09/09/2016
Hand Hygiene
Lets get Practical
Liz Forde, IPCN,
Cork Community Hospitals & Nursing Services
Patricia Coughlan, IPCN,
Disability Services Cork & Kerry.
The lights go out and I can't be saved
Tides that I tried to swim against
Have brought me down upon my knees
Oh I beg, I beg and plead, singing
RCSI 2016
Hand Hygiene Let's get Practical
“22 hand hygiene
opportunities were noted
but just 14 of these were
taken & only 8 with
correct technique” 2016
Come out of things unsaid
Shoot an apple off my head and a
Trouble that can't be named
A tiger's waiting to be tamed, singing
“Patients at risk of
acquiring a healthcare
associated infection”
“Culture of hand
hygiene best practice
was not embedded at
all levels” 2016
Some positive influences
Social influences“Students and qualified
professionals observe &
follow the practice of
others”
Culture “Where there is a supportive
culture, compliance with hand
hygiene guidelines improved”
Cues “Visible resources such as alcohol handrub trigger compliance”
Confusion never stops
Closing walls and ticking clocks
Gonna come back and take you home
I could not stop that you now know,
singing
Smiddy, M; O’Connell, R. and Creedon, S.A. (2015) Systematic qualitative literature review of health care workers’ compliance with
hand hygiene guidelines American Journal of Infection Control 43; 269-274
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
1
09/09/2016
• Improving hand hygiene requires commitment
from all staff to implement the WHO multimodal
HSE/HPSC
strategy in all facilities
Come out upon my seas
Cursed missed opportunities
Am I a part of the cure?
Or am I part of the disease?
• 2015 – Evidence that the WHO-5 is effective at
increasing healthcare worker hand hygiene
Luangasanatip, N.; Hongsuwan, M.’ Limmathurotsakul, D.; Lubell, Y.; Lee, A.S.; Harbath, S.; Day, N.P.J.; Graves, N. and Cooper,
B.S. (2015) Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review & network metaanalysis. Available at http://www.bmj.com/content/351/bmj.h3728
Build it
Teach it
It’s in your hands....
Be part of the cure
Check
It
Sell it
Live it
TODAYS FOCUS
RCSI 2016
Hand Hygiene Let's get Practical
Hand Hygiene
At the right time
and
In the right way
RCSI 2016
Hand Hygiene Let's get Practical
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
2
09/09/2016
Remember to wet
your hands
thoroughly before
applying soap – 1
shot !
RCSI 2016
Hand Hygiene Let's get Practical
RCSI 2016
Hand Hygiene Let's get Practical
Are you hand
hygiene ready?
RCSI 2016
Hand Hygiene Let's get Practical
Remembering to
rinse off all
product after
washing & then
dry thoroughly
with paper
towels!
RCSI 2016
Hand Hygiene Let's get Practical
WHAT PRODUCTS SHOULD WE USE FOR
HAND HYGIENE ?
When using AHR – Remember
Cover all surfaces once using the
6 step technique
Continue rubbing until hands are
completely dry
Duration 20-30 secs
RCSI 2016
Hand Hygiene Let's get Practical
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
Where healthcare is
delivered alcoholbased hand rub(AHR)
is the preferred
method for hand
hygiene when hands
are not visibly
soiled.
RCSI 2016
Hand Hygiene Let's get Practical
Soap and running
water must be used
for hand washing
when
– hands are visibly
soiled
– caring for persons
with diarrhoeal
illness or where
there is potential
for spread of
microorganisms
which are
resistant to AHR
e.g. C.difficile.
Once dry hands are safe
3
09/09/2016
HAND HYGIENE
LET’S GET PRACTICAL
WHO - MY 5 MOMENTS APPROACH
An approach for Hand Hygiene
focusing on the critical times for hand
hygiene when there is a direct risk for
Health care associated infection
applicable to all areas where healthcare is
delivered including primary care, LTCF and
home based care.
HAND HYGIENE - AT THE RIGHT TIME
WHAT ARE THE 5 MOMENTS FOR HAND HYGIENE?
5 MOMENTS FOR HAND HYGIENE
………..Zone
Moment is ……
when there is a perceived or actual
risk of transmission of microorganisms from one surface to
another on the hands
RCSI 2016
Hand Hygiene Let's get Practical
A
RCSI 2016
Hand Hygiene Let's get Practical
RCSI 2016
Hand Hygiene Let's get Practical
At the right time
and
In the right way
………..Zone
Identify the 5 Moments for
Hand Hygiene , giving the
reason whys it’s necessary at
that time
1._______________
Why__________________________
2._______________
Why__________________________
3._______________
Why__________________________
4._______________
Why__________________________
5._______________
Why__________________________
There are two zones …can you
name them?
5 STAGES OF HAND TRANSMISSION
1.
4.
5.
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
PATIENT ZONE
RCSI 2016
Hand Hygiene Let's get Practical
3.
RCSI 2016
Hand Hygiene Let's get Practical
2.
Organisms present on residents/clients skin
and immediate environment surfaces
Organisms transfer onto health-care worker’s
hands
Organisms survive on hands for several
minutes
If hand hygiene isn’t carried out or not done
correctly this results in hands remaining
contaminated
Contaminated hands then transmit germs via
direct contact with residents or resident’s
immediate environment
HEALTH-CARE AREA
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09/09/2016
RESIDENT’S/CLIENTS ZONE
Patient zone:
Single room
Patient/resident/clients surfaces
and items that are temporarily and
exclusively dedicated.
For example bed rails, bedside
table, bed linen, chairs, infusion
tubing, monitors, knobs and
buttons, and other medical
equipment.
This area becomes contaminated by
the residents/patients own flora.
Multi resident
room
Health-care zone:
All surfaces in the health-care setting
outside the residents/patient zone.
For example other residents/patients and
their residents/patient zones and the
wider health-care environment.
The health-care area is characterized by
the presence of various and numerous
microbial species, including multiresistant germs.
PATIENT ZONE
Critical Site
risk of
exposure to
body fluids
OPTIMAL HAND
HYGIENE
CRITICAL SITES
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
POINT-OF-CARE
•Patient/Resident
SHOULD BE
PERFORMED
RCSI 2016
Hand Hygiene Let's get Practical
Sites with in the patient zone which
are associated with a higher risk of
infection.
For example medical devices i.e.
PEG site /Urinary Catheter where
there is a risk of acquiring infection
or
risk of exposure to body fluids i.e.
taking blood sample or handling
incontinence wear.
RCSI 2016
Hand Hygiene Let's get Practical
Critical
sites
Critical Site –
risk of
acquiring HCAI
RCSI 2016
Hand Hygiene Let's get Practical
HEALTH-CARE AREA
•HCW
•Care
5
09/09/2016
WHAT ARE THE 5 MOMENTS
Healthcare Zone
Patient Zone
FOR
HAND HYGIENE?
1.
Why? To protect the resident/patient
from harmful germs on your hands which
could lead to colonisation or infection
MAKING THIS WORK IN RESIDENTIAL
CARE FACILITIES
Why? To protect the
resident/patient from harmful germs
including the patients own germs from
entering his or her body
Where residents are cared for in a dedicated
space with dedicated equipment
Where residents are semi- autonomous they have
their own room or shared room but they also
move within the facility-
3.
Why? To protect yourself and the
health care environment from harmful
germs contained in body fluids
4.
Why? To protect yourself and the
healthcare environment from harmful
germs picked up on your hands when
providing care
5 moments apply
4 moments apply
RCSI 2016
Hand Hygiene Let's get Practical
2.
5.Why? To protect yourself and the
healthcare environment from harmful
germs which maybe in the immediate
environment or on equipment used by
the resident.
___________________________
MAKING THIS WORK IN RESIDENTIAL
CARE FACILITIES
Where residents are semi- autonomous they have
their own room or shared room but they also
move within the facility-
5 moments apply
Remember 4 and 5
moments do not cover
any
social
contacts with
4 moments
apply
or among LTCF residents
unrelated to healthcare
•Staff member enters the residents room and speaks to the resident
Moment 1
•Staff member explains to the resident and takes necessary items from the locker and
dons disposable gloves
RCSI 2016
Hand Hygiene Let's get Practical
If staff provide any
“HEALTHCARE” where
shared activities occur,
the 4 moments for Hand
Hygiene apply.
If staff provide any
“HEALTHCARE” where shared
activities occur, the 4 moments for
Hand Hygiene apply.
Staff member changing a residents incontinence wear
MAKING THIS WORK IN RESIDENTIAL
CARE FACILITIES
Shared areas –dining room, day room etc:
In common areas where residents/clients
gather, the environment is shared by many
people.
To reduce spread of harmful microorganisms,
staff and resident should clean hands before
and after activities.
Some residents may need help cleaning their
hands before they begin and after they end
an activity.
Shared areas –dining room, day room etc:
In common areas where residents/clients
gather, the environment is shared by many
people.
To reduce spread of harmful microorganisms,
staff and resident should clean hands before
and after activities.
Some residents may need help cleaning their
hands before they begin and after they end
an activity.
•Staff member removes and folds incontinence wear and places it in a disposable bag
•Staff member cleans the resident before replacing incontinence wear
•Staff member disposes of waste and then removes and discards gloves in the waste bag
Moment 3
• Staff member positions the resident in a comfortable position and replaces the covers
•Staff member leaves the room
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
RCSI 2016
Hand Hygiene Let's get Practical
Where residents are cared for in a dedicated
space with dedicated equipment
RCSI 2016
Hand Hygiene Let's get Practical
MAKING THIS WORK IN RESIDENTIAL
CARE FACILITIES
Moment 4
6
09/09/2016
HCW CARRYING
OUT OBSERVATIONS IN A FOUR BEDDED ROOM IN A COMMUNITY
HOSPITAL.
•HCW is recording vital signs in a four bedded bay and starts by approaching patient A, brings
the machine to the bed space
Moment 1
•HCW places the thermometer in the patients ear, checks pulse and then records the results
on the chart.
Moment 2
RCSI 2016
Hand Hygiene Let's get Practical
•The patient is diabetic so the HCW performs a finger prick and uses the BGM to get a reading
& records the reading
Moment 5
•The person has a urinary catheter so the HCW bends down to look at the bag which is full
•HCW leaves the room and walks to the sluice to get a container
Moment 2
•HCW returns to the patient and proceeds to empty the bag
•HCW walks to the dirty utility and discards the urine and returns to the patient
Moment 3
•HCW records the volume on the appropriate chart.
Moment 5 & 1
•HCW goes to patient B to carry out observations
HCW ASSISTING RESIDENTS IN A DINING ROOM
In any setting hand hygiene should be carried
out before meals/before eating and residents
facilitated to clean their hands before dining
OUTPATIENT SETTINGS 1
In
•Staff member enters the dining room
•Staff member places meals on the dining room table
•Staff member assists a resident to cut food
Moment 2
•Staff member attends to a residents enteral feeding system, manipulating the
connection and adjusting the feed rate.
Moment 4
•Staff member returns to the dining room table to assist a resident to pour a drink
RCSI 2016
Hand Hygiene Let's get Practical
•Staff member assists residents to sit to the dining room table
the outpatient setting
the patient is considered
the patient zone as the
space and equipment is
not exclusively
dedicated to the patient
for any prolonged time
e.g. vaccination clinic
•Staff member leaves the dining room
RCSI 2016
Hand Hygiene Let's get Practical
OUTPATIENTS SETTING 2
In outpatient settings moment
5 after touching the patient’s
surroundings only applies
where the patient is placed in
a dedicated space for a
certain amount of time
(~>20mins) with dedicated
equipment
In this case it can be
anticipated that the
environment will become
contaminated with patients
own microorganisms, e.g.
dental treatment area,
shedding in a wound care
RCSI 2016
clinic
Hand Hygiene Let's get Practical
PUBLIC VACCINATION CLINIC
• Person walks into a vaccination clinic as previous person walks out
Moment
2
• HCW cleans the site (as needed)
• HCW picks up pre-prepared single use material of vaccination
• HCW performs the injection
• HCW discards the sharps into the sharps bin on the table
• HCW covers the site as needed,
RCSI 2016
Hand Hygiene Let's get Practical
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
• Person sits down & exposes their arm
• HCW records vaccination
• Person leaves the area & another walks in
Moment 4 &
Moments 1
merge for 1
opportunity
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09/09/2016
FIVE KEY POINTS FOR HAND HYGIENE
1
3
4
5
• During health care delivery, remember the moments when it is
essential that you perform hand hygiene.
• Use an alcohol hand rub, as it makes hand hygiene possible right at
the point-of-care, it is faster, more effective and better tolerated.
• Wash your hands with soap and water when visibly soiled, caring
for patients/residents known or suspected to have C.difficile associated
diarrhoea
RCSI 2016
Hand Hygiene Let's get Practical
2
• Hand hygiene must be performed exactly where you are
delivering health care - at the point-of-care.
Hand Hygiene
At the right time, in the right way
Helps Safe lives
Take A Moment for Hand Hygiene,
they all count!
Thank you.
• Perform hand hygiene using the appropriate technique, 6 steps for the
correct duration.
RCSI 2016
Hand Hygiene Let's get Practical
REFERENCES
Pittet, D. (2004). The Lowbury Lecture: behavior in infection control. Journal
of Hospital Infection, 58: 1 – 13.
HSE (2015). Guidelines for Hand Hygiene in Irish Healthcare Settings.
Update of 2005 guidelines.
World Health Organisation (WHO) (2009). WHO guidelines on Hand Hygiene
in Healthcare: First Global Patient Safety Challenge, clean care is safer care.
WHO Press, Geneva.
World Health Organisation (2009). Hand Hygiene: Why, How & When?
http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochu
re.pdf
World Health Organisation (2012) Hand Hygiene in Outpatient and Homebased Care and Long-term Care Facilities A Guide to the Application of the
WHO Multimodal Hand Hygiene Improvement Strategy and the “My Five
Moments for Hand Hygiene” Approach
http://apps.who.int/iris/bitstream/10665/78060/1/9789241503372_eng.pdf?ua
=1
National Audits of Hand Hygiene Compliance in hospitals in Ireland (HPSC)
2015 Accessed August 27th 2015 http://www.hpsc.ie/AZ/MicrobiologyAntimicrobialResistance/EuropeanSurveillanceofAntimicrobial
ConsumptionESAC/PublicMicroB/HHA/a1.html
RCSI 2016 Hand Hygiene
Liz Forde & Patricia Coughlan
RCSI 2016
Hand Hygiene Let's get Practical
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