Hand Hygiene Practices Activity Evaluation Questions Learning Objectives At the end of this course you will be able to explain When and how Hand Hygiene is expected to occur at Jefferson ID: 1000603
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1. Hand Hygiene Workshop
2. OverviewHand Hygiene PracticesActivityEvaluationQuestions
3. Learning ObjectivesAt the end of this course, you will be able to explain:When and how Hand Hygiene is expected to occur at JeffersonDifferent types of thresholds in healthcare at JeffersonSequence of donning and doffing personal protective equipment
4. What are some of the challenges at Jefferson?InfrastructureCrowdingAvailability Time Skin quality/integrityGoing “In and out” without touching
5. Why should I care?Protect your healthProtect your families’ healthProtect our patientsReduce infections (HAIs) and disease transmissionBetter compliance rates at Jefferson
6. Serious about Hand Hygiene (video)
7. Meet Patient APatient A has been in the hospital for 8 days, he had heart surgery and is recovering well. Patient A is on enteric precautions for a Clostridium difficile (C.diff) infection.Teaching Rounds occur at 10amNurse Tech Joe knocks and asks Patient A if he may enter. Patient A agrees.The first thing Joe should do before he enters is:Don glovesDon their gownPerform hand hygienePut on a mask
8. Meet Patient APatient A has been in the hospital for 8 days, he had heart surgery and is recovering well. Patient A is on enteric precautions for C diff.Vital checks occur before breakfastNurse Tech Joe knocks and ask Patient A if he may enter. Patient A agrees.The first thing Joe should do before he enters is:Don glovesDon their gownPerform hand hygiene (soap and water or hand gel upon entry)Put on a mask
9. Hand Hygiene IndicationsHand Hygiene is expected to occur at the Point of Entry of each patient room/zoneBEFORE and AFTER the threshold is crossedExamples of Hand Hygiene Opportunities:Before putting on glovesAfter touching a patient’s surroundings/environmentRepeat hand hygiene/replace gloves when transitioning from “dirty” to “clean” activity while engaging in patient care
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11. Everyday Hand Hygiene Compliance When to washBefore, during, and after preparing foodBefore eating foodBefore and after caring for someone who is sickBefore and after treating a cut or woundAfter using the toiletAfter changing diapers or cleaning up a child who has used the toiletAfter blowing your nose, coughing, or sneezingAfter touching an animal, animal feed, or animal wasteAfter touching garbage
12. Scrub Patterns
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14. Which areas are most often missed by health care providers when using alcohol based hand gel?Thumbs, fingertips, and between fingersFingertips, backs of hands, and wristPalms, thumbs, and between fingers
15. ANSWERWhich areas are most often missed by health care providers when using alcohol based hand gel?Thumbs, fingertips, and between fingersFingertips, backs of hands, and wristPalms, thumbs, and between fingers
16. Hand Hygiene and Glove UseIF:THEN:Gloves are damagedRemove gloves and clean your handsMoving from contaminated body site to clean body siteGloves look dirty or have blood or bodily fluids on them after completing a task ** and DRY
17. Gloves are NOT a substitute for Hand Hygiene.
18. Sequence for Hand Hygiene when Putting on PPEPerform hand hygiene before donning PPE2. Don Gown – Must tie at waist.3. Mask1. Clean hands4. Gloves
19. Sequence for Hand Hygiene when Taking off PPEPerform hand hygiene after doffing PPE2. Remove gown (roll tightly to discard in trash)1. Remove gloves3. Remove mask4. Clean hands
20. Hands Full Guidance - Entering RoomClean hands and don gloves upon entry to patient room/environment1. Enter room2. Put down equipment3. Clean hands and don gloves4. Ready for patient or environment encounter
21. Hands Full Guidance - Exiting room Remove dirty linenfrom room2. Remove glove when using key pad to enter soiled utility room3. Place soiled linen in appropriate bin4. Clean handsRemove a glove before entering soiled utility room to touch key pad, clean hands before leaving soiled utility roomIf moving directly to next patient room and nothing has been touched gel out can count as gel in for next crossing of threshold
22. What is a Threshold? A Threshold is the point in which hand hygiene is required when entering a patient environment.
23. Thresholds -Acute Care Floors – Door SweepDoorAcross door sweep threshold =Hand hygiene requiredIn door sweep threshold = No hand hygiene required
24. Thresholds – Critical Care Units– Sliding DoorsBoth feet past threshold =Hand hygiene requiredOutside of doorway = No hand hygieneStepping both feet over the threshold requires hand hygiene.Threshold
25. Thresholds – Procedural Areas/ ED – Privacy CurtainPrivacy curtain and curtain track = ThresholdWalking through privacy curtain and track threshold = Hand hygiene requiredCommon areaPatient zoneHand hygiene in counts as hand hygiene out when crossing a threshold and nothing else is touched.
26. Virtual ThresholdsPatient areas that do not have doors, curtains, or curtain tracks.Hand hygiene must occur when crossing a virtual threshold into the patient “Zone”Virtual ThresholdPatient ZoneCommon areaCommon Area
27. Hand hygiene when crossing patient zonesPatientZoneCommon areaZone boundary
28. Meet Patient BPatient B (no isolation precautions) is served a meal by the dietary team. The nurse tech is in the room checking the patient’s vitals. The hostess drops the tray off in the patient’s room and exits. The hostess uses hand gel upon exiting. The nurse tech opens Patient’s B’s drink and asks Patient B if there is anything else they need before exiting the room. The patient says no and picks up the turkey sandwich to eat. The tech exits, using hand gel on the way out. Was there a missed opportunity?
29. Meet Patient B ANSWER: Patient Hand Hygiene!A reminder: two Purell hand wipes are placed on every meal tray. Staff should encourage the patient to use hand hygiene before and after each meal via the Purell hand wipes.
30. Patients on Enteric PrecautionsCheck the door frame for yellow “Enteric” signGloves and Gown are required for entry and are located in the yellow isolation cart or in the isolation closet Bleach wipes are available for cleaning of re-useable equipment
31. Patients on Enteric Precautions Special Hand Hygiene RequirementCorrect sequenceHand hygiene (soap and water or alcohol hand gel)Don gloves Patient Care or InteractionHand hygiene following removal of PPE ONLY soap and water upon exit from patient room
32. What can we do about C.diff?Hand washing with soap and water every time leave a C.diff room… Improve hand washing complianceAll equipment that goes in and out of patient room wiped down with a PDI bleach wipe (orange top) (ie. Blood pressure monitors, glucometers, wheelchairs, etc)Education to patient and visitors about importance of hand washingDaily cleaning of all high touch surfaces and bathrooms Actively working with EVS to ensure compliance
33. What is the correct contact time for PDI Bleach wipes?1 minute3 minutes4 minutesUntil the surface is dry
34. ANSWERWhat is the correct contact/wet time for PDI Bleach wipes?1 minute3 minutes4 minutesUntil the surface is dry
35. Patient Care Equipment (eg. BP cuffs, dinamaps…)Contact/Wet Time – Means how long a piece of equipment MUST remain wet.Policy #113.65: All patient equipment must be cleaned after each patient.
36. Patient Care EquipmentSani Cloth (Bleach) disinfection procedure:Perform hand hygiene and don gloves prior to use of this product. Gown and face protection may be needed depending on use.If visibly soiled carefully, without splashing disinfectant, dispense a Sani wipe and clean surface to remove soilage and bioburden from the surface cleaned. Then follow step 3.Carefully dispense a second wipe and thoroughly wet surface to be disinfected; surface must be wet for 4 minutes. Repeated use of the product may be required to ensure the surface remains visibly wet for 4 minutes.**Remove gloves and any other PPE, dispose of appropriately and perform hand hygiene.**Note – if an item is NOT visibly soiled then you can skip step #2 and go right to step 3
37. Patient Care Equipment – Contact/Wet TimeBleach = 4 minutesGermicidal = 3 minutes
38. What is the correct process for removing IV pumps after a discharge?Take the pump off the pole and put it in the dirty utility red bin for SCL/CPD pick up.Remove the pump, clean it with a sani wipe or bleach wipe and return it to clean utility.Roll the IV pole containing the pumps out into the hall for pick up.None of the above
39. ANSWERWhat is the correct process for removing IV pumps after a discharge?Take the pump off the pole and put it in the dirty utility red bin for SCL/CPD pick up.Remove the pump, clean it with a sani wipe or bleach wipe and return it to clean utility.Roll the IV pole containing the pumps out into the hall for pick up.None of the above
40. In review5 moments for hand hygieneDifferent types of thresholds Sequence of PPE
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