Hand hygiene and glove use for ems
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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

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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 and expanded isolation precautions

Standard and Expanded Isolation Precautions


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?


    Gloves

    Gloves


    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 ~


    Hand hygiene and glove use for ems

    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


    The my 5 moments for hand hygiene approach

    The “My 5 Moments for Hand Hygiene” approach


    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%


    Hand hygiene and glove use for ems

    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.


    Hand hygiene and glove use for ems

    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.


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

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

    • Plain soap and water

    • Antimicrobial soap and water

    • Alcohol-based handrub


    Hand hygiene and glove use for ems

    • Plain soap and water

    • Antimicrobial soap and water

    • Alcohol-based handrub

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


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

    • 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)?


    Hand hygiene and glove use for ems

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

    • Strongly agree

    • Agree

    • Don’t know

    • Disagree

    • Strongly disagree


    Hand hygiene and glove use for ems

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

    • Strongly agree

    • Agree

    • Don’t know

    • Disagree

    • Strongly disagree


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

    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.


    Hand hygiene and glove use for ems

    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


    Hand hygiene and glove use for ems

    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


    The my 5 moments for hand hygiene approach includes changing gloves

    The “My 5 Moments for Hand Hygiene” approach – includes changing gloves


    Hand hygiene and glove use for ems

    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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