Hand Hygiene in Health-care Facilities

The Importance of Proper Hand Hygiene for Health-care Workers

Please Complete Your Pre-Test

Objectives:

• Learn the role hand hygiene plays in HAI prevention• Learn the right time and right way for Hand Hygiene• Review the proper use of gloves to prevent germ

transmission• Learn to perform observational studies• Learn to evaluate your Hand Hygiene Program• Strategies for improvement

Hands and Germ Transmission:

A health-care workers hands when not clean are the main route of cross-transmission of potentially harmful germs between patients in a health care facility

Lack of Hand Hygiene + Patient Care = Increased Risks

Increased risk for: •Hand contamination•Potential risk to patient safety

Hand Hygiene in Prevention of HAI’s

Hand hygiene is the undisputed single most effective infection control measure in prevention of HAI’s

Increased Compliance with Hand Hygiene means …

• Reduced numbers of patients acquiring HAI’s• Decreased waste of resources • Saving lives

Hand Hygiene

• right time• right way

Key Terms

• The patient zone- includes the patient, surfaces and items that are temporarily and exclusively dedicated to him/her

• The Health care area- all surfaces in the health care setting outside of the patient zone

The patient zoneThe patient zone contains:•Patient X•Immediate surroundings - surfaces that are touched by or in direct physical contact with the patient

-Bed rails-Bedside tables-Bed linens-Tubing-Medical equipment

The Patient zone is not a static geographical area

Any item designed for reuse or temporarily exposed to the patient should be decontaminated when entering and leaving the patients surroundings

Things such as :- Computers- Shared bathrooms- Tables or equipment used for physical therapy - Wheelchairs

The Health-care Area

Is everything outside of the patient zone:•Hand hygiene while caring for patients helps to protect the wider health care environment from contamination by patients germs

Right Time

To avoid prolonged hand contamination:

Perform hand hygiene when indicated

The 5 Moments for Hand Hygiene

1. BEFORE touching a patient2. BEFORE clean/aseptic procedures3. AFTER a body fluid exposure risk4. AFTER touching a patient5. AFTER touching a patients surroundings

Your 5 Moments for Hand Hygiene

BEFORE touching a patient

Why?

BEFORE touching a patient

Why?To protect the patient against harmful germs carried on your hands

BEFORE clean/aseptic procedures

Why?

BEFORE clean/aseptic procedures

Why?To protect the patient against harmful germs, including the patients own, from entering his/her body

AFTER body fluid exposure risk

Why?

AFTER body fluid exposure risk

Why?To protect yourself and the health-care environment from harmful patient germs

AFTER touching a patient

Why?

AFTER touching a patient

Why?To protect yourself and the health-care environment from harmful patient germs

AFTER touching patients surroundings

Why?

AFTER touching patients surroundings

Why?To protect yourself and the health-care environment from harmful patient germs

Your 5 Moments for Hand Hygiene Film

Right Way

To avoid prolonged hand contamination:

Use the appropriate technique Use an adequate quantity Use for recommended length of time

How to Handwash …

How to Handrub …

Let’s Practice!!!

Fingernails and Artificial Nails

• Natural nail tips should be kept to ¼ inch in length

• Artificial nails should not be worn when having direct contact with high-risk patients (e.g., ICU, OR)

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Understanding Medical Gloves and proper Glove use

Medical gloves – disposable gloves used during medical procedures

They include:

• Examination gloves (non sterile or sterile)• Surgical gloves that have specific characteristics

of thickness, elasticity and strength and are sterile

Gloves DO NOT take the place of hand hygiene

• Glove use neither alters nor replaces the performance of hand hygiene

• Gloves should be removed and hand hygiene performed when indicated by the 5 moments of hand hygiene and clean gloves put back on

Rationale for using medical gloves

Recommended for two reasons:1.To reduce the risk of contamination of health-care workers hands with blood and other body fluids2.To reduce the risk of germ dissemination to the environment and of transmission from the health-care worker to the patient and vice versa, as well as from one patient to another

Inappropriate use of gloves

Use of gloves when it is not indicated is a:•Waste of resources •Does not decrease cross-transmission of germs•May result in missed opportunities for hand hygiene•May actually result in germ transmission

The Glove Pyramid

And Now its time for the GLOVE GAME !!!

GLOVE GAME• Assisting a patient with using the bedpan• Taking Vital Signs• Removing a dressing from a wound• Catheter insertion• Delivering food trays• Emptying emesis basin• Changing the linens for a patient with MRSA • Changing a central line dressing • Administering oral Medications• Emptying a Foley catheter bag

Evaluating Your Hand Hygiene Program

Why it is important…•Measurement of the effectiveness of current practices•Identifying areas needing increased education•To be able to give feedback to employees on their performance

How to observe Hand Hygiene

• Direct observation is the most accurate method• Observer must conduct the observation without

interfering with ongoing work• Observer should be familiar with “The 5

Moments for Hand Hygiene” and the data collection tool that is being utilized

• Identify opportunities for hand hygiene and then record if the worker being observed performed hand hygiene at that time

Sample observation tool:Name or position of person being observed

Position Before touching a patient

Before clean aseptic procedure

After body fluid exposure risk

After touching a patient

After touching patient surroundings

Yes No Yes No Yes No Yes No Yes No

Yes No Yes No Yes No Yes No Yes No

Yes No Yes No Yes No Yes No Yes No

Sample Observational Tool

Name or position of person being observed

Position Before touching a patient

Before clean aseptic procedure

After body fluid exposure risk

After touching a patient

After touching patient surroundings

Suzie CNA Yes No Yes No Yes No Yes No Yes No

Larry RN Yes No Yes No Yes No Yes No Yes No

Betty Housekeeping Yes No Yes No Yes No Yes No Yes No

Calculating Compliance Rates

Total number of times hand hygiene was performed

_______________________________________Total opportunities for hand hygiene

X100

Sample Observational Tool

Name or position of person being observed

Position Before touching a patient

Before clean aseptic procedure

After body fluid exposure risk

After touching a patient

After touching patient surroundings

Suzie CNA Yes No Yes No Yes No Yes No Yes No

Larry RN Yes No Yes No Yes No Yes No Yes No

Betty Housekeeping Yes No Yes No Yes No Yes No Yes No

Calculating Compliance Rates

Total number of times hand hygiene was performed

(4)_______________________________________

Total opportunities for hand hygiene(6)

4/6 = 0.6670.667 x 100= 66.7%

Other Uses for Observational Tool

Name or position of person being observed

Position Before touching a patient

Before clean aseptic procedure

After body fluid exposure risk

After touching a patient

After touching patient surroundings

Suzie CNA Yes No Yes No Yes No Yes No Yes No

Larry RN Yes No Yes No Yes No Yes No Yes No

Betty Housekeeping Yes No Yes No Yes No Yes No Yes No

Feedback to Staff

Why it is important:•Helps them recognize gaps in good practices and knowledge•Can help raise awareness and can convince them there is a problem•Ongoing feedback will demonstrate improvement and sustain motivation

Tips for Improving Hand Hygiene Compliance

• Increase the availability of hand sanitizers• Implement a “buddy” system• Place signs near sinks and hand sanitizers with

the “5 Moments for Hand Hygiene” or other reminders

• Internal Newsletters

Answers to Pre-test

Which of the following is the main route of cross-transmission of potentially harmful germs between patients in a health- care facility? (Pick one answer only)a.Health- care worker’s hands when not cleanb.Air circulating in the facilityc.Patient’s exposure to colonized surfaces (i.e., beds, chairs, tables, floors) between patientsd.Sharing non-invasive objects (i.e., stethoscopes, blood pressure cuffs, etc.) between patients

Answers to Pre-test

Which of the following is the main route of cross-transmission of potentially harmful germs between patients in a health- care facility? (Pick one answer only)a.Health- care worker’s hands when not cleanb.Air circulating in the facilityc.Patient’s exposure to colonized surfaces (i.e., beds, chairs, tables, floors) between patientsd.Sharing non-invasive objects (i.e., stethoscopes, blood pressure cuffs, etc.) between patients

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes No

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes b.Washing hands immediately after a risk of body fluid exposure Yes No

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes b.Washing hands immediately after a risk of body fluid exposure No

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes b.Washing hands immediately after a risk of body fluid exposure Noc.Washing hands after exposure to the immediate surroundings of a patient Yes No

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes b.Washing hands immediately after a risk of body fluid exposure No c.Washing hands after exposure to the immediate surroundings of a patient No

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes b.Washing hands immediately after a risk of body fluid exposure Noc.Washing hands after exposure to the immediate surroundings of a patient Nod.Washing hands immediately before a clean/ aseptic procedure Yes No

Answers to Pre-test

Which hand hygiene actions prevent transmission of germs to the patient?a.Washing hands before touching a patient Yes b.Washing hands immediately after a risk of body fluid exposure Noc.Washing hands after exposure to the immediate surroundings of a patient Nod.Washing hands immediately before a clean/ aseptic procedure Yes

Answers to Pre-test

What is the minimal time needed for alcohol based hand rub to kill most germs on your hands? (Pick one answer only)a.20 secondsb.3 secondsc.1 minuted.10 seconds

Answers to Pre-test

What is the minimal time needed for alcohol based hand rub to kill most germs on your hands? (Pick one answer only)a.20 secondsb.3 secondsc.1 minuted.10 seconds

Summary:

Increased compliance with Hand Hygiene at the appropriate moment and in the appropriate way will lead to reduced numbers of patients acquiring HAI’s and save lives

Observational studies are key to determining the effectiveness and direction of your hand hygiene education.

WHO Hand Hygiene Self-Assessment Framework 2010

• WHO Hand Hygiene Self-Assessment Framework 2010 worksheet– Answer the following based on practices at

your facility:• 3.4 and 3.5 from “Evaluation and feedback”• Entire section of 4 “Reminders in the workplace”• Entire section of 5 “Institutional safety climate for

hand hygiene”

Discussion Questions (3.4)

• Does your facility use WHO “My 5 Moments for Hand Hygiene”?

• How frequently is direct observation of hand hygiene compliance performed at your facility?

• What is the overall hand hygiene compliance rate in your facility?

Discussion Questions (3.5)

• Do you use immediate feedback?• Describe your systematic feedback?

– How often?– Audience?– Impact?

Discussion Questions (4)

• Please share your experience with hand hygiene workplace reminders?– What has worked well? – Or not?– Types of reminders or promotions?

Discussion Questions (5)

• Does anyone have experience with:– Hand hygiene teams?– Visible support from leadership?– Hand hygiene champions or role models?– Patient involvement?– Continuous improvement activities?

References

• Center for Disease Control (CDC)• World Health Organization (WHO)

Questions?