GBMC Corporate Competency for Hand Hygiene

GBMC Corporate Competency for Hand Hygiene

The Case for Hand Hygiene in Healthcare Settings

Background

Costs

Selection of AgentsTechniques Indications Summary

Let’s Get Committed…to Prevention

Healthcare Associated Infections (HAI’s) have increased morbidity and mortality rates among hospitalized patients worldwide

HAI pathogen transmission most often occurs via the contaminated hands of health care workers

HAIs affect nearly 2 million individuals annually in the United States

Approximately 80,000 deaths each year

Hand Hygiene with alcohol- based hand rub (preferred) or soap and water has proven to be most effective measure in preventing HAI’s.

Hand Hygiene Costs

Performing hand hygiene with soap and water or with alcohol hand sanitizer costs

less than a penny

However, healthcare workers cost hospitals $1.98 for every missed hand hygiene opportunity (Bloomberg, 2008)

The missed action costs patients significantly more suffering

In the USA 1/136 patients become infected from HAI at a cost of $4.5-5.7 billion per year

Bacteria can survive for

DAYS

on patient care equipment and other surfaces.By washing your hands you can prevent the spread of HAI’s to your patient and yourself

Definition of Hand HygieneThe killing or removal of microorganisms on the hands that have been picked up by contact with patients, staff, contaminated equipment or the environment

Two Approved Methods for Hand Hygiene

Hand Washing with soap & water

– performed when hands are

visibly soiled

with organic matters, i.e., food, soil, blood, body fluid-urine, stool

-- performed when caring for a patient with Clostridium difficile (C. diff)

Hand Sanitation with Alcohol-based Hand Rub (ABHR)

– preferred method in healthcare settings to clean hands that are

not visibly soiled

Alcohol-based Hand Rubs (ABHR)

Alcohol-based Hand Rub is

the preferred method of hand hygiene in a healthcare setting

Provides a rapid kill or removal of most bacteria on hands

Takes less time than using soap and water

Contains emollients to reduce skin irritation

They can be easily available at the “point of care”

Remember not to rinse off with water immediately after application These cleansers are well tolerated, but may cause temporary stinging when in contact with skin cracks.

Hand Soaps and Soap and Water Washing

Types of Hand Soap

1. All purpose soap

Used for most patient care

Appropriate for most hand washing

2. Antibacterial Soap Soap and water hand washing works by rinsing bacteria off the hand and down the drain.According to the Centers for Disease Control and Prevention (CDC), antibacterial soaps are not necessary, but washing your hands thoroughly with ordinary soap and warm water is one of the most effective ways to break a link in “the chain of infection”.

HOW DO I PRACTICE HAND HYGIENE CORRECTLY?  

HAND RUB

(foam and gel) Apply to palm of one hand (the amount used depends on specific hand rub product).

Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 15 seconds to dry.

HANDWASHING

Wet hands with water.

Apply soap.Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails.Rinse under running water and dry with disposable towel.Use the towel to turn off the faucet.

Steps for hand hygiene using alcohol-based hand rub (ABHR)

Your hands are now safe hands “prepared to

care”.

Steps for Hand Washing with Soap & Water

Your hands are now safe hands “prepared to care”.

Maintaining Healthy Skin Integrity

Healthy skin

is the

1st line of defense against infection

Dry

and cracked skin harbor more microbes

Apply hospital provided lotion to

protect skin after frequent

hand washing to prevent skin breakdown

Hand Lotions

Hand lotions are important to prevent skin dryness and irritation.

Only

hospital-approved

hand lotions

shall be used. Keep personal lotions at home.

Personal lotions are prohibited because they can:

make hand hygiene products less effectivecause breakdown of latex glovesbecome contaminated with bacteria in the hospital environment

Finger Nails and Hand Hygiene

Fingernails shall be natural and must be ¼ inch in length

or less.

Long

nails, chipped polish, artificial nails,

and nail jewelry

are

a reservoir

for microorganisms. Shellac (gel) polish, gel overlays, acrylics, and silks are considered artificial overlays and not permitted by healthcare workersArtificial overlays have been implicated in outbreaks and can tear gloves

GBMC’s Hand Hygiene Program

GBMC’s Hand Hygiene policy is based on the WHO (World Health Organization) 5 Moments.

Policy is visible on the “Info Web” under Infection Prevention dept tab

Includes a policy on Nail length and prohibitions regarding nail jewelry,

ie.,tips

, shellacs etc. for direct care givers, nurses,

nst

, physicians.

GBMC’s Hand Hygiene Monitoring Program

GBMC participates in the Maryland Patient Safety Center (MPSC) Hand Hygiene Collaborative

State facilitated program

Observations conducted by anonymous observers

Report results monthly involving all inpatient units and all disciplines

GBMC also developed a patient observation program titled “Hand to Hand”

Anonymous patient and visitor submission regarding compliance

Over 14,000 patients submitted survey’s on GBMC’s Hand Hygiene practices in FY14!

GBMC is committed to improving compliance and fostering a culture of safety for staff and patients. The Goal for both programs in FY15 is 92% compliance.

INDICATIONS for Hand Hygiene

ALWAYS

perform Hand Hygiene:

Before touching a patient

Before a clean/aseptic procedure

After body fluid exposure risk; including after glove removal

After touching a patient

After having contact with the healthcare environment

****AND….Crossing the room threshold at entry and exit

Semi-Private Rooms with curtain divider:

Health care providers should perform hand hygiene upon crossing the curtain line, ensuring hands are disinfected before moving to the next patient

Perform a Standard Precautions Risk Assessment before providing care

Before providing care, ask the following questions?

What

is the risk of

exposure?

(microbes, non-intact skin, body fluid & substance, mucous membrane, contaminated equipment, etc.)

How

is this organism transmitted?

Is the patient cooperative? How can I prevent spreading the microbes to others? Having the Questioning Attitude: “what task am I going to perform?”

“what PPE do I need to wear to protect myself and help stop the spread of infections”

GLOVES and Hand Hygiene

Gloves should be worn when:

hands may become contaminated with blood, body fluids, excretions, or secretions

when touching mucous membranes, non-intact skin,

or

contaminated surfaces or objects (urinary catheters,

endotrachael

tubes).

Key Reminders with glove use:Do not resuse or wash glovesGloves are not a replacement for hand hygiene

Always change gloves between patients

Discard gloves prior to exiting patient room

“BUT I DIDN'T TOUCH THE PATIENT.

WHY SHOULD I PRACTICE HAND

HYGIENE

?”

Bacteria can survive for

DAYS

on patient care equipment and other surfaces.

Bed rails

Privacy curtains

Light switches

IV pumps, and

Computer keyboards

Are all contaminated with bacteria.

It’s important to practice hand hygiene after you leave the room, even if you only touched patient care equipment or environmental surfaces.

BE A ROLE MODEL FOR GBMC

Colleagues, students, trainees, and other staff watch what you do!

Research has shown that the actions of clinicians influence the behavior of others.

Show your colleagues that hand hygiene is an important part of quality care.

Your patients watch you too!

Your actions send a powerful message.

Show your patients that you are serious about their health and the prevention of infection

TAKE HOME HYGIENE FACTS

Hand Hygiene is the most effective way to prevent the spread of healthcare associated infections (HAIs)

Hand Hygiene is the most cost-effective measure to prevent the spread of germs

Wash hands with soap and water for at least 15 seconds and use warm water

Preferably, if hands are not visibly soiled, use the alcohol based hand sanitizer, as it is more effective than soap and water and better for your skin

Artificial Nail Enhancements are

not

allowed if GBMC employee provides patient care

Gloves do not prevent the need for hand hygiene

ReferencesCenters for Disease Control and Prevention (CDC): Guideline for Hand Hygiene in Health-care Settings.

MMWR 2002; vol. 51, no. RR-16.

World Health Organization (WHO): Guideline on Hand Hygiene in Healthcare, 2009

http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf