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Hand Hygiene and Glove Use for EMS. Centers for Disease Control (CDC) World Health Organization (WHO). Standard and Expanded Isolation Precautions. Standard Precautions. Previously called Universal Precautions Assumes blood and body fluid of ANY patient could be infectious

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hand hygiene and glove use for ems

Hand Hygiene and Glove Use for EMS

Centers for Disease Control (CDC)

World Health Organization (WHO)

standard precautions
Standard Precautions
  • Previously called Universal Precautions
  • Assumes blood and body fluid of ANY patient could be infectious
  • Recommends PPE and other infection control practices to prevent transmission in any healthcare setting
  • Decisions about PPE use determined by type of clinical interaction with patient

PPE Use in Healthcare Settings

ppe for standard precautions
PPE for Standard Precautions
  • Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin
  • Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is anticipated

PPE Use in Healthcare Settings

ppe for standard precautions1
PPE for Standard Precautions
  • Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions

PPE Use in Healthcare Settings

what type of ppe would you wear

Drawing blood?

  • Cleaning an incontinent patient with diarrhea?
  • Irrigating a wound?
  • Taking vital signs?
  • Giving a bed bath?
  • Suctioning oral secretions?
  • Transporting a patient on a stretcher?
  • Responding to an emergency where blood is spurting?
What Type of PPE Would You Wear?

PPE Use in Healthcare Settings

what type of ppe would you wear1

Giving a bed bath?

      • Generally none
  • Suctioning oral secretions?
      • Gloves and mask/goggles or a face shield – sometimes gown
  • Transporting a patient on a stretcher?
      • Generally none required
  • Responding to an emergency where blood is spurting?
      • Gloves, fluid-resistant gown, mask/goggles or a face shield
  • Drawing blood?
      • Gloves
  • Cleaning an incontinent patient with diarrhea?
      • Gloves w/wo gown
  • Irrigating a wound?
      • Gloves, gown, mask/goggles or a face shield
  • Taking vital signs?
    • Generally none
What Type of PPE Would You Wear?
ignaz semmelweis 1815 1865
Ignaz Semmelweis, 1815-1865
  • 1840’s: General Hospital of Vienna
  • Divided into two clinics, alternating admissions every 24 hours:
    • First Clinic: Doctors and medical students
    • Second Clinic: Midwives
the intervention hand scrub with chlorinated lime solution
The Intervention:Hand scrub with chlorinated lime solution

Hand hygiene basin at the Lying-In Women’s Hospital in Vienna, 1847.

hand hygiene not a new concept

Semmelweis’ Hand Hygiene Intervention

Hand Hygiene: Not a New Concept

~ Hand antisepsis reduces the frequency of patient infections ~

Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.

colonized or infected what is the difference
Colonized or Infected:What is the Difference?
  • People who carry bacteria without evidence of infection (fever, increased white blood cell count) are colonized
  • If an infection develops, it is usually from bacteria that colonize patients
  • Bacteria that colonize patients can be transmitted from one patient to another by the hands of healthcare workers

~ Bacteria can be transmitted even if the patient is not infected ~

slide13

Infected

Colonized

The Iceberg Effect

hand transmission
Hand transmission
  • Hands are the most common vehicle to transmit health care-associated pathogens
  • Transmission of health care-associated pathogens from one patient to another via health-care workers’ hands requires 5 sequential steps
5 stages of hand transmission
5 stages of hand transmission

one

two

three

four

five

Germs present on patient skin

and immediate environment surfaces

Germ transferonto health-care worker’s hands

Germs survive on hands for several minutes

Suboptimal or omitted hand cleansing results in hands remaining contaminated

Contaminated hands transmit germs via direct contact with patient or patient’s immediate environment

why should you clean your hands
Why should you clean your hands?
  • Any health-care worker, caregiver or person involved in patient care needs to be concerned about hand hygiene
  • Therefore hand hygiene concerns you!
  • You must perform hand hygiene to:
      • protect the patient against harmful germs carried on your hands or present on his/her own skin
      • protect yourself and the health-care environment from harmful germs
how to clean your hands
How to clean your hands
  • Handrubbing with alcohol-based handrub is the preferred routine method of hand hygiene if handsare not visibly soiled
  • Handwashing with soap and water – essential when when hands are visibly dirty or visibly soiled (following visible exposure to body fluids)1
  • DO NOT use antimicrobial hand soaps – these disrupt normal skin flora, increasing susceptibility to infection.

1 If exposure to spore forming organisms e.g. Clostridium difficile is strongly suspected or proven, including during outbreaks – clean hands using soap and water

how to handrub
How to handrub

To effectively reduce the growth of germs on hands, handrubbing must be performed by following all of the illustrated steps.

This takes only 20–30 seconds!

how to handwash
How to handwash

To effectively reduce the growth of germs on hands, handwashing

must last 40–60 secs

and should be performed by following all of the illustrated steps

hand hygiene and glove use
Hand hygiene and glove use
  • The use of gloves does not replace the need to clean your hands!
  • You should remove gloves to perform hand hygiene, when an indication occurs while wearing gloves
  • You should wear gloves only when indicated – otherwise they become a major risk for germ transmission
the impact of hcai
The impact of HCAI
  • HCAI can cause:
    • more serious illness
    • prolongation of stay in a health-care facility
    • long-term disability
    • excess deaths
    • high additional financial burden
    • high personal costs on patients and their families
most frequent sites of infection and their risk factors
Most frequent sites of infection and their risk factors

URINARY TRACT INFECTIONS

Urinary catheter

Urinary invasive procedures

Advanced age

Severe underlying disease

Urolitiasis

Pregnancy

Diabetes

34%

13%

LOWER RESPIRATORY TRACT INFECTIONS

Mechanical ventilation

Aspiration

Nasogastric tube

Central nervous system depressants

Antibiotics and anti-acids

Prolonged health-care facilities stay

Malnutrition

Advanced age

Surgery

Immunodeficiency

LACK OF HAND HYGIENE

Most common sites of health care-associated infection and the risk factors underlying the occurrence of infections

SURGICAL SITE INFECTIONS

Inadequate antibiotic prophylaxis

Incorrect surgical skin preparation

Inappropriate wound care

Surgical intervention duration

Type of wound

Poor surgical asepsis

Diabetes

Nutritional state

Immunodeficiency

Lack of training and supervision

BLOOD INFECTIONS

Vascular catheter

Neonatal age

Critical careSevere underlying disease

Neutropenia

Immunodeficiency

New invasive technologies

Lack of training and supervision

17%

14%

slide24

Recovery of VRE from Hands and Environmental Surfaces

  • Up to 41% of healthcare worker’s hands sampled (after patient care and before hand hygiene) were positive for VRE1
  • VRE were recovered from a number of environmental surfaces in patient rooms
  • VRE survived on a countertop for up to 7 days2

1 Hayden MK, Clin Infect Diseases 2000;31:1058-1065.

2 Noskin G, Infect Control and Hosp Epidemi 1995;16:577-581.

slide25

The Inanimate Environment Can Facilitate Transmission

Xrepresents VRE culture positive sites

~ Contaminated surfaces increase cross-transmission ~

Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

slide26

What is the single most important reason for EMS workers to practice good hand hygiene?

  • To remove visible soiling from hands
  • To prevent transfer of bacteria from the home to the ambulance
  • To prevent transfer of bacteria from the ambulance to the home
  • To prevent infections that patients acquire in the ambulance
slide27

What is the single most important reason for EMS workers to practice good hand hygiene?

  • To remove visible soiling from hands
  • To prevent transfer of bacteria from the home to the ambulance
  • To prevent transfer of bacteria from the ambulance to the home
  • To prevent infections that patients and EMS staff acquire in the ambulance
slide28
How often do you clean your hands after touching a PATIENT’S INTACT SKIN (for example, when measuring a pulse or blood pressure)?
  • Always
  • Often
  • Sometimes
  • Never
slide29

How often do you clean your hands after touching a PATIENT’S INTACT SKIN (for example, when measuring a pulse or blood pressure)?

  • Always
  • Often
  • Sometimes
  • Never
slide30
Estimate how often YOU clean your hands after touching a patient or a contaminated surface in the ambulance?
  • 25%
  • 50%
  • 75%
  • 90%
  • 100%
which method do you use to clean your hands at work
Which method do you use to clean your hands at work?
  • Plain soap and water
  • Antimicrobial soap and water
  • Alcohol-based handrub
which hand hygiene method is best at killing bacteria
Which hand hygiene method is best at killing bacteria?
  • Plain soap and water
  • Antimicrobial soap and water
  • Alcohol-based handrub
which hand hygiene method is best at killing bacteria1
Which hand hygiene method is best at killing bacteria?
  • Plain soap and water
  • Antimicrobial soap and water
  • Alcohol-based handrub

At least 60% alcohol concentration

slide34

Which of the following hand hygiene agents is LEAST drying to your skin?

  • Plain soap and water
  • Antimicrobial soap and water
  • Alcohol-based handrub
slide35

Plain soap and water

  • Antimicrobial soap and water
  • Alcohol-based handrub

Which of the following hand hygiene agents is LEAST drying to your skin?

slide36

How often do you clean your hands after touching an ENVIRONMENTAL SURFACE near a patient (for example, a clipboard or radio)?

  • Always
  • Often
  • Sometimes
  • Never
slide37

Always

  • Often
  • Sometimes
  • Never

How often do you clean your hands after touching an ENVIRONMENTAL SURFACE near a patient (for example, a clipboard or radio)?

slide38

Use of artificial nails by healthcare workers poses no risk to patients.

  • Strongly agree
  • Agree
  • Don’t know
  • Disagree
  • Strongly disagree
slide39

Use of artificial nails by healthcare workers poses no risk to patients.

  • Strongly agree
  • Agree
  • Don’t know
  • Disagree
  • Strongly disagree
slide40

Can a Fashion Statement Harm the Patient?

Avoid wearing artificial nails, keep natural nails <1/4 inch if caring for high risk patients (ICU, OR, EMS)

ARTIFICIAL

POLISHED

NATURAL

Edel et. al, Nursing Research 1998: 47;54-59

when do you need gloves
When do you need gloves?
  • Whenever risk for exposure to bloodborne pathogens exists
definition of bloodborne pathogens
Definition of Bloodborne Pathogens
  • Bloodborne pathogens are disease-causing microorganisms such as bacteria and viruses found in:
    • Blood
    • Body fluids containing blood
definition of blood
Definition of Blood
  • The term “blood” applies to:
    • Human blood
    • Components of human blood
    • Any product containing human blood
slide44
OPIM
  • Other potentially infectious materials (OPIM) include fluids such as those found:
    • In the joints
    • Around the heart
    • In the abdomen
    • In the chest cavity
    • Cerebrospinal fluid
    • Amniotic fluid
    • Any fluid or unfixed tissues containing gross visible blood
no risk fluids
No-Risk Fluids
  • As long as there are NO visible signs of blood, no-risk fluids include:
    • Sweat
    • Tears
    • Saliva
    • Urine
    • Vomit
    • Sputum
definition of an exposure
Definition of an Exposure
  • An exposure occurs when a pathogen makes direct or indirect contact with:
    • Mucous membranes
    • Non-intact skin
minimize the risk
Minimize the Risk
  • The best way to minimize the risk of contracting a bloodborne pathogen is to treat ALL body fluids as if they are infectious.
slide48

Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms.

  • Strongly agree
  • Agree
  • Don’t know
  • Disagree
  • Strongly disagree
slide49

Glove use for all patient care contacts is a useful strategy for reducing risk of transmission of organisms.

  • Strongly agree
  • Agree
  • Don’t know
  • Disagree
  • Strongly disagree
the glove problem
The Glove Problem

Wilson J, Lynam S, Singleton J, Loveday H. The misuse of clinical gloves: risk of cross-infection and factors influencing the decision of health care workers to wear gloves. Antimircob Resis Infect Contr. 2013; 2(Suppl 1):03

the glove problem1
The Glove Problem
  • Gloves used inappropriately 42% of time
    • Inappropriate = no risk of BBP exposure
  • 39% uses involved cross-contamination
    • More likely with inappropriate use (58% vs. 28%)
  • 24% involved > 5 objects touched by gloved hand prior to performing procedure

Wilson J, Lynam S, Singleton J, Loveday H. The misuse of clinical gloves: risk of cross-infection and factors influencing the decision of health care workers to wear gloves. Antimircob Resis Infect Contr. 2013; 2(Suppl 1):03

gloves1
Gloves

For people, not equipment

slide54

This presentation created in 2013 by Mike McEvoy using slide from CDC and WHO. Power Point version available at www.mikemcevoy.com.

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