The National Hand Hygiene Initiative

1. The National Hand Hygiene Initiative

2. Australian Commission on Safety and Quality in Healthcare • The Commission was established by State and Territory Governments • Purpose – to develop a national strategic framework to guide efforts in improving safety and quality across the health care system in Australia

3. Australian Commission on Safety and Quality in Healthcare The Commission commenced on 1 January 2006. The Commission's role is to: • lead and coordinate improvements in safety and quality in health care • disseminate knowledge and advocate forsafety and quality • report publicly on the state of safety and quality including performance against national standards

4. Australian Commission on Safety and Quality in Healthcare • recommend national data sets for safety and quality, including data development, standards, collection and reporting • provide strategic advice to Health Ministers on best practice • recommend nationally agreed standardsfor safety and quality improvement

5. Australian Commission on Safety and Quality in Healthcare 5 Key Initiatives • National Surveillance System • To reduce harm to patients from hospital associated infections through the use of surveillance • Updated National Infection Control Guidelines • To improve useability and provide permanent currency of information • National Hand Hygiene Initiative - NHHI • Building clinician capacity • To increase the ability of infection control practitioners by providing them with skills and resources to engage and educate clinicians, managers and healthcare consumers to adopt a collective HAI prevention mindset • Antibiotic Utilisation • Development of a national system to monitor antibiotic usage

6. University curricula

8. Statewide Hand Hygiene Compliance Overall HH Compliance: Baseline: 20% (95%CI 19-20%) to12 mths: 53% (95%CI 52-53%) Increases significant after 4-mths and 12-mths (p<0.0001)

9. Statewide - MRSA bacteraemiasPatients with MRSA bacteraemia per month per 100 separations

10. Summary HH Culture-Change Programs associated with: • Improved HH compliance from 18-21% to 47-53% after 12-24 months • 50% (approx.) reduction in rates of MRSA disease after 12-23 months • Generic, centrally coordinated HH Culture-Change programs can be effective in a wide variety of urban and rural healthcare institutions • Such programs represent the single most effective initiative to reduce the burden of MRSA in hospitals

11. Hand Hygiene Australia • 3 years funding from ACSQHC to implement National Hand Hygiene Initiative • Report to ACSQHC • Leverage off existing Hand Hygiene programs • Directed by Prof Lindsay Grayson • Independent of jurisdiction and hospital • Based at Austin Health, Victoria

12. Objectives of HHA • Develop reliable indicators of hand hygiene compliance • Accurately measure hand hygiene compliance • Reduce rates of healthcare associated infection • Make hand hygiene ‘core business’ for all health care workers

13. HHA resources and support Hand Hygiene Australia Manual • Implementing HH program • ABHRS information • Detailed explanation of 5 Moments • Supporting evidence • Examples • Outcome Measures • HH compliance • Data for Staphylococcus aureus bacteraemia

16. Moment 1 Definitions: • Touching a patient in any way • Any personal care activities • Any non-invasive observations • Any non-invasive treatment • Preparation and administration of oral medications • Oral care and feeding

17. Moment 2 Definitions: • Insertion of a needle into a patient’s skin, or into an invasive medical device • Preparation and administration of any medications given via an invasive medical device, or preparation of a sterile field • Administration of medications where there is direct contact with mucous membranes • Insertion of, or disruption to, the circuit of an invasive medical device • Any assessment, treatment and patient care where contact is made with non-intact skin or mucous membranes

18. Moment 3 Definitions: • After any procedure • After any potential body fluid exposure • Blood, Lochia • Saliva or tears • Mucous, wax, or pus • Breast milk, Colostrum • Vomitus • Urine, faeces, semen, or meconium • Pleural fluid, ascitic fluid or CSF • Tissue samples, including biopsy specimens, organs, bone marrow,cell samples

19. Moment 4 Definition: • After touching a patient

20. Moment 5 Definition • After touching the patient’s immediate surroundings when the patient has not been touched

21. Desired Outcome……….. INCREASE INCREASE DECREASE HH Compliance Awareness Healthcare associated infections

22. The 5 Moments in a GP Practice • Imagine a patient walks into your assessment room, you shake hands, take the patient’s blood pressure and temperature, then take a blood sample, give the patient the paperwork to take out to reception, they leave. • Then you write in the medical history, return it to reception and call for the next patient.

23. The 5 Moments in a GP Practice HH M1 • Imagine a patient walks into your assessment room, you shake hands, take the patient’s blood pressure and temperature, then take a blood sample, give the patient the paperwork to take out to reception, they leave. • Then you write in the medical history, return it to reception and call for the next patient. HH M2 HH M3 HH M4

24. Choosing an ABHR Product Selection When selecting an ABHR product, HHA recommends: • The Product meets the EN1500 testing standard for bactericidal effect • The Product has TGA approval as a hand hygiene product However, product selection is ultimately the choice of each health care facility, and other factors should also be considered, such as: • Dermal tolerance • Aesthetic preferences such as fragrance, colour, texture and ease of use • Practical considerations such as availability, convenience and functioning of dispenser, and ability to prevent contamination • Cost issues

25. ABHR Placement • Needs to be at the “Point of Care” • The place where three elements come together: the patient, the HCW, and the care or treatment involving contact with the patient or his/her surroundings. • A hand hygiene product should be easily accessible and as close as possible – within arms reach of where patient care or treatment is taking place. • Point of care products should be accessible without having to leave the patient zone

26. ABHR Placement Examples: • At entrance to clinic for patient’s to use on arrival • At reception desk for reception staff • In assessment / treatment rooms • On desk • On wall near assessment bed • On portable equipment trolleys • Eg. Blood collection trolley

27. Why use ABHR’s? • Reduces bacterial count on hands more effectively than soap and water hand wash • Reduces adverse outcomes and cost associated with healthcare associated infections • Requires less time • Less irritating to skin than soap and water as ABHRs contain an emollient • Can be readily accessible/portable

28. When to use ABHRs???? • When hands are NOT visibly soiled • Before and after touching a patient • After glove use • After contact with the patient’s belongings

29. What can I use for Hand Hygiene? HH means either: • using soap and water to wash with thorough drying when your hands are visibly soiled or • using a waterless hand rubs ( eg. ABHR) when your hands are visibly clean

32. Compatible Moisturiser…. • Use a minimum of 3 times per shift • At coffee break • At meal breaks • At home time • All HCW’s to use work supplied compatible moisturiser (boys included) • Think about the whole 24 hours

33. Gloves…. • Gloves should be used as an adjunct to, not a substitute for hand hygiene. • Hand hygiene is to be performed before & after all glove use. • Gloves need to be changed & HH performed after each patient procedure and when going from dirty to clean sites even on the same patient. • Disposable gloves are to be used once only and never disinfected or washed.

34. “Clean Between” • Use the alcohol impregnated wipes/detergent wipes on all shared non critical equipment • Think about product placement to encourage use e.g near keyboards, on trolleys, in clinic areas,therapy rooms

35. HHA Education Tools • On line learning package • All healthcare workers • Basic hand hygiene information • Why, how and when • Multiple choice questions • annual requirement? • HCW specific packages

38. OH & S Concerns • Splash • Unlikely if a two handed action is used – risk Minor/Moderate • Ingestion • Unlikely during normal use - risk Minor/Moderate • Fire • Possible – but overall risk is extremely low • Spillage / Splash on floor • Possible/likely – risk insignificant • Deliberate or unintentional misuse • Possible by children or cognitively impaired – consider product placement in supervised areas, or personal pocket bottles if regular clientele

39. OH & S Concerns • Alcohol absorption • Unlikely – local studies show that you cannotabsorb enough through your skin to lose you drivers license! • Bulk storage • Ensure that bulk storage complies with state fire regulations and apply standard precautions for flammable liquids (DG class 3) • Skin irriatation • Rare – Risk minor • Patient infection from poor compliance with HH regimen • Almost certain – Risk Major/Severe

40. OH & S and ABHRS There are a number of risks to patients and staff associated with the use of alcohol based handrub, however the benefits in terms of its use far outweigh the risks Healthcare Settings are dangerous Children need to be supervised at all times **Generic HHA Risk Assessment and Management plan** Safety Institute Australia

41. Key messages Alcohol Based Hand Rub Point of Care Before and After Touching a Patient