Hand Hygiene in Health-care Facilities

Hand Hygiene in Health-care Facilities
The Importance of Proper Hand Hygiene for Health-care Workers 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 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

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 Hands and Germ Transmission: A health care workers hand when not clean is 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 Lack of Hand Hygiene + patient care = Increases risks Health care workers hands become progressively colonized with germs and with potential pathogens during patient care. The absence of hand hygiene and the longer the duration of care given to the patient increases the risk of hand contamination and potential risks 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 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 Something as simple as good hand hygiene can reduce the number of patients acquiring HAI, and decrease the waste of resources and ultimately save lives.

Hand Hygiene right time right way
It is just a matter of performing this simple task at the right time and in the 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 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 zone The 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 The patient zone contains: Patient X Immediate surroundings - surfaces that are touch 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 Patient zones is not a static geographical area it changes and accompanies the patient in the health care area where every the patients stays or goes The patients surroundings are contaminated by the patients own flora therefore 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 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 Right Time To avoid prolonged hand contamination, it is important to perform hand hygiene when indicated

The 5 Moments for Hand Hygiene
BEFORE touching a patient BEFORE clean/aseptic procedures AFTER a body fluid exposure risk AFTER touching a patient AFTER touching a patients surroundings The 5 Moments for Hand Hygiene No room for error To minimize differences in the way Hand Hygiene practices are understood by health care workers, trainers and observers Hand Hygiene indications need to become universally understandable. There should be no room for doubt or different interpretations of when Hand Hygiene should occur. BEFORE touching a patient BEFORE clean/aseptic procedures AFTER a body fluid exposure risk AFTER touching a patient AFTER touching a patients surroundings

Your 5 Moments for Hand Hygiene
Before touching a patient When? Clean your hands before touching a patient when approaching him/her Why? To Protect the patient against harmful germs carried on your hands Before Clean/Aseptic procedures Clean your hands immediately before performing a clean/aseptic procedure To protect the patient against harmful germs, including the patient’s own, from entering his/her body After body fluid exposure risk Clean your immediately after an exposure risk to body fluid (and after glove removal) To protect yourself and the health care environment from harmful patient germs After touching a patient Clean your hands after touching a patient and his/her immediate surroundings, when leaving the patient’s side To protect yourself and the health care environment from harmful germs After touching patients surroundings Clean your hands after touching any object or furniture in the patient’s immediate surroundings, when leaving- even if the patient has not been touched To Protect yourself and the health care environment from harmful patient germs

BEFORE touching a patient
Why? BEFORE touching a patient

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

BEFORE clean/aseptic procedures
Why? BEFORE clean/aseptic procedures

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

AFTER body fluid exposure risk
Why? To protect yourself and the health-care environment from harmful patient germs To protect yourself and the health-care environment from harmful patient germs

AFTER touching a patient
Why? AFTER touching a patient

AFTER touching a patient

AFTER touching patients surroundings
Why? AFTER touching patients surroundings

AFTER touching patients surroundings

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 Wash Hand / Use hand rubs properly To avoid prolonged hand contamination, it is not only important to perform hand hygiene when indicated, but also to use the appropriate technique and an adequate quantity of the product to cover all skin surfaces for the recommended length of time (Excersie Hand gel practice)

How to Handwash … How to Handwash properly
Wash hands when visibly soiled, otherwise, you can use hand rubs Duration of the entire procedure: seconds - Wet hands with water - Apply enough soap to cover all hand surfaces - Rub hand palm to palm - Right palm over left dorsum with interlaced fingers and vice versa with the left - Palm to palm with fingers interlaced - Backs of fingers to opposing palms with fingers interlocked - Rotational rubbing of left thumb clasped in right palm and vice versa with the left - Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa with the left - Rinse hands with water - Dry hands thoroughly with a single use towel - Use towel to turn off faucet - Your hands are now safe

How to Handrub … How to Use Hand Rub properly
Rub hands for hand hygiene but wash hands when visibly soiled Duration of the entire procedure: seconds - Apply a palmful of the product in a cupped hand, covering all surfaces - Rub hands palm to palm - Right palm over left dorsum with interlaced fingers and vice versa with the left - Palm to palm with fingers interlaced - Backs of fingers to opposing palms with fingers interlocked - Rotational rubbing of left thumb clasped in right palm and vice versa with the left - Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa with the left - Once dry, your hands are safe

Let’s Practice!!! Demonstrate step by step how to hand rub and ask the audience to participate

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) Nail length is important because even after careful handwashing, HCWs often harbor substantial numbers of potential pathogens in the subungual spaces. Numerous studies have documented that subungual areas of the hand harbor high concentrations of bacteria, most frequently coagulase-negative staphylococci, gram-negative rods (including Pseudomonas spp.), corynebacteria, and yeasts. Natural nail tips should be kept to ¼ inch in length. A growing body of evidence suggests that wearing artificial nails may contribute to transmission of certain healthcare-associated pathogens. Healthcare workers who wear artificial nails are more likely to harbor gram-negative pathogens on their fingertips than are those who have natural nails, both before and after handwashing. Therefore, artificial nails should not be worn when having direct contact with high risk patients.

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 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 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: To reduce the risk of contamination of health-care workers hands with blood and other body fluids 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 Rational for using medical gloves Recommended for two reasons: To reduce the risk of contamination of health-care workers hands with blood and other body fluids 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 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 The glove pyramid is a useful tool to help you determine when to use gloves, both sterile and non-sterile, and when gloves are not indicated. There is a copy of the glove pyramid included in your handouts.

And Now its time for the GLOVE GAME !!!
Instruct participants to put on their glove. To answer the questions, hold up the appropriate hand (or glove). “S” indicates ‘sterile gloves.’ “NS” means “non-sterile.” If you hold up your non-gloved hand, that means no gloves are required. Let’s go!!

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 Assisting a patient with using the bedpan. Non-sterile gloves Taking Vital Signs. No glove Removing a dressing from a wound. Non-sterile gloves Catheter insertion. Sterile gloves Delivering food trays. No Gloves Emptying emesis basin. Non-sterile Gloves Changing the linens for a patient with MRSA. Non-sterile gloves Changing a central line dressing. Sterile gloves Administering oral Medications. No gloves Emptying a Foley catheter bag. Non-sterile gloves

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 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 The first step in evaluating your HH program is by performing observational studies of persons performing HH. 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:
This is a sample observational tool. We have included a copy of this form in the handouts given. There are additional samples in the ”Guide to the Elimination of MRSA in Long Term Care Facilities” and on the WHO web site that can be used or modified to meet the needs of your facility. Remembering the “5 Moments for Hand Hygiene” the observer will watch staff and recognize an opportunity in which hand hygiene should be completed. Then he or she will mark on the form if hand hygiene was performed at the appropriate times

Sample Observational Tool
This is an example of a completed observational tool. Each worker was observed performing their routine duties and the observer noted yes or no for each recognized moment that hand hygiene should have been performed. All 5 moments for HH may not occur with each observation depending on the task that is being observed. Those moments not witnessed should be left blank. For example, Suzie CNA was observed going into a room to assist patient with the bedpan. She did not perform hand hygiene prior to touching the patient so a “no” was recorded. There was no clean or aseptic procedure performed so second square was left blank. After risk of exposure to a body fluid she did complete HH so a “yes” was recorded. After touching a patient, a “yes” was written indicating HH was performed. There was no opportunity observed for HH after touching patient surroundings so that square was left blank. For Larry RN, he was already in the room with the patient when the observer began watching him so the observer did not see him prior to touching the patient, therefore that square was left blank. He did perform HH prior to changing the central line dressing, an aseptic procedure, so a “yes” was recorded. He also performed HH after touching the patient so again a “yes” recorded. The observer left the other squares blank, as those opportunities were not observed. The observer only saw Betty touching patient surroundings. She did not perform HH so a “no” was recorded. The other squares were left blank since none of those moments for HH were present. Any Questions?

Calculating Compliance Rates
Total number of times hand hygiene was performed _______________________________________ Total opportunities for hand hygiene X100 Using the data collected, a hand hygiene compliance rate can be calculated using this formula. This sounds complicated but hopefully it will make sense when we apply it to our sample. You will add all the times that hand hygiene was performed at the appropriate times during the observation for all persons observed. Next add the total number of moments available for hand hygiene that were observed for all persons. Divide the number times HH was performed by the number of moments for HH. Then multiply the number by 100 to get a percentage rate.

Sample Observational Tool
In our sample completed form, there were 4 times that HH was performed at the appropriate time. This is the total number of “yes” squares. There were 6 moments that HH should have been performed. This is the total number of completed squares with both “yes” and “no”

Calculating Compliance Rates
Total number of times hand hygiene was performed (4) _______________________________________ Total opportunities for hand hygiene (6) 4/6 = x 100= 66.7% Plugging these numbers into out formula: Total number of times HH was performed 4; Total opportunities for HH 6. 4 divided by 6= 0.667 Multiply by 100 to get a percentage and you get 66.7% So for this sample, the compliance rate would be 66.7% This observation should be done regularly and the results tracked. An increase in the percentage would indicate that the education being done is having a positive effect. A decrease in the number would indicate the need for additional training on HH.

Other Uses for Observational Tool
You can also use the observational tool to look for areas to focus your educational program and reminders for the staff. In the sample tool we used to calculate compliance rates, you can see that HH was not completed prior to touching a patient and after touching surroundings. If there are areas such as these that commonly missed by staff during observations, they should be reinforced during education.

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 Providing feedback to staff on the results of the observational studies and compliance rates is an important part of the evaluation process. 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 Increase the availability of hand sanitizers. Making hand sanitizer easily available to workers will increase the frequency of its use. Having sanitizer mounted inside each room or outside of each door will make use convenient and serve as a visual reminder to use it. Implement a buddy system. Recognize workers who routinely practice appropriate HH and recruit them to train new employees and provide discreet reminders to staff when HH is needed and not done Place signs near sinks and hand sanitizers with the “5 Moments for Hand Hygiene” or other reminders Signs are available on the WHO and CDC websites that can be printed for free An internal newsletter can be used to highlight a particular staff member or unit that excels or has made improvements in in HH. It can also be used to announce upcoming trainings and provide feedback on current compliance rates.

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) Health- care worker’s hands when not clean Air circulating in the facility Patient’s exposure to colonized surfaces (i.e., beds, chairs, tables, floors) between patients 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? Washing hands before touching a patient Yes No

Answers to Pre-test Which hand hygiene actions prevent transmission of germs to the patient? Washing hands before touching a patient Yes

Answers to Pre-test Which hand hygiene actions prevent transmission of germs to the patient? Washing hands before touching a patient Yes 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? Washing hands before touching a patient Yes Washing hands immediately after a risk of body fluid exposure No Protects the health care worker

Answers to Pre-test Which hand hygiene actions prevent transmission of germs to the patient? Washing hands before touching a patient Yes Washing hands immediately after a risk of body fluid exposure No 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? Washing hands before touching a patient Yes Washing hands immediately after a risk of body fluid exposure No Washing hands after exposure to the immediate surroundings of a patient No Protects the health care worker

Answers to Pre-test Which hand hygiene actions prevent transmission of germs to the patient? Washing hands before touching a patient Yes Washing hands immediately after a risk of body fluid exposure No Washing hands after exposure to the immediate surroundings of a patient No 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? Washing hands before touching a patient Yes Washing hands immediately after a risk of body fluid exposure No Washing hands after exposure to the immediate surroundings of a patient No 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) 20 seconds 3 seconds 1 minute 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” Please take out WHO Hand Hygiene Self-Assessment Framework 2010 worksheet and answer the following based on your practice at your facility after you come back from lunch and we will go over this for about mins: 3.4 and 3.5 from “Evlauation 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) There is also a Hand Hygiene Self-Assessment included in the handouts that you may complete on your own. It is a very good tool to help you evaluate your HH program

Questions?

Hand Hygiene in Health-care Facilities

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