Dr.T.V.Rao MD

Ignaz Philip Semmelweis (1818-1867) championed the importance of hand washing among the medical professional. Yet there is no other procedure which is simple and cost effective in preventing the spread of infections in hospital environment. It is utmost important duty of every medical, paramedical and nursing staff to educate, promote and monitor hand washing. Inspite of more than a century of knowledge many times, this simple procedure is ignored by the many senior staff. The simple procedure of hand washing is the best prayer in prevention of infections in a hospital, continues to be the best remedy in reducing the hospital acquired infections.

The basis of spread of infections in hospital is that microbes are commonly exchanged from patients to patients, patients to medical staff and medical staff to patients.

In the above methods of spread our hands play a great role in transmission of infections. By simple procedure of hand washing the chain of events in spread can be minimised.

Methods of hand washing

1.Social hand washing

2.Hygienic hand washing or disinfection

3.Surgical hand washing

1.Social hand washing

Most commonly practiced procedure involves vigorous mechanical friction applied to all surfaces of hand using simple plain (toilet) soap and water for 15-20 seconds. If no running water is available store water in a clean container, close lid and only necessary amount drawn to the needs with a clean mug. After washing, dry hands with tissue paper or a clean towel. Never use a common towel as the very purpose of washing is lost when you do a clean procedure on the patients.

2.Hygienic hand washing and disinfection

Hand washing using a disinfectant as 4% chlorhexidine gluconate- detergent or Povidone- Iodine detergent solution (containing 0.75% available Iodine and alcohol) is preferred.

The following types of alcohols can be added such as Ethanol- 70% or Isopropanol-70% to 0.5% chlorhexidine or povidone.

3.Surgical hand washing

Hand washing practiced more intensely, usually done before surgical procedures or any interventions.

Soap/ liquid detergent used with warm water. Washing extends up to elbow apart from washing fingers and palms.

Practical Tips in Hand Washing

Use soap and water (if possible mild warm water) Vigorously rub your hands together until you have generated lather.

Scrub your wrist between your fingers, under our nails, around the tips and palms of the hands, practice this for 15-20 seconds and rinse and dry your hands with clean towel.

In view of configuration of hands certain areas of the hands are relatively less cleared of microbes than other surrounding areas.

Common infections spread by unclean hands:

1.Drug Resistant Staphylococci

2.Clostridium spp.

3.Salmonella, E.coli, Shigella, Hepatitis A&E.

4.When you are working in ICU and ICCU the patients are invariably on broad spectrum antibiotics and colonized with multi drug resistant bacteria. Your dedicated effort in hand washing will save the lives of serious patients, from infection.

5.In the era of AIDS and Hepatitis B infection all the blood and body secretions are identified as health risk to all medical/paramedical staff. Hand washing is included as primary importance in the universal precautions.

6.Wearing a glove is not a total protection in handling infectious cases. Even the new gloves contain micro holes. Washing is equally important after you remove gloves.

7.Your children can be effectively protected from infection if you teach simple hand washing, even in school after attending a toilet or before taking food. It is observed that in schools with good washing facilities the children are less likely to be sick with infection from communicable diseases.

Our goals in hand washing promotion Experience has shown that most effective way to increase hand washing is to have physicians, surgeons, senior paramedical staff and other respected individuals as role models to consistently wash their hands and encourage others to do so.

Social hand washing is also an important procedure to be explained to all the patient attendants. As even attendants get infected while serving and may take home the infection or bring some infections from outside when they attend the patients.

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