Hand Hygiene in Health Care

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Hand Hygiene in Health Care

• TRAINING MODULE FOR DIHS CLINCIANS

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So Why All the Fuss About Hand Hygiene?

• Most common mode of transmission of pathogens is
  via hands!
  
• Infections acquired in healthcare
• Spread of antimicrobial resistance
• Accreditation

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CDC Guidelines

• Issued October, 2002
• Aimed at reducing the growing problem of
  healthcare- associated infections in the U.S.
  
• Provides specific recommendations to promote
  improved hand-hygiene practices and reduce
  transmission of pathogenic microorganisms to
  patients and personnel in health-care settings.
• Draws on the scientific literature to compare the
  efficacy, benefits and risks of washing with
  plain soap or anti-microbial soap and water or
  gel formulas
• Summarizes the potential role of alcohol-based
  hand rubs in improving hand-hygiene practices
  
• Source Center for Disease Control and
  Prevention

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Yearly Statistics

• Nearly 2 million new and serious health care
  acquired infections
  
• 90,000 patient deaths 
• U.S. treatment cost - 4.5 billion
• Hand washing compliance rates are poor (40)

Source Center for Disease Control and Prevention
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Healthcare-Associated Infections

• Bacteria that causes hospital-acquired infections
  are most frequently spread from one patient to
  another on the hands of healthcare workers
  
• Cleaning your hands before and after having
  contact with patients is one of the most
  important measures for preventing the spread of
  bacteria in healthcare settings

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Germs Are Everywhere

• Healthcare workers can get germs on their hands
  by doing simple tasks, like
  
• pulling patients up in bed
• taking blood pressure or pulse
• touching a patients hand
• touching the patients clothes or sheets in SSU
• touching equipment such as bedside, over-bed
  tables or IV pumps

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Hand-Hygiene Barriers

• Healthcare workers cite
• heavy workloads (too busy)
• skin irritation and dryness caused by frequent
  use of soap and water
  
• lack of easy access to sinks
• hands dont look dirty
• Interferes with patient relationship
• hand washing takes too long

.
Can you find the sink in this picture?
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The Hidden Sink

• The sink is located behind the patients bed and
  several IV pumps.
  

Workers are unlikely to use the bedside sink if
they are unable to reach it easily!
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Sample Germs From A Nurses Hand
Culture plate showing growth of germs 24 hours
after a nurse placed her hand on the plate
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Resistant Germs
Patients with resistant germs like
methicillin-resistant S. aureus (MRSA) or
vancomycin-resistant enterococci (VRE) often
carry the germ on many areas of their skin, even
when they dont have any wounds or broken skin.
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MRSA Carriers
Percentage of patients with methicillin-resistant
S. aureus (MRSA) who carry the germ
13-25 on the skin under their arms
40 on their hands or wrists
30-39 in the groin area
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Specific Indications for Hand Hygiene
Before Patient contact Donning gloves Inserti
ng invasive devices After Touching equipment o
r furniture near the patient Contact with body fl
uids, or excretions, non intact skin, wound
dressings, specimen Removing gloves Eating, smok
ing Touching your face (nose, mouth, eyes)
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Indications for Technique

• When hands are visibly dirty, contaminated, or
  soiled, wash with non-antimicrobial or
  antimicrobial soap and water.
  
• If hands are not visibly soiled, use an
  alcohol-based handrub for routinely
  decontaminating hands.
  
• Source Centers for Disease Control and Prevention

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Selecting Hand Hygiene Agents Factors to
Consider

• Efficacy of antiseptic agent
• Acceptance of product by healthcare personnel
• Characteristics of product
• Skin irritation and dryness
• Accessibility of product
• Dispenser systems
• Access to Detainees
• Storage

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When To Use Soap And Water
Wash your hands with an anti-microbial soap and
water

• If your hands are visibly soiled (dirty)
• If your hands are visibly contaminated with blood
  or body fluids
  
• when you feel a build-up of emollients onyour
  hands
  
• after using the restroom
• before eating
• Always use warm water!

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Alcohol-Based Handrubs The Benefits

• reduce bacterial counts on the hands of
  personnel more effectively than plain soaps
  
• reduce overall infection rates
• are more accessible than sinks
• causes less skin irritation and dryness than
  soaps
  
• require less time to use effectively (15
  seconds)
  
• improve hygiene

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Alcohol-based products Some Risks

• Alcohols are flammable
• alcohol-based hand rubs should be stored away
  from high temperatures or flames in accordance
  with National Fire Protection Agency
  recommendations.
• Hand rub should be thoroughly rubbed in until dry
  on hands
  
• Alcohols are volatile, containers should be
  designed to minimize evaporation
  

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Dry Hands Alcohol Rubs vs Soap Water
Several studies provide evidence that nurses who
routinely cleaned their hands between patients by
using an alcohol-based handrub had less skin
irritation and dryness than nurses who washed
their hands with soap and water.
Modern alcohol-based handrubs contain skin
conditioners (emollients) that help prevent the
drying effects of alcohol.
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Recommended Hand Hygiene Technique

• Handrubs
• Apply to palm of one hand, rub hands together
  covering all surfaces until dry
  
• Volume based on manufacturer
• Handwashing
• Wet hands with water, apply soap, rub hands
  together for at least 15 seconds
  
• Rinse and dry with disposable towel
• Use towel to turn off faucet

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Fingernails and Artificial Nails

• Natural nail tips should be kept to ¼ inch in
  length
  
• Artificial nails should not be worn when having
  direct contact with high-risk patients (e.g.,
  ICU, OR)
  
• Source The Center for Disease Control and
  Prevention
  

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Gloving

• Wear gloves when contact with blood or other
  potentially infectious materials is possible
  
• Remove gloves after caring for a patient
• Do not wear the same pair of gloves for the care
  of more than one patient
  
• Do not wash gloves
• Source The Centers for Disease Control and
  Prevention

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Why Monitor Hand Hygiene at DIHS

• JCAHO
• ACA
• NCCHC
• Protect the health of our staff
• Reduce MRSA among detainees
• To provide the evidence that DIHS is above
  average!

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PREVENTION IS PRIMARY AT DIHS!

• Lets protect patientsprotect our staff
• and promote quality healthcare!