الفهرس 
INTRODUCTION
Frequency and pathophysiology of irritantOnly 14 pages are availabe for public view
 |  | from | 152 |  |  |
| | | from | 152 | | |
Abstract
Hand hygiene is considered the simplest and most effective measure to prevent cross–transmission of microorganisms and hospital acquired infection .
Hand hygiene has been frequently cited as the single most important practice to reduce the transmission of infectious agents in health care settings and is an essential element of standard precautions. The term ” hand hygiene ” includes both hand washing with either plain or antiseptic – containing soap and water or the use of alcohol - based products (e.g. gel , foams , rinses) that do not require water .
Hand hygiene educational programs decrease infection rates in NICU,although improving hand washing compliance is important , sustaining compliance over long periods of time is difficult .
The hands of healthcare workers are major transmitters of infection and even after only minor contact with the patient or equipment .
The use of an alcohol – based handrub solution is now considered as the gold standard for hand hygiene .The use of alcohol hand rubs has overcome many obstacles to hand washing such as lack of time and lack of access to sinks , and apart from causing some dryness , they are less irritant to the skin than soap and water .It should be emphasised that when contact with body fluids is anticipated , gloves should be worn .
The use of gloves is recommended for the protection of the healthcare worker , and to reduce the cross- transfer of micro- organisms between patients.The use of gloves dose not replace hand washing . Gloves become easily contaminated and hands are then contaminated during the removal of gloves .
The risk of nosocomial infection in NICU is 5 – 10 times greater than those acquired in general medical and surgical wounds . Approximately 25% of all hospital infections and 90% of out breaks occur in the ICU .
Indications for hand hygiene:
F. Wash hands with soap and water when visibly dirty or visibly soiled with blood or other body fluids or after using the toilet ( Ejemot R et al, 2008 ) .
G. If exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of Clostridium difficile,hand washing with soap and water is the preferred means (Hubner NO et al , 2006 ) .
H. Perform hand hygiene:
a. before and after touching the patient (Duckro AN et al, 2005 ) .
b. before handling an invasive device for patient care, regardless of whether or not gloves are used (Hirschmann H et al, 2001 ) .
c. after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings (Lucet JC et al , 2001 ) .
d. if moving from a contaminated body site to another body site during care of the same patient (Pessoa-Silva CL et al , 2004 ) . e.g. after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient ( Hayden MK et al, 2008 )
e. after removing sterile or non-sterile gloves (Tenorio AR et al , 2001).
I. Before handling medication or preparing food perform hand hygiene using an alcohol-based handrub or wash hands with either plain or antimicrobial soap and water .
J. Soap and alcohol-based handrub should not be used concomitantly (Kampf G et al , 2007 ) .
To achieve a high rate of hand hygiene adherence, HCWs need education, clear guidelines, some understanding of infectious disease risk, and acceptable hand hygiene products.
There must be written policies and procedures for hand washing. Simple hygiene procedures may be limited to hands and wrists , surgical procedures include the hand and forearm . procedures will vary with the patient risk assessment .
Optimal “hand hygiene” requirements:
For hand washing:
Running water : large wash basins which require little maintenance , with antisplash devices and hand – free controls .
Products: soap or antiseptic depending on the procedure.
Facilities for drying without contamination (disposable towels if possible).
For hand disinfection:
Specific hand disinfection : alcoholic rubs with antiseptic and emollient gels which can be applied to physically clean hands (Ducel et al, 2002).
This audit study was done during the period between september 2016 and february 2017 and the target population was Hand Hygiene service providers and total number was 1118 including 891 hand wash ( 482 nurses , 409 doctors ) and 227 hand rub .
For hand wash , five indications were applied in this study . they were :
1-Before touching patients :
The total number for this indication was 289 (119 nursesand 170 doctors ). For nurses, 69 were properly done, 23 not done and 27 were improperly done and the main cause was insufficient time for hand wash (‹ 10 second).
For doctors, 119 were properly done, 21were not done and 30 were improperly doneand the main cause was also insufficient time for hand wash ( ‹ 10 second ) .
2-Before aseptic procedures :
This indication was applied only for nurses . The total number for this indication was 101 , properly done were 55 , 15 were not done while improperly done were 31 and the main cause was washing hands with water only between different aseptic procedures .
3-After body fluid exposure :
The total number for this indication was 148 ( 90 nurses and 58 doctors ) . For nurses ,51 were properly done , 12 were not done and 27 were improperly done and the main cause was dry hands in it’s own gown .
For doctors ,35 were properly done , 6 were not done and 17 were improperly done and the main cause was do not rub all areas of hands and fingers .
4-After touching patients :
The total number for this indication was 199 ( 89 nurses and 110 doctors ) . For nurses ,31 were properly done , 22 were not done and 36 were improperly doneand the main cause was use alcohol for hand wash instead of soap and water .
For doctors ,38 were properly done , 27 were not done and 45 were improperly done and the main cause was also use alcohol for hand wash instead of soap and water .
5-After touching patients surrounding :
The total number for this indication was 154 ( 83 nurses and 71 doctors ) . For nurses ,39 were properly done , 13 were not done and 31 were improperly doneand the main cause was insufficient time for hand wash ( ‹ 10 second ) .
For doctors ,36 were proper done, 16 were not done and 19 were improperly done and the main cause was use alcohol for hand wash instead of soap and water .
For hand rub( done by doctors only ) , two indications were applied in this study . they were :
1-Endo – tracheal intubation :
The total number for this indication was 119 . Proper done were 66 , 20 not done and 33 were improper done and the main cause was insufficient time for hand rub ( ‹ 2 min . ) .
2-Umbilical Catheter insertion :
The total number for this indication was 108 . Proper done were 69 , 12 not done and 27 were improper done and the main cause was hand rub not done up to elbow .
Recommendations : -
1 - When washing hands with soap and water, wet hands with water and apply the amount of product necessary to cover all surfaces.
2 – Sufficient time must be taken for hand wash (10 sec. ) and hand rub ( 2 min.) when they are indicated .
3 - Use towel to turn off tap/faucet .Make sure towels are not used multiple times or by multiple people .
4 – When hand rub is indicated , the hands should be higher than the arms at all times to avoid recontamination of the hands by water from the elbows .
5 – White coat should not touching the arms after hand rub to avoid recontamination .
6 - The use of gloves does not replace the need for hand hygiene by either handrubbing or handwashing .
7 - Wear gloves when it can be reasonably anticipated that contact with blood or other potentially infectious materials, mucous membranes, or non-intact skin will occur .
8 - Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient .
9 -When wearing gloves, change or remove gloves during patient care if moving from a contaminated body site to another body site .