Hand Hygiene in Health-care Facilities

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

2. Please Complete Your Pre-Test

3. 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

4. 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

5. Lack of Hand Hygiene + Patient Care = Increased Risks Increased risk for: • Hand contamination • Potential risk to patient safety

6. Hand Hygiene in Prevention of HAI’s Hand hygiene is the undisputed single most effective infection control measure in prevention of HAI’s

7. Increased Compliance with Hand Hygiene means … • Reduced numbers of patients acquiring HAI’s • Decreased waste of resources • Saving lives

8. Hand Hygiene right time right way

9. 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

10. 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

11. 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

12. 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

13. Right Time To avoid prolonged hand contamination: Perform hand hygiene when indicated

14. 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

15. Your 5 Moments for Hand Hygiene

16. BEFORE touching a patient Why?

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

18. BEFORE clean/aseptic procedures Why?

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

20. AFTER body fluid exposure risk Why?

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

22. AFTER touching a patient Why?

23. AFTER touching a patient Why? To protect yourself and the health-care environment from harmful patient germs

24. AFTER touching patients surroundings Why?

25. AFTER touching patients surroundings Why? To protect yourself and the health-care environment from harmful patient germs

26. Your 5 Moments for Hand Hygiene Film

27. Right Way To avoid prolonged hand contamination: Use the appropriate technique Use an adequate quantity Use for recommended length of time

28. How to Handwash …

29. How to Handrub …

30. Let’s Practice!!!

31. 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)

32. 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

33. 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

34. 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

35. 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

36. The Glove Pyramid

37. And Now its time for the GLOVE GAME !!!

38. 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

39. 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

40. 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

41. Sample observation tool:

42. Sample Observational Tool

43. Calculating Compliance Rates Total number of times hand hygiene was performed _______________________________________ Total opportunities for hand hygiene X100

44. Sample Observational Tool

45. Calculating Compliance Rates Total number of times hand hygiene was performed (4) _______________________________________ Total opportunities for hand hygiene (6) 4/6 = 0.667 0.667 x 100= 66.7%

46. Other Uses for Observational Tool

47. 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

48. 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

49. 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

50. 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