GBMC Corporate Competency for Hand Hygiene The Case

GBMC Corporate Competency for Hand Hygiene

The Case for Hand Hygiene in Healthcare Settings �Background �Costs �Selection of Agents �Techniques �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 Hygiene �The 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 ü Provides a rapid kill or removal of most bacteria on hands ü Takes less time than using soap and water ü Contains emollients to reduce skin irritation ü 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. • Regular Soap Better • Antimicrobial Soap Good • Alcohol Based hand rub (foam or gel) Best

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 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 ü ü ü Healthy skin is the 1 st 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 effective • cause breakdown of latex gloves • become contaminated with bacteria in the hospital environment

Finger Nails and Hygiene ü Fingernails shall be natural and must be ¼ inch in length or less. ü Long nails, chipped polish, artificial nails, and nail jewelry are a reservoir for microorganisms. ü Shellac (gel) polish, gel overlays, acrylics, and silks are considered artificial overlays and not permitted by healthcare workers ü Artificial 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 FY 14! � GBMC is committed to improving compliance and fostering a culture of safety for staff and patients. The Goal for both programs in FY 15 is 92% compliance.

INDICATIONS for Hand Hygiene ALWAYS perform Hand Hygiene: 1) 2) 3) 4) 5) 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 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 gloves • Gloves 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

References �Centers 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