Standard Infection Control Precautions HAND HYGIENE

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Standard Infection Control PrecautionsHAND
HYGIENE
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Session outcomes

• By the end of this training
• staff will be able to identify
• the risks associated with not carrying out hand
  hygiene
• why people choose not to carry out hand hygiene
• the when, why and how of hand hygiene

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Why hand hygiene is so important

• Good hand hygiene is one of the single most
  effective measures for reducing the spread of
  infection

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Why hand hygiene is so important

• Hands move micro-organisms from one place to
  another
• By social hand hygiene, we remove transient
  micro-organisms acquired by recent contact with
  patients/clients, or with the environment
• Hand hygiene protects patients/clients, staff,
  people and children receiving care, and visitors

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Why people dont perform hand hygiene

• Many people providing care
• do not fully understand the risks
• associated with not performing hand hygiene

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Why people dont perform hand hygiene

• There are many reasons why staff
• do not perform hand hygiene
• Low staffing levels, and other practical issues,
  contribute to poor hand hygiene, for example
• inadequate sinks
• no soap or hand towels
• poor water temperature control
• Different people respond to different motivators
• identify what works best for individuals

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What lives on our hands?

• Transient micro-organisms acquired by
  contactthese micro-organisms survive on the skin
  for less than 25 hours and can be removed by
  social hand hygiene
• Resident micro-organisms part of normal skin
  flora these micro-organisms survive and multiply
  on the skin, they rarely cause infections except
  when introduced into the body through invasive
  procedures

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When to perform hand hygiene

• All staff should conduct a local risk assessment
  related to all the elements included within hand
  hygiene
• Lets look at
• when
• why
• how

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When to perform social hand hygiene

• All staff should understand how to assess the
  level of hand hygiene required
• level 1 social hand hygiene

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When to perform hygienic hand hygiene

• All staff should understand how to assess the
  level of hand hygiene required
• level 2 hygienic hand hygiene

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When to perform surgical scrub

• All staff should understand how to assess the
  level of hand hygiene required
• level 3 surgical scrub

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When to perform hand hygiene

• Other important considerations
• Even if gloves have been worn, hand hygiene is
  still necessary
• Hand hygiene may need to be performed between
  tasks on the same patient/client

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LEVEL 1 - social hand hygiene

• Why?
• to keep the hands physically clean and to remove
  transient micro-organisms acquired during
  procedures that are considered to be social
  activities

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LEVEL 2 - hygienic hand hygiene

• Why?
• to remove or destroy transient micro-organisms
  and to provide residual effect during times when
  hygiene is particularly important in protecting
  staff and others

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LEVEL 3 - surgical scrub

• Why?
• to substantially reduce resident micro-organisms
  and remove or destroy transient micro-organisms
  during times when surgical or invasive procedures
  are undertaken

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Choice of cleansing agents

• question 1Have you conducted a risk assessment
  to decide the best method of hand hygiene?
• question 2 Do you have any history of certain
  products causing an adverse skin reaction?
• question 3
• Do you have access to the right hand hygiene
  facilities?

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Soap and water

• Hand hygiene with soap and water is sufficient
  for most routine daily activities
• How?
• Soap suspends easily removable micro-organisms
  allowing them to be washed off
• This mechanical removal of micro-organisms makes
  hands socially clean
• If there are no/inadequate facilities for
  handwashing with soap and warm running water,
  then use alcohol hand gels/rubs
• It takes at least 15 seconds to perform effective
  social hand hygiene using the how to wash hands
  technique

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Alcohol-based preparations

• Alcohol-based preparations offer a solution when
  time and facilities are restricted
• How?
• Ideal for rapid hand hygiene on visibly clean
  hands
• Require no facilities
• The technique for alcohol-based preparations is
  the same as for hand hygiene
• Concentrations of 70 are used as they have a
  less drying effect than alcohol-based
  preparations of higher concentrations
• Not a cleansing agent, so visible contaminates
  still need removing with soap and water
• Takes 15 to 30 seconds to perform

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Aqueous antiseptic solutions

• Hygienic hand hygiene removes and destroys
  transient and resident micro-organisms
• How?
• Aqueous antiseptic solutions both reduce resident
  micro-organisms and remove/destroy transient
  micro-organisms
• This chemical removal of micro-organisms prepares
  hands for surgical/invasive procedures
• Antiseptics may also be used during an outbreak
  situation, before aseptic procedures, or
  following contact with blood/body fluids

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Standard Infection Control PrecautionsHAND
HYGIENE

• group activity

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Hand hygiene technique

• Effective hand hygiene technique involves 3
  stages 1 preparation
• 2 procedure
• 3 drying

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Hand hygiene technique

• Stage 1 preparation
• Keep nails short
• Remove wrist watches, jewellery and other items
• Then wet hands under warm running water before
  applying soap

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Hand hygiene technique

• Stage 2 procedure
• Turn the tap on and check the temperature of the
  water
• Hands should be wet before applying the chosen
  solution
• Follow the manufacturers instructions for the
  amount of solution to use (usually about 5ml)
• Ensure all surfaces of the hands are covered
• Then rinse thoroughly under warm running water
• Turn taps off using a hands-free technique

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Hand hygiene technique

• Stage 3 drying
• Make sure hands are completely dry
• Hand drying is a critical factor in the hand
  hygiene process

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Hand hygiene with soap and water

• Definition of handwashing the vigorous, brief
  rubbing together of all surfaces of lathered
  hands, followed by rinsing under running water
  (Garner and Favero 1985)
• Rub hands together vigorously for at least 15
  seconds in total
• Pay particular attention to tips of fingers,
  thumbs and areas between the fingers

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Hand drying

• Micro-organisms transfer most effectively from
  wet surfaces so always dry hands thoroughly
• Use good quality paper disposable hand towels
• Cloth towels can become a source of infection
• Warm air dryers have the potential to spread
  airborne pathogens

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Alcohol hand hygiene technique

• Routine hand hygiene with alcohol products
  involves 2 stages preparation, rubbing
• Rub hands together vigorously for around 15 to 30
  seconds
• Use the manufacturers recommended amount about
  3ml
• Cover all surfaces until the hands are dry
• Choose an alcohol rub when hands are free from
  dirt and organic material

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Skin care

• For staff, frequent hand hygiene can cause
  long-term changes in the skin
• Minimise the risk of skin damage by following
  guidance
• Report any skin irritation or abnormality
  immediately to your Occupational Health
  Department / General Practitioner
• Apply hand cream regularly to protect the skin
  from dryness
• Avoid use of communal jars of hand cream as these
  can become contaminated

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Improving compliance

• For both staff and patients/clients education
  leads to change
• Responsibilities
• all health and social care staff should know and
  comply to a hand hygiene policy
• use the model hand hygiene policy and procedure

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Improving compliance

• For both staff and patients/clients education
  leads to change
• Good practice
• all staff should assess the level of hand hygiene
  required depending upon the procedure being
  undertaken
• all the steps advised in the process of hand
  hygiene should be followed
• Patients/clients, visitors and relatives should
  be encouraged to follow hand hygiene procedures
  when in healthcare settings

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Improving compliance

• For both staff and patients/clients education
  leads to change
• Reporting
• where there are incidents of non-compliance to
  hand hygiene policy, or problems with
  supplies/facilities, these should be reported
  through local reporting procedures

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Further sources and resources

• recommended web sites
• www.hps.scot.nhs.uk/haiic/ic/modelinfectioncontrol
  policies.aspx
• www.hopisafe.ch
• www.med.upenn.edu/mcguckin/handwashing
• www.handhygiene.co.uk
• www.cdc.gov/handhygiene
• www.handhygiene.org/educational_aids.asp
• www.hpa.org.uk/infections/topics_az/hai/guidelines
  .htm
• www.healthcareA2Z.org

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Further reading and references

• Ansari SA, Springthorpe VS, Sattar SA (1991)
  Comparison of cloth, paper and warm air drying in
  eliminating viruses and bacteria from washed
  hands. American Journal of Infection Control, 19
  243 - 249
• Ayliffe GAJ (1992) Efficacy of handwashing and
  skin disinfection. Current Opinion in Infectious
  Diseases, 5, 4 542 546
• Ayliffe GAJ, Fraise AP, Geddes AM, Mitchell K
  (2000) Control of Hospital Infection. A Practical
  Handbook. 4th edition, Arnold, London
• Ayliffe GAJ, Babb JR, Quoraishi AH (1978) A test
  for hygienic hand disinfection. Journal of
  Clinical Pathology 31 923
• Boyce JM, Pittet D (2002) Guideline for hand
  hygiene in healthcare settings. Recommendations
  of the Healthcare Infection Control Practitioners
  Advisory Committee and the ICPAC / SHEA / APIC /
  IDSA Hand Hygiene Task Force. MMWR, 51 (RR16) 1
  44
• Coia JE, Duckworth GJ, Edwards DI et al (2006)
  Guidelines for the control and prevention of
  methicillin-resistant Staphylococcus aureus
  (MRSA) in healthcare facilities. Journal of
  Hospital Infection 635(Suppl 1) S1S44
• Foca M, Jakob K, Whittier S et al (2000) Endemic
  Pseudomonas aeruginosa infection in a neonatal
  intensive care unit. New England Journal of
  Medicine Sep 7 343 (10) 695 - 700
• Garner JS, Favero MS (1985) CDC Guidelines for
  handwashing and hospital environmental control.
  US Department of Health and Human Services,
  Public Health Service, Atlanta, Georgia, USA
• Gould D (1997) Giving infection control a big
  hand. Community Nursing Notes, 15 (1) 3 6
• Gould D, Ream E (1994) Nurses views of infection
  control an interview study. Journal of Advanced
  Nursing 19 1121 - 1131

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Further reading and references

• Hoffman PN, Cooke EM, McCarville MR, Emmerson AM
  (1985) Micro-organisms isolated from skin under
  wedding rings worn by hospital staff. British
  Medical Journal, 290 206 207
• Hoffman P, Wilson J (1995) Hands, hygiene and
  hospital. PHLS Microbiology Digest, 11, 4 211 -
  216
• Jacobson G, Thiele JE, McCune JH, Farrell LD
  (1985) Handwashing ring-wearing and number of
  micro-organisms. Nurse Researcher, 34 186 - 188
• Kerr J (1998) Handwashing. Nursing Standard, 12,
  51 35 42
• Kesavan S, Barodawala S, Mulley GP (1998) Now
  wash your hands? A survey of hospital handwashing
  facilities. Journal of Hospital Infection, 40, 4
  291 293
• Larson EL (1995) APIC guideline for handwashing
  and hand antisepsis in health care settings.
  American Journal of Infection Control, 23, 4, 251
  - 269
• Larsen EL, Killien M (1982) Factors influencing
  handwashing behaviour of patient care personnel.
  American Journal of Infection Control, 10 93
  99
• McGinley KJ, Larson EL, Leyden JJ (1988)
  Composition and density of microflora in the
  subungual space of the hand. Journal of Clinical
  Microbiology, 26 950 3
• Model Infection Control Policies (Hand Hygiene)
  Health Protection Scotland, Infection Control
  Team, 2006

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Further reading and references

• Passaro DJ, Waring L, Armstrong R et al (1997)
  Post operative Serratia marcescens wound
  infection traced to an out-of-hospital source.
  Journal of Infectious Diseases Apr 175 (4) 992
  - 995
• Pittet D, Dharan S, Touveneau S et al (1999)
  Bacterial contamination of the hands of hospital
  staff during routine patient care. Archives
  Internal Medicine, 159 821 - 826
• Pittet D, Boyce JM (2001) Hand hygiene and
  patient care pursuing the Semmelweis legacy. The
  Lancet Infectious Diseases, April, 1 9 19
• Pottinger J, Burns S, Manske C (1989) Bacterial
  carriage by artificial versus natural nails.
  American Journal of Infection Control, 17 340 -
  344
• Pratt RJ, Pellowe C, Loveday HP et al (2001)
  Standard principles for preventing
  hospital-acquired infections. Journal of Hospital
  Infection, 47 (supplement) 531 - 537
• Recommendations of the Healthcare Infection
  Control Practitioners Advisory Committee and the
  ICPAC / SHEA / APIC / IDSA Hand Hygiene Task
  Force. MMWR, 51 (RR16) 1 - 44
• Redway K, Knights B, Bozoky Z et al (1994) Hand
  Drying a study of bacterial types associated
  with different hand drying methods and with
  hot-air dryers. London University of Westminster
• Rotter ML, Simpson RA, Koller W (1998) Surgical
  hand disinfection with alcohols at various
  concentrations parallel experiments using the
  new proposed European Standards method. Infection
  Control in Hospital Epidemiology, 19 778 - 781
• Ward D (2000) Handwashing facilities in the
  clinical area. British Journal of Nursing, 9, 2
  82 86
• Wilson J (2001) Infection control in clinical
  practice. 2nd Edition, Bailliere Tindall,
  Edinburgh

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Standard Infection Control PrecautionsHAND
HYGIENE

• test your hand hygiene knowledge

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Summary

• Three things to take away
• Hand hygiene is one of the single most effective
  measures for reducing the spread of infection.
• Hand hygiene protects patients/clients and staff.
• Its easy and everyone can do it.

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