Hand Hygiene

1. Hand Hygiene An Educational Module* *written by Tricia Just, RN, MSN, CIC Bowling Green University

2. Now About Skin….. • Everyone’s intact skin has normal bacteria on it called “normal flora” • Our intact skin is a fabulous barrier – protecting us from this bacteria invading our body • If the normal bacteria can invade, they are then a pathogen, causing an infection

3. Vocabulary To Remember: • Normal Flora – bacteria that reside on our skin, and throughout our bodies • Pathogen – a germ capable of causing an infection • HCW – healthcare worker. RNs, LPNs, nursing assistants, physicians – everyone who provides care to a patient.

4. Everyone also has small flecks of skin that are shed daily that may contain these potential skin pathogens. These can be found on the patient’s gown, linen, bedside table, and other items in the room. • Touching a patient to check their pulse, straightening sheets, or even checking a water pitcher can create an opportunity for the patient’s pathogens to spread to the healthcare worker’s hands.

5. Then What? • If the healthcare worker (HCW) goes to the next patient’s room without cleaning their hands – or not doing a good job of cleaning their hands – an infection may be spread to a sick patient with altered immunity.

6. Resistant Bacteria • Over many years, bacteria have learned to resist treatment and invade tissues. • Spread of these bacteria can be serious.

7. Some Resistant Organisms • Methicillin Resistant Staphylococcus Aureus (MRSA) • Penicillin Resistant Pneumococcus (PRP) • Methicillin Resistant Coagulase Negative Staphylococcus (MRCONS) • Vancomycin Resistant Enterococcus (VRE) • Vancomycin Resistant, Methicillin Resistant Staphylococcus Aureus (VRMRSA) • Acinetobacter and Citrobacter • Stenotrophomonus Maltophilia • Enterobacter and Serratia

8. Yuck! What’s a HCW to Do? • The CDC has written guidelines that spell out actions to take to stop the spread of infection from one personto another by hand contact.

9. Good hand cleaning (or hand hygiene) greatly reduces the chance of spreading pathogens from patient to patient as well as to the HCW and their families. • Healthcare-related infections have been shown to be lower after the use of germicidal or antibacterial soap and water washing OR with the use of waterless alcohol products versus after plain soap and water washing.

10. How Do I Know Which Cleanser To Use? Alcohol cleansers are not to be used when hands are visibly dirty or contaminated with body fluids. Rubbing and lathering of hands + running water rinse + friction of drying hands on paper towel Removes more visible soil or body fluids than alcohol

11. Alcohol cleansers that have 60% or more alcohol in them: quickly kill organisms on the skin help keep bacteria from re-growing on the skin Skin care products are added to the alcohol rubs to help keep the alcohol from drying the skin. Usually this means that HCWs can use the alcohol rub with less skin problems than with soap and water washing. More About Cleansers?

12. Many HCWs have found their hands tend to stay in better shape when less rubbing of hands with soap, water, and paper towels is happening. So…those who have problems usually have some healing after a long weekend or other period of time off. Upon return to work, use an alcohol cleanser except in certain circumstances. What About Irritated Skin?

13. What Certain Circumstances? • HCWs should always use antibacterial or germicidal soap and water for hand hygiene when: • Hands are visibly dirty • Hands have body fluid on them • Before eating • After using the restroom

14. What About Hand Lotion? • Hand lotions that are provided by the hospital are meant to work with our soaps and alcohol rub products • Use only the products provided by the hospital – other products may make small holes in latex gloves or make your soap ineffective

15. Isn’t Alcohol Flammable? • Yes! • Hands have to be rubbed dry when the alcohol product is used. • Rubbing your hands dry is not only for safety – in order for the germs to be killed, the alcohol must be evaporated from the hands.

16. Is That Really All? • The containers of alcohol hand foam need to be stored away from high temperatures • Europe has used alcohol based products for years with hardly any problems

17. Are There Other Special Circumstances? • Yes! • Sometimes we have patients with diarrhea caused by a a specific bacteria – C. difficile (Clostridium difficile). • This type of bacteria is known as a spore-forming bacteria. • Neither germicidal, antibacterial soap, nor alcohol cleansers kill the spore-forming bacteria. • BUT…it is believed that the rubbing and friction associated with soap and water cleansing and drying with paper towels does more to rid hands of these bacteria than the waterless cleansers.

18. A Word of Warning • C. difficile has been shown to live for a long time in the environment. • So, even care that seems low-risk, like touching the bedrail, bedside table, and bedding, can lead to the organism getting on the HCW hands. • C. difficile is a perfect example of why hands must always be washed after even a simple touching of any patient and/or items in the patient environment.

19. And Now a Word About Nails…. • Studies show that high numbers of bacteria and yeast exist under the fingernails. • These germs continue to be present even after careful handwashing.

20. Freshly applied fingernail polish does not lead to increased numbers of bacteria. • BUT…chipped polish may provide space for the pathogens to get between the polish and the fingernail. • Disease outbreaks have been traced to HCWs wearing artificial nails and to HCWs who have long natural nails. • Studies have shown that more bacteria and yeast live on artificial nails than on natural nails, in spite of good handwashing.

21. Policy Employees who work in positions that provide direct patient care or who work in Food Services cannot: • Wear artificial fingernails, acrylic overlays, nail tips or nail extenders. and • Natural nail tips are to be less than one-fourth of an inch long.

22. When hands are visibly dirty or contaminated with body substances or are soiled with blood or other body fluids, wash with soap and water. If hands are not visibly soiled, use an alcohol-based cleanser. Apply product to palm of one hand, and rub hands together, covering all surfaces of hands and fingers until dry. Major Points To Remember:

23. Before and after having direct contact with patients Before and after performing procedures on patients – even when gloves are worn. After touching items such as medical equipment, bed rails, tables, etc. in a patient’s room. Cleanse your hands whenever you take gloves off. Remember –When to Clean Your Hands…..

24. When to use soap and water? • Whenever you’ve been in the room of a patient with C. difficile – whether you touch the patient or not! • Before eating • After using the restroom • Whenever your hands are visibly soiled or contaminated

25. Handwashing 101 • Step 1: Wet hands with warm water • Step 2: Use about 1 teaspoon of soap • Step 3: Rub hands briskly for about 15 seconds (the time it takes to sing the alphabet twice!) • Step 3 ½: Be sure to rub all areas, including between the fingers and the backs of the hands • Step 4: Rinse under warm running water • Step 5: Dry completely • Step 6: Use the paper towel to turn off the faucet

26. Did You Know… • Using hot water to wash your hands can increase skin irritation? Warm water will do the job!

27. Do not wear artificial nails, nail extenders, nail tips, or acrylic overlays. Natural fingernails should not be longer than ¼ inch. If fingernail polish is chipped –. Remove it before coming to work. Re-apply a fresh coat to repair it. If You Provide Direct Patient Care or Work in Food Services

28. And a Final Word on Gloves… • Wear gloves when contact with body fluids or non-intact skin is expected. • Change gloves during patient care if moving from a contaminated body site to a clean site. • Never wear gloves from a patient room to another work area.

29. How About Hand Hygiene at Home? • Plain soap and water are all that is needed for hand cleaning. • Antibacterial products are not necessary at home.

30. That’s It! • Complete the following brief post-test and you’ll demonstrate your competency about hand hygiene. • All of our patients and you as the healthcare worker will benefit!