Standard Infection Control Precautions HAND DECONTAMINATION

1. Standard Infection Control PrecautionsHAND DECONTAMINATION

2. SPREAD THE WORD NOT GERMS!

3. Learning outcomesBy the end of this session you will have an understanding of the importance of hand decontamination • The risks associated with not carrying out hand decontamination • Why people choose not to carry out hand decontamination • The correct technique to ensure thorough hand decontamination • The different cleansing agents available and when to use them

4. Why hand decontamination is so important Good hand decontamination is one of the single most effective measures for preventing the spread of infection

5. Why hand decontamination is so important Hands move micro-organismsfrom one place to another • By decontaminating our hands, we remove transient micro-organisms acquired by recent contact with patients/clients, or with the environment • Hand decontamination protects both patients/clients and health and social care workers

6. Why people don’t decontaminate their hands Many health and social care workers do not fully understand the risks associated with not decontaminating their hands

7. Why people don’t decontaminate their hands There are many reasons why individuals do not perform hand decontamination • Low staffing levels and other practical issues contribute to poor hand decontamination, such as: • inadequate sinks • no soap or hand towels • poor water temperature control • Different people respond to different motivators • identify what works best for individuals

8. What lives on our hands? • Transient flora–acquired by contactthese micro-organisms survive on the skin for less than 25 hours and can be removed by hand decontamination with soap and water or an alcohol-based preparation • Resident flora– part of our normal skin florathese micro-organisms survive and multiply on the skin, they rarely cause infections except when introduced into the body through invasive procedures

9. When to decontaminate hands Every health and social care worker should conduct a risk assessment to determine when to decontaminate • Decontaminate BEFORE: • starting work, preparing food, eating or drinking • contact with a patient/client • putting on personal protective equipment • preparing and giving medicines • entering or leaving an isolation area

10. When to decontaminate hands Every health and social care worker should conduct a risk assessment to determine when to decontaminate • Decontaminate AFTER: • contact with a patient/client • removing personal protective equipment • any cleaning operation • using the toilet, blowing your nose, smoking or coughing • handling soiled linen, bedding or waste

11. Routine decontamination the aimto remove transient micro-organisms acquired on the hands before they are transferred to other people or surfaces

12. Routine decontamination When to perform ‘hygienic’ hand decontamination • If caring for those with an actual/potential infection • For aseptic procedures • When in contact with immunocompromised patients/clients • When in contact with patients/clients in isolation rooms • In high-risk areas at all times

13. Surgical decontamination the aimto substantiallyreduce resident micro-organismsand remove or destroy transient micro-organisms during times when surgical or invasive procedures are undertaken

14. Choice of cleansing agents question 1Have you conducted a risk assessment to decide the best method of decontamination? question 2Do you have any history of certain products causing an adverse skin reaction? question 3 Do you have access to the right decontamination facilities?

15. Soap and water Handwashing with soap and water is sufficientfor most routine daily activities • Soap suspends easily removable micro-organisms allowing them to be washed off • This mechanical removal of micro-organisms makes hands socially clean • If there are no/inadequate facilities for handwashing with soap and warm running water, then use alcohol hand gels/rubs • It takes at least 15 seconds to achieve effective decontamination using the six-step technique

16. Alcohol-based preparations Alcohol-based preparations offer a solution when time and facilities are restricted • Ideal for rapid hand decontamination on visibly clean hands • Require no facilities • The technique for alcohol-based preparations is the same as for handwashing • Concentrations of 70% alcohol are used as they have less of a drying effect than alcohol-based preparations of higher concentrations • Not a cleansing agent, so visible contaminates still need removing with soap and water • Takes 15 to 30 seconds to perform

17. Aqueous antiseptic solutions Antiseptic handwashremoves and destroys micro-organisms • Aqueous antiseptic solutions both reduce resident flora and remove/destroy transient flora • This chemical removal of micro-organisms prepares hands for surgical/invasive procedures • Antiseptics may also be used during an outbreak situation, before aseptic procedures, or following contact with blood/body fluids

18. Standard Infection Control PrecautionsHAND DECONTAMINATION group activity

19. Hand decontamination technique An effective hand decontamination technique involves three stages 1 = preparation 2 = procedure 3 = drying

20. Hand decontamination techniqueStage 1 = preparation • Keep nails short • Remove wrist watches, jewellery and other items • Then wet hands under warm running water before applying soap

21. Hand decontamination techniqueStage 2 = procedure • Turn the tap on and check the temperature of the water • Hands should be wet before applying the chosen solution • Follow the manufacturer’s instructions for the amount of solution to use (usually about 3 to 5ml) • Ensure all surfaces of the hands are covered • Rinse thoroughly under warm running water • Turn taps off using a ‘hands-free’ technique

22. Hand decontamination techniqueStage 3 = drying • Make sure hands are completely dry • Hand drying is a critical factor in the hand decontamination process

23. Handwashing with soap and water Definition of handwashingthe vigorous, brief rubbing together of all surfaces of lathered hands, followed by rinsing under running water(Garner and Favero 1985) • Rub hands together vigorously for at least 15 seconds in total • Pay particular attention to tips of fingers, thumbs and areas between the fingers

24. Hand drying Micro-organisms transfer most effectively from wet surfaces so always dry hands thoroughly • Use good quality paper disposable hand towels • Cloth towels can become a source of infection • Warm air dryers have the potential to spread airborne pathogens

25. Alcohol decontamination technique Routine hand decontamination with alcohol products involves two stages preparation, rubbing • Rub hands together vigorously for around 15 to 30 seconds • Use the manufacturer’s recommended amount (about 3ml) • Cover all surfaces until the hands are dry • Choose an alcohol rub when hands are free from dirt and organic material

26. Skin care For health and social care workers, frequent hand decontamination can cause long-termchanges in the skin • Minimise the risk of skin damage by following guidance • Report any skin irritation or abnormality immediately to the Occupational Health Service or a General Practitioner • Apply hand cream regularly to protect the skin from dryness • Avoid use of communal jars of hand cream as these can become contaminated

27. Other hand considerations The wearing of nail polish, nail art and jewellery is a potential source of infection • Short nails harbour fewer micro-organisms • Nail art increases the number of micro-organisms on the hands • Jewellery prevents effective hand decontamination • There are higher levels of micro-organisms beneath and around jewellery • Nail brushes cause increased shedding of skin cells and skin damage

28. Other hand considerations The wearing of gloves as a ‘standard infection control precaution’ is exposing most health and social care workers and their patients/clients to latex • Natural Rubber Latex (NRL) protects against blood-borne viruses • There are a range of risks related to wearing NRL gloves • Use gloves that are powder free and have the lowest levels of protein • Provide synthetic gloves for those with known sensitivity to NRL proteins

29. Improving compliance For both health and social care workers and patients/clients education leads to change

30. Improving compliance GOOD practice • All health and social care workers should assess the level of hand decontamination required depending upon the procedure being undertaken • All the steps advised in the process of hand decontamination should be followed • Patients/clients, visitors and relatives should be encouraged to follow hand decontamination procedures when in health and social care settings

31. Improving compliance REPORTING • Where there are incidents of non-compliance to hand decontamination policy, or problems with supplies/facilities, these should be reported through local reporting procedures

32. Summary Three things to take away • Hand decontamination is one of the single most effective measures for reducing the spread of infection. • Hand decontamination protects patients/clients and staff. • It’s easy and everyone can do it.

33. References • ANSARI S A, SPRINGTHORPE V S, SATTAR S A (1991) Comparison of cloth, paper and warm air drying in eliminating viruses and bacteria from washed hands. American Journal of Infection Control, 19, 243-249 • AYLIFFE G A J (1992) Efficacy of handwashing and skin disinfection. Current Opinion in Infectious Diseases, 5 (4), 542-546 • AYLIFEE G A J, FRIASE A P, GEDDES A M, MITCHELL K (2000) Control of Hospital Infection. A Practical Handbook. 4th ed. London: Arnold. • AYLIFFE G A J, BABB J R, QUORAISHI A H (1978) A test for hygienic hand disinfection. Journal of Clinical Pathology, 31, 923 • BOYCE J M, PITTET D (2002) Guideline for hand hygiene in healthcare settings. Recommendations of the Healthcare Infection Control Practitioners Advisory Committee and the ICPAC / SHEA / APIC / IDSA Hand Hygiene Task Force. MMWR, 51 (RR16), 1-44 • COIA J E, DUCKWORTH G J, EDWARDS D et al (2006) Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infection, 635 (Suppl 1), S1–S44 • FOCA M, JAKOB K, WHITTIER S et al (2000) Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. New England Journal of Medicine, Sep 7, 343 (10), 695-700 • GARNER J S, FAVERO M S (1985) CDC Guidelines for handwashing and hospital environmental control. US Department of Health and Human Services, Public Health Service, Atlanta, USA • GOULD D (1997) Giving infection control a big hand. Community Nursing Notes, 15 (1), 3-6 • GOULD D, REAM E (1994) Nurses’ views of infection control: an interview study. Journal of Advanced Nursing, 19, 1121-1131

34. References • HEALTH PROTECTION SCOTLAND, 2006. Model Infection Control Policies (Hand Hygiene). Edinburgh: Health Protection Scotland, Infection Control Team. • HOFFMAN P N, COOKE E M, McCARVILLE M R, EMMERSON A M (1985) Micro-organisms isolated from skin under wedding rings worn by hospital staff. British Medical Journal, 290, 206-207 • HOFFMAN P, WILSON J (1995) Hands, hygiene and hospital. PHLS Microbiology Digest, 11 (4), 211-216 • JACOBSON G, THIELE J E, McCUNE J H, FARRELL L D (1985) Handwashing: ring-wearing and number of micro-organisms. Nurse Researcher, 34, 186-188 • KERR J (1998) Handwashing. Nursing Standard, 12, (51), 35-42 • KESAVAN S, BARODAWALA S, MULLEY G P (1998) Now wash your hands? A survey of hospital handwashing facilities. Journal of Hospital Infection, 40 (4), 291-293 • LARSON E L (1995) APIC guideline for handwashing and hand antisepsis in health care settings. American Journal of Infection Control, 23 (4), 251-269 • LARSON E L, KILLIEN M (1982) Factors influencing handwashing behaviour of patient care personnel. American Journal of Infection Control, 10, 93-99 • McGINLEY K J, LARSON E L, LEYDEN J J (1988) Composition and density of microflora in the subungual space of the hand. Journal of Clinical Microbiology, 26, 950-953 • PASSARO D J, WARING L, ARMSTRONG R et al (1997) Post operative Serratia marcescens wound infection traced to an out-of-hospital source. Journal of Infectious Diseases, Apr, 175 (4), 992-995

35. References • PITTET D, DHARAN S, TOUVENEAU S et al (1999) Bacterial contamination of the hands of hospital staff during routine patient care. Archives Internal Medicine, 159, 821-826 • PITTET D, BOYCE J M (2001) Hand hygiene and patient care: pursuing the Semmelweis legacy. The Lancet Infectious Diseases, April, 1, 9-19 • POTTINGER J, BURNS S, MANSKE C (1989) Bacterial carriage by artificial versus natural nails. American Journal of Infection Control, 17, 340-344 • PRATT R J, PELLOWE C, LOVEDAY H P et al (2001) Standard principles for preventing hospital-acquired infections. Journal of Hospital Infection, 47 (supp), 531-537 • REDWAY K, KNIGHTS, BOZOKY Z et al (1994) Hand Drying: a study of bacterial types associated with different hand drying methods and with hot-air dryers. London University of Westminster. • ROTTER M L, SIMPSON R A, KOLLER W (1998) Surgical hand disinfection with alcohols at various concentrations: parallel experiments using the new proposed European Standards method. Infection Control in Hospital Epidemiology, 19, 778-781 • WARD D (2000) Handwashing facilities in the clinical area. British Journal of Nursing, 9 (2), 82-86 • WILSON J (2001) Infection control in clinical practice. 2nd Ed. Edinburgh: Bailliere Tindall. • WORLD HEATLH ORGANISATION (2005) WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft): A Summary. Geneva, WHO.

36. Further web sources www.dh.gov.uk www.hse.gov.ukwww.hpa.org.uk/infections/topics_az/hai/guidelines.htmhttp://www.cdc.gov/handhygiene/ www.hps.scot.nhs.uk www.npsa.nhs.uk/cleanyourhands www.healthcareA2Z.org www.hopisafe.ch

37. Standard Infection Control PrecautionsHAND DECONTAMINATION test your hand decontamination knowledge

38. THANK YOUplease spread the word!