The National Hand Hygiene Initiative

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The National Hand Hygiene Initiative
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Australian Commission on Safety and Quality in
Healthcare

• The Commission was established by State and
  Territory Governments
• Purpose to develop a national strategic
  framework to guide efforts in improving safety
  and quality across the health care system in
  Australia

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Australian Commission on Safety and Quality in
Healthcare

• The Commission commenced on 1 January 2006.
• The Commission's role is to
• lead and coordinate improvements in safety and
  quality in health care
• disseminate knowledge and advocate for safety and
  quality
• report publicly on the state of safety and
  quality including performance against national
  standards

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Australian Commission on Safety and Quality in
Healthcare

• recommend national data sets for safety and
  quality, including data development, standards,
  collection and reporting
• provide strategic advice to Health Ministers on
  best practice
• recommend nationally agreed standards for safety
  and quality improvement

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Australian Commission on Safety and Quality in
Healthcare

• 5 Key Initiatives
• National Surveillance System
• To reduce harm to patients from hospital
  associated infections through the use of
  surveillance
• Updated National Infection Control Guidelines
• To improve useability and provide permanent
  currency of information
• National Hand Hygiene Initiative - NHHI
• Building clinician capacity
• To increase the ability of infection control
  practitioners by providing them with skills and
  resources to engage and educate clinicians,
  managers and healthcare consumers to adopt a
  collective HAI prevention mindset
• Antibiotic Utilisation
• Development of a national system to monitor
  antibiotic usage

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University curricula
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Statewide Hand Hygiene Compliance
Overall HH Compliance Baseline 20 (95CI
19-20) to12 mths 53 (95CI 52-53) Increases
significant after 4-mths and 12-mths (plt0.0001)
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Statewide - MRSA bacteraemiasPatients with MRSA
bacteraemia per month per 100 separations
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Summary

• HH Culture-Change Programs associated with
• Improved HH compliance from 18-21 to 47-53
  after 12-24 months
• 50 (approx.) reduction in rates of MRSA disease
  after 12-23 months
• Generic, centrally coordinated HH Culture-Change
  programs can be effective in a wide variety of
  urban and rural healthcare institutions
• Such programs represent the single most effective
  initiative to reduce the burden of MRSA in
  hospitals

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Hand Hygiene Australia

• 3 years funding from ACSQHC to implement National
  Hand Hygiene Initiative
• Report to ACSQHC
• Leverage off existing Hand Hygiene programs
• Directed by Prof Lindsay Grayson
• Independent of jurisdiction and hospital
• Based at Austin Health, Victoria

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Objectives of HHA

• Develop reliable indicators of hand hygiene
  compliance
• Accurately measure hand hygiene compliance
• Reduce rates of healthcare associated infection
• Make hand hygiene core business for all health
  care workers

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HHA resources and support

• Hand Hygiene Australia Manual
• Implementing HH program
• ABHRS information
• Detailed explanation of 5 Moments
• Supporting evidence
• Examples
• Outcome Measures
• HH compliance
• Data for Staphylococcus aureus bacteraemia

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Moment 1

• Definitions
• Touching a patient in any way
• Any personal care activities
• Any non-invasive observations
• Any non-invasive treatment
• Preparation and administration of oral
  medications
• Oral care and feeding

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Moment 2

• Definitions
• Insertion of a needle into a patients skin, or
  into an invasive medical device
• Preparation and administration of any medications
  given via an invasive medical device, or
  preparation of a sterile field
• Administration of medications where there is
  direct contact with mucous membranes
• Insertion of, or disruption to, the circuit of an
  invasive medical device
• Any assessment, treatment and patient care where
  contact is made with non-intact skin or mucous
  membranes

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Moment 3

• Definitions
• After any procedure
• After any potential body fluid exposure
• Blood, Lochia
• Saliva or tears
• Mucous, wax, or pus
• Breast milk, Colostrum
• Vomitus
• Urine, faeces, semen, or meconium
• Pleural fluid, ascitic fluid or CSF
• Tissue samples, including biopsy specimens,
  organs, bone marrow, cell samples

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Moment 4

• Definition
• After touching a patient

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Moment 5

• Definition
• After touching the patients immediate
  surroundings when the patient has not been touched

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Everybody knows..

• Healthcare associated pathogens are most often
  transmitted from patient to patient on the hands
  of healthcare workers.
• Cleaning your hands before after touching a
  patient is one of the most important measures for
  preventing the spread of micro organisms.

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Desired Outcome..
INCREASE INCREASE
DECREASE
HH Compliance Awareness
Healthcare associated
infections

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The 5 Moments in a GP Practice

• Imagine a patient walks into your assessment
  room, you shake hands, take the patients blood
  pressure and temperature, then take a blood
  sample, give the patient the paperwork to take
  out to reception, they leave.
• Then you write in the medical history, return it
  to reception and call for the next patient.

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The 5 Moments in a GP Practice
HH M1

• Imagine a patient walks into your assessment
  room, you shake hands, take the patients blood
  pressure and temperature, then take a blood
  sample, give the patient the paperwork to take
  out to reception, they leave.
• Then you write in the medical history, return it
  to reception and call for the next patient.

HH M2
HH M3
HH M4
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Choosing an ABHR

• Product Selection
• When selecting an ABHR product, HHA recommends
• The Product meets the EN1500 testing standard for
  bactericidal effect
• The Product has TGA approval as a hand hygiene
  product
• However, product selection is ultimately the
  choice of each health care facility, and other
  factors should also be considered, such as
• Dermal tolerance
• Aesthetic preferences such as fragrance, colour,
  texture and ease of use
• Practical considerations such as availability,
  convenience and functioning of dispenser, and
  ability to prevent contamination
• Cost issues

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ABHR Placement

• Needs to be at the Point of Care
• The place where three elements come together the
  patient, the HCW, and the care or treatment
  involving contact with the patient or his/her
  surroundings.
• A hand hygiene product should be easily
  accessible and as close as possible within arms
  reach of where patient care or treatment is
  taking place.
• Point of care products should be accessible
  without having to leave the patient zone

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ABHR Placement

• Examples
• At entrance to clinic for patients to use on
  arrival
• At reception desk for reception staff
• In assessment / treatment rooms
• On desk
• On wall near assessment bed
• On portable equipment trolleys
• Eg. Blood collection trolley

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Why use ABHRs?

• Reduces bacterial count on hands more effectively
  than soap and water hand wash
• Reduces adverse outcomes and cost associated with
  healthcare associated infections
• Requires less time
• Less irritating to skin than soap and water as
  ABHRs contain an emollient
• Can be readily accessible/portable

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When to use ABHRs????

• When hands are NOT visibly soiled
• Before and after touching a patient
• After glove use
• After contact with the patients belongings

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What can I use for Hand Hygiene?

• HH means either
• using soap and water to wash with thorough drying
  when your hands are visibly soiled
• or
• using a waterless hand rubs
• ( eg. ABHR) when your hands are visibly clean

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Compatible Moisturiser.

• Use a minimum of 3 times per shift
• At coffee break
• At meal breaks
• At home time
• All HCWs to use work supplied compatible
  moisturiser (boys included)
• Think about the whole 24 hours

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Gloves.

• Gloves should be used as an adjunct to, not a
  substitute for hand hygiene.
• Hand hygiene is to be performed before after
  all glove use.
• Gloves need to be changed HH performed after
  each patient procedure and when going from dirty
  to clean sites even on the same patient.
• Disposable gloves are to be used once only and
  never disinfected or washed.

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Clean Between

• Use the alcohol impregnated wipes/detergent wipes
  on all shared non critical equipment
• Think about product placement to encourage use
  e.g near keyboards, on trolleys, in clinic
  areas,therapy rooms

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HHA Education Tools

• On line learning package

• All healthcare workers
• Basic hand hygiene information
• Why, how and when
• Multiple choice questions
• annual requirement?
• HCW specific packages

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OH S Concerns

• Splash
• Unlikely if a two handed action is used risk
  Minor/Moderate
• Ingestion
• Unlikely during normal use - risk Minor/Moderate
• Fire
• Possible but overall risk is extremely low
• Spillage / Splash on floor
• Possible/likely risk insignificant
• Deliberate or unintentional misuse
• Possible by children or cognitively impaired
  consider product placement in supervised areas,
  or personal pocket bottles if regular clientele

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OH S Concerns

• Alcohol absorption
• Unlikely local studies show that you cannot
  absorb enough through your skin to lose you
  drivers license!
• Bulk storage
• Ensure that bulk storage complies with state fire
  regulations and apply standard precautions for
  flammable liquids (DG class 3)
• Skin irriatation
• Rare Risk minor
• Patient infection from poor compliance with HH
  regimen
• Almost certain Risk Major/Severe

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OH S and ABHRS

• There are a number of risks to patients and staff
  associated with the use of alcohol based handrub,
  however
• the benefits in terms of its use
• far outweigh the risks
• Healthcare Settings are dangerous
• Children need to be supervised at all times

Generic HHA Risk Assessment and Management
plan Safety Institute Australia
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Key messages
Alcohol Based Hand Rub
Point of Care
Before and After Touching a Patient