1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI The How To of Hand Hygiene Training Module 1 for All Long-term Care Staff

2. Upon completion of this training module, long-term care staff will be able to demonstrate a working knowledge of: why hand hygiene is so important to prevent the spread of infections; when and how to perform hand hygiene; and key hand hygiene practices for prevention of healthcare- associated infections (HAI), particularly catheter-associated urinary tract infections (CAUTI). 2 Learning Objectives

3. Health Care Workers’ Hands Spread Infections 1-3 million serious infections are estimated to occur every year in US nursing homes Hand hygiene is one of the most important ways to prevent the spread of infections 3 Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674. Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Mody et al Infect Control Hosp Epidemiol; 2003:24:165-171

4. Simplifying the Moments for Hand Hygiene 4 Adapted from World Health Organization Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands Educational Resources: http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspxhttp://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx

5. Alcohol-based Hand Rub (ABHR) Hand Hygiene Technique Apply hand rub to palm of hand Rub hands together, covering all surfaces Focus on thumbs, tips of fingers, and under fingernails Hands are clean when dry – Usually takes about 15-20 seconds 5 http://www.cdc.gov/handhygiene/Resources.html#HCP

6. Soap and Water Hand Washing Hand Hygiene Technique Wet hands with water Apply soap to palm of hand Rub hands together, covering all surfaces for at least 15 seconds Rinse hands with water Dry hands with paper towel and use towel to turn off faucet – Paper towel prevents hands from being re-contaminated by faucet handles 6 http://www.cdc.gov/handhygiene/Resources.html#HCP

7. Notes About Hand Hygiene Products Alcohol-based hand rubs/gels are preferred for hang hygiene when hands are not visibly soiled or dirty There are certain times when hands should be washed with soap (non-antimicrobial or antimicrobial) and water: When hands are visibly dirty, contaminated or soiled After care with residents with infectious diarrhea 7 Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

8. Efficacy of Hand Hygiene Preparations in Killing Bacteria 8 Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Good Better Best Plain soap Antimicrobial soap Alcohol-based hand rub

9. Hand Hygiene and C. diff Hand hygiene with soap and water is superior at removing the spore form of C. diff (compared to alcohol-based products) AHBR is more effective for hand disinfection with all other organisms and there have been no studies linking ABHR use with an increase in C. diff infection Encourage soap and water after care of residents with acute diarrhea and use of gowns/gloves to prevent spore contamination of hands 9 Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944. Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628-645

10. Important Points About Glove Use Gloves play a key role in preventing hand contamination—but, do NOT replace hand hygiene Change gloves during care when moving from a contaminated body site to a clean body site Do not wear the same pair of gloves for the care of more than one resident Remove and discard gloves after use Do not wash gloves 10 Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16

11. Hand Hygiene Before Urinary Catheter Care Perform hand hygiene and wear gloves immediately before : Placing or removing an indwelling catheter. Accessing the drainage system to empty the drainage bag or collecting a urine sample. Why? Interacting with the resident or environment before handling the urinary device, may contaminate hands. Reaching for gloves with unclean hands may contaminate the glove box and outside of the gloves. Then, gloves will contaminate the urinary catheter or urine collection system. 11

12. Hand Hygiene After Urinary Catheter Care Remove gloves and perform hand hygiene immediately after: Handling an indwelling catheter Accessing the drainage system to empty the drainage bag or collecting a urine sample Why? Hand contamination may occur as a result of small, undetected holes in gloves. Hand contamination may occur during glove removal. Hand hygiene protects your hands and the environment from being contaminated. 12

13. Hand Hygiene Case Scenarios Let’s chat! Review as a group the three hand hygiene case scenarios. As you discuss them, think about the following questions: Does our facility staff experience similar challenges to performing hand hygiene at the appropriate times? Why or why not? What could our facility do to reduce barriers to hand hygiene? How can I help support a culture of safety around improving hand hygiene in our facility? 13

14. Take the Pledge… 14

15. Stay Updated with Useful Resources AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety TeamSTEPPS® for Long-term Care 15 Take the PledgeTake the Pledge… (to practice all infection prevention skills) World Health Organization How to Handrub Poster World Health Organization How to Handwash Poster

16. References Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm.http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm Centers for Disease Control and Prevention. Hand Hygiene Resources. http://www.cdc.gov/handhygiene/Resources.html#HCP. http://www.cdc.gov/handhygiene/Resources.html#HCP Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628-645. Mody et al. Infect Control Hosp Epidemiol; 2003:24:165-171. Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944. Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674. World Health Organization Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands. http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCY H-ltch-Education-and-training.aspx. http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCY H-ltch-Education-and-training.aspx 16