily task of caring for infants to prevent nosocomial infections, a recent article published in the Journal of Hospital Infection (2005) reports as a modest effect! a 40% reduction in infection rates with the sole use of hand hygiene.

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Researchers at the University of Michigan Health System assessed eight different designs across four intensive care units to determine how dirty sinks and faucets really are. They found that a shallow depth of the sink bowl enabled potentially contaminated water to splash onto patient care items, healthcare worker hands, and into patient care spaces – at times at a distance of more than four feet from the sink itself.

“The inside of faucets where you can’t clean were much dirtier than expected,” said study author Kristen VanderElzen, MPH, CIC. “Potentially hazardous germs in and around sinks present a quandary for infection preventionists, since having accessible sinks for handwashing is so integral to everything we promote. Acting on the information we found, we have undertaken a comprehensive faucet replacement program across our hospital.”

To identify the grime level of the sinks, the researchers used adenosine triphosphate (ATP) monitoring to measure the cleanliness. Visible biofilm was associated with higher ATP readings, and cultures tested over the course of the study grew Pseudomonas aeruginosa, mold, and other environmental organisms.

The research team also found aerators on sinks where they had previously been removed, pointing to an overall inconsistency of equipment protocols across the facility. Included in the design improvement program were sink guards, which were shown to limit splash significantly.

“As we learn more about the often stealthy ways in which germs can spread inside healthcare facilities, infection preventionists play an increasingly important role in healthcare facility design – including in the selection of sink and faucet fixtures – as this study illustrates,” said 2019 APIC president Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. “Because the healthcare environment can serve as a source of resistant organisms capable of causing dangerous infections, an organization’s infection prevention and control program must ensure that measures are in place to reduce the risk of transmission from environmental sources and monitor compliance with those measures.”

Source: APIC & Infection control today magazine

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Recent studies indicate that electronic devices can play an important role in hand hygiene compliance. Venkatesh conducted a prospective, interventional study to evaluate the use of an electronic device to measure and impact hand hygiene practices and control transmission of VRE in a 30-bed academic medical center hematology unit. The researchers identified 8,235 measurable hand hygiene opportunities during the study, with compliance improvement from 36.3 percent at baseline to 70.1 percent during the second phase of the study. The use of audible alerts improved hand hygiene compliance for both the day shift and the night shift, as well as across rooms with higher HCW traffic and lower HCW traffic.

Swoboda  attempted to determine through a three-phase study whether electronic monitoring of hand hygiene and voice prompts could improve hand hygiene and decrease infection rates in a 14-bed, university hospital-based surgical intermediate care unit. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for failure to perform hand hygiene on room exit; and phase III was electronic monitoring only. All patient rooms, utility room and staff lavatory were monitored electronically. Participants included all healthcare personnel including physicians, nurses, nursing support personnel, ancillary staff, all visitors and family members, and any other personnel interacting with patients on the unit. All patients with an intermediate care unit length of stay greater than 48 hours were followed for hospital-acquired infections (HAIs). Electronic monitoring was conducted during all phases, with computerized voice prompts during phase II only. The researchers evaluated a total of 283,488 electronically monitored entries into a patient room with 251,526 exits for 420 days (10,080 hours and 3,549 patient days). Compared with phase I, hand hygiene compliance in patient rooms improved 37 percent during phase II and 41 percent in phase III. When adjusting for patient admissions during each phase, point estimates of HAIs decreased by 22 percent during phase II and 48 percent during phase III; when adjusting for patient days, the number of infections decreased by 10 percent during phase II and 40 percent during phase III. Although the overall rate of HAIs significantly decreased when combining phases II and III, the association between HAIs and individual phase was not significant. The researchers concluded that electronic monitoring provided effective ongoing feedback about hand hygiene compliance.

Swoboda also hypothesized that both patient isolation and electronic hand hygiene prompts incrementally improve hand hygiene of HCWs compared with non-isolation rooms. They conducted a prospective, 14.5-month, three-phase electronic surveillance study of hand hygiene behavior on an intermediate care unit with nine patient rooms (three isolation rooms and six non-isolation rooms); phase I was electronic observation, phase II was electronic observation with automated voice messages urging hand hygiene, and phase III was electronic observation. Electronic sensors monitored room entries and exits and use of all sinks and all soap dispensers. Phase I (1,616 patient-days) HCWs were 49 percent more likely to wash their hands in isolation rooms versus non-isolation rooms; phase II (1,390 patient-days) and phase III (543 patient-days) healthcare workers were 59 percent more likely to wash their hands in isolation versus non-isolation rooms, P = .001. The researchers concluded that HCWs improve hand hygiene when constrained by isolation rooms, that electronic voice prompts further improve hand hygiene behavior, and that both physical and auditory reminders improve hand hygiene.

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Since then, World Handwashing Day aims to extend the best hygiene practices to the entire planet. The practice of washing your hands is common in most parts of the world, but soap is rarely used after critical moments (after using the toilet, cleaning a child’s stool or before handling food).

Handwashing with soap is one of the most effective and economical ways to prevent diarrheal and respiratory diseases, which are responsible for ensuring that every year more than 3 million children do not reach 5 years of life. Every 20 seconds, a child dies as a result of poor sanitation, that means 1.5 million deaths a year that could be prevented. According to WHO, washing hands with soap and water would reduce the risk of acute diarrheal diseases by 47 percent.

Incorporating the practice of handwashing with soap in every home in the world could save more lives than any medical intervention. Declaring October 15 as World Handwashing Day also has as another key objective to ensure access to sanitation and drinking water sources throughout the world.

A gesture as simple as washing your hands with soap and water can be key to the survival of millions of people, especially the little ones. Children are especially vulnerable to the effects of diarrhea and respiratory infections, diseases that can be easily and cheaply prevented with a little soap and water. This day wants to serve as a reminder of the importance of this practice.

Equitable access to hygiene facilities that allow us to wash our hands with soap helps us build a better future as we move towards achieving the Sustainable Development Goals.

Today we celebrate World Handwashing Day, but it is a call to practice it every day; We have a great challenge in converting an idea that is often abstract in an internalized and conscious behavior in homes, schools and communities around the world.

Aspects we should all know about hand washing

Washing your hands only with water is not enough, it is a widespread practice worldwide, but it is much less effective than doing so using soap. The soap favors rubbing, gives off a smell and produces a pleasant sensation that encourages its use.

Different medical studies have confirmed that washing your hands with soap is an effective way to prevent disease transmission even in impoverished settlements with high levels of pollution. Skin or eye infections, intestinal parasites, different types of flu and even a health improvement for people with HIV / AIDS are possible with proper hand washing.

There are critical times of the day when it is mandatory to wash your hands with soap: after using the bathroom, when coming into contact with feces or before handling food. The hands are the main carriers of germs that cause disease.

Washing your hands is the most effective and cheap health or hygiene intervention in the world.

A final key aspect of World Handwashing Day is to turn children into “handwash ambassadors” nationwide in all countries. Involving children in these activities can be a real factor of change to absolutely establish this practice worldwide.

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With this action, which does not take more than a minute, intrahospital infections can be reduced by up to 50%, the spread of existing bacteria in the environment is prevented and the early recovery of hospitalized patients and people with Acute Respiratory Infections is contributed (GO TO).

As explained by the Department of Epidemiology and Prevention of Infectious Diseases of the Central Military Hospital, washing your hands at the right time can save lives. This is confirmed by the World Health Organization -OMS-, which ensures in recent years, this measure in health care has saved the lives of millions of people.

Through the Hand Hygiene Program of the Epidemiology Service of the Central Military Hospital, in the course of 2019 it has been possible to impact more than 1,500 people during the awareness sessions on handwashing. The first was from March 26 to April 9 and the second was held on May 2 and 3.

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According to a study published in the Pediatrics Magazine. Spanish researchers demonstrated that children who used hand sanitizers instead of soap and water reduced their days of illness, suffered less respiratory infections and used less antibiotic prescriptions.

“Washing hands as a way to prevent infections is no longer new. We are now paying more attention to the fact that it is not just about washing your hands, but how to wash your hands. ” Janet Haas, epidemiologist of the Lenox Hill Hospital in New York.
The sample of the study was of 911 small children (up to 3 years) of 24 different nursery schools in the province of Almeria.
For the realization of the study, children, their families and their kindergarten were divided into three groups:

1. The first group used disinfecting hands to clean hands.

2. The second sample used water and soap with strict protocols.

3. And the third party was a control group that followed its usual routines of hand washing.

The study lasted 8 months, during which the hand disinfectant group recorded 3.25% of lost day care days. The group of water and soap lost 3.9%. The group that followed their usual hand washing routine lost 4.2%.

The study demonstrated the advantages of including a disinfectant in hand washing. The group that used hand sanitizers recorded a 23% decrease in respiratory infections among students, compared to those of the control group that followed the usual guidelines for hand hygiene.

The study also concluded that the group that used water and soap had a 21% higher risk of getting a respiratory infection and a 3% higher prescription of antibiotics than children who used hand sanitizers.

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Six-step hand hygiene 30 seconds

Six-step hand hygiene 15 seconds

Three-step hand hygiene 30 seconds

Three-step hand hygiene 15 seconds

All participants are assigned to each group.

Three, 15 seconds of three-step technology is just as effective

The results showed that the 15-second three-step technique was as effective as reducing the bacterial count on the volunteer’s hand for a 30-second three- or six-step protocol.

Four-step, 15-second three-step technology is simple and convenient

Professor Tschudin-Sutter said in a statement: “The time pressure and heavy workload experienced by medical workers have reduced adherence to the health standards of our opponents. Our results show that shortening hand rub time and simplifying hand rubbing techniques It may be a safe alternative to adapting to their busy day-to-day work, improving the overall quality of hand hygiene performance and having a positive impact on compliance. Further research is needed to verify the shortened application time in daily clinical practice. which performed.”

The research team agreed that unless research was conducted in the actual clinical setting, the study could not provide a comprehensive statement of the ability of the three-step protocol to prevent microbial transmission.

5. Hand hygiene and reduction of staphylococcal infections

In 2009, the Australian National Hand Health Initiative (NHHI) was implemented, and since then, the reduction in staphylococcal infections in health care facilities has improved significantly. The results of this new study are entitled “Improving Hand Hygiene Compliance (HHC) is associated with a significant reduction in medical-related Staphylococcus aureus bacteremia (HA Sab) in 132 largest hospitals in Australia: Australian National Hand Health Initiative The results (NHHI) were published at the European Conference on Clinical Microbiology and Infectious Diseases (ECCMID) in Amsterdam, the Netherlands, from April 13th to 16th.

Sixth, hand hygiene management significantly reduces bacterial infections

The report shows that hand hygiene and its compliance with Australian health care workers have improved significantly. This reduces the risk of the transmission of commonly fatal medical-related S. aureus infections. The researchers noted a 10% increase in compliance with hand hygiene guidelines and a 15% reduction in the incidence of S. aureus bloodstream infections in 132 of the largest public hospitals in Australia. They added that these hospitals served more than 15 million patients nationwide in 2016-17. This is equivalent to more than three-quarters of hospitalizations in Australia.

Seven, 5 moments of hand hygiene

The team is following up on the WHO campaign called “5 moments of hand hygiene”, which will reduce the risk of medical-related infections.

These five moments include;

Before contacting the patient

After touching the patient

After touching the environment

Before the cleaning process

After exposure to body fluids/wounds

Health and hygiene, starting from a doctor, is responsible for both yourself and the patient.

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