Hand Hygiene

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Hand Hygiene

• An Educational Module
• written by Tricia Just, RN, MSN, CIC
• Bowling Green University

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Now About Skin..

• Everyones intact skin has normal bacteria on it
  called normal flora
• Our intact skin is a fabulous barrier
  protecting us from this bacteria invading our
  body
• If the normal bacteria can invade, they are then
  a pathogen, causing an infection

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Vocabulary To Remember

• Normal Flora bacteria that reside on our skin,
  and throughout our bodies
• Pathogen a germ capable of causing an infection
• HCW healthcare worker. RNs, LPNs, nursing
  assistants, physicians everyone who provides
  care to a patient.

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• Everyone also has small flecks of skin that are
  shed daily that may contain these potential skin
  pathogens. These can be found on the patients
  gown, linen, bedside table, and other items in
  the room.
• Touching a patient to check their pulse,
  straightening sheets, or even checking a water
  pitcher can create an opportunity for the
  patients pathogens to spread to the healthcare
  workers hands.

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Then What?

• If the healthcare worker (HCW) goes to the next
  patients room without cleaning their hands or
  not doing a good job of cleaning their hands an
  infection may be spread to a sick patient with
  altered immunity.

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Resistant Bacteria

• Over many years, bacteria have learned to resist
  treatment and invade tissues.
• Spread of these bacteria can be serious.

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Some Resistant Organisms

• Methicillin Resistant Staphylococcus Aureus
  (MRSA)
• Penicillin Resistant Pneumococcus (PRP)
• Methicillin Resistant Coagulase Negative
  Staphylococcus (MRCONS)
• Vancomycin Resistant Enterococcus (VRE)
• Vancomycin Resistant, Methicillin Resistant
  Staphylococcus Aureus (VRMRSA)
• Acinetobacter and Citrobacter
• Stenotrophomonus Maltophilia
• Enterobacter and Serratia

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Yuck! Whats a HCW to Do?

• The CDC has written guidelines that spell out
  actions to take to stop the spread of infection
  from one person to another by hand contact.

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• Good hand cleaning (or hand hygiene) greatly
  reduces the chance of spreading pathogens from
  patient to patient as well as to the HCW and
  their families.
• Healthcare-related infections have been shown to
  be lower after the use of germicidal or
  antibacterial soap and water washing OR with the
  use of waterless alcohol products versus after
  plain soap and water washing.

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How Do I Know Which Cleanser To Use?

• Alcohol cleansers are not to be used when hands
  are visibly dirty or contaminated with body
  fluids.
• Rubbing and lathering of hands
• running water rinse
• friction of drying hands on paper towel
• Removes more visible soil or body fluids than
  alcohol

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More About Cleansers?

• Alcohol cleansers that have 60 or more alcohol
  in them
• quickly kill organisms on the skin
• help keep bacteria from re-growing on the skin

• Skin care products are added to the alcohol rubs
  to help keep the alcohol from drying the skin.
• Usually this means that HCWs can use the alcohol
  rub with less skin problems than with soap and
  water washing.

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What About Irritated Skin?

• Many HCWs have found their hands tend to stay in
  better shape when less rubbing of hands with
  soap, water, and paper towels is happening.

• Sothose who have problems usually have some
  healing after a long weekend or other period of
  time off.
• Upon return to work, use an alcohol cleanser
  except in certain circumstances.

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What Certain Circumstances?

• HCWs should always use antibacterial or
  germicidal soap and water for hand hygiene when
• Hands are visibly dirty
• Hands have body fluid on them
• Before eating
• After using the restroom

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What About Hand Lotion?

• Hand lotions that are provided by the hospital
  are meant to work with our soaps and alcohol rub
  products
• Use only the products provided by the hospital
  other products may make small holes in latex
  gloves or make your soap ineffective

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Isnt Alcohol Flammable?

• Yes!
• Hands have to be rubbed dry when the alcohol
  product is used.
• Rubbing your hands dry is not only for safety
  in order for the germs to be killed, the alcohol
  must be evaporated from the hands.

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Is That Really All?

• The containers of alcohol hand foam need to be
  stored away from high temperatures
• Europe has used alcohol based products for years
  with hardly any problems

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Are There Other Special Circumstances?

• Yes!
• Sometimes we have patients with diarrhea caused
  by a a specific bacteria C. difficile
  (Clostridium difficile).
• This type of bacteria is known as a spore-forming
  bacteria.
• Neither germicidal, antibacterial soap, nor
  alcohol cleansers kill the spore-forming
  bacteria.
• BUTit is believed that the rubbing and friction
  associated with soap and water cleansing and
  drying with paper towels does more to rid hands
  of these bacteria than the waterless cleansers.

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A Word of Warning

• C. difficile has been shown to live for a long
  time in the environment.
• So, even care that seems low-risk, like touching
  the bedrail, bedside table, and bedding, can lead
  to the organism getting on the HCW hands.
• C. difficile is a perfect example of why hands
  must always be washed after even a simple
  touching of any patient and/or items in the
  patient environment.

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And Now a Word About Nails.

• Studies show that high numbers of bacteria and
  yeast exist under the fingernails.
• These germs continue to be present even after
  careful handwashing.

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• Freshly applied fingernail polish does not lead
  to increased numbers of bacteria.
• BUTchipped polish may provide space for the
  pathogens to get between the polish and the
  fingernail.
• Disease outbreaks have been traced to HCWs
  wearing artificial nails and to HCWs who have
  long natural nails.
• Studies have shown that more bacteria and yeast
  live on artificial nails than on natural nails,
  in spite of good handwashing.

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Policy

• Employees who work in positions that provide
  direct patient care or who work in Food Services
  cannot
• Wear artificial fingernails, acrylic overlays,
  nail tips or nail extenders.
• and
• Natural nail tips are to be less than one-fourth
  of an inch long.

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Major Points To Remember

• When hands are visibly dirty or contaminated with
  body substances or are soiled with blood or other
  body fluids, wash with soap and water.

• If hands are not visibly soiled, use an
  alcohol-based cleanser.
• Apply product to palm of one hand, and rub hands
  together, covering all surfaces of hands and
  fingers until dry.

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Remember When to Clean Your Hands..

• Before and after having direct contact with
  patients
• Before and after performing procedures on
  patients even when gloves are worn.

• After touching items such as medical equipment,
  bed rails, tables, etc. in a patients room.
• Cleanse your hands whenever you take gloves off.

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When to use soap and water?

• Whenever youve been in the room of a patient
  with C. difficile whether you touch the patient
  or not!
• Before eating
• After using the restroom
• Whenever your hands are visibly soiled or
  contaminated

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Handwashing 101

• Step 1 Wet hands with warm water
• Step 2 Use about 1 teaspoon of soap
• Step 3 Rub hands briskly for about 15 seconds
  (the time it takes to sing the alphabet twice!)
• Step 3 ½ Be sure to rub all areas, including
  between the fingers and the backs of the hands
• Step 4 Rinse under warm running water
• Step 5 Dry completely
• Step 6 Use the paper towel to turn off the
  faucet

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Did You Know

• Using hot water to wash your hands can increase
  skin irritation?
• Warm water will
• do the job!

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If You Provide Direct Patient Care or Work in
Food Services

• Do not wear artificial nails, nail extenders,
  nail tips, or acrylic overlays.

• Natural fingernails should not be longer than ¼
  inch.
• If fingernail polish is chipped .
• Remove it before coming to work.
• Re-apply a fresh coat to repair it.

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And a Final Word on Gloves

• Wear gloves when contact with body fluids or
  non-intact skin is expected.
• Change gloves during patient care if moving from
  a contaminated body site to a clean site.
• Never wear gloves from a patient room to another
  work area.

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How About Hand Hygiene at Home?

• Plain soap and water are all that is needed for
  hand cleaning.
• Antibacterial products are not necessary at home.

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Thats It!

• Complete the following brief post-test and youll
  demonstrate your competency about hand hygiene.
• All of our patients and you as the healthcare
  worker will benefit!