routine hand hygiene

CutanAlcohol Gel

Hands frequently acquire a variety of microorganisms through contact with the environment, objects in the environment and other people. Transient microorganisms (those that are found on the surface of the skin), such as meticillin-resistant Staphylococcus aureus (MRSA), are readily acquired during healthcare delivery (NPSA, 2008). Transient bacteria are easily transferred to and from healthcare workers’ hands during routine procedures, such as moving or washing a patient (Pittet et al., 1999). Pathogens (disease-producing microorganisms) are most likely to contaminate hands in large numbers when handling moist or heavily contaminated substances such as body fluids or excretions (Pittet et al., 1999). Hand hygiene is therefore one of the most important ways of breaking the chain of infection and reducing the risk of healthcare-associated infections (HCAI)(Loveday et al., 2014; WHO, 2009).

The National Patient Safety Agency (NPSA) (2008) indicates that failure to carry out thorough hand hygiene may result in an HCAI in one of the following ways:

• By transferring the patient’s own microorganisms from the site where they normally live into sterile areas of the patient’s body during care delivery or treatment;• By transferring microorganisms from one patient to other patients, resulting in cross-infection;• By transferring microorganisms from the environment or equipment to a patient.

HCAIs can occur in any setting where healthcare is delivered, including the hospital setting, nursing/care homes, a health centre, general practitioner’s

surgery and even the patient’s own home if receiving healthcare. Hand hygiene is therefore essential at the point of care, wherever healthcare is delivered. The point of care can be defined as the time and place where care is being delivered, which is the point at which there is the greatest likelihood of transmitting potentially pathogenic microorganisms that may result in infection—that is, the patient’s immediate environment. In the hospital setting, the point of care refers to the patient’s bed and immediate bed space/area and any equipment, including curtains. National guidance (Loveday et al., 2014), based on the World Health Organization’s 5 Moments for Hand Hygiene (WHO, 2006) and guidelines from the National Institute for Health and Care Excellence (NICE, 2017), make recommendations for hand hygiene at the following critical points in time:

• Immediately before each episode of direct patient contact or care, including clean/aseptic procedures;• Immediately after each episode of direct patient contact or care;• Immediately after contact with body fluids, mucous membranes and non-intact skin;• Immediately after other activities or contact with objects or equipment in the immediate patient environment that may result in the hands becoming contaminated;• Immediately after the removal of gloves (Loveday et al., 2014).

Your choice of hand hygiene product (soap and water versus alcohol hand sanitiser) will be influenced by a variety of factors. You will need to consider what task has just been performed or is going to be performed, whether your hands are visibly soiled, and the availability of products.

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Infection Control MeasuresAdults

Routine hand hygieneDemonstrated by Shila Patel, Clinical Nurse Specialist Infection Prevention and Control and Vascular Access,

Epsom and St Helier University Hospitals NHS Trust

©2019 Clinical Skills Limited. All rights reserved

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

National guidance (Loveday et al., 2014) highlights the following time points when hand hygiene is critical in order to help avoid HCAIs: (a) immediately before each episode of direct patient contact or care; (b) including clean/aseptic procedures; (c) immediately after each episode of direct patient contact or care; (d) immediately after contact with body fluids, mucous membranes and non-intact skin; (e) immediately after other activities or contact with objects or equipment in the immediate patient environment that may result in the hands becoming contaminated; and (f) immediately after the removal of gloves.

Critical points for hand hygiene

a b c

d e f

Liquid

100ml

ST System

Extra Mild Non Perfumed

SoapClean and refreshingliquid soap

savon liquide300ml

POWDER-FREE NITRILEEXAMINATION GLOVES POWDER-FREENITRILE

EXAMINATION G

LOVES

M MM

Infection Control Measures

Adults

Routine hand hygiene

Page 2 of 5

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution

Do not wear gloves unnecessarily or use them as a substitute for hand hygiene. Indiscriminate use may also result in adverse reactions and skin sensitivity (Loveday et al., 2014).

(b)Gloves: (a)

Nails short; no nail varnish or false nails

Cuts and abrasions covered with waterproof dressing

Remove all hand jewellery (or follow local policy)

No watches or bracelets

12

6

3 9

General principles: (a) (b)

In order to be able to thoroughly decontaminate your hands, including the wrists, wear short-sleeved clothing when delivering patient care (Loveday et al., 2014). Some organisations have adopted a policy of “bare below the elbows”, therefore follow local policy.

Cover any cuts or abrasions with a waterproof dressing, to minimise the risk of cross-infection by pathogenic microorganisms. Ensure that nails are cut short. Remove all wrist and hand jewellery before delivering care (Loveday et al., 2014). Some organisations permit a plain wedding ring: follow local policy.

Gloves may puncture or tear (potentially allowing the transfer of microorganisms) and cross-contamination may also occur when removing gloves (Loveday et al., 2014). Therefore, always decontaminate your hands at the appropriate points in time, as outlined above, even if you are wearing gloves.

Soap and water allows the mechanical removal of transient microorganisms when using a good hand-washing technique (Wilson, 2006). You must carry out hand washing with soap and water in preference to other types of hand decontamination, such as alcohol-based hand sanitiser: if your hands are visibly soiled; when caring for patients with vomiting or diarrhoeal illness, regardless of whether gloves are worn or not (Loveday et al., 2014); after using the toilet yourself; and before handling food.

Soap and water(c)

Wear disposable gloves (whether clean or sterile) appropriately: when there is a risk of exposure to blood or body fluids, for contact with non-intact skin or mucous membranes, or for contact with sterile areas (Wilson, 2006). Gloves must conform to current EU regulations and be appropriate to the task. Polythene gloves should not be worn for clinical interventions (NICE, 2017). Avoid the use of natural rubber latex gloves if possible; where it is necessary to use latex gloves, alternatives should be provided for use with patients or staff who have sensitivity to latex (NICE, 2017).

CutanAlcohol GelSpecially for the rapidand convenient disinfection ofphysically clean handsUse to supplement your routine

hand washing procedures

Alcohol Gel

Hand disinfectant

Alcohol Gel

ALCOHO

L GEL

HAND D

ISINFEC

TANT

Effective against MRSA

50ML

BARRIER CREAM

Nail brushes

HIBISCRUB

H I B I S O L

Virtually nonirritating

16 Fl Oz

hair and natural fabrics

nonstaining to skin

ANTISEPTIC

Antisepticsolution

MICROBE


Adults


Alcohol-based hand sanitiser: (a)

Antiseptic solutions

Contact dermatitis is more commonly reported with antiseptic agents containing substances such as iodine and chlorhexidine (WHO, 2009). Their routine use in hand hygiene is therefore not recommended. It is more appropriate to use antiseptic solutions when a higher level of hand hygiene is necessary, e.g., before undertaking invasive procedures such as surgery.

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Change to pic of urine being poured away in slop hopper or have pic of putting bedpan into a bedpan washer. It is not recommended to dispose of body fluids in patient toilets as this can lead to splashing and cross contamination (does this point affect any other procedures?)

Change pic to show the patient’s immediate environ-ment, ie furniture and equipment in their bedspace--per-haps a M&H pic might be suitable?

Alcohol-based hand sanitiser provides a good alternative to hand washing and is often preferred because it is more effective, quicker to use, better tolerated by the skin and can be used directly at the point of care (Loveday et al., 2014). Hands should be washed with soap and water after several applications of alcohol hand sanitiser (e.g., three applications), in line with the manufacturer’s instructions.

Hand disinfectant

Alcohol Gel

(b)

Alcohol-based hand sanitiser should not be used when hands are visibly soiled, as it is ineffective in the presence of organic soiling. In addition, alcohol-based sanitiser should not be used when caring for patients with vomiting or diarrhoea, because patients with these symptoms may have Clostridium difficile, norovirus or other diarrhoeal infections against which alcohol-based hand hygiene products are ineffective (Loveday et al., 2014; NICE, 2017).

Frequent hand washing can irritate the skin, so good skin care is important. To help limit the damaging effects of hand washing, always wet hands before applying soap and dry hands thoroughly by patting dry with paper hand towels rather than rubbing (Loveday et al., 2014; Wilson, 2006). An emollient hand cream should be used regularly, e.g. when taking a break or at the end of a shift, to help maintain the integrity of the skin. If you do experience skin irritation, consult your occupational health department (if available) or see your general practitioner (Loveday et al., 2014). Avoid communal tubs or tubes of hand cream as these can act as a vector for transferring microorganisms from one person to another. Wall-mounted cartridge dispensers are preferable in the healthcare setting (Hill & Millward, 2009).

Nailbrushes are not recommended for routine social hand washing (Hill & Millward, 2009); they can act as a vector for transferring microorganisms from one person to another. Where needed, such as for surgical hand scrubbing, it is essential to use single-use nail brushes.

Healthcare staff should not use bar soap for hand washing, as bars of soap may harbour and encourage the growth of microorganisms (Archibald et al., 1997). Organisations should therefore provide liquid soap dispensed from wall-mounted disposable cartridges (Hill & Millward, 2009; DH, 2013).

Soaps

Should be adisposable bed pan

Need to discuss what is the di�erence between these two

Skin care

Is part of the drawing missing here? it looks like she is carrying a plate

Hand decontamination: use either soap and water or alcohol-based sanitiser Skin care

Alternatively, apply alcohol-based sanitiser (on dry, visibly clean hands).

If washing your hands, wet themfirst.

Then apply soap or a cleanser. Some newer soap dispensers are movement activated and do not require you to touch them. With the type shown, use the heel of your hand to dispense the soap.

For skin care, apply hand moisturiser regularly, e.g., during a break, at the end of your shift and before going to sleep, in order to help keep your skin in good condition. See your occupational health department or general practitioner if you experience skin irritation or dermatitis (Loveday et al., 2014).


Adults


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2. Palm to back of hand, fingers overlaced

4. Fingers interlocked

Interlock the fingers in opposing palms and rub vigorously to decontaminate the backs of the fingers.

Decontaminate the backs of the hands by rubbing the palm of one hand over the back of the other hand with fingers overlaced and vice versa.

3. Palm to palm, fingers interlaced

Decontaminate the interdigital spaces, which are often heavily contaminated, by interlacing the fingers and rubbing vigorously.

If washing your hands, lather the soap well for a minimum of 10–15 seconds, ensuring that your hands remain outside of the running water while lathering. These illustrations show hand washing, but you need to perform the same movements whether using soap and water, alcohol sanitiser or hand cream. First rub hands palm to palm.

1. Palm to palm


Adults


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6. Rub fingertips of one hand in other palm, rotating

8. Hand washing only: rinsing your hands

If you have washed your hands, rinse your hands and wrists thoroughly under running water; residual soap can dry the skin or damage its integrity. After rinsing, do not touch the taps with your hands. Turn off hand-operated taps with paper towels to prevent cross-contamination onto hands. Ideally, use hands-free taps, operated by elbows or the foot.

Decontaminate the fingertips and nails of both hands: rub the fingertips of your left hand in the palm of the right hand and vice versa.

7. Rub each wrist, rotating

Rotate your right hand around your left wrist and vice versa. If using alcohol-based sanitiser, continue rubbing until it has fully evaporated and omit the next two steps.

Areas most frequently missed

Effective hand hygiene involves methodically rubbing all parts of the hands and wrists. This illustration shows the areas of the hands that are most frequently missed and which therefore need particular attention.

9. Hand washing only: drying your hands

Following washing, dry hands thoroughly using good-quality paper hand towels. Dispose of these as domestic waste after use. When disposing of used paper hand towels, take care not to recontaminate hands; use a foot-operated pedal bin.

Rotate your right hand around your left thumb and vice versa.

5. Rub each thumb in each palm, rotating

routine hand hygiene

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