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
ent c
olon
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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.