Evidence Base project, SDSU College of Nursing

1. By Jennifer Amponsah & Abina Luitel

2. Objectives
By the end of this presentation students will;
 Demonstrate proper hand-washing and proper use of
PPE.
 Verbalize at least three the importance of hand-
washing and PPE in infection control.
 Verbalize when to wash hands and use PPE.
 Describe the history of hand hygiene and PPE.
 Describe the impact of hand washing and PPE on
human health

3. PICO question
 Population: Health care workers and patients
 Interventions: Proper hand washing and PPE
 Comparison: No proper hand washing and use of PPE
 Outcome: Decrease spread of nosocomial infections
 PICO question: For Patients, does the use of proper
hand washing and PPE by health care workers reduce
the risk of nosocomial infection compared with
improper hand washing and use of PPE?

4. Background Questions??
 How often do you see nurses on your unit wash their
hands?
 What is effective handwashing?
 What is the purpose of personal protective equipment
(PPE)?
 How do Healthcare workers get contaminated with
Bacteria ?

5. Video
 http://www.youtube.com/watch?v=NHHrCZkcFXk&fe
ature=related

6. Introduction
 Hand-washing is a first break of infection, and the
most effective and inexpensive ways to prevent
infection including nosomical infections
 The majority of HAI cases are preventable through a
combination of strategies including environmental
control and cleaning, use of isolation precautions, and
use of personal protective equipment (PPE) when
appropriate
(Landers, McWalters, Behta, Bufe, Ross, Vawdrey &
Larson, 2010)

7. History of Hand-washing
 Concept of using antiseptic agent for hand-washing
begin in 19th century
 In 1961, the U. S. Public Health Service produced a
training film that demonstrated hand-washing
techniques recommended for use by health-care
workers (HCWs)
 In 1975 and 1985, formal written guidelines on hand-
washing practices in hospitals were published by CDC
(Hand hygiene for health care workers, 2009)

8. History of PPE
 In 1970, the US CDC recommended the use of seven
isolation categories , later in 1983, tuberculosis
isolation, drainage/secretion precautions, and blood
and body fluid precautions were also included
 In 2007, CDC extended the level of standard
precautions to incorporate safe injection practices,
respiratory/cough etiquette and use of masks for
invasive measures
(Landers et al., 2010)

9. Statistics & Facts
 1 in 10 person may experience nosocomial infection
(Biddle, 2009)
 At any one time, an estimated 1.4 million people suffer
from (Healthcare-associated infections) HAIs
(Landers et al., 2010)
 Global Hand-washing Day is in October 15th of each
year
 Hospital acquired infections account for 1.7 million
infections and 99,000 deaths each year (CDC.gov)

10. When to Wash Hands
 Before and after direct contact with patient
 Before and after invasive procedures and sterile
procedures
 After contact with body fluids or secretions, mucus
membrane, non-intact skin, and wound dressing
 After contact with inanimate objects
 Before and after gloving
(Kampf, Löffler, & Gastmeier, 2009).

11. Proper Hand-washing Technique
 Palm to palm
 Right palm over left dorsum and left
 palm over right dorsum
 Palm to palm, fingers interlaced
 Fingers to opposing palms
 Rotational rubbing of right thumb clasped over left
and vice versa
 Rotational rubbing backwards and forwards
(Pirie, 2010).

12. Components of PPE
 Gloves
 Gowns
 Aprons
 Masks
 Goggles
 Visors
 Caps
 Theatre footwear
(Hinkin, Jayne & Cutter, 2008)

13. Selecting Appropriate PPE
 Anticipated exposure such as touch, splashes, sprays,
blood or body fluids
 Categories of isolation precautions a patient
 Durability and appropriateness of PPE for the task
 PPE Fit the categories of exposure
(Akridge, 2011)

14. Sequence for Donning PPE
 Gown: Fully cover torso from neck to knees, arms to
end of wrists, and wrap around the back, fasten in
back of neck and waist
 Mask or respirator: Secure ties or elastic bands at
middle of head and neck, fit flexible band to nose
bridge, snug to face and below chin
 Goggles or face shield: Place over face and eyes to
adjust
 Gloves: Extend to cover wrist of isolation gown
(Transferring More than Patients, 2011)

15. Sequence of Removing PPE
 Gloves: Grasp outside of glove with opposite gloved hand
to peel off, hold removed glove in gloved hand and slide
fingers of ungloved hand under remaining glove at wrist.
Peel and discard
 Goggles or face shield: handle by head band or ear
pieces. Place in designated receptacle
 Gown: Unfasten ties. Pull away from neck and shoulders,
touching inside of gown only. Turn gown inside out, fold or
roll into a bundle and discard.
 Mask or respirator: Grasp bottom, then top ties or elastics
and remove and discard
(Transferring More than Patients, 2011)

16. Video for PPE
 http://www.youtube.com/watch?v=_IYrqiQjvyQ

17. Impact on Health Care Workers
Excessive hand-washing and wearing occlusive gloves can
cause
 Sore and damaged skin
 Skin irritation and dryness
 In winter months some personnel may develop cracks in
their skin that cause bleeding
 Darker skin has less skin irritation than darker skin
 Dermatitis (hand washing with soap before or after alcohol
based product)
(Bissett, 2007)

18. Impact on Patients
Nosomocial infections causes
 Increase morbidity and mortality rate in patients
 Prolonged hospital stay
 Increase health care costs
(Chen & Chiang, 2007)

19. Impact on Cost
 Estimated 1.4 million people suffer from HAIs which
increased direct and indirect costs,
 prolonged hospitalization
 high rates of disability and death.
 In the US, estimated that HAIs account for direct
hospital costs of $28.4–$45 billion per year
(Landers et al. 2010)

20. Challenge and Barriers
 Skin irritation
 Time consuming (15-30 sec)
 Work load stress (too busy)
 Shortage of staff
 Availability of PPE
 Lack of knowledge
 Interfere in ability to provide care
(Hinkin, Jayne & Cutter, 2008)

21. Research
 Relevant Databases
 EBSCO MegaFILE
 CINAHL
 Key Words
 Hand-washing
 “PPE”
 Nosocomial infections
 Nursing implicaitons
 Streamline
 Dates: 2007 to Present
 Publication Type: Research, Journal

22. Research Article One
 In 206 hospital healthcare workers,
 observed episodes for hand hygiene and glove use .
 74.7% for hand hygiene and 72.4% glove use .
 two-third of episodes, participants washed their hands after each
patient contact.
 78.5% failed to rub their hands together vigorously for at least 15
seconds.
 major break in compliance with glove use was failure to change
gloves between procedures on the same patient.
 In 28.6% of observed glove use episodes, participants did not
wear gloves during procedures that exposed them to blood, body
fluids, excretion, non-intact skin or mucous membranes.
(Chau, Thompson, Twinn, Lee, & Pang,2011).

23. Research Article Two
 123 families in 15-bed PICU of a medical centre in central
Taiwan
 A video-centered teaching program based on social
learning principles
 The video-based teaching program was effective in
increasing compliance and accuracy with a hand-washing
policy among families with children in intensive care units.
 Study period indicate that compliance with hand washing
in families in experimental group was higher than the
comparison group at a statistically significant level.
(Chen, & Chiang, 2007).

24. Research Article Three
 500 patients in Division of General Surgery, King
Khalid University Hospital, Riyadh, Saudi Arabia.
 Preoperative alcohol hand-rub preparations are as
effective as traditional surgical scrub in reducing SSI.
 The alcohol hand-rub easier to use and preferred by
surgeons.
(Al-Naami, Anjum, Afzal, Al-Yami, Al-Qahtani, Al-Dohayan, & ... Al-Saif, 2009)

25. Research Article Four
 211 Registered Nurses from Trakya University Training
and Research Hospital, Turkey participate in four
curricula on infection control and to identify sources
of information.
 There was significant increase in the quality of hand
washing by the nurses after training. compliance with
hand-washing recommendations was 70% before
training and increased to 84% after training
(Erkan, Findik, & Tokuc, 2011)

26. Research Article Five
 317 Registered Nurses from three different hospital at
campus in East-cost, US participate in describing
isolation precautions correct identification of required
personal protective equipment.
 Correct identification of hand hygiene
recommendations across all scenarios was 94.6%,
 Identifying proper placement of patients in a private
room when transmission-based precautions are
required was 62.9%
(Landers, McWalters, Behta, Bufe, Ross, Vawdrey, &
Larson, 2010)

27. Research Article Six
 Cross-sectional studies done in 350 students studying
medical, nursing, physiotherapist and assistant
radiologist at Rouen University, France
 To evaluate the knowledge of healthcare students after
four curricula on infection control and to identify
sources of information
 The mean overall score (±SD) was 21.5 ± 2.84. Nursing
students had a better mean overall score (23.2 ± 2.35)
(Tavolacci, Ladner, Bailly, Merle, Pitrou, & Czernichow,
2008)

28.  Does proper hand-washing and use of PPE helps to
prevent the spread of infections???

29. Answer to PICO Question
 Six research studies analyzed support the use of
proper hand washing and PPE by health care workers
reduce the risk of nosocomial infection in patients
compared with improper hand washing and use of PPE

30. Conclusion
 Studies show the bacteria that cause
hospital acquired infections are
frequently spread from patient to
patient by health care workers hand
 CDC and many research support
that proper hand-washing before
and after having contacts with
patients is the one most important
measure for preventing the spread
of infection in health care settings

31. Foreground Questions
 What are the importance of hand washing and PPE in
infection control?
 When should healthcare workers wash their hands
and use PPE?
 When did the concept of using antiseptic agent for
hand washing begin?
 What are the impact of hand washing and PPE on
human health?

32. Any Question???

33. References
Akridge, J. (2011). Clinicians armor up with PPE to battle infections. Healthcare Purchasing News, 35(2),
20-26.
Al-Naami, M., Anjum, M., Afzal, M., Al-Yami, M., Al-Qahtani, S., Al-Dohayan, A., & ... Al-Saif, F. (2009). Alcohol-
based hand-rub
versus traditional surgical scrub and the risk of surgical site infection: a randomized controlled equivalent
trial. EWMA Journal,
9(3), 5.
Biddle, C. (2009). Semmelweis revisited: Hand hygiene and nosocomial disease transmission in the anesthesia
workstation. AANA Journal, 77(3), 229-237.
Bissett, L. (2007). Skin care: An essential component of hand hygiene and infection control. British Journal Of
Nursing (BJN), 16(16), 976
Chen, Y., & Chiang, L. (2007). Effectiveness of hand-washing teaching programs for families of children in
pediatric intensive care units. Journal Of Clinical Nursing, 16(6), 1173-1179 doi: 10.1111/j.1365-
2702.2006.01665.x
Chau, J., Thompson, D., Twinn, S., Lee, D., & Pang, S. (2011). An evaluation of hospital hand hygiene practice
and glove use in Hong Kong. Journal Of Clinical Nursing, 20(9/10), 1319-1328.
Erkan, T., Fındık, U., & Tokuc, B. (2011). Hand-washing behaviour and nurses' knowledge after a training
programme. International Journal Of Nursing Practice, 17(5), 464-469. doi:10.1111/j.1440-
172X.2011.01957.x

34. References
Hand hygiene for health care workers. (2009). http://www.learnwell.org/handhygiene.htm
Hinkin, J., Gammon, J., & Cutter, J. (2008). Review of personal protection equipment used in
practice. British Journal Of Community Nursing, 13(1), 14-19.
Kampf, G., Löffler, H., & Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial
infections. Deutsches Aerzteblatt International, 106(40), 649-655.
doi:10.3238/arztebl.2009.0649
Landers, T., McWalters, J., Behta, M., Bufe, G., Ross, B., Vawdrey, D., & Larson, E. (2010). Terms
used for isolation practices by nurses at an academic medical center. Journal Of Advanced
Nursing, 66(10), 2309-2319. doi:10.1111/j.1365-2648.2010.05398.x
Pirie, S. (2010). Hand washing and surgical hand antisepsis. Journal Of Perioperative
Practice, 20(5), 169-172.
Tavolacci, M., Ladner, J., Bailly, L., Merle, V., Pitrou, I., & Czernichow, P. (2008). Prevention of
nosocomial infection and standard precautions: Knowledge and source of information among
healthcare students. Infection Control & Hospital Epidemiology, 29(7), 642-647.
Transferring more than patients. (2011). Hospital Infection Control & Prevention, 38(11), 129-130.