🧼 Chapter 133: Hand Hygiene

WHO guidelines · Alcohol-based hand rub (≥70% alcohol) · Hand washing vs hand rubbing · 6-step technique · Indications · Irritant dermatitis prevention · Glove use · Patient zone

🔍 Core Concepts: Hand Hygiene in PICU

📌 Definition & Importance
Hand hygiene is the single most important measure to prevent healthcare-associated infections. Compliance among HCWs is often <40%.
🧴 Alcohol-based hand rub (ABHR)
Preferred method in most clinical situations. Requires ≥60-95% alcohol (ideally ≥70%). Takes 20-30 seconds, rub until dry. Not effective against C. difficile spores.
🚿 Hand washing (soap & water)
Indicated for visible soiling, C. difficile, norovirus, after restroom use. Takes 40-60 seconds. Liquid soap preferred over bar soap.
📋 Indications (WHO 5 Moments)
Before touching a patient, before clean/aseptic procedure, after body fluid exposure, after touching patient, after touching patient surroundings.
🧤 Glove use
Does NOT replace hand hygiene. Perform hand hygiene before donning and after removal. Do not reuse or disinfect gloves.
💍 Jewellery & nails
No rings/bracelets; short natural nails; no artificial nails. Rings increase bacterial load.
⚠️ Complications
Irritant dermatitis (most common) – prevent with emollients, avoid hot water, use ABHR instead of soap. Flash fires rare – ensure hands dry before touching objects.

🧼 Stepwise Hand Hygiene Technique (WHO 6 Steps)

1
Palm to palm
Apply sufficient ABHR (2-3 mL, 1-2 squirts) to cover all surfaces. Rub palms together.
2
Right palm over left dorsum and vice versa
Interlace fingers and rub backs of hands.
3
Palm to palm fingers interlaced
Rub between fingers.
4
Backs of fingers to opposing palms
Rub fingertips in palms.
5
Rotational rubbing of thumbs
Clasp thumb in opposite palm and rotate.
6
Rotational rubbing of clasped fingers
Rub fingertips in opposite palm. Rub until hands are dry (20-30 seconds total).