safe patient care “keeping our hand hygiene.. residents ... · • world health organisation...

24/08/2016

SafePatientCare 2016

NiamhMcDonell & PatriciaCoughlan 1

Safe Patient Care “Keeping our Residents Safe”

2016

Standard Precautions: All Residents at all Times #safepatientcare

Hand Hygiene..Lets get practical

Niamh McDonnell, IPCN St Finbarrs Hospital Patricia Coughlan, IPCN, Disability Services

Infection Prevention & Control, Sept 2rd 2016


Build it

Check It

Live it Live it Live it Live it

Teach it

Sell it

WHO - My 5 Moments Approach

An approach for Hand Hygiene which

• focusing on the critical times for hand hygiene when there is a direct risk for Health care associated infection

• applicable to all areas where healthcare is delivered including primary care, LTCF and home based care.


Hand Hygiene - At the right timeWhat are the 5 moments for Hand Hygiene?

Identify the 5 Moments for Hand Hygiene , giving the reason whys it’s necessary at that time

1._______________Why___________________________

2._______________Why___________________________

3._______________Why___________________________

4._______________Why___________________________

5._______________Why___________________________


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Today Focus

Hand Hygiene

At the right time

and

In the right way




Remember to wet your hands thoroughly

before applying soap – 1 shot !


Remembering to rinse off all product after washing & then dry thoroughly with paper towels!


Are you hand hygiene ready?


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• Soap and running water must be used for hand washing when – hands are visibly soiled

– caring for persons with diarrhoeal illness or where there is potential for spread of microorganisms which are resistant to AHR e.g. C.difficile.

•Where healthcare is delivered alcohol-based hand rub(AHR) is the preferred method for hand hygiene when hands are not visibly soiled.


What products should we use for Hand Hygiene ?

Alcohol Based Hand Rub Products

“alcohol based hand rubs are the only known means for rapidly and effectively inactivating a wide array of potentially harmful micro-organisms on the hands. “

Pittet et al 2004

WHO recommends alcohol based hand rubs as there is growing evidence to show they are/have

� Fast acting

� Broad spectrum of antimicrobial activity with minimal risk of generating resistance

� Suitability in areas with limited facilities

� Capacity to promote compliance

� Economic benefit by reducing infection rates


Hand Hygiene Products Effectiveness

National Specification for AHR & Soap


Time Management

Hand washing

up to 1 ½

minutes for

entire procedure

Alcohol hand

rubs 20-30 secs,

can be done on

the move,


When using AHR – Remember

�Cover all surfaces once using

the 6 step technique

�Continue rubbing until hands are completely dry

�Duration 20-30 secs

�Once dry hands are safe


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5 Moments for Hand Hygiene

•A Moment is ……

when there is a perceived or actual risk of a micro-organism transmission from one surface to another on the hands


5 stages of Hand Transmission

Organisms present on residents/clients skin

and immediate environment surfaces

Organisms transfer onto health-care

worker’s hands

Organisms survive on hands for several

minutes

If hand hygiene isn’t carried out or not done

correctly this results in hands remaining

contaminated

Contaminated hands then transmit germs via

direct contact with residents or resident’s

immediate environment

one

two

three

four

five


HEALTH-CARE AREA

PATIENT ZONEMoment 2 –before clean/aseptic procedure

Moment 3-after handling blood and bodily fluids


OPTIMAL HAND HYGIENE

POINT-OF-CARE

•Patient/Resident

•HCW

•Care

SHOULD BE PERFORMED


Moment 1

•When? Clean your hands before contact with the resident / touching the patient

•Why? To protect the resident/patient from harmful germs on your hands with could lead to colonisation or infection

Moment 2

•When? Clean your hands before Clean or Aseptic Procedures

•Why? To protect the resident/patient from harmful germs including the patients own germs from entering his or her body

Moment 3

•When? Clean your hands immediately after contact with body fluids including after glove removal

•Why? To protect yourself and the health care environment from harmful germs contained in body fluids

Moment 4

•When? After contact with the resident

•Why? To protect yourself and the healthcare environment from harmful germs picked up on your hands when providing care

Moment 5

•When? After contact with the residents/patients immediate environment – bed, furniture – even without touching the patients environment

•Why? To protect yourself and the healthcare environment from harmful germs which maybe in the immediate environment or on equipment used by the resident.


Making this work in LTCF’s

�Where residents are cared for in a dedicated space with dedicated equipment – 5 moments apply

�Where residents are semi- autonomous they have their own room or shared room but they also move within the facility-4 moments apply to where healthcare is delivered

Remember 4 and 5 moments do not cover any social contacts with or among LTCF residents unrelated to

healthcare


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Social Settings

Shared activities areas –dining room, day room etc:

�In common areas where residents/clients gather, the environment is shared by many people.

�To reduce spread of organisms, staff and resident should clean hands before beginning and after ending the activity.

�Some residents may need help cleaning their hands before they begin and after they end an activity.

If staff provide any “HEALTHCARE” where shared activities occur, the 4 moments for Hand Hygiene are to be

followed.Standard Precautions: All Residents at all Times

#safepatientcareStandard Precautions: All Residents at all Times

#safepatientcare

Hand Hygiene

• At the right time and

• In the right way

• Helps Safe lives

• Its in our hands


Outpatients Setting 1

In outpatient settings moment 5 after touching the patient’s surroundings only applies where the patient is placed in a dedicated space for a certain amount of time (~>20mins) with dedicated equipment – in this case it is anticipated that the environment will become contaminated – e.g. dental treatment area, shedding in a wound care clinic Standard Precautions: All Residents at all

Times #safepatientcare

Outpatient Settings 2

• In the outpatient setting the patient is considered the patient zone as the space and equipment is not exclusively dedicated to the patient for any prolonged time e.g. vaccination clinic


References• Pittet, D. (2004). The Lowbury Lecture: behavior in infection control. Journal of Hospital Infection, 58: 1 – 13.

• HSE (2015). Guidelines for Hand Hygiene in Irish Healthcare Settings. Update of 2005 guidelines.

• World Health Organisation (WHO) (2009). WHO guidelines on Hand Hygiene in Healthcare: First Global Patient Safety Challenge, clean care is safer care. WHO Press, Geneva.

• World Health Organisation (2009). Hand Hygiene: Why, How & When? http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

• World Health Organisation (2012) Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities A Guide to the Application of the WHO Multimodal Hand Hygiene Improvement Strategy and the “My Five Moments for Hand Hygiene” Approach http://apps.who.int/iris/bitstream/10665/78060/1/9789241503372_eng.pdf?ua=1

• National Audits of Hand Hygiene Compliance in hospitals in Ireland (HPSC) 2015 Accessed August 27th 2015 http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanSurveillanceofAntimicrobialConsumptionESAC/PublicMicroB/HHA/a1.html


safe patient care “keeping our hand hygiene.. residents ... · • world health organisation...

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