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

The How To of Hand Hygiene

Training Module 1 for All Long-term Care

Staff

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Upon completion of this training module, long-term care staff will be able to demonstrate a working knowledge of:

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

• when and how to perform hand hygiene; and

• key hand hygiene practices for prevention of healthcare-associated infections (HAI), particularly catheter-associated urinary tract infections (CAUTI).

Learning Objectives

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Health Care Workers’ Hands Spread Infections

• 1-3 million serious infections are estimated to occur every year in US nursing homes

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

Gram-negative bacilli Candida sp Staph. aureus Vancomycin-resistant enterococci

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Perc

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HCW Hand Colonization Following Routine Resident Care

Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674. Centers for Disease Control and Prevention. 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

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Simplifying the Moments for Hand Hygiene

Adapted from World Health Organization 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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Alcohol-based Hand Rub (ABHR)Hand Hygiene Technique

• Apply hand rub to palm of hand

• Rub hands together, covering all surfaces

• Focus on thumbs, tips of fingers, and under fingernails

• Hands are clean when dry

– Usually takes about 15-20 seconds

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

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Soap and Water Hand WashingHand Hygiene Technique

• Wet hands with water

• Apply soap to palm of hand

• Rub hands together, covering all surfaces for at least 15 seconds

• Rinse hands with water

• Dry hands with paper towel and use towel to turn off faucet

– Paper towel prevents hands from being re-contaminated by faucet handles

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

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Notes About Hand Hygiene Products

• Alcohol-based hand rubs/gels are preferred for hang hygiene when hands are not visibly soiled or dirty

• There are certain times when hands should be washed with soap (non-antimicrobial or antimicrobial) and water:

• When hands are visibly dirty, contaminated or soiled

• After care with residents with infectious diarrhea

Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

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Efficacy of Hand Hygiene Preparationsin Killing Bacteria

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Good Better Best

Plain soap Antimicrobial soap

Alcohol-based hand rub

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Hand Hygiene and C. diff

• Hand hygiene with soap and water is superior at removing the spore form of C. diff (compared to alcohol-based products)

• AHBR is more effective for hand disinfection with all other organisms and there have been no studies linking ABHR use with an increase in C. diff infection

• Encourage soap and water after care of residents with acute diarrhea and use of gowns/gloves to prevent spore contamination of hands

Oughton 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

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Important Points About Glove Use

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

• Change gloves during care when moving from a contaminated body site to a clean body site

• Do not wear the same pair of gloves for the care of more than one resident

• Remove and discard gloves after use• Do not wash gloves

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16

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Hand Hygiene Before Urinary Catheter Care

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.

Why?• Interacting with the resident or environment before

handling the urinary device, may contaminate hands.

• Reaching for gloves with unclean hands may contaminate the glove box and outside of the gloves.

• Then, gloves will contaminate the urinary catheter or urine collection system.

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Hand Hygiene After Urinary Catheter Care

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

Why?• Hand contamination may occur as a result of

small, undetected holes in gloves.

• Hand contamination may occur during glove removal.

• Hand hygiene protects your hands and the environment from being contaminated.

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Hand Hygiene Case Scenarios

Let’s chat!

Review as a group the three hand hygiene case scenarios. As you discuss them, think about the following questions:

• Does our facility staff experience similar challenges to performing hand hygiene at the appropriate times? Why or why not?

• What could our facility do to reduce barriers to hand hygiene?

• How can I help support a culture of safety around improving hand hygiene in our facility?

Take the Pledge…

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Stay Updated with Useful Resources

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

Username: ltcsafetyPassword: ltcsafety

TeamSTEPPS® for Long-term Care

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

World Health Organization How to Handrub Poster

World Health Organization How to Handwash Poster

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References

Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm.

Centers for Disease Control and Prevention. Hand Hygiene Resources. http://www.cdc.gov/handhygiene/Resources.html#HCP.

Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628-645.

Mody et al. Infect Control Hosp Epidemiol; 2003:24:165-171.

Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944.

Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674.

World Health Organization Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands. http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx.