1. Hand Hygiene(HH) for Environment staff

2. Hand Hygiene History
Hand hygiene is not a new concept even the cave men lived near the water to clean themselves
So why now in this day and age are we still having to remind people to attend to their hand hygiene

3. We are taught to wash our hands as toddlers…
Our memory seem to fail us over time
We all know how to wash, we are taught this when we are about 2 when toilet training so the big question is why don’t we……………

4. Hand Hygiene
Hand hygiene is generally poorly adhered to across the board from all levels of Health Care Workers
Most staff underestimate the time and frequency they spend on hand hygiene
Sing “happy birthday” twice

5. What is it???????
Hand hygiene
using soap and water to wash and then dry hands thoroughly
using a waterless hand rub system( eg. Alcohol based hand rub)

6. Hand Hygiene Reasons why we don’t wash our hands Skin irritation
Takes too long
Skin irritation
Sinks poorly located
Too busy
I only touched “it” a little bit
I forgot
I meant too/I thought I did
I will next time
I didn’t know you were watching
We set about finding out why HCW’s in general did not preform HH as we would have liked

7. What we did to help Alcohol impregnated wipes/detergent cleaning wipes
Alcoholic Based hand rubs(ABHR)
Compatible moisturiser

8. When should I do HH at work?
You will see these posters around you facility, try and remember these 5 Moments

9. Also remember to clean your hands….
When your hands are dirty
Before you start your shift
Before and after glove use
After touching the patients environment
After using the bathroom
Before,during and after preparing food
After sneezing,blowing nose & coughing
After handling/patting animals

10. When to use what… Use ABHR: Use soap and water:
If your hands look clean
Use soap and water:
If your hands are visibly dirty

11. Hand Hygiene Why to use ABHR’s Reduces bacterial count on hands
More effective for standard hand wash
Reduces adverse outcomes and cost associated with HCAI’s
Requires less time
Less irritating
Readily accessible/portable
It’s important to sell the advantages of Hand rubs and regularly remind staff that the new product contains an emollient so it wont dry their hands like the olds ones did.
Staff should be encouraged to report any irritations they experienced from the products

12. Soap & Water Hand Washing
Hand Hygiene
Hand Rubs
Soap & Water Hand Washing
Post HH
Post HH
Pre HH
Pre HH
The ABHR have definitely shown to improvement in compliance/MRSA /BSIs and monetary wise also.
Hand rubs should be on your trolleys for use ,in corridors, in rooms, on bed ends in clinics etc

13. How to do it…

14. Hand Hygiene “Clean Between”
Use the alcohol impregnated wipes/detergent wipes on all shared equipment after each patient use
All areas/equipment still require routine and terminal cleaning as documented in your cleaning schedules
We encouraged wards to place these brackets on all trolleys, in each bay/room, in treatment rooms also to use on their own equipment like stethoscope, ID badges and on office equipment like the phones and keyboards
But all areas and equipment will still require routine and terminal cleaning according to your cleaning schedules

15. Hand Hygiene Compatible Moisturiser Used minimum of 3 times per shift
At coffee break
At meal breaks
at home time
All HCW’s to use(including boys)
Use hospital supplied compatible moisturiser
The introduction of a compatible moisturiser was equally as important .
The placement of the moisturiser canister was a big issue so by having them in common areas such as handover rooms, tea rooms and at the nurses station encouraged all HCW’s to use it.
Getting the male staff members can prove a bit of a challenge

16. Hand Hygiene
We must remember that if we don’t clean our hands we could get sick or we could make someone else sick
No-one likes to be sick or think that they made someone else sick ,but our hands can transfer many germs on to others
Hands are the most common way to spread infections. HH is the easiest thing to do but in reality its poorly adhered to. HCW’s do wash their hands a lot but its not always the most effective wash. It doesn’t matter where you work or what you do our hands are the focal point for us all. We are tactile creatures by nature and that will never change so we must change and improve our practices/habits.
Simple things like covering your nose and mouth with a tissue every time you cough or sneeze, throw away the tissue, don’t use your sleeve and preform HH.
Stay home if you are sick, remember that keeping your distance from others may protect them from getting sick
Immunisations are available for many things contact you staff health dept.

17. Hand Hygiene
One of the most common ways we catch a cold is by rubbing our eyes or nose after touching something or someone that has the germ rhinovirus on it
Stay away from work if you are ill
Did you know that we are most likely to catch a cold from a person by shaking his hands than from his sneeze. Hands with the cold virus on them can deposit 92% of the virus onto another surface and then 67% from that surface to another person.

18. Hand Hygiene
Another really disgusting germ is called rotavirus and it causes gastro illness
This nasty germ can live on dry, hard surfaces like table tops or toys for up to 20 minutes
Stay away from work until you are 48 hours free of all symptoms
So its also important to clean things down after we use them, things like the phone, keyboards etc, shared equipment, both at home and at work

19. Hand Hygiene We are all role models, at all times Lead by example
Our patients deserve to see you clean your hands
“Healthcare workers in a room with senior staff member or peer who DID NOT wash hands were significantly less likely to wash their own hands” it read
The part of role models should not be underplayed either and all who work in healthcare are seen as role models
It doesn’t really matter walk of life we are in the part of role models is the same, teacher–student, parent-child, colleague to colleague, friend to friend
THIS WAS A STUDY SHOWING THAT STAFF WERE MUCH LESS LIKELY TO WASH THEIR OWN HANDS IF A PEER OR SENIOR MEDICAL STAFF MEMBER DIDN’T WASH THEIR HANDS
Remember that promoting HH is not always easy so by leading by example it’s a great way to start.
EMERGING INFECTIOUS DISEASES FEB 2003

20. Hand Hygiene
Gloves
Gloves should be used as an adjunct to, not a substitute for hand hygiene.
HH is to be used before & after all glove use.
Disposable gloves are to be used once only and not disinfected or washed.
Only wear gloves for the job at hand
Where possible use disposable work gloves
Heavy duty gloves are single person allocation

21. Hand Hygiene Limit jewellery worn to work
Jewellery should not inhibit your HH practices
Don’t bite your fingernails
Nails-keep short
No chipped polish
No acrylic nails in clinical areas
Don’t bite your nails for 2 reasons one it looks really yucky but more important our skin is our 1st line of defence or natures way of protecting us against germs and bugs and if we have a spilt or cut in our skin we are leaving ourselves open to pick up any uninvited guest or germ that might lead to an infection.
Most people don’t think about there finger nails when washing there hands but we should. things get stuck under the nails easily. Use the fingernail on one hand to clean under the nails of the other hands.
Nail fungus is made up of tiny organisms (Tinea unguium) that can infect finger and toe nails. These fungus live under the nails which provide a safe place for the fungus to grow as fungus thrive in dark and damp places. Nails painted or acrylic nails can trap moisturise and fungi. Another reason not to eat them.
Acrylic nails may look good but you cant see what happening underneath them.
Check your local facility dress code policy but HHA does not recommend acrylic nails for those that work in clinical areas

22. Hand Hygiene Hand health influenced by Season Location (climate) Age
Home habits
Glove usage
Your skin is your 1st line of defence against infections-look after it
A few of these factors cannot be controlled by us but the last 2 can so its important to control the ones we can affect
The use of gloves has increased with the adoption of universal precautions but gloves can impact on our skin condition. Ensure that you use the correct type of glove for the correct procedure and if needed use latex free and /or powder free. Ensure they fit well and remember gloves are single use DO NOT WASH YOUR GLOVES

23. Hand Hygiene Hand health Cover cuts, scratches, rashes
Use a waterproof dressing/not band-aids in clinical areas
Clean you wounds
Don’t pick sores
Don’t touch open wounds
Wear gloves the garden
Wear gloves for the dishes
Think about the 24 hour picture, think about your practices at home, do you wear gloves to do the dishes, in the garden or laundry. Think about your hobbies re pulling car apart etc.
Always cover cuts abrasions and scratches.
Once a bandaid gets wet they become a haven for micro organisms
We suggest an occlusive dressing/water proof dressing. These can be brought at a chemist and for the first few days when your wound is open. What may only be a paper cut to you to the bugs is like the grand canyon.

24. Hand Hygiene
Think about the bathroom at your work place, are they clean, do they have soap (not bar soap as these harbour bacteria’s), do they have either paper towels or air dryers, are there bins around are they well ventilated, good lightening etc. If these areas are unpleasant or inadequate then staff/ guests/patrons wont use them properly. Make sure the bathrooms are clean and inviting to use , can the younger kids reach the hand towels, is the water temperature OK, is soap available , do the people feel safe in them etc
Encourage everyone to want to clean their hands before they leave

25. Hand Hygiene At work we are in close contact with each other
We share equipment
Make sure you to have clean hands before you start
Make sure you have clean hands when you finish
It’s a really good idea to wash your hands after the end of each break and to daily wipe over shared items things like computer keyboards, office phones, mop handles, trolley handles ,drawers etc especially during flu season. Serious respiratory illnesses like influenza, whooping cough and even SARS are spread by coughing or sneezing and via unclean hands. These illnesses spread easily in crowded places when people are in close contact.

26. ? Hand Hygiene SUSTAINABILITY Is up to you..
I heard a story many years ago about a Nurse manager who said she knew who of her staff washed their hands by the number used of hand towels in the bin, we don’t want recommend that the NUMs go around snooping in bins again but the million dollar question is “Sustainability”
It is up to us……..
Sustainability is going to be an issue for all large multi campus hospitals as having the allocated EFT dedicated to HH to cover all areas 24 hours a day is unlikely to ever happen.
We need to encourage ward staff to take ownership of the problem with ward champions , encourage the NUM to tackle the issue at a ward level, remind Department heads, consultants, hospital executive the list goes on, being constantly in their face, educating as many as possible not giving up
Its important to note that This is not just an Infection Control problem it belongs to the whole hospital

27. Hand Hygiene Empowerment Remind food handlers
Remind health care workers
Remind the kids/family
Remind yourself
Remind colleagues
It’s not a secret we want the word out there

28. Hand Hygiene
When you think about it 20 years ago we would have been sitting here under a layer of smoke - that message is getting through.
When l was a kid we all jumped in the back of the station wagon and away we went, nobody thought about seat belts, now we wouldn’t dream of starting the car without our belts on, so that message is getting through
And don’t forget the slip slop slap message, this generation are great at it
So we can achieve changes in culture but we need your help

29. Hand Hygiene Take home message Look after your skin
We are all role models
Use moisturiser
Wear gloves
Don’t bite your nails
Make it an effective wash
Stay healthy, be happy
Being healthy makes us feel better, feel positive, feel able to cope and achieve more each day

30. Hand Hygiene
1. Pittet D,Boyce J.Hand Hygiene and patient care: pursuing the Semmelweiss legacy.
The Lancet Infectious Diseases 2001:April:9-20
2. Centre for Disease Control and Prevention. “Guideline for Hand Hygiene in health care settings: recommendations of the Healthcare Infection Control practices Advisory Committee and the HICPAC/SHEA/APIA/IDSA Hand Hygiene Task force”,
Morbidity and Mortality Weekly Report, 2002:51(No.RR-16)
3. Victorian Quality Council Hand Hygiene Project. “A practical model for implementing hand hygiene in hospitals”. Austin Health Coordinating centre, First edition 2004.
4. History of infection Control and its Contributions to the Development and Success of Brain Tumour Operations. Miller et al, Medscape article
5.Larsen EL.APIC Guideline Committee.APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect control 1995:23:251-69
6. HHA, 5 Moments for Hand Hygiene, Advanced draft, version 4,2008