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 - PowerPoint PPT PresentationTRANSCRIPT
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
• 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
• 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 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?
• Giving a bed bath?
• Suctioning oral secretions?
• Transporting a patient on a stretcher?
• Responding to an emergency where blood is spurting?
• Drawing blood?
• Cleaning an incontinent patient with diarrhea?
• Irrigating a wound?
• Taking vital signs?
PPE Use in Healthcare Settings
What Type of PPE Would You Wear?
• 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
Gloves
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
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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 ConceptMaternal Mortality due to Postpartum Infection General Hospital, Vienna, Austria, 1841-1850
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MDs Midwives
Semmelweis’ Hand Hygiene Intervention
~ Hand antisepsis reduces the frequency of patient infections ~
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.
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 ~
The Iceberg Effect
Infected
Colonized
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
Germs present on patient skin and immediate environment surfaces
Germ transfer onto 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
one two three four five
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
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
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 handrub
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
■ 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
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
LOWER RESPIRATORY TRACT INFECTIONSMechanical ventilationAspirationNasogastric tubeCentral nervous system depressantsAntibiotics and anti-acidsProlonged health-care facilities stayMalnutritionAdvanced ageSurgeryImmunodeficiency
13%
BLOOD INFECTIONSVascular catheterNeonatal ageCritical care Severe underlying diseaseNeutropeniaImmunodeficiencyNew invasive technologiesLack of training and supervision
14%
SURGICAL SITE INFECTIONSInadequate antibiotic prophylaxis
Incorrect surgical skin preparationInappropriate wound care
Surgical intervention durationType of wound
Poor surgical asepsisDiabetes
Nutritional stateImmunodeficiency
Lack of training and supervision 17%
URINARY TRACT INFECTIONSUrinary catheter
Urinary invasive proceduresAdvanced age
Severe underlying diseaseUrolitiasis
PregnancyDiabetes
34%
Most common sites of health care-associated infection and the risk factors
underlying the occurrence of
infections
LACK OF HAND
HYGIENE
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.
The Inanimate Environment Can Facilitate Transmission
~ 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.
X represents VRE culture positive sites
What is the single most important reason for EMS workers to practice good hand
hygiene?
1. To remove visible soiling from hands
2. To prevent transfer of bacteria from the home to the ambulance
3. To prevent transfer of bacteria from the ambulance to the home
4. To prevent infections that patients acquire in the ambulance
What is the single most important reason for EMS workers to practice good hand
hygiene?
1. To remove visible soiling from hands
2. To prevent transfer of bacteria from the home to the ambulance
3. To prevent transfer of bacteria from the ambulance to the home
4. To prevent infections that patients and EMS staff acquire in the ambulance
How often do you clean your hands after touching a PATIENT’S INTACT
SKIN (for example, when measuring a pulse or blood pressure)?
1. Always
2. Often
3. Sometimes
4. Never
How often do you clean your hands after touching a PATIENT’S INTACT
SKIN (for example, when measuring a pulse or blood pressure)?
1. Always
2. Often
3. Sometimes
4. Never
Estimate how often YOU clean your hands after touching a patient or a contaminated surface in the ambulance?
1. 25%
2. 50%
3. 75%
4. 90%
5. 100%
Which method do you use to clean your hands at work?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
Which hand hygiene method is best at killing bacteria?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
Which hand hygiene method is best at killing bacteria?
At least 60% alcohol concentration
Which of the following hand hygiene agents is LEAST drying to
your skin?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
Which of the following hand hygiene agents is LEAST drying to
your skin?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
How often do you clean your hands after touching an ENVIRONMENTAL
SURFACE near a patient (for example, a clipboard or radio)?
1. Always
2. Often
3. Sometimes
4. Never
How often do you clean your hands after touching an ENVIRONMENTAL
SURFACE near a patient (for example, a clipboard or radio)?
1. Always
2. Often
3. Sometimes
4. Never
Use of artificial nails by healthcare workers poses no
risk to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Use of artificial nails by healthcare workers poses no
risk to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Can a Fashion Statement Harm the Patient?
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Natural (n=31)Artificial (n=27)Polished (n=31)
ARTIFICIAL
POLISHEDNATURAL
Edel et. al, Nursing Research 1998: 47;54-59
Avoid wearing artificial nails, keep
natural nails <1/4 inch if caring for
high risk patients (ICU, OR, EMS)
When do you need gloves?
Whenever risk for exposure to bloodborne pathogens exists
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
The term “blood” applies to:
– Human blood
– Components of human blood
– Any product containing human blood
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
As long as there are NO visible signs of blood, no-risk fluids include:– Sweat– Tears– Saliva– Urine– Vomit– Sputum
Definition of an Exposure An exposure
occurs when a pathogen makes direct or indirect contact with:– Mucous
membranes– Non-intact skin
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.
Glove use for all patient care contacts is a useful strategy for reducing risk of
transmission of organisms.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Glove use for all patient care contacts is a useful strategy for reducing risk of
transmission of organisms.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
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 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
• 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
Gloves
For people, not equipment
The “My 5 Moments for Hand Hygiene” approach – includes changing gloves
This presentation created in 2013 by Mike McEvoy using slide from CDC and WHO. Power Point version available at www.mikemcevoy.com.