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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-

Routine hand washing

Hygienic hand care

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.

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).



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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