ahrq safety program for long-term care: hais/cauti exploring hand hygiene knowledge and practice...
Post on 19-Jan-2016
219 Views
Preview:
TRANSCRIPT
AHRQ Safety Program for Long-term Care: HAIs/CAUTI
Exploring Hand Hygiene
Knowledge and Practice
Training Module #1 for the CAUTI LTC Core Team
Insert Headshot
2
Learning Objectives
Upon completion of this training, the facility core team members will be able to:
• explain why hand hygiene is so important to prevent the spread of infections;
• reinforce when and how to perform hand hygiene;
• recognize challenges to hand hygiene in their facility, and identify possible solutions; and
• discuss ways to monitor hand hygiene adherence and develop feedback reports.
3
Front-line Staff Training Recap
• Hand hygiene is one of the most important ways to prevent the spread of infections
• Germs, especially gram-negative bacteria are frequently found on healthcare worker hands following routine resident care
• The WHO 4 moments provide a simple framework for remembering when staff should perform hand hygiene during any resident interaction
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16 Mody et al Infect Control Hosp Epidemiol; 2003:24:165-171 Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands Educational Resources: http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx
4
Hand Hygiene Technique
http://www.who.int/gpsc/en/http://www.cdc.gov/handhygiene/Resources.html#HCP
5
Front-line Staff Training Recap
• Alcohol-based hand products are preferred for hand hygiene during almost all routine patient care activities
Exceptions:
1. When hands are visibly soiled
2. After care of a resident with known or suspected infectious diarrhea
• It’s important to clarify hand hygiene expectations during care of a resident with C.difficile.
• Alcohol-based hand rubs are appropriate on entry to room; appropriate glove use to prevent hand contamination; washing with soup and water upon glove removal and exiting room
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944. Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628-645
Good Better Best
Plain soap Antimicrobial soap Alcohol-based hand rub
6
Front-line Staff Training Recap
Gloves play a key role in preventing hand contamination – but, do NOT replace hand hygiene
Perform hand hygiene and wear gloves immediately before:
• Placing or removing an indwelling catheter
• Accessing the drainage system to empty the drainage bag
or collecting a urine sample
Remove gloves and perform hand hygiene immediately
after:
• Handling an indwelling catheter
• Accessing the drainage system to empty the drainage
bag or collecting a urine sample
7
Health Care Worker Challenges with Hand Hygiene
Belief that Hand Hygiene guidelines aren’t applicable• 30% wouldn’t change current practices; 20% said guidelines were impractical
Lack of access to appropriate Hand Hygiene supplies• 16.2% lack of available sink; 27.5% lack of alcohol-based hand rub
No Hand Hygiene because of glove use• 23% nurses, 17% CNAs, 26% other HCWs
Forgot about Hand Hygiene because of workload• 35% of nurses, 22% CNAs, 44% other HCWs
Lack of access to Hand Hygiene feedback and/or education• 55% never to rarely received personal feedback on HH practices• Other HCWs less often received periodic education on HH (86.8% vs. 92% of nurses and
CNAs, p=0.03)
Ashraf MS et al. ICHE 2010; 31(7):758-762
8
Addressing Barriers to Hand Hygiene
Let’s Chat!
• What challenges do you experience performing hand hygiene in your facility?
• What solutions do you propose to address these challenges in your facility?
• How can you support a culture of safety around hand hygiene?
9
Hand Hygiene Adherence Monitoring Options
Method Pros Cons
Direct observation of hand hygiene technique • Educational moment • Does not measure adherence
during patient care
Direct observation of hand hygiene adherence
• Captures information on product, technique
• Data summarized by staff type, shift, unit
• Educational moment
• Time and resource intensive• Can influence performance
Measurement of volume of AHBR or soap used • Easy to track consistently
• Consumption may not correlate with appropriate use
• Could be biased by purchasing patterns
Survey/self-report of hand hygiene adherence
• Captures perceptions and barriers • Rates often inflated
10
Feedback and Dissemination of Hand Hygiene Rates
• Providing feedback on hand hygiene adherence to front-line staff is a key component to raising awareness and maintaining high compliance rates.
• Also consider opportunities for “just in time” education when incorrect practices are observed.
Jan-12
Apr-12
Jul-1
2
Oct-12
Jan-13
Apr-13
Jul-1
3
Oct-13
Jan-14
0
40
80
Hand Hygiene ComplianceNursesCNAsPhysiciansRehab (PT/OT/ST)
% C
ompl
ianc
e
Jan-12
Mar-12
May-12
Jul-12
Sep-12
Nov-12Jan
-13
Mar-13
May-13
Jul-13
Sep-13
Nov-13Jan
-140
40
80
Hand Hygiene Compliance
Unit 1Unit 2
% C
ompl
ianc
e
11
Interactive Activities
• Demonstration of hand hygiene technique– Culture staff hands before and after
hand hygiene
• Demonstration of germ transfer– Use glow powder on commonly
touched objects to see how and where “germs” travel
Before After
Hand Hygiene Videos
• WHO - SAVE LIVES: Clean Your Hands
• Hand Hygiene Video New England Journal of Medicine
• Hand Hygiene Training Films and Slides
• O les mains Hand Hygiene Dance
• CDC—Hand Hygiene Interactive Education Video
• Public Health Ontario—Just Clean Your Hands (based on WHO 5 Moments)
• NPSA Wi-Five Hand Hygiene Video Game
12
13
Hand Hygiene Posters
Create your own!– Have staff role model positive
behaviors
Other Resources:– CDC and WHO Hand Hygiene Resou
rces• Additional posters
– Public Health Ontario – Just Clean Your Hands
http://www.cdc.gov/handhygiene/Resources.html#HCP
14
Take the Pledge…
15
AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project WebsiteLogin information
Username: ltcsafetyPassword: ltcsafety
TeamSTEPPS® for Long-term Care
Stay Updated with Useful Resources
Take the Pledge… (to practice all infection prevention skills)
World Health Organization How to Handrub Poster
World Health Organization How to Handwash Poster
top related