2Hand Hygiene HistoryHand hygiene is not a new concept even the cave men lived near the water to clean themselvesSo why now in this day and age are we still having to remind people to attend to their hand hygiene
3We are taught to wash our hands as toddlers… Our memory seem to fail us over timeWe 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……………
4Hand HygieneHand hygiene is generally poorly adhered to across the board from all levels of Health Care WorkersMost staff underestimate the time and frequency they spend on hand hygieneSing “happy birthday” twice
5What is it???????Hand hygieneusing soap and water to wash and then dry hands thoroughlyusing a waterless hand rub system( eg. Alcohol based hand rub)
6Hand Hygiene Reasons why we don’t wash our hands Skin irritation Takes too longSkin irritationSinks poorly locatedToo busyI only touched “it” a little bitI forgotI meant too/I thought I didI will next timeI didn’t know you were watchingWe set about finding out why HCW’s in general did not preform HH as we would have liked
7What we did to help Alcohol impregnated wipes/detergent cleaning wipes Alcoholic Based hand rubs(ABHR)Compatible moisturiser
8When should I do HH at work? You will see these posters around you facility, try and remember these 5 Moments
9Also remember to clean your hands…. When your hands are dirtyBefore you start your shiftBefore and after glove useAfter touching the patients environmentAfter using the bathroomBefore,during and after preparing foodAfter sneezing,blowing nose & coughingAfter handling/patting animals
10When to use what… Use ABHR: Use soap and water: If your hands look cleanUse soap and water:If your hands are visibly dirty
11Hand Hygiene Why to use ABHR’s Reduces bacterial count on hands More effective for standard hand washReduces adverse outcomes and cost associated with HCAI’sRequires less timeLess irritatingReadily accessible/portableIt’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
12Soap & Water Hand Washing Hand HygieneHand RubsSoap & Water Hand WashingPostHHPostHHPreHHPreHHThe 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
14Hand Hygiene “Clean Between” Use the alcohol impregnated wipes/detergent wipes on all shared equipment after each patient useAll areas/equipment still require routine and terminal cleaning as documented in your cleaning schedulesWe 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 keyboardsBut all areas and equipment will still require routine and terminal cleaning according to your cleaning schedules
15Hand Hygiene Compatible Moisturiser Used minimum of 3 times per shift At coffee breakAt meal breaksat home timeAll HCW’s to use(including boys)Use hospital supplied compatible moisturiserThe 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
16Hand HygieneWe must remember that if we don’t clean our hands we could get sick or we could make someone else sickNo-one likes to be sick or think that they made someone else sick ,but our hands can transfer many germs on to othersHands 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 sickImmunisations are available for many things contact you staff health dept.
17Hand HygieneOne 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 itStay away from work if you are illDid 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.
18Hand HygieneAnother really disgusting germ is called rotavirus and it causes gastro illnessThis nasty germ can live on dry, hard surfaces like table tops or toys for up to 20 minutesStay away from work until you are 48 hours free of all symptomsSo 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
19Hand 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 readThe part of role models should not be underplayed either and all who work in healthcare are seen as role modelsIt 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 friendTHIS 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 HANDSRemember that promoting HH is not always easy so by leading by example it’s a great way to start.EMERGING INFECTIOUS DISEASES FEB 2003
20Hand HygieneGlovesGloves 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 handWhere possible use disposable work glovesHeavy duty gloves are single person allocation
21Hand Hygiene Limit jewellery worn to work Jewellery should not inhibit your HH practicesDon’t bite your fingernailsNails-keep shortNo chipped polishNo acrylic nails in clinical areasDon’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
22Hand Hygiene Hand health influenced by Season Location (climate) Age Home habitsGlove usageYour skin is your 1st line of defence against infections-look after itA few of these factors cannot be controlled by us but the last 2 can so its important to control the ones we can affectThe 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
23Hand Hygiene Hand health Cover cuts, scratches, rashes Use a waterproof dressing/not band-aids in clinical areasClean you woundsDon’t pick soresDon’t touch open woundsWear gloves the gardenWear gloves for the dishesThink 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 organismsWe 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.
24Hand HygieneThink 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 etcEncourage everyone to want to clean their hands before they leave
25Hand Hygiene At work we are in close contact with each other We share equipmentMake sure you to have clean hands before you startMake sure you have clean hands when you finishIt’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 upIts important to note that This is not just an Infection Control problem it belongs to the whole hospital
27Hand Hygiene Empowerment Remind food handlers Remind health care workersRemind the kids/familyRemind yourselfRemind colleaguesIt’s not a secret we want the word out there
28Hand HygieneWhen 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 throughAnd don’t forget the slip slop slap message, this generation are great at itSo we can achieve changes in culture but we need your help
29Hand Hygiene Take home message Look after your skin We are all role modelsUse moisturiserWear glovesDon’t bite your nailsMake it an effective washStay healthy, be happyBeing healthy makes us feel better, feel positive, feel able to cope and achieve more each day
30Hand Hygiene1. Pittet D,Boyce J.Hand Hygiene and patient care: pursuing the Semmelweiss legacy.The Lancet Infectious Diseases 2001:April:9-202. 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 article5.Larsen EL.APIC Guideline Committee.APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect control 1995:23:251-696. HHA, 5 Moments for Hand Hygiene, Advanced draft, version 4,2008