16. Hand Hygiene Procedure

Transcription

1 16. Hand Hygiene Procedure POLICY STATEMENT: All Community Services Clinical policies and procedures must be developed, ratified, distributed, reviewed and destroyed in line with the standard corporate procedure. Accountable Director: Policy Author: Jill Freer Josie McHale-Owen & Carol Talbot Approved by: Date approved: 28 th October 2008 Infection Prevention & Control & Decontamination Steering Policy Group Issue date: December 2008 Review date: October 2010 Person responsible for instigation: Links to Standards Standards for Better Health and NHSLA Implementation plan in place: Equality Impact Assessment (EIA): Matron for Infection Prevention & Control, Infection Prevention & Control Team S4BH C4a NHSLA Yes Yes Policy/Version : 1 Previous Version N/A Source: Community Version 1-1-

2 Table of Contents 1. Introduction Purpose of the Document Audience 3 4. Responsibilities/Duties Handwashing Technique Facilities for Handwashing 8 7. Training Associated Documents Monitoring Compliance and Effectiveness Authors Equality Impact Assessment Tool References Appendix 1. Hand Decontamination Technique Appendix 2. Monitoring Compliance and Effectiveness Tool 12 Version 1 Page 2 of 13

3 1. Introduction The spread of infection via hands is well established. (Larson 1981: Ayliffe et al 1990). It is also well established that handwashing is one of the most important procedures for the prevention of cross infection. Healthcare associated infection (HCAI) is becoming an increasing problem and has both human and financial cost implications. With increased and more effective application of existing knowledge, and implementation of realistic infection prevention practices, healthcare associated infection (HCAI) can be significantly reduced. The most simple and important of these practices, which is backed up by clear and undisputed evidence, is that all health care workers need to decontaminate their hands before and after each episode of direct patient contact/care and after any activity or contact that potentially results in hands becoming contaminated. (Epic guidelines, 2001) The spread of antibiotic resistant organisms can also be attributed at least in part to the failure of health care workers to decontaminate their hands, either as often or as efficiently as the situation requires, despite appropriate written infection prevention and control policies. (Heenan, 1992). 2. Purpose of these Guidelines Hands are the principle route by which HCAI occurs. (Elliott, 1992). Therefore the aim of routine handwashing is to render the hands socially clean, to remove all transient organisms, or to reduce their numbers to below the level of an infecting dose, before they are transferred to a susceptible patient or piece of equipment. Routine handwashing must be carried out if hands become potentially contaminated with micro-organisms and before and after contact with a patient. These guidelines will cover routine hand decontamination and not surgical scrub technique. 3. Audience All Trust staff. 4. Responsibilities / Duties Chief Executive The Chief Executive is ultimately accountable for Infection Prevention and Control ensuring that there are effective arrangements and facilities in place for effective Hand Decontamination. Director of Infection Prevention and Control (DIPC) As set out in the Chief Medical Officers document Winning Ways (2003) the DIPC will be the liaison person between the Infection Prevention and Control Team and the Trust Board. He/she will be responsible for liaising directly with the Trust Board and not through Version 1 Page 3 of 13

4 any other committee or group. Infection Prevention and Control Team The Infection Prevention and Control Team are responsible for ensuring that these guidelines reflect national guidance, and are disseminated throughout the Trust. They are responsible for co-ordinating the compliance monitoring of these guidelines and ensuring that appropriate actions are taken if compliance with these guidelines are inadequate. Clinical leads and all managers Clinical Leads and all Managers are responsible for ensuring that these guidelines are made available to all staff within their department, and ensuring that staff are compliant with them on a day- to-day basis. Managers must also ensure that all clinical staff undertake a practical hand decontamination assessment annually and a comprehensive record of this training must be held on the ward area. Qualified staff are responsible for ensuring their practice and that of unqualified staff they supervise comply with these guidelines and that they have received adequate training and support. Other clinical staff All other clinical staff must comply with this procedure. Any trust staff All other staff must comply with this procedure, when in a clinical environment. 5. Hand Washing Technique Indications for Hand Washing This is not a comprehensive list, only a guide. There will be many other appropriate occasions when hands must be washed. Before commencing and leaving work Before each aseptic technique Before and after attending to a patient After handling body fluids Before preparing and handling food After removal of protective clothing After visiting the toilet Before and after administering medication After making a bed Before leaving an isolation room After handling equipment or clinical waste Version 1 Page 4 of 13

5 When hands are visibly soiled After removing gloves After caring for patients with Diarrhoea and/or Vomiting The Correct Technique Hand washing with a good technique covering all surfaces of the hands is more important than the agent used or the duration of handwashing. (Ayliffe et al, 1992). To facilitate a good handwashing technique, healthcare workers must ensure that: a) Nails are kept short, clean and natural b) Stoned rings are not worn c) Hands are free from nail polish and false/acrylic nails d) Sleeves are rolled up or short sleeves worn. Wrist watches and bracelets are removed (no rings to be worn, with the exception of a plain wedding band) Bare Below the Elbow directive must be strictly adhered to. (Safe Clean Care DH 2008) e) Wrists are included when washing hands Hand washing can be based on the following principles: What have I just done? What am I about to do? Routine Handwashing Technique ACTION 1. Wet hands thoroughly with running water 2. Apply one dose of soap to a cupped hand and work soap into hands creating lather 3. Follow the handwashing technique (appendix 1) using five strokes for each step using a backward and forward motion for seconds in total (Ayliffe, 1978) RATIONALE To prevent irritation from the undiluted cleansing agent To ensure an even distribution of the cleansing agent To remove dead skin cells and reduce bacteria present on hands 4. Rinse hands under running water To remove the bacteria and soap 5. Turn off taps using forearms (where in place) 6. Dry hands thoroughly using disposable paper towels 7. Dispose of paper towels into a foot operated bin 8. Apply moisturising cream/lotion when hands are at rest i.e. when going to To prevent the recontamination of hands To reduce the carriage of transient bacteria and prevent deterioration of the skin surface To prevent recontamination of hands To protect the integrity of the skin from chapping, potentially leading to the Version 1 Page 5 of 13

6 break, lunch etc. colonisation of hands by bacteria The Gloved Hand It must be emphasised that the use of sterile or non-sterile gloves, in addition to handwashing, is an added protection. They must not be used as an alternative to handwashing. Gloves are an important protective measure in reducing the exposure of body fluids to the wearer. They are also effective in reducing the risks of cross infection providing they are worn correctly. Used incorrectly they may lead to cross infection. Gloves should latex (or a suitable alternative in the case of latex sensitivity) and be low protein and powder free Gloves must be changed between patients Gloves are to be changed between dirty and clean procedures Hands must always be washed after removal of gloves and before sterile gloves are worn Gloves are not to be washed or cleaned with alcohol hand rubs or wipes. (ICNA, 1997) Gloves do not need to be worn for routine social patient care that does not involve exposure to blood or body fluids. Alcohol Hand Gel The antimicrobial activity of alcohol is due to its ability to denature proteins. Alcohol hand rub solutions are a quick convenient method of cleansing clean hands of gram-negative, gram-positive vegetative bacteria, tuberculosis and a variety of fungi, but have poor activity against bacterial spores. Alcohol cannot remove dirt, organic material or toxic substances such as drugs or radioactivity. Alcohol hand products come in a variety of solutions, gels and foams. Alcohol hand gel is an effective alternative to soap and water when hands are socially clean and where there is a need for rapid hand decontamination e.g. After direct contact with a patient After touching equipment or furniture near the patient During aseptic technique During bed making Before examining patients During ward rounds/clinics. In the domestic setting if hand washing facilities fall below an acceptable standard. Alcohol hand gels are not effective against some organisms that cause symptoms of diarrhoea or vomiting i.e. rovirus and Clostridium difficile. Therefore, the Version 1 Page 6 of 13

7 preferred method of hand decontamination when managing patients with enteric symptoms is hand washing using soap and water and following the Ayliffe technique (Appendix 1). Method of application of alcohol hand rub Dispense a measure onto hands. Follow manufactures instructions for the amount of alcohol hand rub to be used Rub into hands using the Ayliffe technique. (Appendix 1). Ensure solution covers all hand surfaces Rub until dry Do not shake hands dry Alcohol Hand Gel must be made available at point of care i.e. end of patients beds, in treatment rooms or supplied as individual dispensers to enable staff to access the hand rub at point of care. Following recent incidents reported by the national patient safety agency (NPSA) alcohol hand rub products should not be placed in public areas unless adequate risk assessments have been undertaken which ensures that vulnerable persons do not access the product for ingestion. Patients, public and visitors should be encouraged to wash their hands with soap and water or encouraged to use the alcohol hand rub products at the patient bedside or in the immediate vicinity of the patient bed space. Hand Drying Wet surfaces transfer microorganisms more effectively that dry ones. (Hoffman & Wilson. 1994). Therefore hand drying is important in the prevention of infection. Hands must be dried using disposable paper towels, which are effective in rubbing away microorganisms and old dead skin cells loosely attached to the surface of the hands. Paper towels must be disposed of as domestic waste by placing into a foot operated bin to avoid recontamination of clean hands, with the exception of isolation practice where all waste generated within the patients room will be disposed of as clinical waste. Hand Care Hand care is very important to prevent hands from becoming dry and chapped. Broken skin will harbour bacteria which is difficult to remove during hand decontamination. Painful, sore hands will reduce the amount of handwashing that takes place and also limit the amount of drying with paper towels. Hands should therefore be well protected by: - Wetting the skin prior to applying soap. Thorough rinsing of soap. Thorough drying of hands. The application of hand cream from a dispenser pump operated not a communal tub of cream. Keep cuts and lesions covered with a clean waterproof dressing. Report any skin problems to the Occupational Health Department. Version 1 Page 7 of 13

8 6. Facilities Required for Handwashing (Clinical areas) Dedicated handwashing sink without plug or overflow. The sink must not be used for any other purpose (i.e. emptying washbowls, washing cups etc) Running warm water Elbow/wrist/knee/foot operated mixer taps or single taps with thermostatic control Pump dispensed plain soap Good quality paper towels Pump dispensed moisturising cream (Patient s Home) All health care workers must have access to adequate equipment that allows them to decontaminate their hands when required. Health care workers should be encouraged to take alcohol hand gel, liquid soap and paper towels with them on domiciliary visits to ensure adequate decontamination, if facilities are inappropriate. If hand washing is required, then a liquid soap should be used in a sink that is clean and free from articles. If the sink is not clean or free from articles, then care should be taken to avoid splashing. If liquid soap is not available, or the facilities are such that hand washing is not feasible then hands can be decontaminated using alcohol hand gel. When drying hands, paper towels or kitchen roll should be used in preference, but patients own towels should never be used 7. Training Members of the Infection Prevention & Control Team and trained Link Staff in Infection Prevention & Control will provide practical demonstrations and training on effective hand decontamination to include hand washing and application of alcohol gel. Training with regard to hand decontamination is covered at induction, as part of the infection prevention presentation to all new members of staff and also at the clinical update sessions delivered to all clinical staff on an annual basis. Warwickshire PCT actively encourages all staff and patients to challenge any incidences of poor practice or lack of compliance to the Hand Hygiene Procedure. The following groups of staff are required to have such training on induction to the Trust and thereafter on an annual basis as part of their mandatory training: Version 1 Page 8 of 13

9 All clinical staff that provide hands on care to patients. All staff who at any point during their work will touch a patient or their immediate environment. n-attendance at training will be monitored through the training records by the training department and reported back to the nominating manager. 8. Associated Documents Dress Code Mandatory training policy Clean safe Care DH 2008 National patient Safety Agency Alert on hand hygiene: Clean Care is Safer Care 2nd September 2008 The Health Act October Monitoring Compliance and Effectiveness Compliance to this policy will be measured by: The results of audits, which will be undertaken formally on a six monthly basis, by the designated Infection Prevention Link Nurse, matron or a member of the Infection Prevention and Control Team. Observational audits will be undertaken monthly in inpatient areas from October 2008 and the findings reported to the infection control and decontamination steering group Observational audits of hand decontamination compliance in other areas of the trust will form part of the essential steps audit program and will be undertaken by professional development team or the IPCT 10. Author Based on an original document produced by South Warwick Infection Prevention and Control Team 2008 Amended by Josie McHale- Owen & Carol Talbot 11. Equality Impact Assessment Tool Has an Equality Impact assessment been carried out? Preliminary Stage 1 Equality Impact Assessment (must be completed if required*) What date was Stage 1 completed and published? Has a Full Assessment Stage 2 Equality Impact Assessment Tool been undertaken*? If yes, what was the date of assessment and publication of Stage 2 and action plan? Low priority planned for 2009/10 n/a NO Version 1 Page 9 of 13

10 12. References Ayliffe G.A,J, Collins B.J, Taylor L.J. (1990). Hospital Acquired Infections: Principles and Prevention. 2 nd Edition. Wright. London. Ayliffe G.A.J, Lowburry E.J.L, Geddes A.M, and Williams J.D. (2000). Control of Hospital Infection: A Practical Handbook. 4 th Edition. Arnold. London. Elliot P.R.A. (1992). Handwashing: A Process of Judgement and Effective Decision Making. Professional Nurse. 2: The epic Project: Developing National Evidence-Based Guidelines for Preventing Healthcare Associated Infections. (2001). Journal of Hospital Infection. Supplement. Volume 47. Heenan A.I.J, (1992) Handwashing Solutions. Professional Nurse. 11: (9) Hoffman P.N, Wilson J. (1994). Hands, Hygiene and Hospitals. PHLS Microbiology Digest. 11: (4) Infection Control Nurses Association (ICNA). (1997). Guidelines for Hand Hygiene. Deb Ltd. Derbyshire. Larson E. (1981) Resistant Carriage of Gram Negative Bacteria on the Hands. American Journal if Infection Control. 9: National Patient Safety Agency (2004) Hand Hygiene Procedure South Warwick Hospital NHS Trust 2008 Marsden Manual sixth addition Clean Safe Care DH 2008 National Patient Safety Agency Alert on Hand Hygiene: Clean Care is Safer Care (2008) 13. Appendices Appendix 1 - Hand washing Technique Appendix 2 - Monitoring Compliance and Effectiveness of Procedure for Hand Hygiene Procedure Appendix 3 Equality Impact Assessment Tool Version 1 Page 10 of 13

11 Appendix 1 Wash hands using the following 8 steps. Each step consists of five strokes rubbing backwards and forwards. 1. Wet hands under running water. Take a measure of soap. 3. Right hand over back of left and vice versa. 5. Back of left fingers to right palms, fingers interlocked and vice versa. 2. Work int hands, pal to palm. 4. Rub palm palm, finge interlaced 6. Rotational rubbing of rig thumb clasp in left hand a vice versa. 7. Rub left palm with clasped fingers of right hand and vice versa. Rinse hands under running water and dry thoroughly 8. Left wrist w right hand a vice versa Version 1 Page 11 of 13

12 Title of Document Hand Hygiene Procedure Date vember 2008 Standards for Better Health (SfBH) relating to this document (if any) NHSLA Standard related to this document (if any) Does the document fulfil the criterion of NHSLA and SfBH (Please circle as appropriate) SFBH C4a NHSLA YES If not, why not: NO 1. How will the document be monitored? (Please circle as appropriate) 2. What is the process for reviewing results of monitoring? 3. Who is responsible for conducting the monitoring? (Please circle as appropriate) 4. How often will the document be monitored? (Please circle as appropriate) Audit KPI Review Other, please specify; Methodology: Audits quarterly in inpatient areas Audits to form part of essential steps in all other areas within the trust. Audit results sent to IPC team, data is analysed and disseminated to appropriate management structures compliance scores to be presented to the ICD&S group Group / Committee Individual Name / Title (also include position of individuals): Infection Prevention Link workers Matrons Infection Prevention Nurses 3 Monthly 6 Monthly Yearly Monthly as part of Clean your hands campaign Comments: Results of audits will monitor compliance to policy Version 1 Page 12 of 13

13 Appendix 3 Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Yes/ Comments 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age 2. Is there any evidence that some groups are affected differently? 3. Is there a need for external or user consultation 4. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 5. Is the impact of the policy/guidance likely to be negative? N/a 6. If so can the impact be avoided? N/a no 7. What alternatives are there to achieving the policy/guidance without the impact? 8. Can we reduce the impact by taking different action? N/a N/a If you have identified a potential discriminatory impact of this procedural document, please complete the full equality and impact assessment form which can be found in the Corporate Policies on Policies For advice in respect of answering the above questions, please contact [insert name of appropriate person and contact details]. Version 1 Page 13 of 13