MODULE 2 Hand Hygiene

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MODULE 2 Hand Hygiene
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Hand HygieneIs Key to Keeping Kidney Patients
Safe
MODULE 2 Hand Hygiene
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Hand Hygiene
MODULE 2 Hand Hygiene

• Hand hygiene practices - the use of
  alcohol-based hand rubs or use of soap and water
  before and after patient contact, removal of
  gloves and contact with the immediate patient
  care environment - protect both healthcare
  personnel and patients from contact with
  infectious agents.
• Proper hand hygiene breaks the chain of
  infection transmission and minimizes micro
  organisms acquired by contact with infected
  surfaces.

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Facts About Hand Hygiene
MODULE 2 Hand Hygiene

• Hemodialysis patients tend to be among the first
  to experience antibiotic-resistant pathogens.
• Improved adherence to hand hygiene has been shown
  to reduce transmission of antimicrobial resistant
  organisms (e.g. methicillin resistant
  staphylococcus aureus) and reduce overall
  infection rates.
• 11 of patients report seeing nurses or
  technicians who fail to wash hands or change
  gloves before touching a patients access or
  change gloves before touching their access site.
• 27 of professionals reported observing staff
  fail to wash hands or change gloves before
  touching a patients access.
• Gloves reduce hand contamination by 70-80,
  prevent cross-contamination and protect patients
  and health care personnel from infection.
• The use of gloves does not eliminate the need for
  hand hygiene.

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Hand Hygiene Best Practices
MODULE 2 Hand Hygiene

• Immediately before touching a patient, performing
  an invasive procedure, or manipulating an
  invasive device.
• Immediately after touching a patient,
  contaminated items or surfaces, or removing
  gloves.
• Before putting on gloves.
• After removing gloves.
• After touching items or surfaces in the immediate
  patient care environment regardless of patient
  contact.
• When using an alcohol-based hand rub, apply
  product to palm of one hand and rub hands
  together, covering all surfaces of hands and
  fingers, until hands are dry.
• When hands are visibly soiled, wash hands with
  soap and water. Rub hands together for at least
  15 seconds, covering all surfaces, focusing on
  fingertips and fingernails.

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Handle of Cupboard in HD ClinicBlood Stains with
Luminol
MODULE 2 Hand Hygiene

Luminol is used to detect trace amounts of blood
as it reacts with iron found in hemoglobin.
Bergervoit PWM et al, Application of the
forensic Luminol for blood in infection control,
J Hosp Infection (2008), 68, 329-333.
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Control Panel of HD MachineBlood Stains with
Luminol
MODULE 2 Hand Hygiene

Luminol is used to detect trace amounts of blood
as it reacts with iron found in hemoglobin.
Bergervoit PWM et al, Application of the
forensic Luminol for blood in infection control,
J Hosp Infection (2008), 68, 329-333.
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Factors Contributing to Poor Hand Hygiene
MODULE 2 Hand Hygiene

• Inconvenient sink location 
• Cleaning hands causes skin irritation and dryness
     
• Lack of soap or hand rub    
• Too busy/lack of time    
• Insufficient knowledge about risks of not
  practicing hand hygiene

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Why Use Alcohol-Based Hand Rubs?
MODULE 2 Hand Hygiene

• Alcohol-based hand rubs kill most microbes more
  effectively and more quickly than hand washing
  with soap and water.
• Less damaging to skin than soap and water,
  resulting in less dryness and irritation.
• Require less time than hand washing with soap and
  water. In an eight-hour shift, an estimated one
  hour of an ICU nurse's time will be saved by
  using an alcohol-based hand rub.
• Bottles/dispensers can be placed at the point of
  care so they are more accessible.
• Alcohol rubs cannot be used when hands are
  visibly soiled or have been exposed to
  Clostridium difficile.

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How to Use Hand Rubs
MODULE 2 Hand Hygiene

• Apply 1.5 to 3ml hand rub to palm of one hand
  and rub hands together, covering all surfaces of
  hands and fingers, until hands are dry.
• If you have applied a sufficient amount of hand
  rub, it should take at least 10-15 seconds of
  rubbing until hands feel dry.

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When to use soap and water
MODULE 2 Hand Hygiene

• When hands are visibly dirty or contaminated with
  proteinaceous materials.
• When taking care of a patient with known or
  suspected Clostridium difficile (C diff.)
  diarrhea (the C diff. spores are not killed by
  alcohol)
• When alcohol rubs are not available.

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How to use soap and water
MODULE 2 Hand Hygiene

• Wet hands with running water.
• Rub hands together with soap and lather, covering
  all surfaces
• Weave fingers and thumbs together, and vigorously
  rub all surfaces of lathered hands for 15
  seconds. Wash under and around rings, cuticles
  and under fingernails.
• Rinse hands under a stream of clean, running
  water until all soap is gone. Remember to point
  fingers down so water and contaminants wont drip
  towards elbows.
• Pat hands dry, beginning at the wrist and moving
  down.
• Turn off water, using a paper towel.

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What About Hand Lotions?
MODULE 2 Hand Hygiene

• Hand lotions are important to prevent skin
  dryness and irritation. Use only
  hospital-approved hand lotions. Other lotions
  may
• make hand hygiene less effective
• cause breakdown of latex gloves
• become contaminated with bacteria if dispensers
  are refilled

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When to Wear Gloves

• Always, when caring for a patient
• When touching any machine, equipment, bloodlines,
  or medical device
• When to CHANGE gloves
• Whenever dirty
• When moving from contaminated areas to clean
  areas
• When moving between patients

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Developing Policies and Procedures
MODULE 2 Hand Hygiene

• Review current policies and procedures to ensure
  they meet current recommendations for hand
  hygiene.
• Review CMS Conditions for Coverage for ESRD
  Facilities
• Consider using a process analysis fishbone to
  examine policies and procedures
• Review examples of Quality Improvement Projects
  (QIPs) and develop QIPS appropriate for your
  facility.

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CMS Conditions for Coverage for ESRD Facilities -
ESRD Program Interpretive Guidance Version 1.1
MODULE 2 Hand Hygiene

• Interpretive guidelines that address hand hygiene
  include
• V113 Glove requirements
• Requires gloves when caring for a patient or
  touching the patients equipment. Must perform
  hand hygiene after removal of gloves between
  each patient or station.
• V114 Sufficiency of sinks to facilitate hand
  hygiene
• V132 Infection Control Training Education
• Requires training and education for both new
  existing staff members
• V147 Education training for care of IV
  catheters
• V142 Biohazard infection control policies
  activities
• V625 Quality assessment and performance
  improvement (QAPI)
• Requires performance measures
• V637 Infection Control

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Process Analysis Fishbone
MODULE 2 Hand Hygiene

• A process analysis fishbone is a diagrammatic way
  to examine the policies, procedures, people, and
  equipment involved in a process leading to an
  outcome.
• Providers may use the process analysis to develop
  Quality Improvement Projects (QIPs)

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MODEL HANDWASHINGPOLICIES AND PROCEDURES
MODULE 2 Hand Hygiene

• REQUIRED HAND HYGIENE PRACTICES
• 1. PURPOSE This Veterans Health Administration
  (VHA) Directive provides guidance for
  establishing the basic requirements for hand
  hygiene practices in VHA facilities.
• 2. BACKGROUND
• a. Hand decontamination has been shown to prevent
  the spread of infectious agents in clinical
  settings for over 150 years.
• b. In October of 2002, the Centers for Disease
  Control and Prevention (CDC) issued a new
  Guideline on Hand Hygiene in Health-Care
  Settings, which examined the evidence in over 400
  publications and provided 44 recommendations for
  hand hygiene practices. The need to decontaminate
  hands before and after engaging in direct patient
  care activities by using an alcohol-based hand
  rub (in the absence of visibly soiled or
  contaminated hands), or as an alternative by
  using an antimicrobial soap and water, has been
  emphasized.
• c. In July of 2003, the Joint Commission on
  Accreditation of Healthcare Organizations (JCAHO)
  issued national patient safety goals, which
  became effective January 1, 2004. Goal 7, reduce
  the risk of health care associated infections,
  requires compliance with the CDC recommendations
  that were supported by a high level of evidence
  or required by law (identified as category IA,
  IB, or IC recommendations in the Guideline). This
  goal has been retained by JCAHO as a national
  patient safety goal for 2005.
• d. In December of 2003, the Under Secretary for
  Health issued a memorandum to all Veterans
  Integrated Services Network (VISN) Directors and
  VA medical center Directors summarizing the CDC
  Guideline requirements and affirming the need to
  make any necessary changes to improve hand
  hygiene practices.
• 3. POLICY It is VHA Policy that each VHA
  facility must have a written policy regarding
  hand hygiene and that policy must be implemented
  by March 1, 2005.
• 4. ACTION Each VHA facility Director is
  responsible for ensuring
• a. A hand hygiene policy (conforming to the
  Category IA, IB, and IC recommendations presented
  in the CDC Guideline as summarized in subpars.
  4b-4i) is implemented by March 1, 2005.
• b. All health care workers in direct patient
  contact areas, i.e., inpatient rooms, outpatient
  clinics, etc., as well as those who may have
  direct patient contact in other settings, such as
  radiology technicians, phlebotomists, etc.,

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Focused Education Program for Patients,
Caregivers and Staff
MODULE 2 Hand Hygiene

• Provide in-service training to staff about hand
  hygiene procedures and policies
• Reinforce hand hygiene policies through
  newsletter articles, brochures and bulletin
  board postings
• Provide information on hand hygiene to patients
  and caregivers

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World Health Organization Five Moments for
Hand Hygiene
MODULE 2 Hand Hygiene

• Before Patient Contact
• Before Aseptic Task
• After Body Fluid Exposure Risk
• After Patient Contact
• After Contact with Patient Surroundings

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MODULE 2 Hand Hygiene
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Which hand hygiene method is more effective at
killing bacteria?
MODULE 2 Hand Hygiene

• Regular soap and water  
• Anti-bacterial soap and water
• Alcohol-based hand rub (foam or gel)

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Which hand hygiene method is more effective at
killing bacteria?
MODULE 2 Hand Hygiene

• Regular soap and water  
• Anti-bacterial soap and water
• Alcohol-based hand rub (foam or gel)

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How long should you rub your hands together when
washing with soap and water?
MODULE 2 Hand Hygiene

• 5 seconds
• 15 seconds        
• 1 minute
• 3 minutes

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How long should you rub your hands together when
washing with soap and water?
MODULE 2 Hand Hygiene

• 5 seconds
• 15 seconds        
• 1 minute
• 3 minutes

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When is the use of alcohol-based hand rubs not
appropriate?
MODULE 2 Hand Hygiene

• A. Before touching a patient
• B. Before manipulating an invasive device
• C. When hands are visibly soiled
• D. When surfaces in the patient care environment
  have been touched

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When is the use of alcohol-based hand rubs not
appropriate?
MODULE 2 Hand Hygiene

• A. Before touching a patient
• B. Before manipulating an invasive device
• C. When hands are visibly soiled
• D. When surfaces in the patient care environment
  have been touched

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True or False
MODULE 2 Hand Hygiene

• Hand hygiene does not need to be practiced if
  you touched items or surfaces in the patient care
  environment, but didnt touch the patient while
  you were there.

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True or False
MODULE 2 Hand Hygiene

• Hand hygiene does not need to be practiced if
  you touched items or surfaces in the patient care
  environment, but didnt touch the patient while
  you were there.
• FALSE
• Hand hygiene should be practiced after all
  contact.

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Additional Resources About Hand Hygiene
MODULE 2 Hand Hygiene

• Centers for Disease Control and Prevention
  Guideline for Hand Hygiene in Healthcare Settings
  - 2002http//www.cdc.gov/Handhygiene/
• Hand Hygiene Resource Center
• http//www.handhygiene.org/
• World Health Organization Hand Hygiene Tools
  http//www.who.int/gpsc/tools/en/

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Additional Resources About Hand Hygiene
MODULE 2 Hand Hygiene

• Free Quality Tools http//www.freequality.org/Def
  ault.aspx?page27
• 5-Diamond Patient Safety Programhttp//www.esrdne
  t5.org/5Diamond.asp
• Veterans Health Administration, Required Hand
  Hygiene Practices http//www1.va.gov/vhapublicati
  ons/viewpublication.asp?pub_id1214