HAND HYGIENE AND HAND CARE POLICY AND PROCEDURE Policy / Procedure Number: Authors: 74/04 Version2 Patricia Cross, Infection Control Nurse Rebecca Stretch, Infection Control Nurse Donna Taylor, Infection Control Nurse Departments: Public Health, Blackpool Primary and Quality, Standards and Effectiveness, North Lancashire Primary Date: July 2007 Review Date: July 2010 To ensure services provided by Blackpool Primary and North Lancashire Primary are accessible and information is available upon request in a variety of accessible formats including large print, Braille, on audiocassette or computer disk. We can also provide help for British Sign Language users and provide information in languages other than English. Ratified 30/08/07 Original copy filed in Clinical Governance Department Blackpool PCT
1.0 PURPOSE To ensure that all staff employed by Blackpool Primary and North Lancashire Primary maintain the highest standards of hand hygiene. Effective hand hygiene results in a significant reduction in the carriage of potential pathogens on the hands and logically decreases the incidence of preventable healthcare-associated infections (Pratt et al 2007). Blackpool and North Lancashire Primary s must ensure that all staff are provided with training, educational material and the facilities to undertake effective hand hygiene. 2.0 SCOPE All staff employed by Blackpool and North Lancashire Primary s must adhere to the policy and the supporting hand decontamination procedure. 3.0 POLICY Hand hygiene is one of the most important and effective procedures for reducing healthcare associated infections (HCAI). It is therefore important that hand decontamination is carried out immediately before each and every episode of direct patient contact or care and after any activity or contact that could potentially result in hands becoming contaminated. This document stipulates the standards of hand hygiene required by Trust staff. Audits of compliance will be undertaken to ensure that standards are maintained. 4.0 PROCEDURE 4.1 General standard of hand care Fingernails must be kept clean and short. No nail varnishes, false nails, nail extensions or any form of nail art is to be worn by clinical staff. Jewellery must not be worn, except a plain band, for example a wedding ring. Cuts and abrasions to the skin must be covered with a waterproof dressing. Medical advice must be sought for skin damaged by other factors, for example eczema or psoriasis. Page 1 of 8
4.2 Hand hygiene facilities A hand washbasin with elbow-operated mixer or non-touch taps must be available in clinical areas. Facilities must be easily accessible within clinical areas. Liquid soap must be available (liquid soap must never be "topped up" and the spout must be kept clean). Bar soap must not be used in a clinical environment. Wall mounted disposable paper towel dispenser must be available. Supplies of alcohol hand gel must be available. An emollient hand cream must be available Foot operated domestic waste bin must be available. 4.3 Hand hygiene Hands must always be decontaminated in the following situations: Before and after direct patient care. Before a clean procedure. Before and after handling food and medication. Between care episodes for a single patient. Between different patients. Before and after visiting the toilet. After handling waste. After a dirty procedure, even if gloves were worn. Hands which are visibly soiled, or potentially grossly contaminated with dirt or organic material, must be washed with liquid soap and water 4.4 Washing with liquid soap and water (social hand washing) This removes physical dirt and the majority of transient organisms; it is adequate hand decontamination for non-invasive procedures. Page 2 of 8
4.5 Surgical hand decontamination Hand decontamination is necessary prior to surgery or other highly invasive procedures. Extra care must be taken to increase the removal of transient micro organisms and reduce resident micro organisms. This process is achieved by using an antiseptic hand cleansing preparation, for example a Chlorhexidine based solution. 4.6 Method of washing When washing the hands, either with soap or an antiseptic hand preparation, the following procedure must be adopted (appendix 1). Turn on taps, with elbow levers if available; adjust water temperature to avoid scalding hands. Wet hands thoroughly before applying liquid soap/antiseptic hand cleaning solution. Apply liquid soap/antiseptic hand cleaning solution, using sufficient to obtain a good lather. Wash all areas of the hands, paying particular attention to the thumbs, fingertips, between the fingers, and the backs of the hands, as these are the areas most commonly missed (see appendix 2). Hands are rubbed together for 10-15 seconds, until all areas have been covered. Rinse hands thoroughly with water removing all soap/antiseptic solution deposits, to prevent soreness. Dry well with good quality paper towels and discard into a foot operated domestic waste bin. If the taps are not elbow-operated, they may be turned off using a paper towel to avoid recontamination of the washed hands. 4.7 Alcohol hand gel Alcohol hand gel is: a quick, easy and convenient method to rapidly disinfect physically clean hands. useful if access to suitable hand washing facilities are unavailable Page 3 of 8
4.8 Method of applying alcohol hand gel Apply between 1 and 3 millilitres of the alcohol hand gel, depending on the size of your hands. Sufficient must be used to cover all areas of the hands. Rub into all areas of the hands, again paying attention to the thumbs, fingertips, between the fingers and the backs of the hands, for approximately 15 seconds or until the hands feel dry (see appendix 1). After [approximately] 5 applications of the hand gel or if hands are grossly contaminated and/or physically dirty, it is necessary to decontaminate hands with soap and water. 4.9 Hand Cream An emollient hand cream must be applied at break times and at the end of shifts/sessions to help reduce the potentially damaging effects of hand decontamination products. 5.0 REFERENCES AND BIBLIOGRAPHY Ayliffe, G.A.J. Geddes, A.M. Fraise, A.P. Mitchell, K. (2000). Control of Hospital infection: A Practical Handbook. Fourth edition. London: Chapman and Hall. Hoffman PN, Wilson JA.(1995) Hands, hygiene and hospitals. PHLS Microbiological Digest; (40: 211-16). Larson E (1995) APIC. Guidelines for Hand Disinfection. American Journal of Infection Control. Nov. 1995. NICE (2003) Infection Control: Prevention of healthcare-associated infection in primary and community care. Clinical Guideline 2 Pratt RJ, Pellowe C, Loveday HP, et al. (2007) epic2: National Evidence-Based Guidelines for Preventing Healthcare- Associated Infections Journal of Hospital Infection; (65) supplement S1 S64. DH (2006) Essential steps to safe clean care. Page 4 of 8
6.0 ASSOCIATED DOCUMENTS Document Title 19/03 The Infection Control Policy 20/03 Procedure for Decontamination of Play Equipment 22/03 Procedure for Handling and Transportation of Specimens 24/03 Procedure for Body Substance Precautions and Personal Protective Equipment (PPE) 25/03 Procedure for the Disposal of Waste 27/03 Procedure for the Decontamination of Re-usable Medical Devices and Environment in the Community Loan Store 29/03 Procedure for Decontamination of Environment and Equipment 6.0 APPENDICES Appendix 1 Hand decontamination technique. Appendix 2 Areas on the hands that are frequently missed. 7.0 IMPACT ASSESSMENT This document has not been impact assessed by the author as it is already a working document. No issues in relation to equality, diversity, gender, colour, race or religion are identified as raising a concern. Page 5 of 8
8.0 PEER REVIEW The document, entitled Hand Care and Hand Hygiene Policy and Procedure has been peer reviewed by the following people: Name (print) Post held Date Signature Rebecca Stretch Community Infection Control Nurse Donna Taylor North Lancashire Primary Community Infection Control Nurse Blackpool Primary Page 6 of 8
Appendix 1 Hand decontamination technique Run water, set temperature, wet hands and apply soap using the following technique. Each step consists of five strokes backwards and forwards and should take approximately 15 seconds. Rinse hands thoroughly and dry well. 1 Palm to palm 2 Right palm over the back of left hand and vice versa 3 Palm to palm fingers interlaced 4 Backs of fingers to opposing palm. 5 Clasp right thumb in left palm and rotate vice versa 6 Rub, backwards and forwards, with fingertips on opposing hand. For hand disinfection prior to aseptic procedures following hand washing, alcohol hand rub should be applied following steps 1 6. For further information contact the Community Infection Control Nurse. Page 7 of 8
Appendix 2 Areas on the hands that are frequently missed Areas of the hands most frequently missed during hand washing Least frequently missed Less frequently missed Most frequently missed Page 8 of 8