Medical Asepsis Clean Technique Surgical Asepsis Sterile Technique

Transcription

1 Welcome to Section D, Principles/Practices of Asepsis and Hand Hygiene and Environmental Issues in Disease Transmission, the fourth of a seven part course, created by the Statewide Program for Infection Control and Epidemiology to meet compliance with NC Rule.0206 Infection Control in Health Care Settings. This course was specifically designed to meet compliance for healthcare provided in outpatient settings only. Section D 1

2 There are two objectives for this lecture that will be addressed. The first objective is to describe the principles and practices of asepsis and hand hygiene. The second objective is that at the conclusion of this lecture you will have a better understanding of the risk the contaminated environment plays in disease transmission. Section D 2

3 What are some of the basic principles underlying asepsis? First, microorganisms are capable of causing illness in humans. Second, these illnesses can be prevented by interrupting the transmission of microorganisms from the reservoir to the susceptible host. Let s begin by discussing asepsis. Asepsis is the practices that results in an absence of pathogenic or disease producing microorganisms. Healthcare providers have used that information since the time of Florence Nightingale and Joseph Lister to determine when and how asepsis should be carried out to prevent disease transmission in healthcare settings. Medical Asepsis: refers to practices that reduce the numbers of microorganisms and/or prevent or reduce transmission from one person to another; also referred to as Clean Technique Surgical Asepsis: refers to practices designed to render and maintain objects and areas maximally free from microorganisms; also referred to as Sterile Technique Section D 3

4 The practice and science of infection control is the knowledge that the risk of infection acquired by a patient is based on several factors to include: the dose of microorganism which varies from one pathogen to another, whether a small or large inoculums is more likely to lead to infection. This risk continues to be multiplied if there is prolonged exposure in time, increasing the total dose. And finally, the risk is affected by the virulence or strength of the particular pathogen causing systemic disease from a mild case, for example a cold virus, to Ebola, which is life threatening in humans. The ability to withstand any microorganism and its outcome is based on the host s defense or underlying resistance that can be compromised by age, nutrition, disease, or further compromised by medical treatments. Section D 4

5 Medical asepsis, also called clean technique, refers to practices that reduce the numbers of microorganisms or that prevent or reduce transmission from one person to another. Some examples of medical asepsis are hand hygiene which includes hand washing or the use of waterless alcohol based hand rubs. Medical asepsis also includes barrier techniques such as the use of clean gloves for the purpose of minimizing clothing contamination, clean gloves to avoid direct contact with infectious materials, and the no touch dressing technique to avoid contamination of sterile supplies or sterile gloves for dressing application. Medical asepsis also includes routinely cleaning the environment to keep the bio-burden low. An important concept of asepsis is to always clean from the clean areas to the dirty, so as not to recontaminate what is clean by dragging contamination back onto the area that is being decontaminated. A good example of that is prepping skin in a concentric circle out or by back and forth working out from incision. The same principles apply to cleaning the environment. Section D 5

6 Medical asepsis then is to be utilized for all patient care activities. This includes hand hygiene at designated times, and the routine cleaning and disinfection of equipment that we discuss further in this lecture. Medical asepsis also includes the care of patients with communicable diseases And medical asepsis should be followed for all non-surgical procedures (for example, general exams and IV medications). Section D 6

7 One of the important concepts of asepsis is the role the environment plays in disease transmission in healthcare settings. Environmental surfaces can become contaminated with microorganisms during patient care. While environmental surfaces have not been directly involved in bloodborne pathogen transmission to healthcare workers (HCWs) or patients, these surfaces have been associated with an increased risk for multi-drug resistant organisms (MDRO) pathogens. However, environmental surfaces that include things like exam tables, countertops, chairs, door handles do not require decontamination procedures as stringent as those used on patient care items. You cannot sterilize the environment. But HCWs can reduce bioburden and pathogens to make it safer for patients. Section D 7

8 It is important to realize that bloodborne pathogens have a fairly long survival time. HIV has the least survival time averaging a one log reduction every eight hours. What that means is the average person with HIV infection may have 1000 HIV particles per ml of blood. If a ml of blood is on a hard surface after eight hours of exposure to the air and light, a one log reduction would mean there be 100 infectious particles, and after another eight hours there would be only 10 infectious particles. Thus after 24 hours most HIV infectious particles on unprotected surfaces will be dead. Some studies have shown that HIV in sewage can survive longer because the organic material is protected from light and air that promotes the viral death. We know less about HBV survivability. But blood contamination, even when it cannot be seen by the human eye on a surface, can be detected by culture for about a week. This information is important in areas with lots of blood contamination such as dialysis units and blood drawing labs when thinking about reuse of items such as tourniquets. Regarding HCV, a recent study found that the virus can survive for at least 14 days, decreasing by 3 to 4 logs over that time. Section D 8

9 There are two categories of environmental surfaces. Clinical contact surfaces have a high potential for direct contamination from patient secretions especially during procedures that generate spray or splatter, or by contact with HCWs gloved hands or from the patient s or family s contaminated hands. These surfaces can become a reservoir for contamination of instruments, patient care devices, or HCW s bare or gloved hands. Housekeeping surfaces such as the floor, walls, curtains, windows do not come into contact with patients or devices used in healthcare procedures. Therefore, they have a limited risk of disease transmission. Section D 9

10 General cleaning recommendations include the use of appropriate protective barriers such as heavy-duty utility gloves, masks, and protective eyewear when cleaning and disinfecting surfaces. In general, cleaning and removal of microorganisms is as important as the disinfection process itself. Blood or other patient materials left on surfaces can interfere with the disinfecting process. Follow the manufacturer s instructions for proper storage, dilution, and use of hospital disinfectants. Because of their toxic nature, the use of sterility or high-level disinfectants on environmental surfaces is NOT recommended. It is critical to read the manufacture's recommendations for correct use and verify that the written information says that the product is an EPA approved or registered germicidal disinfectant for healthcare. Section D 10

11 There is a plethora of EPA approved germicidal cleaning agents for use in healthcare facilities available on the market today. Some products have to be diluted, and others are pre-diluted by the manufacturer, which are more convenient but generally are more costly. There are several makers of disinfectant wipes which are very convenient and improve HCW compliance because of the ease of use. All disinfection products have an expiration date that needs to be monitored to prevent out of date products from being used. Also once products have been mixed, they will have a recommended time to be used according to the manufacturer's instructions, which regulatory agencies may be checking along with the evidence of the correct dilution. Section D 11

12 The EPA approved healthcare disinfection products are formulated and tested for the ability to kill microorganisms. If the product can kill all microorganisms, except for high numbers of bacterial spores, then it is considered a high level disinfectant. Spores such as anthrax and C difficile are the most resistant pathogens to disinfection. An intermediate level disinfectant product can destroy mycobacterium species including tuberculosis. This is important because the soil and water contain mycobacterium other than TB species, such as M bovis that could contaminate instruments if tap water rinses are used during reprocessing. Then there are low level disinfectants; these products kill all the common vegetative bacteria (Staph, strep, E coli, Pseudomonas and all other gram negative and positive bacteria). But these products do not kill TB or other strains of mycobacteria such M bovis. Quaternary ammonium based compounds are the most common products used in healthcare in the US for low or intermediate cleaning and disinfection products. Section D 12

13 Recommendations for cleaning nonclinical housekeeping surfaces, which have the least risk for transmitting infections in healthcare settings, include the following. On a routine basis, these environmental surfaces should be cleaned with either soap and water, or an EPA-registered detergent/hospital disinfectant. Wet mops and cloths may become contaminated with microorganisms, so clean the mop and cloths after use and allow them to dry thoroughly before re-using. Prepare fresh cleaning and disinfecting solutions daily and follow the manufacturer s recommendations for use. Section D 13

14 In the past decade, computers have become commonplace throughout most healthcare settings. Because of the frequent hand contact and that the keyboards are often in clinical areas, these surfaces may be frequently contaminated and then serve as reservoirs for pathogens. The question of how to disinfect keyboards was evaluated in a study done by the researchers at the University of North Carolina Healthcare System. Section D 14

15 UNC tested products for their effectiveness to remove or inactivate the test pathogens Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa from the computer keyboards. Importantly, no functional or cosmetic damage occurred after 300 wipes. The disinfectants tested included: 3 quaternary ammonium compounds, 70% isopropyl alcohol, a phenolic, and chlorine at (80ppm). At present, based on the results of the study where all disinfection agents in this study were found to have a 95% effectiveness, it is recommend that keyboards be disinfected daily (for 5 sec), and when visibly soiled, and that disinfectant wipes be used for one surface cleaning area only one time. Section D 15

16 In addition, the study found that the there was some sustained efficacy of the disinfectants when applied to the keyboards which was evaluated by using target pathogen Vancomycin-resistant Enterococcus (VRE). VRE was placed on control keys and on keys that had been wiped with one of the disinfectants listed, then challenged by reintroduction of VRE onto the keys at 6, 24, and 48 hours and re-cultured after 10 and 60 minute exposures. The results represent the percentage differences in the number of colony forming units on the treated versus the control keys at each of the challenges. CaviWipes, Chlorox Disinfecting Wipes, and Sani-Cloth Plus Wipes all had 100% sustained effectiveness at 6, 24, and 48 hours, demonstrating good residual sustained protection with these products. However, alcohol and sterile water had minimal sustained effectiveness, which was expected. Section D 16

17 One of the expectations of CMS surveyors and OSHA inspectors is to have a policy that includes environmental cleaning with the appropriate disinfection products readily available, and education of HCWs as demonstrated by their ability to describe how to decontaminate blood or other potentially infectious materials or (body fluids) known as OPIM. The most important of these steps is to decontaminate promptly to prevent others from being contaminated. Appropriate PPE must be worn that will prevent skin or clothing contamination. The product used can be either a 1:10 to 1:100 bleach to water dilution (that means one part bleach to 9 or 99 parts of water). The concentration depends on the size of the spill and amount of blood. The CDC recommends that the bleach solutions be made fresh daily. However, UNC completed a study that demonstrates a 50% reduction in effectiveness over 30 days if the solution is kept in a tightly closed and opaque container. Alternatively, the CDC recommends use of intermediate level disinfectants that have a tuberculocidal label claim, or a HIV and hepatitis B label claim for killing effectiveness. And as a reminder, although considered patient friendly, it is not recommend to have carpets in operating or procedure rooms, labs, and instrument processing areas because of the gross amount of contamination. Section D 17

18 Now that we have described the key points of medical asepsis, let s review the recommended methods to follow for sterile technique or surgical asepsis for maintaining a sterile field when doing invasive sterile procedures and in the operating room. These techniques include that scrubbed persons wear sterile gowns and gloves, that sterile drapes are used to establish a sterile field, and that items used within a sterile field are sterile. Finally all items introduced onto a sterile field are opened, dispensed, and transferred by methods that maintain sterility and integrity as described in the Association of Operating Room Nurses (AORN) Standards. Any equipment or medications should be prepared immediately before the procedure to avoid contamination of the sterile field. Opened sterile packs should not be covered especially if the idea is to preserve the setup for use later. Section D 18

19 Sterile technique also includes environmental controls to maximize the reduction of microorganisms during surgical procedures. Control activities that will reduce airborne transmission include: keep patient, supplies and reprocessing separated, segregate clean and dirty supplies, and enforce a protocol for transporting clean, sterile, and soiled equipment and supplies to and from the operating room. Limit those entering the operating room to only necessary personnel. When visible soiling or contamination with blood or OPIM of surfaces or equipment occurs during an operation, use a disinfectant cleaner to clean the affected area before the next case. Wet vacuum or use a clean mop and solution on the OR floor at end of day, clean all horizontal surfaces (the surgical lights, floors, equipment) on a daily basis, and clean patient transport vehicles including straps after each use. Section D 19

20 Many minor office procedures are performed in examination or treatment rooms. Consider designating one room to be reserved for any procedures involving incisional surgery. The room should be easy to clean and contain minimal excess equipment or carpeting. Masks for most minor brief procedures are unnecessary. However, for long procedures with a high risk of infection due to interruption on normal host defenses, such as those affecting or creating non-intact skin or disrupting mucous membranes (for example, Mohs surgery, or a spinal tap) a mask and sterile technique should be followed. This preparation should include at least a scrub with CHG or povidone iodine soap. Also, sterile technique is recommended by the United States Pharmacopeia (USP) for preparation and administration of medications and fluids administered via vascular catheters. Section D 20

21 The next topic to be discussed is Hand Hygiene. Section D 21

22 According to the CDC, hand hygiene is the single most important factor in preventing the spread of pathogens in healthcare settings. First, because hands are the most common mode of pathogen transmission. Second, hand hygiene can reduce the spread of antibiotic resistance in healthcare settings Finally, hand hygiene can prevent a healthcare-associated infections. [Additional comments: CDC estimates that each year nearly 2 million patients in the United States acquire infections in hospitals, and about 90,000 of these patients die as a result.] Section D 22

23 Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, alcohol-based handrub, or surgical hand hygiene/antisepsis. Handwashing refers to washing hands with plain soap and water. Antiseptic handwash refers to washing hands with water and soap or other detergents containing an antiseptic agent, such as triclosan or chlorhexidine. Using a waterless agent containing 60% 95% ethanol or isopropanol alcohol-containing preparation is referred to as an alcohol handrub. These agents are a new addition to the guidelines and have become used frequently in the United States to improve compliance with handwashing in hospitals. Surgical antisepsis refers to an antiseptic handwash or alcohol-based handrub performed preoperatively by surgical personnel to eliminate microorganisms on hands. Antiseptic preparations for surgical hand hygiene should have persistent (long-lasting) antimicrobial activity. * If using an alcohol-based handrub as a surgical scrub, the hands should first be washed with soap and water. Section D 23

24 In the absence of a true emergency, personnel should always perform hand hygiene Before and after taking care of patients Before performing invasive procedures Before eating When hands are visibly soiled After bare handed contact with a source that is likely to be contaminated with blood, saliva, or respiratory secretions Before and always after glove removal 24

25 First, let s examine what is know about the presence of hand-borne microorganisms. Bacterial counts on hands range from 10 4 to 10 6, very high numbers. Resident microorganisms are attached to deeper layers of the skin and are more resistant to removal, but these are much less likely to be associated with healthcare-associated infections (HAIs). They include nonvirulent skin flora like Diphtheroids, including Corynebacterium spp, coagulase-negative staphylococcus often speciated as Staph epidermis and others. That compares to transient microorganisms that colonize the superficial layers of skin and are more easily removed. These are acquired by direct contact with patients or contaminated environment surfaces and are frequently associated with HAIs. Typical examples in healthcare are the gram negative rods, whose reservoirs are wet areas to include Pseudomonas, Serratia, and Escherichia (E) coli, and gram positives, most significantly Staph aureus, including MRSA. 25

26 What do we know about how pathogens on the hands of HCWs can be transmitted to patients? Transmission from patient to patient via healthcare worker (HCW) hands requires four elements: The organisms must first be present on HCWs hands (via patient or environment contact). The organisms must be able to survive for several minutes on hands between patient contacts. The HCWs hand hygiene must be inadequate or the agent inappropriate. And the contaminated hands of HCW must come in contact with another patient (or an inanimate object that will contact the patient) 26

27 Thirty-four studies of hand hygiene practices, mostly in hospitals, observed doctors, nurses and respiratory therapists mostly before alcohol based hand rubs (ABHRs) were widely available, so these observations were made for evaluating compliance with soap and water hand washing. These studies reported an astoundingly low 40% average of hand-washing compliance overall. Physicians consistently performed the worst in these studies. The most frequent reasons given by HCWs for the lack of hand-washing were inaccessibility of hand hygiene supplies, skin irritation from the hand hygiene agents, interference with patient care, lack of knowledge of the guidelines, and lack of information on the importance of hand hygiene. 27

28 Hand hygiene encompasses hand-washing shown here or the use of alcohol based hand rubs. Hand hygiene when done correctly and appropriately is the single most effective procedure that HCWs can do to prevent crosstransmission and subsequent healthcare-associated infections. The purpose of hand hygiene is to remove transient microbial contamination acquired by recent contact with infected or colonized patients or environmental surfaces. 28

29 It is one of the first procedures taught in nursing education programs, BUT many HCWs do not use correct hand-washing technique. Standard handwashing technique begins with removing jewelry; then wetting hands under running water while keeping the hands lower than the elbows; next applying soap or antiseptic; and using friction to clean between fingers, palms, backs of hands, wrists, and forearms, vigorously washing under a stream of water for at least 15 seconds; rinsing under running water; and using paper towels to dry hands. Ideally, use the paper towel to turn off the faucet. Section D 29

30 Unfortunately, observational studies of HCWs have revealed dismal compliance with the recommended handwashing technique just described, with the average duration of handwashing between 6.5 to 21 seconds. In 10 of 14 studies, handwashing duration was less than the recommended minimum of 15 sec, and in 8 of 14 studies it was less than 10 sec. These are inadequate lengths of time for effective handwashing because it does not allow for all surfaces of the hands and fingers to be cleaned as noted in these studies. The areas between the fingers and the areas around and under the fingernails are the most contaminated on hands. 30

31 Alcohol based hand rubs (ABHRs) are waterless, and so can be placed in more accessible places and carried as home health providers travel. ABHRs have been shown to be more efficacious than soap and water and have a low incidence of dermatitis associated with their use. The technique HCWs should use with ABHRs is to apply to one hand and rub hands together, covering all surfaces. Follow manufacturer s recommendation on volume (e.g., form golf ball versus softball size). HCWs should be educated regarding the manufacturer s instructions about the specific product used in their organization for number of applications (generally 6 to 8) between a soap and water wash to remove the build-up of the ABHR product. HCWs should also be educated about the importance of allowing the hands to dry completely before providing direct or indirect contact with patients or surfaces. The time for drying is when the activity of the ABHR is eradicating organisms. HCWs should not wipe their hands on their clothing to facilitate drying. 31

32 This slide lists the benefits and limitations of alcohol-based preparations. Alcohol handrubs have a rapid and effective antimicrobial action when applied to the skin but must contain other ingredients, such as chlorhexidine or triclosan, to achieve persistent (long-lasting) activity. When combined with emollients, or skin softeners, they can improve skin condition. In hospital settings, they are often more accessible than sinks. However, Alcohol is not a good cleaning agent, so these products cannot be used if hands are visibly soiled. Because of their flammable nature, they must be stored away from high temperatures or flames. In addition, there is some concern that hand softeners and glove powders might build up on the hands after repeated use. Hands should be washed occasionally with soap and water. Section D 32

33 In studies comparing the efficacy of plain soap or antimicrobial soap versus ABHR in reducing bacterial counts on hands, the ABHRs were found to be more effective than plain soap and water in 17 studies. ABHRs are perceived to be easier to use by HCWs and more available since a sink is not required. In all but two trials (15 out of 17), ABHRs reduced bacterial counts on hands to a greater extent, than washing with soaps or detergents containing povidoneiodine, 4% CHG, or triclosan. 33

34 In summary, plain soap is good for reducing bacterial counts, but antimicrobial soap is better and alcohol-based handrubs are the best for providing activity that prevents or inhibits survival of microorganisms after the product is applied. Section D 34

35 A brief review of official hand-washing recommendations indicates significant changes over the past 50 years. The U.S. Public Health Service in 1961 recommended a soap and water wash for 1-2 min before and after patient contact. The CDC between the years 1975 and 1985 recommended a non-antimicrobial hand-washing between patient contacts and antimicrobial before invasive procedures. Elaine Larson completed the APIC Guidelines for Hand-washing and Antisepsis in 1988, which were similar to the prior CDC recommendations, except they included more discussion on the ABHRs, and were revised in CDC in 1996 stated that either antimicrobial soap or ABHRs should be used upon leaving the room of a patient on precautions for MDROs (MRSA/VRE) which then brings us to the most current guidelines revisions published by the CDC in

36 The current CDC HICPAC, Guideline for Hand Hygiene in Healthcare Settings was released as prepared by Drs. John Boyce and Didier Pittet. This guideline as well as all CDC HICPAC Guidelines can be found on the SPICE ( or CDC.gov website. We will review the current recommendations in detail. As we review the recommendations, keep in mind, category IA and IB are recommendations from the peer reviewed scientific literature that have been evaluated by HICPAC to be have value in implementing. Category IC are recommendations from governmental or regulatory authority so must be done. Category II are not based on current science to date; these procedures may or be of some merit and have some theoretical rational but there are no studies available to support recommending. Unresolved issues are procedures or practices that are unanswered as to the efficacy. 36

37 The rational for adding the IB recommendations for HCWs to do hand hygiene before having direct contact with patients and after any patient contact, even with intact skin, is because of studies that show HCWs contaminate hands even by performing clean procedures. Nurses contaminated their hands with CFU during such clean activities as lifting patients, taking the patient s pulse, blood pressure, or oral temperature, or touching the patient s hand, shoulder, or groin. 37

38 What are the indications for handwashing and hand antisepsis? A category IA, the strongest scientifically supported recommendation and one that all healthcare organizations should adopt and implement, is that if hands are visibly dirty or soiled, they should be washed with a nonantimicrobial soap and water, or antimicrobial soap and water. That is because ABHRs, just like all antiseptic and disinfectant, cannot work effectively in the presence of organic material and dirt. BUT, if hands are not visibly soiled, HCWs should use an alcohol-based handrub for routinely decontaminating hands in all other clinical situations, a IA recommendation. It is important because the CDC suggests using ABHRs as directed as the routine choice for all hand hygiene, with the exception if hands are visibly contaminated. However, not all healthcare facilities and organizations could implement the use of ABHRs quickly, so the CDC included a IB recommendation that alternatively, HCWs wash hands with antimicrobial soap and water. (IB) There are 11 indications for when CDC recommend hand hygiene be completed including the IB recommendations: 1)Before having direct contact with patients. IB 2) Before donning sterile gloves when inserting a central intravascular catheter. IB 38

39 Continuing with CDC recommended indications for hand hygiene using ABHR if not visibly soiled: 3) Before inserting urinary catheters, peripheral vascular catheters, or other invasive devices. IB 4) After contact with a patient s intact skin. IB 5)After contact with body fluids, mucous membranes, non-intact skin or wound dressings, as long as hands are not soiled. IA 6)If moving from a contaminated body site to clean a site. II 7)After contact with inanimate objects in vicinity of patient. II 8)And after removing gloves. IB 39

40 The last 3 CDC HICPAC indications for handwashing or hand antisepsis include: 9) Use non-antimicrobial/antimicrobial soap and water before eating and after using a restroom. IB The rational is fecal oral spread pathogens including the non-enveloped virus (Norovirus), and spore forming Clostridium difficile are not inactivated by alcohol, so the ABHRs are not effective against transmission. Soap and water, even antiseptic soap, will not kill these pathogens either, BUT used as directed, soap and water will physically remove the pathogens 10) Antimicrobial towelettes may be an alternative to washing hands with non-antimicrobial soap and water, but studies have demonstrated they are not as effective as the ABHRs. IB 11) No recommendation on routine use of non-alcohol-based handrubs. There a few non ABHRs in the US market but as yet the data does support their use in healthcare. Unresolved issue. 40

41 Hand lotions can prevent skin dryness associated with hand washing. However, it s important to consider the compatibility of lotion and antiseptic products and the effect of petroleum or other oil emollients on the integrity of gloves when selecting and using them. Short nails allow thorough cleaning of nails and may reduce premature glove tearing. Artificial nails can harbor pathogens thus, their use should be avoided. During surgical procedures, hand or arm jewelry can harbor microorganisms or increase risk of glove failure. If worn during non-surgical procedures, hand or arm jewelry can affect glove placement, fit, or durability. Section D 41

42 Occupationally-related contact dermatitis can develop from frequent and repeated use of hand hygiene products, exposure to chemicals, and glove use and create compliance issues for HCWs with hand hygiene as well as additional exposures for HCWs and patients to bloodborne pathogens and microorganisms. Section D 42

43 Healthcare personnel with dermatitis may pose a risk to patients they contact because the condition creates cracks and crevices in the skin that for allow colonization where large numbers of bacteria can lodge. Even with hand washing of the damaged skin the bacterial counts are appreciably reduced. Adding to the problem that these individuals are a likely reservoir for potentially pathogenic organisms is that personnel with dermatitis tend to avoid hand washing due to the fear of making their condition worse and or the discomfort from performing hand hygiene on damaged skin. Section D 43

44 Several recommendations for HCWS to help prevent and alleviate dermatitis are known. These include To rinse and dry skin adequately after performing hand washing. To use the appropriate amount of antiseptic per the manufacturer s directions. To use hand lotions when appropriate and that are compatible with the soap and ABHR products. To obtain alternative antiseptic agent for the HCW. A dermatologic consult may need to be obtained to determine a plan for HCW which could include wear gloves or glove liners and or in combination some protective hand creams have claims of efficacy in reducing dermatitis. Section D 44

45 Latex allergy is a Type I or an immediate hypersensitivity reaction to the proteins found in natural rubber latex. These proteins can attach to the powder in gloves which, in turn, causes more latex protein to reach the skin. This reaction is generally a more severe and immediate systemic reaction than contact dermatitis. Common reactions include runny nose, itchy eyes, hives, and burning skin sensations. More severe reactions are characterized by breathing difficulty and, rarely, anaphylaxis (shock) or death. Photo credit: Arto Lahti, MD, Department of Dermatology, University of Oulu, Finland. Section D 45

46 Not all skin reactions are due to an allergic reaction to latex rubber. Most skin reactions are attributed to an irritant or allergic contact dermatitis. Irritant contact dermatitis develops as dry, itchy, irritated areas on the skin around the contact area. It is commonly associated with frequent handwashing and is not an allergic reaction. The second type of contact dermatitis is a type IV or delayed hypersensitivity or allergic reaction due to contact with a chemical allergen (e.g., accelerators and other chemicals used in the manufacture of patient-care gloves). Reactions are generally localized to the contact area and occur slowly, over a period of hours. Section D 46

47 Other recommendations can minimize the risk of contact dermatitis and latex hypersensitivity: Educate healthcare personnel about reactions associated with frequent hand hygiene and glove use. Staff that have dermatologic problems should get a diagnosis from a qualified medical provider before making changes in gloves or hand hygiene agents. Screen patients and healthcare personnel for latex allergy in your medical histories. Healthcare personnel and patients with latex allergy should not have direct contact with latex-containing materials and should be in a latex-safe environment with all latex-containing products removed from their vicinity. Have medical emergency latex-free products available at all times. Section D 47

48 Like all liquids used in healthcare including disinfectants and soap products, appropriate storage to prevent contamination is important. Disposable containers are generally recommended for liquid hand care products. However, be sure if using containers that are refillable that they are closeable and can be washed and dried between all refills. It is especially important, not to add soap or lotions which is called topping off to partially empty containers. The rationale is that a small amount of contaminate can continue to grow in the containers when topping off is done. Eventually, depending on the amount of the inoculums and type of organisms, the soap can become contaminated. Section D 48

49 In summary, it is most important that HCWs know when hand hygiene should be performed to comply with regulatory agencies and for patient protection. The CDC recommends that hand hygiene be performed: When hands are visibly dirty. After touching contaminated objects with bare hands. Before and after patient treatment; that is, before glove placement and immediately after glove removal. Photo credit: Centers for Disease Control and Prevention, Atlanta, GA. Section D 49

50 Thank you for your time and attention. That concludes Section D. References follow on the last slide and I encourage you to use these references, along with the this slide presentation in the development or updating of policies. Section D 50

51 Section D 51