How to Maintain Hand Hygiene

Hand Hygiene Technique with Soap (Plain/Antimicrobial) and Water

Duration of the entire procedure: 40-60 seconds

1. Wet hands with water

2. Apply enough soap to cover all hand surfaces

3. Rub hands palm to palm

4. Right palm over left dorsum with interlaced fingers and vice versa

5. Palm to palm with fingers interlaced

6. Back of fingers to opposing palms with fingers interlocked

7. Rotational rubbing of left thumb clasped in right palm and vice versa

8. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa

9. Rinse hands with water

10. Dry hands thoroughly with a single use towel

11. Use towel to turn off the tap

12. Your hands are safe now

Hand Care

• Take care of your hands by regularly using a protective hand cream or lotion of good quality, at least dailyto prevent skin damage.
• Do not routinely wash hands with soap and water immediately before or after using an alcohol-basedhandrubas it is not only unnecessary but also may lead to dermatitis.
• Washing with soap and water is harsher on the skin than hand rubbing with an alcohol­basedhandrubcontaininga humectant.
• Do not usehot water to rinseyour hands.
• Rubhandsuntil thealcohol-basedproduct has completelyevaporated.
• Dry hands carefully after washing withsoapandwater.
• After hand rubbing or hand washing, let your hands dry completely before putting on gloves or elseit may increase theriskof skinirritation.
• Powdered gloves can cause irritation when used concurrently with alcohol based products.
• Using a protective hand cream helps to improve skin condition provided it is compatible with thehandhygiene products andgloves used.

Hand Safety

• Do not wear finger rings; keep hands and forearms free of jewellery (bracelets, wrist watches,etc.) during health care as wearing jewellery encourages the presence and survivalof transient flora.
• Keep natural nails,short and unvarnished,as the areas above and below nails attract germs,particularly if nails arelong and varnished.
• Do not wear artificial fingernails or extenders when in direct contact with patients asthey may contribute to thetransmission of certainhealthcare associatedpathogens.
• Hand hygiene actions are more effective when hand skin is free of cuts. Any changes in the superficial layer of theepidermis anddeeper damage also encourage colonization by non-commensal skin flora (e.g.,Staphylococcus aureus and Gram negative bacteria).

Drug Compatibility

Can a mixture of two different drugs be used for nebulization?

Based on Data on file, Cipla Ltd.

Using the Nebulizer Correctly

1. Place the compressor on a sturdy surface so that the rubber pads are resting on it.

 

 

 

 

 

 

 

 

 

2. Plug the power cord into the electrical outlet.

3. Connect one end of the nebulizer tubing to the compressor air outlet.

4. Open the cap of the medication chamber.

5. Add the medication into the chamber. Re-attach the cap.

6. Attach the mouthpiece/face mask to the cap of the medication chamber and connect the tubing at the bottom of the medication chamber.

7. Switch on the power and the compressor.

8. If using a mouthpiece, keep it between the teeth and place the lips around it.

OR

8. If a face mask is used, place the mask over the mouth and nose.

Inhale deeply and slowly through the mouth and then exhale slowly.

Continue to breathe through the face mask/mouthpiece for the duration recommended.

9. When the treatment is complete, turn the switch off.

For more information, please refer to the manufacturer’s instructions provided with the nebulizer.

Practical Aspects while using Nebulization

• Place the compressor where it can safely be plugged to a power source and where one can reach the ON/OFF switch.
• Wash hands prior to each treatment.
• Use a clean and dry nebulizer.
• Fill volume is usually 2 to 5 ml.
• Oxygen,if required can be use of at 6-8 L/min.
• Holding the nebulizer in an upright position prevents spillage and promotes better nebulization.
• Occasionally tapping the side of the medication chamber (while in use) is beneficial.
• Nebulization time is generally 5- 10 minutes.
• A pattern of steady normal breathing,combined with occasional deep breathing is beneficial.
• Respules contain liquid drugs,which are pre-diluted;hence,they can be used directly.
• The respirator solution should be diluted in a ratio of 1:3 i.e.1 part of drug concentrate to 3 parts of normal saline (0.9% sodium chloride solution).
• Care should be taken that after diluting,the fill volume should not be in excess of 5 ml (or as recommended by the manufacturer).Do not use distilled water or tap water for dilution.
• Always follow the manufacturer's recommendations for cleaning.
• The nebulizer should be run empty for sometime,before the next use,after cleaning.
• Any scratches,damage,or discolouration indicates that the nebulizer accessories and the tubing should be changed.
• Nebulization should be continued for about a minute after the"spluttering"*sound occurs.

*spluttering: change in the sound indicating dryness in the mediation chamber

When to use a Face Mask and a Mouthpiece?

Mouthpiece should be preferred if delivering

1. Nebulized steroids and antibiotics (to avoid administration on facial skin and into the eyes)
2. Anticholinergics (in patients with glaucoma)

Face mask should be used in

Acutely ill patients, babies and young children who find it difficult to co-ordinate with the mouthpiece.

Cleaning of the Nebulizer

To prevent the possible risk of infection, cleaning of the nebulizer is recommended after each treatment.

1. With the power switch off, unplug the power cord.

2. Disconnect the tubing from the air outlet.

3. Disassemble the mouthpiece or face mask from the cap. Open the medication cap and remove the baffle.

4. Wash all the accessories (except the tubing), in warm water/mild detergent solution. Rinse with warm water to remove detergent residue. Allow to air-dry.

5. Wipe the outer surface of the tubing regularly. If you notice some liquid droplets in the tubing, connect it to the compressor air outlet, switch on the compressor and blow air through the tubing for a few seconds. 

Care and Maintenance of the Nebulizer

Disinfect daily

Step 1

Using a clean container, soak all the accessories (except the tubing) for 30 minutes in:

• Commercially available medical disinfectant or

• Mild detergent or

• Vinegar solution (1 part white vinegar and 3 parts warm water)

Step 2

With clean hands, rinse all the accessories with warm water, and air-dry.

Maintenance

• Do not open the compressor cabinet. All disassembly and maintenance must be done by the manufacturer.
• Filter- The filter should be changed when it discolours totally. Do not reuse or wash the filter or substitute it with any other material.

• Compressor- Wipe the outside of the compressor with a clean cloth regularly.

For more information, please refer the manufacturer’s user manual.

References

• Ann Emerg Med. 2000; 36: 198-203
• Chest 2007; 131: 286-289
• Ann Allergy Asthma Immunol. 1998; 80: 499-508
• J Asthma 1997; 34(6): 521-530
• Cochrane Database Syst Rev. 2003; (4): CD001115
• J Aerosol Med 2007; 20(7): S78-84
• Am J RespirCrit Care Med 2000; 162: 593-598
• Respir Care 2000; 45(6): 609-622
• J Asthma 2002; 39(4): 337-339
• Thorax 1997; 52(5uppl2): S1-S106
• EurRespir J 2001; 18: 228-242
• User Manual of Nebuflo Compressor Nebulizer System: Jay Precision Products
• http://www.nottingham.ac.uk/mhs/documents/c/inical­skills/nuh-guidelines/nebu/iser.pdf (Accessed on  27^th March2014)
• Adapted form of WHO guidelines on hand hygiene in health care 2009 and hand hygiene technical reference manual (WHO), 2009