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MODULE 2 Hand Hygiene

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Title: MODULE 2 Hand Hygiene


1
MODULE 2 Hand Hygiene
2
Hand HygieneIs Key to Keeping Kidney Patients
Safe
MODULE 2 Hand Hygiene
3
Hand Hygiene
MODULE 2 Hand Hygiene
  • Hand hygiene practices - the use of
    alcohol-based hand rubs or use of soap and water
    before and after patient contact, removal of
    gloves and contact with the immediate patient
    care environment - protect both healthcare
    personnel and patients from contact with
    infectious agents.
  • Proper hand hygiene breaks the chain of
    infection transmission and minimizes micro
    organisms acquired by contact with infected
    surfaces.

4
Facts About Hand Hygiene
MODULE 2 Hand Hygiene
  • Hemodialysis patients tend to be among the first
    to experience antibiotic-resistant pathogens.
  • Improved adherence to hand hygiene has been shown
    to reduce transmission of antimicrobial resistant
    organisms (e.g. methicillin resistant
    staphylococcus aureus) and reduce overall
    infection rates.
  • 11 of patients report seeing nurses or
    technicians who fail to wash hands or change
    gloves before touching a patients access or
    change gloves before touching their access site.
  • 27 of professionals reported observing staff
    fail to wash hands or change gloves before
    touching a patients access.
  • Gloves reduce hand contamination by 70-80,
    prevent cross-contamination and protect patients
    and health care personnel from infection.
  • The use of gloves does not eliminate the need for
    hand hygiene.

5
Hand Hygiene Best Practices
MODULE 2 Hand Hygiene
  • Immediately before touching a patient, performing
    an invasive procedure, or manipulating an
    invasive device.
  • Immediately after touching a patient,
    contaminated items or surfaces, or removing
    gloves.
  • Before putting on gloves.
  • After removing gloves.
  • After touching items or surfaces in the immediate
    patient care environment regardless of patient
    contact.
  • When using an alcohol-based hand rub, apply
    product to palm of one hand and rub hands
    together, covering all surfaces of hands and
    fingers, until hands are dry.
  • When hands are visibly soiled, wash hands with
    soap and water. Rub hands together for at least
    15 seconds, covering all surfaces, focusing on
    fingertips and fingernails.

6
Handle of Cupboard in HD ClinicBlood Stains with
Luminol
MODULE 2 Hand Hygiene

Luminol is used to detect trace amounts of blood
as it reacts with iron found in hemoglobin.
Bergervoit PWM et al, Application of the
forensic Luminol for blood in infection control,
J Hosp Infection (2008), 68, 329-333.
7
Control Panel of HD MachineBlood Stains with
Luminol
MODULE 2 Hand Hygiene

Luminol is used to detect trace amounts of blood
as it reacts with iron found in hemoglobin.
Bergervoit PWM et al, Application of the
forensic Luminol for blood in infection control,
J Hosp Infection (2008), 68, 329-333.
8
Factors Contributing to Poor Hand Hygiene
MODULE 2 Hand Hygiene
  • Inconvenient sink location 
  • Cleaning hands causes skin irritation and dryness
       
  • Lack of soap or hand rub    
  • Too busy/lack of time    
  • Insufficient knowledge about risks of not
    practicing hand hygiene

9
Why Use Alcohol-Based Hand Rubs?
MODULE 2 Hand Hygiene
  • Alcohol-based hand rubs kill most microbes more
    effectively and more quickly than hand washing
    with soap and water.
  • Less damaging to skin than soap and water,
    resulting in less dryness and irritation.
  • Require less time than hand washing with soap and
    water. In an eight-hour shift, an estimated one
    hour of an ICU nurse's time will be saved by
    using an alcohol-based hand rub.
  • Bottles/dispensers can be placed at the point of
    care so they are more accessible.
  • Alcohol rubs cannot be used when hands are
    visibly soiled or have been exposed to
    Clostridium difficile.

10
How to Use Hand Rubs
MODULE 2 Hand Hygiene
  • Apply 1.5 to 3ml hand rub to palm of one hand
    and rub hands together, covering all surfaces of
    hands and fingers, until hands are dry.
  • If you have applied a sufficient amount of hand
    rub, it should take at least 10-15 seconds of
    rubbing until hands feel dry.

11
When to use soap and water
MODULE 2 Hand Hygiene
  • When hands are visibly dirty or contaminated with
    proteinaceous materials.
  • When taking care of a patient with known or
    suspected Clostridium difficile (C diff.)
    diarrhea (the C diff. spores are not killed by
    alcohol)
  • When alcohol rubs are not available.

12
How to use soap and water
MODULE 2 Hand Hygiene
  • Wet hands with running water.
  • Rub hands together with soap and lather, covering
    all surfaces
  • Weave fingers and thumbs together, and vigorously
    rub all surfaces of lathered hands for 15
    seconds. Wash under and around rings, cuticles
    and under fingernails.
  • Rinse hands under a stream of clean, running
    water until all soap is gone. Remember to point
    fingers down so water and contaminants wont drip
    towards elbows.
  • Pat hands dry, beginning at the wrist and moving
    down.
  • Turn off water, using a paper towel.

13
What About Hand Lotions?
MODULE 2 Hand Hygiene
  • Hand lotions are important to prevent skin
    dryness and irritation. Use only
    hospital-approved hand lotions. Other lotions
    may
  • make hand hygiene less effective
  • cause breakdown of latex gloves
  • become contaminated with bacteria if dispensers
    are refilled

14
When to Wear Gloves
  • Always, when caring for a patient
  • When touching any machine, equipment, bloodlines,
    or medical device
  • When to CHANGE gloves
  • Whenever dirty
  • When moving from contaminated areas to clean
    areas
  • When moving between patients

15
Developing Policies and Procedures
MODULE 2 Hand Hygiene
  • Review current policies and procedures to ensure
    they meet current recommendations for hand
    hygiene.
  • Review CMS Conditions for Coverage for ESRD
    Facilities
  • Consider using a process analysis fishbone to
    examine policies and procedures
  • Review examples of Quality Improvement Projects
    (QIPs) and develop QIPS appropriate for your
    facility.

16
CMS Conditions for Coverage for ESRD Facilities -
ESRD Program Interpretive Guidance Version 1.1
MODULE 2 Hand Hygiene
  • Interpretive guidelines that address hand hygiene
    include
  • V113 Glove requirements
  • Requires gloves when caring for a patient or
    touching the patients equipment. Must perform
    hand hygiene after removal of gloves between
    each patient or station.
  • V114 Sufficiency of sinks to facilitate hand
    hygiene
  • V132 Infection Control Training Education
  • Requires training and education for both new
    existing staff members
  • V147 Education training for care of IV
    catheters
  • V142 Biohazard infection control policies
    activities
  • V625 Quality assessment and performance
    improvement (QAPI)
  • Requires performance measures
  • V637 Infection Control

17
Process Analysis Fishbone
MODULE 2 Hand Hygiene
  • A process analysis fishbone is a diagrammatic way
    to examine the policies, procedures, people, and
    equipment involved in a process leading to an
    outcome.
  • Providers may use the process analysis to develop
    Quality Improvement Projects (QIPs)

18
MODEL HANDWASHINGPOLICIES AND PROCEDURES
MODULE 2 Hand Hygiene
  • REQUIRED HAND HYGIENE PRACTICES
  • 1. PURPOSE This Veterans Health Administration
    (VHA) Directive provides guidance for
    establishing the basic requirements for hand
    hygiene practices in VHA facilities.
  • 2. BACKGROUND
  • a. Hand decontamination has been shown to prevent
    the spread of infectious agents in clinical
    settings for over 150 years.
  • b. In October of 2002, the Centers for Disease
    Control and Prevention (CDC) issued a new
    Guideline on Hand Hygiene in Health-Care
    Settings, which examined the evidence in over 400
    publications and provided 44 recommendations for
    hand hygiene practices. The need to decontaminate
    hands before and after engaging in direct patient
    care activities by using an alcohol-based hand
    rub (in the absence of visibly soiled or
    contaminated hands), or as an alternative by
    using an antimicrobial soap and water, has been
    emphasized.
  • c. In July of 2003, the Joint Commission on
    Accreditation of Healthcare Organizations (JCAHO)
    issued national patient safety goals, which
    became effective January 1, 2004. Goal 7, reduce
    the risk of health care associated infections,
    requires compliance with the CDC recommendations
    that were supported by a high level of evidence
    or required by law (identified as category IA,
    IB, or IC recommendations in the Guideline). This
    goal has been retained by JCAHO as a national
    patient safety goal for 2005.
  • d. In December of 2003, the Under Secretary for
    Health issued a memorandum to all Veterans
    Integrated Services Network (VISN) Directors and
    VA medical center Directors summarizing the CDC
    Guideline requirements and affirming the need to
    make any necessary changes to improve hand
    hygiene practices.
  • 3. POLICY It is VHA Policy that each VHA
    facility must have a written policy regarding
    hand hygiene and that policy must be implemented
    by March 1, 2005.
  • 4. ACTION Each VHA facility Director is
    responsible for ensuring
  • a. A hand hygiene policy (conforming to the
    Category IA, IB, and IC recommendations presented
    in the CDC Guideline as summarized in subpars.
    4b-4i) is implemented by March 1, 2005.
  • b. All health care workers in direct patient
    contact areas, i.e., inpatient rooms, outpatient
    clinics, etc., as well as those who may have
    direct patient contact in other settings, such as
    radiology technicians, phlebotomists, etc.,

19
Focused Education Program for Patients,
Caregivers and Staff
MODULE 2 Hand Hygiene
  • Provide in-service training to staff about hand
    hygiene procedures and policies
  • Reinforce hand hygiene policies through
    newsletter articles, brochures and bulletin
    board postings
  • Provide information on hand hygiene to patients
    and caregivers

20
World Health Organization Five Moments for
Hand Hygiene
MODULE 2 Hand Hygiene
  • Before Patient Contact
  • Before Aseptic Task
  • After Body Fluid Exposure Risk
  • After Patient Contact
  • After Contact with Patient Surroundings

21
MODULE 2 Hand Hygiene
22
Which hand hygiene method is more effective at
killing bacteria?
MODULE 2 Hand Hygiene
  • Regular soap and water  
  • Anti-bacterial soap and water
  • Alcohol-based hand rub (foam or gel)

23
Which hand hygiene method is more effective at
killing bacteria?
MODULE 2 Hand Hygiene
  • Regular soap and water  
  • Anti-bacterial soap and water
  • Alcohol-based hand rub (foam or gel)

24
How long should you rub your hands together when
washing with soap and water?
MODULE 2 Hand Hygiene
  • 5 seconds
  • 15 seconds        
  • 1 minute
  • 3 minutes

25
How long should you rub your hands together when
washing with soap and water?
MODULE 2 Hand Hygiene
  • 5 seconds
  • 15 seconds        
  • 1 minute
  • 3 minutes

26
When is the use of alcohol-based hand rubs not
appropriate?
MODULE 2 Hand Hygiene
  • A. Before touching a patient
  • B. Before manipulating an invasive device
  • C. When hands are visibly soiled
  • D. When surfaces in the patient care environment
    have been touched

27
When is the use of alcohol-based hand rubs not
appropriate?
MODULE 2 Hand Hygiene
  • A. Before touching a patient
  • B. Before manipulating an invasive device
  • C. When hands are visibly soiled
  • D. When surfaces in the patient care environment
    have been touched

28
True or False
MODULE 2 Hand Hygiene
  • Hand hygiene does not need to be practiced if
    you touched items or surfaces in the patient care
    environment, but didnt touch the patient while
    you were there.

29
True or False
MODULE 2 Hand Hygiene
  • Hand hygiene does not need to be practiced if
    you touched items or surfaces in the patient care
    environment, but didnt touch the patient while
    you were there.
  • FALSE
  • Hand hygiene should be practiced after all
    contact.

30
Additional Resources About Hand Hygiene
MODULE 2 Hand Hygiene
  • Centers for Disease Control and Prevention
    Guideline for Hand Hygiene in Healthcare Settings
    - 2002http//www.cdc.gov/Handhygiene/
  • Hand Hygiene Resource Center
  • http//www.handhygiene.org/
  • World Health Organization Hand Hygiene Tools
    http//www.who.int/gpsc/tools/en/

31
Additional Resources About Hand Hygiene
MODULE 2 Hand Hygiene
  • Free Quality Tools http//www.freequality.org/Def
    ault.aspx?page27
  • 5-Diamond Patient Safety Programhttp//www.esrdne
    t5.org/5Diamond.asp
  • Veterans Health Administration, Required Hand
    Hygiene Practices http//www1.va.gov/vhapublicati
    ons/viewpublication.asp?pub_id1214
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