HAND HYGIENE AWARENACE

Identification Communication Medication Eliminate Infection Falls

International Patient SafetyGoals

Reduce the Risk of Health Care-acquired Infections

Comply with current published and distributed hand hygiene guidelines

IPSG 5: Reduce the Risk of Health Care-Associated Infections

A collaborative process is used to develop P&P that address reducing the risk of health care–associated infections

Infections

Most common mode of transmission of pathogens is via hands!

Infections acquired in healthcare Spread of antimicrobial

resistance

So Why All the Fuss About Hand Hygiene?

All health care’s works involve the hands

Handsspreadgerms

Hands are contaminated

The health care environment is contaminated

Colonized or Infected:What is the Difference?

People who carry bacteria without evidence of infection (fever, increased white blood cell count) are colonized

If an infection develops, it is usually from bacteria that colonize patients

Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers

The Iceberg EffectInfected

Colonized

The inanimate environment is a reservoir of pathogens

~ Contaminated surfaces increase cross-transmission ~Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2007, Chicago, IL.

X represents a positive Enterococcus culture

The pathogens are ubiquitous

The inanimate environment is a reservoir of pathogens

Recovery of MRSA , VRE & ACINITOBACTER.

Devine et al. Journal of Hospital Infection. 2007;43;72-75

Lemmen et al Journal of Hospital Infection. 2004; 56:191-197

Trick et al. Arch Phy Med Rehabil Vol 83, July 2006

Walther et al. Biol Review, 2007:849-869

Patients are vulnerable to infection

Types of hand hygiene

Normal hand washingAntiseptic hand washingAlcohol-based hand rubCan be used instead of hand washing , if hands are not visibly soiled with blood or any other patient body fluids

Surgical hand wash

Routine Hand Washing

Antiseptic Hand Washing

Waterless Hand Rub “alcohol-based hand rub

Hand Hygiene Options

~ Use soap and water for visibly soiled hands ~~ Do not wash off alcohol handrub ~

Apply to palm; rub hands until dry

Wet hands, apply soap and rub for

>10 seconds. Rinse, dry & turn

off faucet with paper towel.

Adoption of alcohol-based handrub is the gold standard in all other clinical situations

Handwashing with soap and water when hands are visibly dirty or following visible exposure to body fluids

Hand rubbing is the solution to obstacles to improve hand hygiene compliance

WHO Guidelines on Hand Hygiene in Health Care (2010)

Surgical Hand Wash

Areas Most Frequently Missed

HAHS © 1999

Adequate handwashing with water and soap requires 40-60 seconds

Average time usually adopted by health-care workers: <10 seconds

Time constraint = major obstacle for hand hygiene

What is the KKH Multimodal Hand What is the KKH Multimodal Hand Hygiene Improvement Strategy?Hygiene Improvement Strategy?

Based on the evidence and recommendations from the WHO Guidelines on Hand Hygiene in Health Care (2010), a number of components make up an effective multimodal strategy for hand hygiene

ONE System changeAccess to a safe, continuous water supply as well as to soap and towels; readily accessible alcohol-based handrub at the point of care

TWOTraining / Education Providing regular training to all health-care workers

THREE Evaluation and feedback Monitoring hand hygiene practices, infrastructure, perceptions and knowledge, while providing results feedback to health-care workers

FOUR Reminders in the workplacePrompting and reminding health-care workers

FIVE Institutional safety climateCreating an environment and the perceptions that facilitate awareness-raising about patient safety issues

KKH Hand Hygiene

Hand Hygiene Comment

Typical Compliance

Observational studies of hand hygiene report compliance rates of 42.6%-57.9%

Common Reported Barriers To Compliance

Insufficient time, understaffing, patient overcrowding, lack of knowledge of hand hygiene guidelines, skepticism about hand washing efficacy, inconvenient location of sinks and hand disinfectants and lack of hand hygiene promotion by the institution

Compliance

With hand hygiene they’re dead

Skin irritation Inaccessible hand washing

facilitiesWearing glovesToo busy Lack of appropriate staffBeing a physician

(“Improving Compliance with Hand Hygiene in Hospitals” Didier Pittet. Infection Control and Hospital Epidemiology. Vol. 21 No. 6 Page 381)

Why Not?Working in high-risk areas Lack of hand hygiene

promotion Lack of role model Lack of institutional priority Lack of sanction of non-

compliers

Hand CareNailsRingsHand creamsCuts & abrasions“Chapping”Skin Problems

Fingernails & Artificial Nails Keep fingernails short

Allows thorough cleaning and prevents glove tears

Long nails make glove placement more difficult and may result in glove perforation

Fingernails & Artificial Nails

Follow MCH policy regarding artificial fingernails; use of artificial fingernails is not allowed.

USAF Guidelines for Infection Control in Dentistry, 2004.

What is the Story on Moisturizers and Lotions?

ONLY USE facility-approved and supplied lotions

Because: Some lotions may make medicated

soaps less effective Some lotions cause breakdown of latex

gloves Lotions can become contaminated with

bacteria if dispensers are refilled

~ Do not refill lotion bottles ~

Gloves are not a substitute for handwashing!

≠

Gloves are not a substitute for handwashing!

Wearing gloves does not replace the need for hand hygiene

Small, inapparent defects

Frequently torn during use

Hands frequently become contaminated during removal

DeGroot-Kosolcharoen 2004, Korniewicz 1999, Kotilainen 2001, Olsen 1998, Larson 2005, Murray 2001, Burke 2005, Burke 1990, Nikawa 1994, Nikawa 2006, Otis 2007

What is the single most important reason for healthcare workers to practice good

hand hygiene?

1. To remove visible soiling from hands2. To prevent transfer of bacteria from

the home to the hospital3. To prevent transfer of bacteria from

the hospital to the home 4. To prevent infections that patients

acquire in the hospital

How often do you clean your hands How often do you clean your hands S INTACT S INTACT ’’PATIENTPATIENTafter touching a after touching a

(for example, when measuring (for example, when measuring SKINSKINa pulse or blood pressurea pulse or blood pressure)?)?

1.1. AlwaysAlways

2.2. OftenOften

3.3. SometimesSometimes

4.4. NeverNever

clean your YOUEstimate how often hands after touching a patient or a contaminated surface in the hospital?

1. 25%2. 50%3. 75%4. 90%5. 100%

1. Plain soap and water2. Antimicrobial soap and

water3. Alcohol-based hand rub

Which hand hygiene method is best at killing bacteria?

Which of the following hand hygiene agents is LEAST drying to your skin?

1. Plain soap and water2. Antimicrobial soap and

water3. Alcohol-based hand rub

It is acceptable for healthcare workers to supply their own lotions to relieve dryness of hands in

the hospital.

1. Strongly agree2. Agree3. Don’t know4. Disagree5. Strongly disagree

Healthcare-associated organisms are commonly resistant to alcohol.

1. Strongly agree2. Agree3. Don’t know4. Disagree5. Strongly disagree

When a healthcare worker touches a patient who is COLONIZED, but not infected with resistant

organisms (e.g., MRSA or VRE) the HCW’s hands are a source for spreading resistant organisms to

other patients.

1. Strongly agree2. Agree3. Don’t know4. Disagree5. Strongly disagree

A co-worker who examines a patient with VRE, then borrows my pen without cleaning his/her

hands is likely to contaminate my pen with VRE.

1. Strongly agree2. Agree3. Don’t know4. Disagree5. Strongly disagree

How often do you clean your hands after touching an ENVIRONMENTAL SURFACE near a patient (for

example, a countertop or bedrail)?

1. Always2. Often3. Sometimes4. Never

Use of artificial nails by healthcare workers poses no risk to patients.

1. Strongly agree2. Agree3. Don’t know4. Disagree5. Strongly disagree

Glove use for all patient care contacts is a useful strategy for reducing risk of

transmission of organisms.

3. Don’t know4. Disagree5. Strongly

disagree

HAND HYGIENE AWARENACE