Sinks in treatment rooms?

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Hi all

With the advent of waterless hand sanitizing is it still important to have a hand basin in the consulting room?

Does everyone always have a hand basin anyway? Is there a regulation in Victoria stating that you must have one?

Regards
Stuart

 

Hi Stuart,
We still have handbasins in all treatment rooms. I am not convinced on waterless handwashing. Isn't scrubbing still advocated. Do you have further info on this???

 

We do however they are only recommended when hands are visibly soiled or prior to surgical procedures. Otherwise, think pink and use the good old avagard hand rub. I think we have the potential at any time to get our hands visibly dirty so can't see us doing away with the sinks yet.

Linda, we run on the hospital guidelines based on this research project by DHS, under the product selection there is a lit review on the effectiveness of hand rubs:
http://www.health.vic.gov.au/qualitycouncil/activities/handhyg.htm

 

Alcohol-based hand rubs are popular in most hospitals, but only for sanitising between patient contact that doesn't involve exposure to body fluids or similar. They are not a substitute for hand-washing or surgical scrubbing prior to minor procedures, injections or direct contact wound care etc.

Intentional ingestion of alcohol-based gels/lotions is becoming a growing issue in public hospitals and public facilities, and there have been calls to ban them due to intentional misuse.

LL

 

Just covered this topic this week at Uni - the A Pod Council has a handbook on Infection control guidelines on their website. You are supposed to wash your hands between patients unless there are no facilities. A seperate sink for handwashing is also mentioned (not the same one used for cleaning tools)
Looks like I'll be saving up for a while to set up my clinic after reading all these requirements!
Cheers,
Kara

 

I have a sink but find I hardly ever use it with my hands not very often getting visbly dirty (I do work hard though)
I tend to use the avagard, I do find that when you have a busy day my hands tend to peel a little bit from the extended use.

 

I'm quite surprised you would consider not washing if the facility is present. I don't think we are so short of water that you need to cut this corner for any reason.
regards Phill Carter

 

I had a visit from the health inspector last week.

My hand basin is not in the treating room, he didnt have a problem with that but he did want to see the basin. So I guess there must be some facility within reason to wash your hands.

 

Every little drop counts Phil! No I generally wash in the morning, before and after lunch and the end of the day, the rest is avagard as I find this quicker and easier when it is attached by a bracket to my treatment trolley, unless my hands are visibly dirty.

 

I'm prepared to accept that not everyone sees it my way....but this "visibly dirty" thing is a bit of a Furphy.....what does that really mean and who are we kidding? Who was the guy who first worked out post birth infection transfer and got laughed out of the medical profession?...This wheel has already been invented.
regards Phill

 

maybe phil it has and I accept that you dont see it the same way I just dont feel the need to be washing with water and drying every time the gloves go on and off when it can be 10 secs with the avagard I think it also improves compliance with handwashing with it being easy and quick. (not that washing with hands takes a huge amount longer, just my opinion.)

 

Geez. I'm sure that must also mean there's no need to for a 5 minute scrub before any invasive surgery either...as long as you haven't been doing gardening just prior to the procedure.

Beekez - please tell me this is a joke and you're pulling our collective legs? You're scaring me and every microbiologist on the planet.

LL

 

not much of a gardener LL!

I think you are taking it the wrong way, I use the alcohol based hand rub in between all patient contact, before the gloves go on and after they come off and very regularly throughout the day but not if there has been exposure to body fluids etc in which case i go to the sink, I think the visibly dirty thing does obviously confuse the issue looking at it like this. Phile I have been enlightened!

I am hoping you took as I said 'I only wash my hands before lunch for the day' and that was why you are concerned. This is when I use the sink and microshield instead of the alcohol based hand rub which was under the impression was just as effective at reducing micro-organisms present if not better. Otherwise I have been firmly put in my place and need the right way pointed out to me.:wacko:

 

Avagard and similar alcoholic hand rubs were introduced into hospitals over the last 5 years. They were introduced to improve compliance with handwashing protocols, as to fully comply during a patient encounter you should wash your hands or use a hand rub
before you put on gloves
After you remove gloves
After you touch a pen
after you touch a patient file
after you use a keyboard
after touching a patients shoes/socks
etc. etc

On average this would require about 8 hand washes during an encounter, so potentially 160 a day!
The better hand rubs are more gentle on the skin and do improve compliance, and the guidelines are about washing when visibly dirty or after using the bathroom as the hand rubs are able to appropriately reduce the hand pathogens for non invasive clinical work.

 

Who was the guy who first worked out post birth infection transfer and got laughed out of the medical profession?...


Dr. Ignaz Semmelweis in the middle of the 1800's, I think. The biography channel, had a documentary on him recently.

 

I believed that hand gels were not to replace routine hand washing (ie. pre & post t/x). The NHS in the UK have previously advised the use of alcohol gel as an additional preventative to infection while still adhering to regular hand washing. Visibly dirty. Hmm. I thought mud was visible but germs aren't. Otherwise why do we bother with protocols when cleaning & sterilising instruments?


http://inventors.about.com/library/inventors/blantisceptics.htm

http://en.wikipedia.org/wiki/Joseph_Lister

Only my thoughts.

Regards to all,

Mandy.

 

LL, no one has discounted the use of appropriate scrub prior to invasive surgery. A lot of the discussion about hand rubs is for social contact. The before and after touch a pen, a file, taking a patients pulse etc. As someone that sees predominantly kids, I rarely see blood, pus or pick up instruments however am prone to gastro, conjuctivitis, fifth dz etc due to parents thinking it's ok to still bring the contagious mites in.

However following the stages of contact from what Steve posted and based on some pretty good evidence, including recommendations from the almight WHO, they are finding it is reducing the need for hand washing in social situations.

Ie:
http://www.hha.org.au/About/ABHRS.aspx

 

I'm happy to accept that there are levels of contact and levels of cleaning etc otherwise we'd need to disinfect the chairs in our trains between every journey or the seats in our waiting rooms, we are not terribly consistent about this stuff. On the one hand we are not supposed to bathe feet in unsterilized bowls due to cross infection risk, but in the birthing suite one bleeding girl back out a baby in the bath, they give it a swab out and ten minutes later another girtl is in there groaning away. One is accepted, one is not, is this logical? probably not. And in reality it's not "sterility" that we want, because none of our patients are sterile in this way anyway, it's just lack of nasties from somebody who had nasties, and we probably achieve this most of the time.
regards Phill Carter

 

At a recent inservice, they showed us some petrie dishes of some hand prints. One was of someone who did a traditional handwash, and the other using the alcohol based hand rub. The difference was amazing. The alcohol based hand rub had very minimal growth, the hand wash petrie dish was covered in MRSA, yeasts etc.... Our hospital reccommends that after using the alcohol rub about ?5 times (could be wrong), to wash your hands, as it tends to build up. They also reccommend that we moisturise 5 times a day...

 

I remember doing this in our microbiology labs at uni, it is a huge difference visually, at the time I remember the lecturer questioning whether it was a good thing for the skin to remove almost all organisms as the experiment showed.

Interesting point about the build up and the need to wash every so often because of that.