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Hand Hygiene. What it’s all about…. Hand Hygiene. Hand Hygiene (HH) is generally poorly adhered to across the board by all levels of Health Care Worker’s. THE UNWASHED HAND!. Hand Hygiene. The problem: HAIs / MRSA, ESBLs, VRE etc Majority are preventable Costly to patient

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Hand Hygiene


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hand hygiene

Hand Hygiene

What it’s all about…

hand hygiene2
Hand Hygiene

Hand Hygiene (HH) is generally poorly adhered to across the board by all levels of Health Care Worker’s

hand hygiene4
Hand Hygiene

The problem:

HAIs / MRSA, ESBLs, VRE etc

Majority are preventable

Costly to patient

Costly to health service

slide6

Maternalmortality rates, Firstand SecondObstetrics Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1846

(%)

Semmelweis IP, 1861

slide7

Intervention

May 1847

  • Students and doctors were required to:
  • clean their hands with a chlorinated lime solution when entering the labour room

in particular when moving from the autopsy to the labour room

slide8

Maternalmortality rates,

Firstand SecondObstetrics Clinics, GENERAL HOSPITAL OF VIENNA, 1841-1850

Intervention

May 15, 1847

Semmelweis IP, 1861

slide9

Ignaz Philipp Semmelweis before and after he insisted that students and doctors clean their hands with a chlorine solution between each patient

slide10

Evidence of Relationship Between Hand Hygiene and Healthcare-Associated Infections

  • Substantial evidence that hand hygiene reduces the incidence of infections
  • Historical study: Semmelweis
  • More recent studies: rates lower when antiseptic hand washing was performed

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

what we know
What we Know
  • In summary we know:
    • Bugs are on our hands
    • Bugs can be washed off
    • Washing bugs off our hands saves lives
  • So what is the problem???
  • HCWs don’t wash their hands!!!
slide12

Why we don’t wash our hands

  • Too busy/insufficient time
  • Patient needs take priority
  • Understaffing/overcrowding

HCW are not bad just busy!

  • Sinks are inconveniently located or lack of sinks
  • Lack of soap and paper towels

Poor design

Poor product

  • Hand washing agents cause irritation and dryness
  • Low risk of acquiring infection from patients

More education

Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.

slide13

What can we do to help change this

  • Provide easy access to hand hygiene materials
    • Handrub solution
      • Conveniently located:
        • at the patient’s bedside
        • at the patient’s room entrance
        • in convenient / appropriate locations
        • in high traffic public areas
      • Working appropriately
      • Full of product
      • Within use by date
what the austin did
What the Austin did

Full culture change program in 3 parts

Alcohol Based Hand Rub(ABHR)

Moisturiser

Alcohol impregnated wipes

Aim:

Increase HH compliance

Reduce HAIs

slide15

How we did it

  • Rolled out in one area (zone) at a time, then all hospital
  • Education/learning packages
  • “Talking Walls” = participation, ownership ,fun & reminders
  • Monitoring before and after
    • Handrub supply
    • Hand hygiene compliance
    • MRSA rates
  • Feedback of results
  • Recruitment of area champions
  • Launch days, t-shirts,BBQ,wine etc
  • Strong support from management
slide16

ABHR’s are literally the solution

Sample products only

Pittet Geneva

slide17

Time Spent Cleansing Hands

  • One nurse per 8 hour shift
  • Hand washing with soap and water: 56 minutes
      • Based on seven (60 second) hand washing episodes per hr
  • Alcohol-based hand rub: 18 minutes
    • Based on seven (20 second) hand rub episodesper hr

~ Alcohol-based hand rubs reduce time needed for hand hygiene ~

Voss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.

slide18

Hand Hygiene Definitions

  • Hand washing
    • The application of non-antimicrobial soap and water to the surface of the hands

Antiseptic hand wash

    • Washing hands with water and soap or other detergents containing an antiseptic agent

Alcohol-based hand rub

    • an alcohol-containing preparation designed for application to the hands in order to reduce the number of viable organisms with maximum efficacy and speed

Surgical hand hygiene/antisepsis

    • Hand washing or using an alcohol-based hand rub before operations by surgical personnel
slide19

Indications for Hand Hygiene

  • When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water.
  • If hands are visibly clean, use an alcohol-based hand rub for routinely decontaminating hands.

Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

hand hygiene compliance
Hand Hygiene Compliance

Compliance = using hand hygiene products appropriately

Non compliance = failure to apply hand hygiene products at the appropriate time

Is when HH is considered necessary & classified according to one of the 5 Moments

Total moments observed=Y

Actual moments performed=X

X/Y x100%=% rate of HH compliance

product choice
Product Choice

HHA is non product specific

ABHR more effective than either medicated/non medicated soap

Isopropanol alcohol has slightly greater activity against bacteria than ethanol

Chlorhexidine has persistent activity

HCWs happy to use

why use abhr
Why Use ABHR ??
  • Reduces bacterial count on hands
  • More effective for standard hand wash
  • Reduces adverse outcomes and cost associated with HAI’s
  • Requires less time
  • Less irritating
  • Can be readily accessible/

portable

what to use and when
What to use and When

When hands are visibly soiled use soap and water to wash

If your hands are visibly CLEAN use ABHR

Before and after touching a patient

Before and after a procedure

After touching a patient’s surroundings

Before and after glove use

program organiser
Program Organiser

Organise product selection

Product placement

Education

Marketing/promotions

Meeting (internal/external)

Funding

Reports(Gantt charts), proformas

Launch

Passion/energy/dedication

steering committee
Steering Committee

High level chair/executive support

Heads of depts

Sentinel wards NUMs

Champions

Regular meeting

Minutes/agendas/meeting planners

education
Education

Varies depending on whom

Grand rounds/medical support

Handovers

Team meetings

NUMs groups

Allied health

Hospital orientation

Newsletters

Flyers/payslips/magazine

slide27

Easy Message

ROLL

rub hands together covering all aspects of your fingers & hands until dry

SQUIRT

one squirt (1-3 ml) to your hands

RUB

apply to palm

easy message
Easy Message

Basic message always the same

“Clean you hands before and after every patient touch”

Instructions always the same

  • Squirt
  • Rub
  • Roll
champions
Champions

Ward liaison/link nurses

Staff with interest

Doctors with passion

Consultants

Dept heads

CEO

Involve all areas

slide30

Role Models

“Healthcare workers in a room with a senior staff member or peer who DID NOT wash their hands were significantly less likely to wash their own hands”

EMERGING INFECTIOUS DISEASES FEB 2003

promotion
Promotion

Area ownership

Area specific

Strap lines/slogans

Keep changing

Rewards/incentives

Posters,poetry and song competitions

Newsletters,payslips,local media

T-shirts,food,stickers,badges,giveaways

slide33

Skin irritation

  • - is an important barrier to compliance
  • is more frequent with soap and water than with handrubs
  • is reduced and can be treated by emollient-containing solutions

Boyce et al. Inf Contr Hosp Epi 2000;21:442

Kramer et al. J Hosp Infect 2002; 51:114

Larson et al. Heart Lung 2000; 29:139

Pittet. Emerging Inf Dis 2001; 2:234

slide34

Consolidating Culture

  • Learning package mandatory for new staff
  • Annual Learning Package planned for all current staff - to be linked to performance appraisal
  • Website: www.hha.org.au
slide35

Glove use

  • Hand hygiene is required regardless of whether gloves are used or changed
  • Failure to remove gloves after patient contact or between dirty and clean body site care in the same patient has to be regarded as noncompliance with recommendations
  • Gloves should not be washed or reused
  • Gloved HCWs can cause cross infections
mythbusters
Mythbusters

Absorption

Local studies have demonstrated minimal rates of cutaneous alcohol absorption.

You cannot absorb enough through your skin to lose you drivers license

Fire

The overall risk of fires associated with ABHR is extremely low

Consult MSDS,local OH&S requirements & HHA guidelines for placement of product

mythbusters37
Mythbusters

Ingestion

  • Unlikely as ABHR tastes unpleasant
  • Risk of poisoning uncommon but some diarrhoea/vomiting has been reported

Splashes

  • Product should be placed at a height to minimise risk of splashes
  • If splash occurs don’t rub ,flush eye and seek help ASAP

Children need to be supervised at all times in hospitals

references
References
  • Guideline for Hand Hygiene in Health-Care Settings.MMWR 2002:vol,51,no RR-16
  • Pittet D,Inf .Control Hospital Epidemiology 200:21:381-386
  • Voss A and Widmer AF,Inf. Control Hospital Epidemiology 1997:18:205-208
  • HHA 5 Moments for Hand Hygiene,Advanced draft, August 2008
  • WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) April 2006
  • Boyce et al.Inf. Control Hospital Epidemiology 2000:21:442
  • Kramer et at,Journal Hospital Inf. 2002:51:114
  • Larson et al.Heart Lung 2000:29:139
  • Pittet.D.Emerging Inf Dis 2001:2:234