IMPROVING HAND HYGIENE PRACTICES IN HEALTHCARE SETTINGS

1. IMPROVING HAND HYGIENE PRACTICES IN HEALTHCARE SETTINGS Adopted from Hand Hygiene Resource Center Hospital of Saint Raphael New Haven, CT www.handhygiene.org, Used with permission.

2. So Why All the Fuss About Hand Hygiene? Most common mode of transmission of pathogens is via hands! * Many studies have shown that the bacteria that cause Nosocomial and Healthcare Associated Infections (HAIs) are most frequently spread from one patient to another on the hands of healthcare workers and account for the Spread of antimicrobial resistance * CDC estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection.

3. When should you wash your hands with soap and water? • Wash your hands with plain soap and water, or with anti-microbial soap and water if: • your hands are visibly soiled (dirty) • hands are visibly contaminated with blood or body fluids • before/after eating • after using the restroom

4. How is the track record on handwashing in healthcare facilities? Although handwashing has been proven to reduce the spread of germs in healthcare facilities, healthcare workers often do not wash their hands when recommended. In 34 studies of handwashing, workers washed their hands only 40% of the time.

5. Why is compliance with recommended handwashing so poor? What are some reasons why healthcare workers do not wash their hands as often as they should:  heavy workloads (too busy)  skin irritation caused by frequent use of soap and water  hands don’t look dirty  sinks are poorly located  handwashing takes too long

6. Where’s the sink?

7. Sinks are often inconveniently located The sink is located behind the patient’s bed and behind several IV pumps.(see arrow)

8. Patients often carry resistant germs on their skin Patients with resistant germs like methicillin-resistant S. aureus (MRSA) or vancomycin-resistant enterococci (VRE) often carry the germ on many areas of their skin, even when they don’t have any wounds or broken skin.

9. Percent of Patients with MRSA Who Carry the Organism on Their Skin The chart shows the percent of patients with methicillin-resistant S. aureus (MRSA) who carry the germ on the skin under their arms, on their hands or wrists, or in the groin area. 13-25% 40% 30-39%

10. Another Way Healthcare Workers Get Germs on Their Hands Resistant germs on the skin or in the digestive tract of patients can often be found on the patient’s gown, bed sheets, and on equipment items such as blood pressure cuffs, bedside rails, over bed tables, and IV pumps. Healthcare workers can get germs on their hands by touching environmental surfaces near affected patients.

11. 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.

12. How can we overcome problems associated with handwashing? • Since washing hands frequently with soap and water is: • inconvenient • time-consuming • often causes skin irritation and dryness • A new 2002 guideline has been developed by the Centers for Disease Control and Prevention (CDC) and infection control organizations which recommends that healthcare workers use an alcohol-based handrub (a gel, rinse or foam) to routinely clean their hands between patient contacts, as long as hands are not visibly dirty.

13. Alcohol-based Handrubs Using an alcohol-based handrub requires about 15 seconds of time, versus approximately 60 seconds to go to a sink, perform a handwas Handrubs can be placed in convenient locations, making the product readily accessible Cause less skin irritation and dryness Are more effective in reducing the number of germs on hands

14. When should you use an alcohol-based handrub? • If hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based handrub for routinely cleaning your hands: • before having direct contact with patients after having direct contact with a patient’s skin • after having contact with body fluids, wounds or broken skin • after touching equipment or furniture near the patient • after removing gloves

15. Tips on How to Use an Alcohol-based Handrub • Apply nickel or quarter-sized amount of an alcohol gel or rinse to the palm of one hand, and rub hands together • cover all surfaces of your hands and fingers • include areas around/under fingernails • continue rubbing hands together until alcohol dries • if you have applied a sufficient amount of alcohol handrub, it should take at least 10 -15 seconds of rubbing before your hands feel dry

16. More Tips on How to Use an Alcohol-Based Handrub If after cleaning your hands 5 to 10 times with an alcohol-based handrub, you feel a “build-up” of emollients on your hands, wash your hands with soap and water. If you clean your hands with an alcohol- based handrub before putting on gloves, make sure the alcohol has dried completely before putting on gloves.

17. Can a Fashion Statement Harm the Patient? ARTIFICIAL POLISHED NATURAL Avoid wearing artificial nails, keep natural nails <1/4 inch if caring for patients Edel et. al, Nursing Research 1998: 47;54-59

18. In conclusion, which hand hygiene method is best at killing bacteria? • Plain soap and water • Antimicrobial soap and water • Alcohol-based handrub

19. Let’s Practice By now, you should understand the importance of good hand hygiene. Handwashing and alcohol-based handrubs can reduce the risks of spreading germs in healthcare facilities. For more information, visit us online at www.handhygiene.org.