HAND HYGIENE AND SKINCARE

1. HAND HYGIENE AND SKINCARE A guide to best practice Presenter’s Name Title of Presenter Date

2. Presentation Contents • The importance of hand hygiene • The microbiology of hands • Choice of hand hygiene agents • Hand hygiene techniques • Skin care • Improving hand hygiene

3. The importance of hand hygiene

4. Definition of Healthcare Associated Infection (HCAI) • “An infection occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission. • This includes infections acquired in the health-care facility but appearing after discharge, and also occupational infections among health-care workers of the facility” (1) • Also referred to as “nosocomial” or “hospital” infection (1) World Health Organisation

5. The cost of HCAI • In 2007 approximately 9,000 people died with MRSA bloodstream infections or Clostridium difficile infections as the underlying cause or a contributory factor 1 • Department of Health estimated there were 300,000 HCAIs in 20042 • Between 8 and 9% of patients acquire an infection while in UK health services care 3 • HAIs cost the NHS approx £1 billion per year 4 • The average cost of a single infection is approximately £3,000 4 • On average a patient spends 11 days longer in hospital if they acquire a HAI4 • Department of Health estimates 15-30% of HCAIs are preventable 5 • Office for National Statistics, 2008: Health Statistics Quarterly 39 • House of Commons Committee of Public Accounts – 24th Report 2004-05: Improving patient care by reducing the risks of HAI • Health Protection Agency, 2007, Annual reports and accounts • Plowman et al, 1999, The Socio-economic Burden of Hospital Acquired Infection • Pratt et all, 2001, The epic project phase 1, Guidelines for preventing hospital acquired infections

6. Other impacts of HCAI • More serious illness • Prolonged stay in healthcare facilities • Long-term disability • Death • High additional financial burden • High personal costs on patients and their families

7. The role of handwashing in preventing HCAIs “Hand hygiene is recognised as the single most important procedure in preventing hospital acquired infection” (Reybrouk 1983)

8. The microbiology of hands

9. Types of micro-organisms • Resident skin flora • Transient skin flora

10. Resident skin flora • Have a protective function • Not easily removed by routine hand washing • Can cause infection only when introduced via skin breaks

11. Transient skin flora • Loosely attached to skin surface and easily transferred by direct contact • Easily removed with routine hand hygiene • Most abundant around finger tips • Important source of cross-infection

12. Choice of hand hygiene agents

13. Types of hand hygiene • Routine Hand HygieneTo remove transient micro-organisms • Surgical Hand HygienePrior to surgical or highly invasive procedure, transient micro-organisms need removing and resident flora needs reducing too

14. Overview • Soap and water • Mechanically removes micro-organisms and soil, but does not kill micro-organisms • Removes transient skin flora, but only limited resident flora • Alcohol rubs • Do not mechanically remove micro-organisms or soil, but kill micro-organisms. • Kill transient skin flora, but only limited resident flora • Aqueous antiseptic solutions • Mechanically remove and kill micro-organisms and soil • Remove and kill transient and some resident skin flora

15. Soap and water • Need a sink, water and paper towels • Basic surfactants can irritate skin • Modern soaps minimise irritation

16. Alcohol rubs • Greatest reduction in microbial count of all hand hygiene choices • Water, sink, paper towels are not needed • Alcohol rubs contain emollients to minimise irritation • Use only on pre-cleaned hands

17. Aqueous antiseptic solutions • Remove transient and resident flora • Residual efficacy, so useful for pre-surgical use • Contain emollients to minimise irritation

18. Hand hygiene technique

19. When to perform hand hygiene Before touching a patient Before clean / aseptic procedures After body fluid exposure / risk After touching a patient After touching patient surroundings

20. Hand wash or hand rub? When to handwash: Whenever they are visibly dirty Whenever they are visibily soiled with blood or other body fluids After suspected exposure to potential spore-forming pathogens, including outbreaks of Clostridium difficile After using the toilet If an alcohol-based handrub is not available Use of an alcohol-based handrub is the preferred means for routine hand hygiene, except in the following situations:

21. Preparation of hands prior to hand hygiene • Keep fingernails cleaned and trimmed, and don’t wear nail varnish or artificial nails to work • Remove all jewellery, wrist watches and rings with ridges or stones • Cover cuts and scratches with waterproof dressings • Roll up long sleeves

22. Hand Wash

23. Hand Rub

24. Areas frequently missed Taylor L (1978), An evaluation of handwashing techniques; Nursing Times, 12 January

25. Hand drying Hand drying is an important part of the process as wet hands transfer micro-organisms more readily and skin can become chapped and itchy if left wet on a regular basis. There are 3 methods: Electric hand driers • Used in many public areas • Not recommended for use in clinical areas as they re-circulate air from the surrounding area which may contain micro-organisms Disposable paper towels • Recommended hand drying method in healthcare as they are single use Reusable cloth towels • Not recommended for use in clinical practice as they can become contaminated

26. Skin care

27. The skin and hand hygiene • Soaps and detergents can be some of the most damaging of all substances routinely applied to the skin • Preservatives, fragrances, colourings and surfactants are the worst culprits • Only use wash products that are dermatologically approved

28. The skin and hand hygiene • Frequent handwashing with soap and water often causes skin irritation and dryness • The skin on the hands of some personnel may become so dry and cracked that inflammation occurs • When this occurs, personnel avoid washing or decontaminating their hands because it is painful to do so

29. Prevention of skin damage • Choose hand hygiene products that contain emollients which are kinder to the skin • Do not use simple soaps that contain fragrance or colour • Alcohol rubs are less drying to the hands than soap and water • Moisturise your hands regularly

30. Moisturise • Use a moisturiser to protect hands from the drying effects of regular washing and decontamination • Choose a light, non-greasy formulation • Use at break times and at the end of shifts

31. Improving hand hygiene

32. Factors causing poor hand hygiene compliance Staff cite the following reasons for low compliance: • Heavy workloads • Sinks are poorly located • Skin irritation caused by frequent exposure to soap and water • Hands do not look dirty • Handwashing takes too long • Unaware of risks associated with non-compliance

33. Improving compliance to hand hygiene Factors that improve compliance: • Widely available alcohol-based hand rub • Education, training, observation and feedback • Improved understanding and awareness of the risks of passing on HCAIs via contaminated hands

34. End of presentation • For further information about hand hygiene and skin care best practice, speak to your local Ecolab representative