Hand Hygiene for Clinical Staff

Infection Prevention & ControlJuly 2012

Objectives

• To understand the 4 moments for hand hygiene

• To understand the two environments for hand hygiene and the impact on transmission of organisms

• To identify areas for improving hand hygiene within your clinical practice

Ask Yourself……..

• How good is your hand hygiene?

• Where have your hands been?

• Do you clean your hands between every patient?

• Are there opportunities for you to improve your hand hygiene?

Did You Know?

• Most health care providers believe they are already practicing good hand hygiene, but research has shown that hand hygiene compliance is:

<40%

Two Different Environments

Healthcare Environment

• Everything outside the patient’s immediate environment

• In a single room, this is outside the room. In a multiple room, this is everything outside the patient’s bed area

Patient Environment

• The patient’s immediate area

Transmission of Organisms

• Health care providers move from patient to patient and room to room to provide care

• This movement provides many opportunities for the transmission of organisms to occur

• It only takes ONE missed hand hygiene opportunity to spread an infection

When should hand hygiene be performed?

• Before putting on gloves and after taking gloves off• Before preparing, handling, serving or eating food• After personal body functions• When unsure if hands are clean because germs are

not visible• THE 4 MOMENTS FOR HAND HYGIENE are some

essential moments in health care where the risk of transmission is greatest and hand hygiene must always be performed

The 4 Moments for Hand Hygiene

1. Before contact with the patient/patient environment

3. After body fluid exposure

2. Before aseptic procedure

4. After contact with the patient/patient environment

The 4 Moments for Hand Hygiene

1. Before contact with the patient/patient environment

Examples include:

• Before shaking hands• Before taking blood pressure,

pulse or chest auscultation• Helping to move or bath a

patient• Before adjusting an IV

The 4 Moments for Hand Hygiene

2. Before Aseptic Procedure Examples Include:

• Oral/dental care, giving eye drops, secretion aspiration

• Skin lesion care, wound dressing, injection

• Catheter insertion• Preparing of medication or

dressing sets

The 4 Moments for Hand Hygiene

3. After Body Fluid Exposure Examples Include:

• Secretion aspiration, oral/dental care

• Skin lesion care, wound dressing, injection

• Drawing any fluid sample• Cleaning up urine/feces/vomit,

handling waste (bandages, incontinence pads)

• Emptying catheter

The 4 Moments for Hand Hygiene4. After contact with patient/patient environment Examples Include:

• After shaking hands• Moving patient, bathing patient• Taking pulse, blood pressure,

chest auscultation, abdominal palapation

• Changing bed linens• Holding a bed rail• Clearing the bedside table• Touching monitor

Where are the opportunities for hand hygiene?You enter a ward room, the patient in bed 3 asks for help out of bed and upon leaving the room patient in bed 1 asks you to check her IV site.

How many moments for hand hygiene in this example?1.Before you enter the ward room2.After contact with the patient in bed 3 & before contact with the patient in bed 13.After contact with the patient in bed 1

3 Opportunities

Where are the opportunities for hand hygiene?You enter a room, take the patient’s vital signs, change a dressing on the patient’s foot and then set the patient up for lunch before exiting the room.

How many moments for hand hygiene in this example?1.Before you enter the room2.Before starting the dressing change3.After the dressing change4.Upon exiting the room 4 Opportunities

Is this Okay?• Wear gloves for as short a time as

possible• Do not walk from room to room or

common areas of the hospital while wearing gloves

• Hands are often contaminated in the process of glove removal

• Gloves do not replace the need to perform hand hygiene

• Always perform hand hygiene before putting on gloves and after removing gloves

Hand Hygiene Reminders

• Keep nails short and clean• Do not wear artificial nails• Remove chipped nail polish• Remove hand jewellery• Clean hands for a minimum of 15 seconds• Apply lotion frequently• Notify occupational health if you develop skin

irritation due to hand hygiene