Hand Hygiene and Glove Use for EMS

1. Hand Hygiene and Glove Use for EMS Centers for Disease Control (CDC) World Health Organization (WHO)

2. Standard and Expanded Isolation Precautions

3. Standard Precautions • Previously called Universal Precautions • Assumes blood and body fluid of ANY patient could be infectious • Recommends PPE and other infection control practices to prevent transmission in any healthcare setting • Decisions about PPE use determined by type of clinical interaction with patient PPE Use in Healthcare Settings

4. PPE for Standard Precautions • Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin • Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated PPE Use in Healthcare Settings

5. PPE for Standard Precautions • Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions PPE Use in Healthcare Settings

6. Drawing blood? • Cleaning an incontinent patient with diarrhea? • Irrigating a wound? • Taking vital signs? • Giving a bed bath? • Suctioning oral secretions? • Transporting a patient on a stretcher? • Responding to an emergency where blood is spurting? What Type of PPE Would You Wear? PPE Use in Healthcare Settings

7. Giving a bed bath? • Generally none • Suctioning oral secretions? • Gloves and mask/goggles or a face shield – sometimes gown • Transporting a patient on a stretcher? • Generally none required • Responding to an emergency where blood is spurting? • Gloves, fluid-resistant gown, mask/goggles or a face shield • Drawing blood? • Gloves • Cleaning an incontinent patient with diarrhea? • Gloves w/wo gown • Irrigating a wound? • Gloves, gown, mask/goggles or a face shield • Taking vital signs? • Generally none What Type of PPE Would You Wear?

8. Gloves

9. Ignaz Semmelweis, 1815-1865 • 1840’s: General Hospital of Vienna • Divided into two clinics, alternating admissions every 24 hours: • First Clinic: Doctors and medical students • Second Clinic: Midwives

10. The Intervention:Hand scrub with chlorinated lime solution Hand hygiene basin at the Lying-In Women’s Hospital in Vienna, 1847.

11. Semmelweis’ Hand Hygiene Intervention Hand Hygiene: Not a New Concept ~ Hand antisepsis reduces the frequency of patient infections ~ Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

12. Colonized or Infected:What is the Difference? • People who carry bacteria without evidence of infection (fever, increased white blood cell count) are colonized • If an infection develops, it is usually from bacteria that colonize patients • Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers ~ Bacteria can be transmitted even if the patient is not infected ~

13. Infected Colonized The Iceberg Effect

14. Hand transmission • Hands are the most common vehicle to transmit health care-associated pathogens • Transmission of health care-associated pathogens from one patient to another via health-care workers’ hands requires 5 sequential steps

15. 5 stages of hand transmission one two three four five Germs present on patient skin and immediate environment surfaces Germ transferonto health-care worker’s hands Germs survive on hands for several minutes Suboptimal or omitted hand cleansing results in hands remaining contaminated Contaminated hands transmit germs via direct contact with patient or patient’s immediate environment

16. Why should you clean your hands? • Any health-care worker, caregiver or person involved in patient care needs to be concerned about hand hygiene • Therefore hand hygiene concerns you! • You must perform hand hygiene to: • protect the patient against harmful germs carried on your hands or present on his/her own skin • protect yourself and the health-care environment from harmful germs

17. The “My 5 Moments for Hand Hygiene” approach

18. How to clean your hands • Handrubbing with alcohol-based handrub is the preferred routine method of hand hygiene if handsare not visibly soiled • Handwashing with soap and water – essential when when hands are visibly dirty or visibly soiled (following visible exposure to body fluids)1 • DO NOT use antimicrobial hand soaps – these disrupt normal skin flora, increasing susceptibility to infection. 1 If exposure to spore forming organisms e.g. Clostridium difficile is strongly suspected or proven, including during outbreaks – clean hands using soap and water

19. How to handrub To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps. This takes only 20–30 seconds!

20. How to handwash To effectively reduce the growth of germs on hands, handwashing must last 40–60 secs and should be performed by following all of the illustrated steps

21. Hand hygiene and glove use • The use of gloves does not replace the need to clean your hands! • You should remove gloves to perform hand hygiene, when an indication occurs while wearing gloves • You should wear gloves only when indicated – otherwise they become a major risk for germ transmission

22. The impact of HCAI • HCAI can cause: • more serious illness • prolongation of stay in a health-care facility • long-term disability • excess deaths • high additional financial burden • high personal costs on patients and their families

23. Most frequent sites of infection and their risk factors URINARY TRACT INFECTIONS Urinary catheter Urinary invasive procedures Advanced age Severe underlying disease Urolitiasis Pregnancy Diabetes 34% 13% LOWER RESPIRATORY TRACT INFECTIONS Mechanical ventilation Aspiration Nasogastric tube Central nervous system depressants Antibiotics and anti-acids Prolonged health-care facilities stay Malnutrition Advanced age Surgery Immunodeficiency LACK OF HAND HYGIENE Most common sites of health care-associated infection and the risk factors underlying the occurrence of infections SURGICAL SITE INFECTIONS Inadequate antibiotic prophylaxis Incorrect surgical skin preparation Inappropriate wound care Surgical intervention duration Type of wound Poor surgical asepsis Diabetes Nutritional state Immunodeficiency Lack of training and supervision BLOOD INFECTIONS Vascular catheter Neonatal age Critical careSevere underlying disease Neutropenia Immunodeficiency New invasive technologies Lack of training and supervision 17% 14%

24. Recovery of VRE from Hands and Environmental Surfaces • Up to 41% of healthcare worker’s hands sampled (after patient care and before hand hygiene) were positive for VRE1 • VRE were recovered from a number of environmental surfaces in patient rooms • VRE survived on a countertop for up to 7 days2 1 Hayden MK, Clin Infect Diseases 2000;31:1058-1065. 2 Noskin G, Infect Control and Hosp Epidemi 1995;16:577-581.

25. The Inanimate Environment Can Facilitate Transmission Xrepresents VRE culture positive sites ~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

26. What is the single most important reason for EMS workers to practice good hand hygiene? • To remove visible soiling from hands • To prevent transfer of bacteria from the home to the ambulance • To prevent transfer of bacteria from the ambulance to the home • To prevent infections that patients acquire in the ambulance

27. What is the single most important reason for EMS workers to practice good hand hygiene? • To remove visible soiling from hands • To prevent transfer of bacteria from the home to the ambulance • To prevent transfer of bacteria from the ambulance to the home • To prevent infections that patients and EMS staff acquire in the ambulance

28. How often do you clean your hands after touching a PATIENT’S INTACT SKIN (for example, when measuring a pulse or blood pressure)? • Always • Often • Sometimes • Never

29. How often do you clean your hands after touching a PATIENT’S INTACT SKIN (for example, when measuring a pulse or blood pressure)? • Always • Often • Sometimes • Never

30. Estimate how often YOU clean your hands after touching a patient or a contaminated surface in the ambulance? • 25% • 50% • 75% • 90% • 100%

31. Which method do you use to clean your hands at work? • Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub

32. Which hand hygiene method is best at killing bacteria? • Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub

33. Which hand hygiene method is best at killing bacteria? • Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub At least 60% alcohol concentration

34. Which of the following hand hygiene agents is LEAST drying to your skin? • Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub

35. Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub Which of the following hand hygiene agents is LEAST drying to your skin?

36. How often do you clean your hands after touching an ENVIRONMENTAL SURFACE near a patient (for example, a clipboard or radio)? • Always • Often • Sometimes • Never

37. Always • Often • Sometimes • Never How often do you clean your hands after touching an ENVIRONMENTAL SURFACE near a patient (for example, a clipboard or radio)?

38. Use of artificial nails by healthcare workers poses no risk to patients. • Strongly agree • Agree • Don’t know • Disagree • Strongly disagree

39. Use of artificial nails by healthcare workers poses no risk to patients. • Strongly agree • Agree • Don’t know • Disagree • Strongly disagree

40. Can a Fashion Statement Harm the Patient? Avoid wearing artificial nails, keep natural nails <1/4 inch if caring for high risk patients (ICU, OR, EMS) ARTIFICIAL POLISHED NATURAL Edel et. al, Nursing Research 1998: 47;54-59

41. When do you need gloves? • Whenever risk for exposure to bloodborne pathogens exists

42. Definition of Bloodborne Pathogens • Bloodborne pathogens are disease-causing microorganisms such as bacteria and viruses found in: • Blood • Body fluids containing blood

43. Definition of Blood • The term “blood” applies to: • Human blood • Components of human blood • Any product containing human blood

44. OPIM • Other potentially infectious materials (OPIM) include fluids such as those found: • In the joints • Around the heart • In the abdomen • In the chest cavity • Cerebrospinal fluid • Amniotic fluid • Any fluid or unfixed tissues containing gross visible blood

45. No-Risk Fluids • As long as there are NO visible signs of blood, no-risk fluids include: • Sweat • Tears • Saliva • Urine • Vomit • Sputum

46. Definition of an Exposure • An exposure occurs when a pathogen makes direct or indirect contact with: • Mucous membranes • Non-intact skin

47. Minimize the Risk • The best way to minimize the risk of contracting a bloodborne pathogen is to treat ALL body fluids as if they are infectious.

48. Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms. • Strongly agree • Agree • Don’t know • Disagree • Strongly disagree

49. Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms. • Strongly agree • Agree • Don’t know • Disagree • Strongly disagree

50. The Glove Problem Wilson J, Lynam S, Singleton J, Loveday H. The misuse of clinical gloves: risk of cross-infection and factors influencing the decision of health care workers to wear gloves. Antimircob Resis Infect Contr. 2013; 2(Suppl 1):03