History of Hand Washing

1st Year MB;BS

( 2014 2015 )
BMS Block

Hand Washing
Message
Clean Hands Saves Lives
Clean care is safe Care
WHO

WHO - Five Moments

Remember always..

Before patient care

After environmental contact
After contact with blood / body fluids
Before an aseptic task
After patient care

.points to note.

What is hand washing

The importance of hand washing
Brief history of hand washing.. the time
Role of Moses bin Maimon and
Semmelweis
Micro-organisms on the hands / palms
Types of hand washing
How to wash hands paying particular
attention to specific areas

History of Hand Washing

Hand Washing Is The

Single
Most Important Means Of
Preventing The Spread
Of
Diseases

Checks the spread of Diseases

minimize spread of influenza

diarrhea prevention 3.5 million
avoiding respiratory infections 1.8 million
preventive infant deaths in
home-deliveries
checks the diseases
spread by virus
(SARS)

Moses bin Maimon

(1135 1204)

Never to forget to wash

your hands after
touching a sick patient
the history of hand washing
went through a painfully slow
pace stretched over 700 years
Moses bin Maimon
familiar with the works of
Hippocrates and Galen
practiced and taught medicine
in Egypt
contributed to the principles of
hygiene

Before seeing patients

container water for

washing

Maimonides strictly
followed the principles of
hygiene by observing
cleanliness
Cleanliness is the
physicians best friend
I dismount from my
animal,
Wash my hands
Go forth to my patients.

History of Hand Washing

Maimons observations and teachings on
cleanliness were ignored by
the medical profession
No progress from 1204 1843

Anatomy

Oliver Wendell Holmes

(1809 -1894)
Harvard Professor of Anatomy
in 1843 published
Puerperal Fever, as a
Private Pestilence

History of Hand Washing

From one person to another
puerperal fever (child-bed fever)
transmitted from patient to patient by
none other than the doctors
and nurses attending them
he preached the doctrine of
child-bed cleanliness
To guard is better than to heal
was ignored. His views were not accepted.

History of Hand Washing

Hungarian-born physician
worked in 3 institutions
15 years working experience
1846 -- Vienna Lying in Hospital
observed that puerperal fever was
more common in women after
childbirth when assisted by
medical students
than in women when
Semmelweis
assisted by midwives

History of Hand Washing

patient afflicted in rows
primiparae worse
women delivered enroute
to hospital
less likely to develop fever
appeared that students/physician
who conducted autopsy
carried the infection
to women in the First Clinic Ward

History of Hand Washing

Two clinics
First Clinic Wards - student doctors

= 11.25 mortality
Second Clinic Wards midwives
= 2.85 mortality
(within 7 months mortality rate dropped to 3%)

History of Hand Washing

1847 mandate
Semmelweis issued orders
students and physicians who
performed postmortem
examinations
have to wash their hands
chlorine water / chlorinated
lime solution before seeing patients
(the reward - he was fired from this job)

History of Hand Washing

Disbelief and Reluctance greeted
his findings and recommendations
in 1850 he left Vienna
returned to Hungary
in 1861 he published
(The Etiology, the concept
and Prophylaxis
of Childbed Fever)
died in 1865
from Pyopneumothorax after
suffering from a wound
sustained in an insane asylum

History of Hand Washing

only in the 20th Century was hand
washing finally accepted as a
procedure
now considered the single
most important procedure
prevent nosocomial infection
over 2 million of these
infections occur annually
in American hospitals

Hand Washing
Technique
MBBS Year 1 (2014-2015)
Semester 1
September 2014
Dr. P Y Lee

Hand Washing Technique

Hand Washing Technique

Hand Washing Technique

Hand Washing Technique

Soap and Water

Cheap and Effective:
Soap and water are more effective
than hand sanitizers
at removing or inactivating certain
microbes
Using soap is more effective than
using water alone because the
surfactants in soap lift soil and
microbes from skin

Hand Washing technique

Why do you think you have to learn
how to wash your hands?

hand-mediated transmission
one of the major contributing factors
reduces or even cut off the chain of
transmission
reduces complication of wounds / surgical
wounds**
directly cuts down length of hospital stay**
cuts down cost in the care of patient

Hand Washing technique

What is good to avoid and to follow?
avoid the use of soap unless
it is one cake for each person
avoid using the blower / dryer
wash hands before and after examining
the next patient,
some surgeons do it before patients
leave the consultation

Hand Washing technique

Micro-organisms
Resident normal flora (commensals)
deeper in the epidermis (difficult to remove)
skin crevices
nails, sweat glands, hair follicles
Transient
located on the surface of the skin
poses a problem
direct contact causes transfer of these
micro-organisms

Hand Washing technique

Levels of decontamination
social
hygiene
surgical hand washing

Surgical hand washing

most important
detergent and time of scrubbing**
(second washing, shorter time needed)
wrist and forearms
sterile brush
towel

Hand Washing technique

Important to note the following:
observe time taken for washing
variable, depending on level of importance
the detergent applied
plain soap and water, antiseptic detergent
chlorhexadine, povidine-iodine,
alcoholic rubgel**
can be anything from 30 sec. up to 3 min.
or even 10 min.
follow the SOP and your Study Guide

October 15