Hand Hygiene GBMC Corporate Competency

1. Hand Hygiene GBMC Corporate Competency To every patient, every time, we will provide the care that we would want for our own loved ones. Health, healing and hope.

2. Why All the Fuss About Hand Hygiene? • Clean hands are the single most important factor in preventing the spread of pathogens (germs) and antibiotic resistance in healthcare settings. • Hand hygiene reduces the incidence of healthcare associated infections (HAIs). • CDC estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection.

3. Hand Transmission – the spread of germs • Hands are the most common vehicle to transmit health care associated organisms. • Germs are spread from person to person by direct contact or touching. • Germs are also spread from person to person indirectly from surfaces and/or equipment.

4. Hand Transmission: Step 1 (The Lancet Infectious Diseases 2006) Organisms/germs are present on patient skin and environment surfaces. • Organisms/germs are present on intact areas of some patients’ skin. • Nearly 1 million skin cells containing germs are shed daily from normal skin. • The patient environment (bed linen, furniture, objects) becomes contaminated by patient germs.

5. Hand Transmission: Step 2 (The Lancet Infectious Diseases 2006) Organisms transfer on health care providers’ hands- examples: • Healthcare workers contaminate their hands with germs during “clean” activities (examination, lifting patients, taking the patient’s pulse, blood pressure, or oral temperature, picking up an object in the patient’s room, etc.).

6. Hand Transmission: Step 3 (The Lancet Infectious Diseases 2006) • Organisms survival on hands. • Following contact with patients and/or contaminated environment, germs can survive on hands for differing lengths of time (minutes or hours). • In the absence of hand hygiene, the longer the duration of care, the higher the degree of hand contamination.

7. Hand Transmission: Step 4 (The Lancet Infectious Diseases 2006) • Defective hand cleansing results in hands remaining contaminated. • Insufficient amount of product, and/or insufficient technique and duration of hand hygiene action lead to poor hand cleaning. • Germs may still be recovered on hands following hand washing with soap and water, whereas hand sanitizer has been proven significantly more effective.

8. Hand Transmission: Step 5 (The Lancet Infectious Diseases 2006) • Contaminated hands cross-transmit organisms. • In many outbreaks, germs spread between patients and from the environment to patients through health care providers’ hands.

9. Recommended Hand Hygiene Technique • Handrubs (alcohol hand sanitizer): • ○Apply to palm of one hand, rub hands together • covering all surfaces until dry. • ○Volume needed: based on manufacturer, make sure • that all surface area of hands are covered with • sanitizer. • Hand washing: • ○Wet hands with water, apply soap, rub hands • together for at least 15 seconds. • ○Rinse and pat dry with disposable towel. • ○Use paper towel to turn off faucet.

10. Techniques for Performing Hand Hygiene • To clean hands properly: • Pay special attention to fingertips, between fingers, backs of hands and base of thumbs. • Apply lotion to hands frequently after washing. ○Keep nails short and clean ○Remove rings and bracelets ○Do not wear artificial nails ○Remove chipped nail polish ○Make sure that sleeves are rolled up and do not get wet

11. Specific Indications for Hand Hygiene • Before: • ○Entering patient’s environment “WASH IN” • ○Patient contact • ○Donning gloves when inserting a central venous catheter • ○Donning gloves when inserting urinary catheters, • peripheral vascular catheters, or other invasive devices that • don’t require surgery • After: • ○Contact with a patient’s skin • ○Contact with body fluids or excretions, non-intact skin, • wound dressings • ○Removing gloves • ○Exiting patient’s environment “WASH OUT”

12. Selection of Agents for Hand Hygiene • When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. • If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands. • Plain soap is good at reducing bacterial counts but antimicrobial soap is better, and alcohol-based handrubs are the best.

13. Hand Care is Important • Intact skin is the first line of defense against organisms. • Organisms can enter skin that is cracked or broken. • Frequent washing with soap and water can create dry hands. • If hands are cracked and irritated, contact Employee Health for an assessment and recommendations.

14. Alcohol-Based Handrubs: What Benefits Do They Provide? • Require less time • More effective for standard hand washing than soap • More accessible than sinks • Reduce bacterial counts on hand • Improve skin condition

15. Long Nails and Jewelry Interfere With Effective Hand Hygiene NAILS JEWELRY • Rings increase the number of germs present on hands and increase the risk of tears in gloves. • Eczema often starts under a ring as irritants may be trapped under ring causing irritation. • Arm jewelry interferes with the action of hand hygiene. • Long nails are: • ○difficult to clean • ○can pierce gloves • ○covered with more • germs than short nails • Artificial nails and nail enhancements have been implicated in the transfer of germs.

16. Artificial Nail “Enhancements” • NOT ALLOWED for a direct patient care provider per HR and IP policies (reference CDC guidelines since 2002) • Nail enhancements include: • ○Tips ○Acrylic • ○Wraps ○Gels • ○Overlays/Jewelry ○Nail • ○Fiberglass Schlac • If it doesn’t “grow on its own” it’s an artificial enhancement! • Keep natural nail tips less than ¼ inch in length

17. Gloving • Wear gloves when contact with blood or other potentially infectious materials is possible. • Remove gloves after caring for a patient. • Do not wear the same pair of gloves for the care of more than one patient. • Do not wash gloves. • Hand Hygiene must occur immediately after glove removal. Glove use does not prevent the need for hand cleansing.

18. Take Home Hand Hygiene Facts! • Hand Hygiene is the most effective way to prevent the spread of healthcare associated infections (HAIs). • Hand Hygiene is the most cost-effective measure to prevent the spread of germs. • Wash hands with soap and water for at least 15 seconds and use warm water. • Preferably, if hands are not visibly soiled, use the alcohol based hand sanitizer, as it is more effective than soap and water and better for your skin. • Artificial Nail Enhancements are not allowed if GBMC employee provides patient care. • Gloves do not prevent the need for hand hygiene.