Hand Hygiene Toolkit Training Presentation

1
Hand Hygiene ToolkitTraining Presentation
2
Introduction

• Do you want your hands to offer hope and healing?
• Or do you want your hands to help spread hospital
  acquired infections?
• Its as simple as that and
• Its up to us to help make Canadas Healthcare
  System a safer place for all of us!

3
Overview

• Canadian Patient Safety Institute established in
  2005
• In 2007 Canada joined the WHOs Global Patient
  Safety Challenge
• Launched the STOP! Clean Your Hands Campaign
• 2009 Developed Human Factors Toolkit.
• 2009/10 Launched a review, update redesign and
  integration to Safer Healthcare Now!

4
Goals

• To promote the importance of hand hygiene in
  reducing the occurrence of healthcare associated
  infections (HCAI) in Canada.
• To educate healthcare workers, patients, and
  families about the importance of practicing
  optimal hand hygiene.
• To support organizations in making the delivery
  of healthcare safer for everyone!

5
Objectives

• To support the needs of healthcare organizations
  for capacity building, leadership development
  and/or the production of tools to help promote
  hand hygiene.
• To assist organizations in understanding how to
  meet Accreditation Canadas Required
  Organizational Practices specific to hand
  hygiene.
• To engage participants across the continuum of
  care in understanding and practicing optimal hand
  hygiene

6
Available Materials

• A website designed to reach out to a broader
  audience and to disseminate information as
  rapidly as possible. (www.handhygiene.ca)
• Fact sheets demonstrate the need for better hand
  hygiene, optimal techniques, and other related
  supportive materials.
• Variety of tools online learning module, audit
  training, various types of assessment tools, a
  patient/family guide, and additional patient and
  family tools and information.
• A nationally consistent audit tool
• Helps establish baseline performance on hand
  hygiene compliance
• Helps to monitor and report on improvements over
  time

7
System change Alcohol-based hand-rubs at point
of care

• An evidence based approach, made up of
• 5 core components, to improve hand hygiene in
  health-care settings

Training and education of staff

Observation of hand hygiene and feedback to staff

Reminders in the workplace

Establishment of a safety climate Individual
active participation and institutional support
8
Healthcare Associated Infections (HCAI)

• An infection occurring in a patient during the
  process of care in a hospital or other health
  care facility which was not present or incubating
  at the time of admission. This includes
  infections acquired in the hospital but appearing
  after discharge, and also occupational infections
  among staff of the facility.
• Ducel G et al. Prevention of hospital-acquired
  infections. A practical guide. WHO 2002

9
The Burden of HCAIs

• More than 220,000 patients acquire healthcare
  associated infections (HCAIs) in Canada every
  year resulting in 8,000 12,000 deaths.1
• At any time, over 1.4 million people worldwide
  are suffering from infections acquired in
  hospital.2
• Up to 50 of HCAIs could have been prevented.3,4
• Zoutman, D., Ford, B.D., Bryce, E., Gourdeau,
  M., Hébert, G., Henderson, E., and Paton, S.
  Canadian Hospital Epidemiology Committee,
  Canadian Nosocomial Infection Surveillance
  Program and Health Canada.
• Zoutman et. al, The state of infection
  surveillance and control at Canadian acute care
  hospitals, American Journal of Infection
  Control, 200331 , 266-275.
• WHO Information Sheet 1 Clean care is Safer
  Care Challenge
• Pittet D, Hugonnet S, Harbarth S, Mourouga P,
  Sauvan V, Touveneau S, Perneger TV. Effectiveness
  of a hospital-wide programme to improve
  compliance with hand hygiene. Infection Control
  Programme. Lancet 2000 Oct 14356(9238)1307-12.
• Patient Safety and Hand Hygiene Matter ! CPSW
  Week 2006 brochure

10
The Case for Hand Hygiene

• Hand hygiene is one of the most effective
  measures to reduce the occurrence of HCAI.
• Good hand hygiene saves lives and reduces the
  strain on our healthcare system. 1
• It takes less than one minute to properly wash
  hands using soap and water and less than 30
  seconds to properly clean hands with
  alcohol-based hand-rub. Both methods are
  effective.
• 1 Roth, Virginia, MD, FRCPC Hands that harm,
  hands that heal November 2006 PowerPoint
  presentation, slide 31

11
The Case for Hand Hygiene Cont.

• As a healthcare worker you should know ...
• You are also susceptible to carrying around
  infectious organisms
• 80 of staff who dressed MRSA wounds carried the
  organism on their hands for 3 hours afterward
• 60 of the hands of staff, within ½ hour of
  contact with patients with Clostridium difficile
  were contaminated without even touching the
  patient
• Meanwhile, washing with soap and water in these
  cases virtually eradicated these organisms!
• Stone, S.P. JR Soc Medicine 2001 94(6) 278-281.
  Cited in Mitka, M. JAMA 2009 302(17) reprinted.

12
Where Were Your Hands?

• Any time within 3 hours of completing a dressing
  change on a patient with MRSA or within ½ hour of
  making any contact in the room of a patient with
  C. difficile?
• Did you eat?
• Did you have coffee?
• Did you cough, rub your nose or eyes?
• Did you approach and make contact with another
  patient or a family member?
• Before you touch anything or anyone...
• STOP! Clean Your Hands!

13
Obstacles to Hand Hygiene

• Too busy
• It is essential that you make time
• Skin irritation
• Use lotions hand rub appropriately
• Glove use
• is not a substitute for hand hygiene
• Not top of mind
• needs to become as spontaneous as using aseptic
  technique and all other safety strategies.

14
So, Why Clean your hands?

• 1) to protect the patient against harmful
  pathogens carried on your hands or present on
  his/her own skin
• 2) to protect yourself and the healthcare
  environment from harmful pathogens

15
Key Concepts

• Hand hygiene must be performed at the point of
  care.
• During healthcare delivery, there are four
  moments when it is essential that you perform
  hand hygiene.
• Handrub is often preferable to handwashing.
• If isolation precautions are in place, always
  adhere to the hand hygiene activities described
  in those precautions.
• It is essential that everyone perform hand
  hygiene using the appropriate technique and time
  duration in order for it to be effective.

16
Point of Care

• The place where three elements align
• The patient
• The healthcare worker
• The care of the patient involving any contact
  with the patient or the patients zone.
• A hand hygiene product should be as close as
  possible to the point of care.
• WHO Hand Hygiene Guidelines, August 2009

17
Four Times to Clean

• FOUR Moments of hand hygiene during healthcare
  have been identified and are crucial to
  preventing hand transmission of infections.
• Before initial patient/patient environment
  contact
• Before aseptic procedure
• After body fluid exposure risk
• After patient/patient environment contact
• This was adapted from the WHOs 5 Moments of Hand
  Hygiene (Ontario Ministry of Health and Long Term
  Care).

18
(No Transcript)
19
Time

• Optimal hand hygiene using an alcohol-based hand
  rub takes 20-30 seconds
• Optimal hand hygiene using soap and water takes
  40-60 seconds
• Both are effective methods

20
Alcohol Based Hand Rub

• Apply a palm full of rub and cover all surfaces
  of the hand rub together until the hands are dry.

21
How to Hand Rub
To effectively reduce the growth of germs on
hands, handrubbing must be performed by
following all steps illustrated on the
left. This takes only 20-30 secs!
22
Soap Water

• Wet the hands first and apply enough soap to
  cover all surfaces of the hands. Make sure the
  hands are dry and the towels are not used
  repeatedly or by multiple people.
• Thorough drying of hands after hand washing has
  important protective benefits and helps to
  eliminate more pathogens from your hands.

23
How to Hand Wash
To effectively reduce the growth of pathogens on
hands, handwashing must last 40-60 secs and
should be performed by following all steps
illustrated on the left.
24
Gloves Skin care

• Gloves do not replace the practice of optimal
  hand hygiene
• Avoid hand washing immediately before or after
  using an alcohol-based hand rub
• Avoid hot water
• Let hands dry completely before donning gloves
• Use hand lotions and creams
• Allergies or adverse reactions use alternative
  products
• No artificial fingernails or extenders
• Keep natural nails short (0.5 cm)
• Remove jewelry

25
Resources

• World Health Organization Guidelines on Hand
  Hygiene in Health Care. First Global Patient
  Safety Challenge, Clean Care is Safer Care.
  August 2009.
• http//whqlibdoc.who.int/publications/2009/9789241
  597906_eng.pdf
• WHO Clean Care is Safer Care Tools and
  Resources http//www.who.int/gpsc/5may/tools/en/i
  ndex.html
• Canadian Patient Safety Institute
  www.handhygiene.ca
• Community and Hospital Infection Control
  Association Canada. http//www.chica.org/links_h
  andhygiene.htmlSTANDARDS

26
Resources

• Public Health Agency of Canada, Hand Hygiene
  Recommendations for Remote and Isolated Community
  Settings. http//www.phac-aspc.gc.ca/alert-alerte/
  h1n1/public/handhygiene-eng.php?optionprint
• Health Canada The Benefits of Handwashing
  http//www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-mala
  dies/hands-mains-eng.php
• Canadian Centre for Occupational Health and
  Safety http//www.ccohs.ca/http//www.ccohs.ca/
• http//www.ccohs.ca/pandemic/subject/handwashing.h
  tml
• The Art of Washing Hands http//www.theartofwashi
  nghands.com/index.html

27
Questions?
28
Introduction

• Do you want your hands to offer hope and healing?
• Or do you want your hands to help spread hospital
  acquired infections?
• Its as simple as that and
• Its up to us to help make Canadas Healthcare
  System a safer place for all of us!

29
Overview

• Canadian Patient Safety Institute established in
  2005
• In 2007 Canada joined the WHOs Global Patient
  Safety Challenge
• Launched the STOP! Clean Your Hands Campaign
• 2009 Developed Human Factors Tool Kit.
• 2009/10 Launched a review, update redesign and
  integration to Safer Healthcare Now!

30
Goals

• To promote the importance of hand hygiene in
  reducing the occurrence of healthcare associated
  infections (HCAI) in Canada.
• To educate healthcare workers, patients, and
  families about the importance of practicing
  optimal hand hygiene.
• To support organizations in making the delivery
  of healthcare safer for everyone!

31
Objectives

• To support the needs of healthcare organizations
  for capacity building, leadership development
  and/or the production of tools to help promote
  hand hygiene.
• To assist organizations in understanding how to
  meet Accreditation Canadas Required
  Organizational Practices specific to hand
  hygiene.
• To engage participants across the continuum of
  care in understanding and practicing optimal hand
  hygiene

32
Available Materials

• A website designed to reach out to a broader
  audience and to disseminate information as
  rapidly as possible. (www.handhygiene.ca)
• Fact sheets demonstrate the need for better hand
  hygiene, optimal techniques, and other related
  supportive materials.
• Variety of tools online learning module, audit
  training, various types of assessment tools, a
  patient/family guide, and additional patient and
  family tools and information.
• A nationally consistent audit tool
• Helps establish baseline performance on hand
  hygiene compliance
• Helps to monitor and report on improvements over
  time

33
System change Alcohol-based hand-rubs at point
of care

• An evidence based approach, made up of
• 5 core components, to improve hand hygiene in
  health-care settings

Training and education of staff

Observation of hand hygiene and feedback to staff

Reminders in the workplace

Establishment of a safety climate Individual
active participation and institutional support
34
Healthcare Associated Infections (HCAI)

• An infection occurring in a patient during the
  process of care in a hospital or other health
  care facility which was not present or incubating
  at the time of admission. This includes
  infections acquired in the hospital but appearing
  after discharge, and also occupational infections
  among staff of the facility.
• Ducel G et al. Prevention of hospital-acquired
  infections. A practical guide. WHO 2002

35
The Burden of HCAIs

• More than 220,000 patients acquire healthcare
  associated infections (HCAIs) in Canada every
  year resulting in 8,000 12,000 deaths.1
• At any time, over 1.4 million people worldwide
  are suffering from infections acquired in
  hospital.2
• Up to 50 of HCAIs could have been prevented.3,4
• Zoutman, Dick, MD, FRCPC, B. Douglas Ford, MA,
  Elizabeth Bryce, MD, Marie Gourdeau, MD,Ginette
  Hébert, RN, Elizabeth Henderson, PhD, and Shirley
  Paton, MN, Canadian Hospital Epidemiology
  Committee, Canadian Nosocomial Infection
  Surveillance Program and Health Canada. Zoutman
  et. al, The state of infection surveillance and
  control at Canadian acute care hospitals,
  American Journal of Infection Control, 200331 ,
  266-275.
• WHO Information Sheet 1 Clean care is Safer
  Care Challenge
• Pittet D, Hugonnet S, Harbarth S, Mourouga P,
  Sauvan V, Touveneau S, Perneger TV. Effectiveness
  of a hospital-wide programme to improve
  compliance with hand hygiene. Infection Control
  Programme. Lancet 2000 Oct 14356(9238)1307-12.
• Patient Safety and Hand Hygiene Matter ! CPSW
  Week 2006 brochure

36
The Case for Hand Hygiene

• Hand hygiene is one of the most effective
  measures to reduce the occurrence of HCAI.
• Good hand hygiene saves lives and reduces the
  strain on our healthcare system. 1
• It takes less than one minute to properly wash
  hands using soap and water and less than 30
  seconds to properly clean hands with
  alcohol-based hand-rub. Both methods are
  effective.
• 1 Roth, Virginia, MD, FRCPC Hands that harm,
  hands that heal November 2006 PowerPoint
  presentation, slide 31

37
The Case for Hand Hygiene Cont.

• As a healthcare worker you should know ...
• You are also susceptible to carrying around
  infectious organisms
• 80 of staff who dressed MRSA wounds carried the
  organism on their hands for 3 hours afterward
• 60 of the hands of staff, within ½ hour of
  contact with patients with Clostridium difficile
  were contaminated without even touching the
  patient
• Meanwhile, washing with soap and water in these
  cases virtually eradicated these organisms!
• Stone, S.P. JR Soc Medicine 2001 94(6) 278-281.
  Cited in Mitka, M. JAMA 2009 302(17) reprinted.

38
Where Were Your Hands?

• Any time within 3 hours of completing a dressing
  change on a patient with MRSA or within ½ hour of
  making any contact in the room of a patient with
  C. difficile?
• Did you eat?
• Did you have coffee?
• Did you cough, rub your nose or eyes?
• Did you approach and make contact with another
  patient or a family member?
• Before you touch anything or anyone...
• STOP! Clean Your Hands!

39
Obstacles to Hand Hygiene

• Too busy
• It is essential that you make time
• Skin irritation
• Use lotions hand rub appropriately
• Glove use
• is not a substitute for hand hygiene
• Not top of mind
• needs to become as spontaneous as using aseptic
  technique and all other safety strategies.

40
So, Why Clean your hands?

• 1) to protect the patient against harmful
  pathogens carried on your hands or present on
  his/her own skin
• 2) to protect yourself and the health-care
  environment from harmful pathogens

41
Key Concepts

• Hand hygiene must be performed at the point of
  care.
• During healthcare delivery, there are four
  moments when it is essential that you perform
  hand hygiene.
• Handrub is often preferable to handwashing.
• If isolation precautions are in place, always
  adhere to the hand hygiene activities described
  in those precautions.
• It is essential that everyone perform hand
  hygiene using the appropriate technique and time
  duration in order for it to be effective.

42
Point of Care

• The place where three elements align
• The patient
• The healthcare worker
• The care of the patient involving any contact
  with the patient or the patients zone.
• A hand hygiene product should be as close as
  possible to the point of care.
• WHO Hand Hygiene Guidelines, August 2009

43
Four Times to Clean

• FOUR Moments of hand hygiene during healthcare
  have been identified and are crucial to
  preventing hand transmission of infections.
• Before initial patient/patient environment
  contact
• Before aseptic procedure
• After body fluid exposure risk
• After patient/patient environment contact
• This was adapted from the WHOs 5 Moments of Hand
  Hygiene (Ontario Ministry of Health and Long Term
  Care).

44
(No Transcript)
45
Time

• Optimal hand hygiene using an alcohol-based hand
  rub takes 20-30 seconds
• Optimal hand hygiene using soap and water takes
  40-60 seconds
• Both are effective methods

46
Alcohol Based Hand Rub

• Apply a palm full of rub and cover all surfaces
  of the hand rub together until the hands are dry.

47
How to Hand Rub
To effectively reduce the growth of germs on
hands, handrubbing must be performed by
following all steps illustrated on the
left. This takes only 20-30 secs!
48
Soap Water

• Wet the hands first and apply enough soap to
  cover all surfaces of the hands. Make sure the
  hands are dry and the towels are not used
  repeatedly or by multiple people.
• Thorough drying of hands after hand washing has
  important protective benefits and helps to
  eliminate more pathogens from your hands.

49
How to Hand Wash
To effectively reduce the growth of pathogens on
hands, handwashing must last 40-60 secs and
should be performed by following all steps
illustrated on the left.
50
Gloves Skin care

• Gloves do not replace the practice of optimal
  hand hygiene
• Avoid hand washing immediately before or after
  using an alcohol-based hand rub
• Avoid hot water
• Let hands dry completely before donning gloves
• Use hand lotions and creams
• Allergies or adverse reactions use alternative
  products
• No artificial fingernails or extenders
• Keep natural nails short (0.5 cm)
• Remove jewelry

51
Resources

• World Health Organization Guidelines on Hand
  Hygiene in Health Care. First Global Patient
  Safety Challenge, Clean Care is Safer Care.
  August 2009.
• http//whqlibdoc.who.int/publications/2009/9789241
  597906_eng.pdf
• WHO Clean Care is Safer Care Tools and
  Resources http//www.who.int/gpsc/5may/tools/en/i
  ndex.html
• Canadian Patient Safety Institute
  www.handhygiene.ca
• Community and Hospital Infection Control
  Association Canada. http//www.chica.org/links_h
  andhygiene.htmlSTANDARDS

52
Resources

• Public Health Agency of Canada, Hand Hygiene
  Recommendations for Remote and Isolated Community
  Settings. http//www.phac-aspc.gc.ca/alert-alerte/
  h1n1/public/handhygiene-eng.php?optionprint
• Health Canada The Benefits of Handwashing
  http//www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-mala
  dies/hands-mains-eng.php
• Canadian Centre for Occupational Health and
  Safety http//www.ccohs.ca/http//www.ccohs.ca/
• http//www.ccohs.ca/pandemic/subject/handwashing.h
  tml
• The Art of Washing Hands http//www.theartofwashi
  nghands.com/index.html

53
Questions?