AHRQ Safety Program for Long-term Care: HAIs/CAUTI

Exploring Hand Hygiene

Knowledge and Practice

Training Module #1 for the CAUTI LTC Core Team

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Learning Objectives

Upon completion of this training, the facility core team members will be able to:

• explain why hand hygiene is so important to prevent the spread of infections;

• reinforce when and how to perform hand hygiene;

• recognize challenges to hand hygiene in their facility, and identify possible solutions; and

• discuss ways to monitor hand hygiene adherence and develop feedback reports.

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Front-line Staff Training Recap

• Hand hygiene is one of the most important ways to prevent the spread of infections

• Germs, especially gram-negative bacteria are frequently found on healthcare worker hands following routine resident care

• The WHO 4 moments provide a simple framework for remembering when staff should perform hand hygiene during any resident interaction

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16 Mody et al Infect Control Hosp Epidemiol; 2003:24:165-171 Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands Educational Resources: http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx

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Hand Hygiene Technique

http://www.who.int/gpsc/en/http://www.cdc.gov/handhygiene/Resources.html#HCP

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Front-line Staff Training Recap

• Alcohol-based hand products are preferred for hand hygiene during almost all routine patient care activities

Exceptions:

1. When hands are visibly soiled

2. After care of a resident with known or suspected infectious diarrhea

• It’s important to clarify hand hygiene expectations during care of a resident with C.difficile.

• Alcohol-based hand rubs are appropriate on entry to room; appropriate glove use to prevent hand contamination; washing with soup and water upon glove removal and exiting room

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944. Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628-645

Good Better Best

Plain soap Antimicrobial soap Alcohol-based hand rub

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Front-line Staff Training Recap

Gloves play a key role in preventing hand contamination – but, do NOT replace hand hygiene

Perform hand hygiene and wear gloves immediately before:

• Placing or removing an indwelling catheter

• Accessing the drainage system to empty the drainage bag

or collecting a urine sample

Remove gloves and perform hand hygiene immediately

after:

• Handling an indwelling catheter

• Accessing the drainage system to empty the drainage

bag or collecting a urine sample

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Health Care Worker Challenges with Hand Hygiene

Belief that Hand Hygiene guidelines aren’t applicable• 30% wouldn’t change current practices; 20% said guidelines were impractical

Lack of access to appropriate Hand Hygiene supplies• 16.2% lack of available sink; 27.5% lack of alcohol-based hand rub

No Hand Hygiene because of glove use• 23% nurses, 17% CNAs, 26% other HCWs

Forgot about Hand Hygiene because of workload• 35% of nurses, 22% CNAs, 44% other HCWs

Lack of access to Hand Hygiene feedback and/or education• 55% never to rarely received personal feedback on HH practices• Other HCWs less often received periodic education on HH (86.8% vs. 92% of nurses and

CNAs, p=0.03)

Ashraf MS et al. ICHE 2010; 31(7):758-762

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Addressing Barriers to Hand Hygiene

Let’s Chat!

• What challenges do you experience performing hand hygiene in your facility?

• What solutions do you propose to address these challenges in your facility?

• How can you support a culture of safety around hand hygiene?

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Hand Hygiene Adherence Monitoring Options

Method Pros Cons

Direct observation of hand hygiene technique • Educational moment • Does not measure adherence

during patient care

Direct observation of hand hygiene adherence

• Captures information on product, technique

• Data summarized by staff type, shift, unit

• Educational moment

• Time and resource intensive• Can influence performance

Measurement of volume of AHBR or soap used • Easy to track consistently

• Consumption may not correlate with appropriate use

• Could be biased by purchasing patterns

Survey/self-report of hand hygiene adherence

• Captures perceptions and barriers • Rates often inflated

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Feedback and Dissemination of Hand Hygiene Rates

• Providing feedback on hand hygiene adherence to front-line staff is a key component to raising awareness and maintaining high compliance rates.

• Also consider opportunities for “just in time” education when incorrect practices are observed.

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Interactive Activities

• Demonstration of hand hygiene technique– Culture staff hands before and after

hand hygiene

• Demonstration of germ transfer– Use glow powder on commonly

touched objects to see how and where “germs” travel

Before After

Hand Hygiene Videos

• WHO - SAVE LIVES: Clean Your Hands

• Hand Hygiene Video New England Journal of Medicine

• Hand Hygiene Training Films and Slides

• O les mains Hand Hygiene Dance

• CDC—Hand Hygiene Interactive Education Video

• Public Health Ontario—Just Clean Your Hands (based on WHO 5 Moments)

• NPSA Wi-Five Hand Hygiene Video Game

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Hand Hygiene Posters

Create your own!– Have staff role model positive

behaviors

Other Resources:– CDC and WHO Hand Hygiene Resou

rces• Additional posters

– Public Health Ontario – Just Clean Your Hands

http://www.cdc.gov/handhygiene/Resources.html#HCP

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Take the Pledge…

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Stay Updated with Useful Resources

Take the Pledge… (to practice all infection prevention skills)

World Health Organization How to Handrub Poster

World Health Organization How to Handwash Poster