Hand Hygiene Workshop

1. Hand Hygiene Workshop

2. Overview • Hand Hygiene Practices • Activity • Evaluation • Questions

3. Learning Objectives At the end of this course, you will be able to explain: • When and how Hand Hygiene is expected to occur at Jefferson • Different types of thresholds in healthcare at Jefferson • Sequence of donning and doffing personal protective equipment

4. What are some of the challenges at Jefferson? • Infrastructure • Crowding • Availability • Time • Skin quality/integrity • Going “In and out” without touching

5. Why should I care? • Protect your health • Protect your families’ health • Protect our patients • Reduce infections (HAIs) and disease transmission • Better compliance rates at Jefferson

6. Serious about Hand Hygiene (video)

7. Meet Patient A • Patient A has been in the hospital for 8 days, he had heart surgery and is recovering well. Patient A is on enteric precautions for a Clostridium difficile (C.diff) infection. • Teaching Rounds occur at 10am • Nurse Tech Joe knocks and asks Patient A if he may enter. Patient A agrees. The first thing Joe should do before he enters is: • Don gloves • Don their gown • Perform hand hygiene • Put on a mask

8. Meet Patient A • Patient A has been in the hospital for 8 days, he had heart surgery and is recovering well. Patient A is on enteric precautions for C diff. • Vital checks occur before breakfast • Nurse Tech Joe knocks and ask Patient A if he may enter. Patient A agrees. The first thing Joe should do before he enters is: • Don gloves • Don their gown • Perform hand hygiene (soap and water or hand gel upon entry) • Put on a mask

9. Hand Hygiene Indications • Hand Hygiene is expected to occur at the Point of Entry of each patient room/zone • BEFORE and AFTER the threshold is crossed • Examples of Hand Hygiene Opportunities: • Before putting on gloves • After touching a patient’s surroundings/environment • Repeat hand hygiene/replace gloves when transitioning from “dirty” to “clean” activity while engaging in patient care

11. Everyday Hand Hygiene Compliance When to wash • Before, during, and after preparing food • Before eating food • Before and after caring for someone who is sick • Before and after treating a cut or wound • After using the toilet • After changing diapers or cleaning up a child who has used the toilet • After blowing your nose, coughing, or sneezing • After touching an animal, animal feed, or animal waste • After touching garbage

12. Scrub Patterns

14. Which areas are most often missed by health care providers when using alcohol based hand gel? • Thumbs, fingertips, and between fingers • Fingertips, backs of hands, and wrist • Palms, thumbs, and between fingers

15. ANSWER • Which areas are most often missed by health care providers when using alcohol based hand gel? • Thumbs, fingertips, and between fingers • Fingertips, backs of hands, and wrist • Palms, thumbs, and between fingers

16. Hand Hygiene and Glove Use ** and DRY

17. Gloves are NOT a substitute for Hand Hygiene.

18. Sequence for Hand Hygiene when Putting on PPE Perform hand hygiene before donning PPE 2. Don Gown – Must tie at waist. 1. Clean hands 4. Gloves 3. Mask

19. Sequence for Hand Hygiene when Taking off PPE Perform hand hygiene after doffing PPE 4. Clean hands 1. Remove gloves 2. Remove gown (roll tightly to discard in trash) 3. Remove mask

20. Hands Full Guidance - Entering Room Clean hands and don gloves upon entry to patient room/environment 4. Ready for patient or environment encounter 2. Put down equipment 1. Enter room 3. Clean hands and don gloves

21. Hands Full Guidance - Exiting room • Remove a glove before entering soiled utility room to touch key pad, clean hands before leaving soiled utility room • If moving directly to next patient room and nothing has been touched gel out can count as gel in for next crossing of threshold 2. Remove glove when using key pad to enter soiled utility room 3. Place soiled linen in appropriate bin Remove dirty linenfrom room 4. Clean hands

22. What is a Threshold? • A Threshold is the point in which hand hygiene is required when entering a patient environment.

23. Thresholds -Acute Care Floors – Door Sweep Door Across door sweep threshold = Hand hygiene required In door sweep threshold = No hand hygiene required

24. Thresholds – Critical Care Units– Sliding Doors • Stepping both feet over the threshold requires hand hygiene. Both feet past threshold = Hand hygiene required Threshold Outside of doorway = No hand hygiene

25. Thresholds – Procedural Areas/ ED – Privacy Curtain Privacy curtain and curtain track = Threshold Walking through privacy curtain and track threshold = Hand hygiene required Patient zone Hand hygiene in counts as hand hygiene out when crossing a threshold and nothing else is touched. Common area

26. Virtual Thresholds • Patient areas that do not have doors, curtains, or curtain tracks. • Hand hygiene must occur when crossing a virtual threshold into the patient “Zone” Patient Zone Virtual Threshold Common Area Common area

27. Hand hygiene when crossing patient zones Patient Zone Common area Zone boundary

28. Meet Patient B • Patient B (no isolation precautions) is served a meal by the dietary team. The nurse tech is in the room checking the patient’s vitals. The hostess drops the tray off in the patient’s room and exits. The hostess uses hand gel upon exiting. The nurse tech opens Patient’s B’s drink and asks Patient B if there is anything else they need before exiting the room. The patient says no and picks up the turkey sandwich to eat. The tech exits, using hand gel on the way out. • Was there a missed opportunity?

29. Meet Patient B • ANSWER: Patient Hand Hygiene! • A reminder: two Purell hand wipes are placed on every meal tray. Staff should encourage the patient to use hand hygiene before and after each meal via the Purell hand wipes.

30. Patients on Enteric Precautions • Check the door frame for yellow “Enteric” sign • Gloves and Gown are required for entry and are located in the yellow isolation cart or in the isolation closet • Bleach wipes are available for cleaning of re-useable equipment

31. Patients on Enteric Precautions Special Hand Hygiene Requirement Correct sequence • Hand hygiene (soap and water or alcohol hand gel) • Don gloves Patient Care or Interaction • Hand hygiene following removal of PPE • ONLYsoap and water upon exit from patient room

32. What can we do about C.diff? • Hand washing with soap and water every time leave a C.diff room… Improve hand washing compliance • All equipment that goes in and out of patient room wiped down with a PDI bleach wipe (orange top) (ie. Blood pressure monitors, glucometers, wheelchairs, etc) • Education to patient and visitors about importance of hand washing • Daily cleaning of all high touch surfaces and bathrooms • Actively working with EVS to ensure compliance

33. What is the correct contact time for PDI Bleach wipes? • 1 minute • 3 minutes • 4 minutes • Until the surface is dry

34. ANSWER What is the correct contact/wet time for PDI Bleach wipes? • 1 minute • 3 minutes • 4 minutes • Until the surface is dry

35. Patient Care Equipment (eg. BP cuffs, dinamaps…) • Contact/Wet Time – Means how long a piece of equipment MUSTremain wet. Policy #113.65: All patient equipment must be cleaned after each patient.

36. Patient Care Equipment • Sani Cloth (Bleach) disinfection procedure: • Perform hand hygiene and don gloves prior to use of this product. Gown and face protection may be needed depending on use. • If visibly soiled carefully, without splashing disinfectant, dispense a Sani wipe and clean surface to remove soilage and bioburden from the surface cleaned. Then follow step 3. • Carefully dispense a second wipe and thoroughly wet surface to be disinfected; surface must be wet for 4 minutes. Repeated use of the product may be required to ensure the surface remains visibly wet for 4 minutes.** • Remove gloves and any other PPE, dispose of appropriately and perform hand hygiene. • **Note – if an item is NOT visibly soiled then you can skip step #2 and go right to step 3

37. Patient Care Equipment – Contact/Wet Time Bleach = 4 minutes Germicidal = 3 minutes

38. What is the correct process for removing IV pumps after a discharge? • Take the pump off the pole and put it in the dirty utility red bin for SCL/CPD pick up. • Remove the pump, clean it with a sani wipe or bleach wipe and return it to clean utility. • Roll the IV pole containing the pumps out into the hall for pick up. • None of the above

39. ANSWER What is the correct process for removing IV pumps after a discharge? • Take the pump off the pole and put it in the dirty utility red bin for SCL/CPD pick up. • Remove the pump, clean it with a sani wipe or bleach wipe and return it to clean utility. • Roll the IV pole containing the pumps out into the hall for pick up. • None of the above

40. In review • 5 moments for hand hygiene • Different types of thresholds • Sequence of PPE