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Infection Control 101 Handwashing!!!

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Title: Infection Control 101 Handwashing!!!


1
Infection Control 101Handwashing!!!
2
Handwashing and Long/Artificial Fingernails
  • Decrease effectiveness of gloves
  • Decrease the effectiveness of handwashing
  • Decrease the effectiveness of waterless hand
    sanitizers
  • Higher of pathogens/bacteria
  • Studies linking long and artificial nails to
    infection
  • Can lead to fungal nail infection

3
Bacterial carriage Artificial NailsAJIC 1989
Dec17(6)340-4
  • VA Medical Center, Sioux Falls, S.D
  • Cultures before and after handwashing
  • 56 in each group
  • Higher number of GNR with artificial nails

4
Pathogens and artificial nailsInfect Control
Hosp Epidemiol 2000 Aug21(8)505-9
  • Study 1
  • 12 HCW artificial nails on non-dominant hand,
    natural nails on dominant hand
  • More samples contained pathogens from artificial
    nails than native nails 92 vs 62
  • Study 2 Case control study n60
  • Those with artificial nails were more likely to
    have a pathogen (87 vs 43)

5
Soap versus Hand Gel-Clin Infect Dis 2001
Feb132(3)367-72
  • Michigan Medical School, Ann Arbor
  • Case Control Study compared HCW with and without
    artificial nails n41
  • Before and after washing with soap
  • Before and after alcohol waterless hand gel

6
Soap versus Hand Gel (cont)
  • Artificial Nails
  • 86 pathogens prior to washing
  • 11 cleared pathogens w soap
  • 38 cleared pathogens with gel
  • Natural nails
  • 35 pathogens prior to washing
  • 14 cleared pathogens w soap
  • 80 cleared pathogens with gel

7
S. marcescens wound infectionsJ Infect Dis 1997
Apr175(4) 992-5
  • S marcescens in 1 SSI 1992
  • September 1994-1 month time period
  • 6 of 31 cardiac post op S.marcescens infections
  • 1 of 29 vascular post-op S.marcescens infections
  • 5 SSI, 2 BSI, 1 death

8
S.marcescens investigation
  • Hospital suspended elective cardiac surgery
  • Isolates typed-identical
  • Cultures collected
  • Hands of MDs, nurses,( OR ICU), pharmacists
  • Environmental-OR,cardiac cath,lounges in ICU
  • Water- OR, cath lab, ICU faucets
  • All cultures negative

9
Investigation break-through
  • Earlier surgery e.g Monday had higher association
    with infection
  • Final SSI linked only to one scrub nurse
  • Home cultures revealed S.marcescens in exfoliant
    cream identical molecular typing to cases
  • Nurse removed artificial nails during study period

10
Candida Osteo/Diskitis after Spinal Surgery CID
2001l32352-7
  • Feb 1997-3 post-op lami C.albicans infections
    (1st in 10 years)
  • Identical PFGE isolates
  • Case control study- scrub tech w artificial nails
  • Procedure required kneading of bone wax

11
Oklahoma NICU- P aeruginosaInfect Control Hosp
Epidemiol 2000 Feb21(2)80-5
  • 15 month time period 439 admitted
  • 46 infants- (10.5) BSI and ET tube colonization
  • 16 deaths (35)
  • Long nails- artificial and natural 2 nurses

12
Handwashing and Fingernails
  • Studies linking long and artificial nails to
    infection
  • Decrease effectiveness of gloves
  • Decrease the effectiveness of handwashing
  • Decrease the effectiveness of waterless hand
    sanitizers
  • Higher of pathogens/bacteria
  • Can lead to fungal nail infection

13
WHY???
14
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