CNA Training Advisor

CNA Training Advisor Volume 13 Issue No. 9 SEPTEMBER 2015 According to the Centers for Disease Control and Prevention (CDC), clean hands are the single most important factor in preventing the spread of infection. When healthcare professionals forgo good hand hygiene, they put their fragile patients at greater risk for contracting infection and experiencing painful symptoms. In recent years, experts have expanded their focus beyond hand washing to the broader practice of hand hygiene, which encompasses the use of alcoholbased sanitizers. Complying with hand hygiene procedures in the face of evolving expectations can be a challenge for frontline staff. Insufficient time, inconveniently located sinks, and skin irritation caused by cleaning agents are just a few reported drivers of poor practice. Fortunately, some of these burdens can be alleviated by learning more effective techniques. This issue of CNA Training Advisor identifies the specific care circumstances that call for stringent hand hygiene, distinguishing between situations that require washing with soap and water and those that require only sanitizer. It also provides step-by-step procedures for performing these crucial activities. Have a good day of training, and stay tuned for next month s issue, which will cover toileting. Wear gloves to fight infection In addition to cleaning hands properly, wearing gloves is another vital approach to fighting infection. Healthcare staff should always don gloves during patient care activities involving blood or body fluids contaminated with blood. At the same time, workers should remember that gloves cannot single-handedly prevent the spread of all infections. For these reasons, CNAs must be cognizant of the strengths, limitations, and protocols surrounding gloves. Visit the websites of infection control experts, such as the CDC and the World Health Organization, for more guidance on glove usage. Quiz answer key 1. c 2. a 3. d 4. c 5. a 6. b 7. b 8. b 9. a 10. c Program Prep Program time Approximately 30 minutes Learning objectives Participants in this activity will be able to: Recognize the rationale behind leading hand hygiene approaches, as well as the care situations that call for them Discuss methods of skin and nail care that can fight infection Apply best practices for cleaning hands using soap and water, as well as with alcohol-based sanitizer Preparation Review the material on pp. 1 4 Duplicate the CNA Professor insert for participants Gather equipment for participants (e.g., an attendance sheet, pencils, etc.) Method 1. Place a copy of CNA Professor and a pencil at each participant s seat 2. Conduct the questionnaire as a pretest or, if participants reading skills are limited, as an oral posttest 3. Present the program material 4. Review the questionnaire 5. Discuss the answers SEE ALSO hcpro.com/long-term-care

CNA Training Advisor September 2015 This document contains privileged, copyrighted information. If you have not purchased it or are not otherwise entitled to it by agreement with HCPro, any use, disclosure, forwarding, copying, or other communication of the contents is prohibited without permission. EDITORIAL ADVISORY BOARD Product Director Adrienne Trivers atrivers@hcpro.com Associate Editor Delaney Rebernik drebernik@hcpro.com STAY CONNECTED Interact with us and the rest of the HCPro community at HCPro.com Become a fan at facebook.com/hcproinc Follow us at twitter.com/hcpro_inc Email us at customerservice@hcpro.com Questions? Comments? Ideas? Contact Associate Editor Delaney Rebernik at drebernik@hcpro.com or 781-639-1872, Ext. 3726. Don t miss your next issue If it s been more than six months since you purchased or renewed your subscription to CNA Training Advisor, be sure to check your envelope for your renewal notice or call customer service at 800-650-6787. Renew your subscription early to lock in the current price. Relocating? Taking a new job? If you re relocating or taking a new job and would like to continue receiving CNA Training Advisor, you are eligible for a free trial subscription. Contact customer serv ice with your moving information at 800-650-6787. At the time of your call, please share with us the name of your replacement. CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online]) is published monthly by HCPro, a division of BLR. Subscription rate: $159/year; back issues are available at $15 each. CNA Training Advisor, 100 Winners Circle, Suite 300, Brentwood, TN 37027. Copyright 2015 HCPro, a division of BLR. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, a division or BLR, or the Copyright Clearance Center at 978-750-8400. Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781-639-1872 or fax 781-639-7857. For renewal or subscription information, call customer service at 800-650-6787, fax 800-639-8511, or email customerservice@hcpro.com. Visit our website at www.hcpro.com. Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department at the address above. Opinions expressed are not necessarily those of CTA. Mention of products and serv ices does not constitute en dorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Nosocomial infections are those contracted by patients during care in a hospital or other healthcare facility that are unrelated to the reason for admittance. Some common varieties of these infections, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci, are difficult to treat and resistant to many antibiotics. Such infections, which are an especially serious threat to fragile patient populations, can be easily spread by healthcare workers, particularly those who provide frontline care. In fact, one major contributor to the thousands of infections that result in patient deaths each year is the failure of healthcare staff to clean their hands properly. CNAs and other frontline workers can pick up infectious organisms by touching patients, as well as contaminated furniture, dressings, or equipment. They can then carry these organisms to the other patients they come in contact with, who may in turn contract an infection. The goal of good hand hygiene is to break this dangerous cycle by preventing the transfer of germs from one patient to another during care delivery. CNAs must therefore perform proper hand hygiene before each new patient contact to protect the individuals for whom they regularly care. More specifically, aides should perform hand hygiene before and after completing the following activities, as well as any others that could put a member of the nursing home community at risk for infection: Taking a resident s blood pressure or pulse Helping a resident ambulate Touching a resident s gown, bedsheets, or dressings Handling bed rails, blood pressure equipment, the TV remote, or any other equipment near the resident Many organizations and individuals decide which cleaning agents to use based on feel, smell, consistency, and whether a particular product causes skin irritation. A nursing facility should identify and stock specific hand hygiene products for field staff to use. The remainder of this newsletter discusses the specific hand hygiene techniques and agents CNAs should use in care circumstances they are likely to encounter on the job. Washing hands with soap and water Soaps are cleaning products that come in a variety of forms: bars, tissues, leaves, and liquids. Their cleaning power comes from their detergent properties, which remove dirt, soil, and organic substances from the hands. Liquid is considered the most effective form of soap, but it comes 2 HCPRO.COM 2015 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.

September 2015 CNA Training Advisor with a caveat: Adding it to a partially empty dispenser (a practice sometimes referred to as topping off ) can contaminate the soap and is therefore never recommended. Bar soap, meanwhile, tends to leave buildup on the surface it rests on, which can foster microbial growth. It can also retain germs from users when not rinsed properly. If bar soap is the only available option, use small bars and store them on a rack that permits drainage to prevent bacterial growth. Finally, plain soaps have little, if any, ability to kill microorganisms. However, hand washing with this type of soap removes dirt and many germs, so it s better than forgoing the process altogether. Whenever possible, CNAs should wash with soap and water when their hands are (or will become) visibly dirty, soiled, or contaminated, such as before and after: Preparing and eating food Treating wounds or cuts Touching a sick or injured person Moving from a contaminated body site to a clean body site during patient care (e.g., when providing a bed bath) Before: Having direct contact with patients. Cleaning indwelling urinary catheters. Making contact with body fluids or excretions, mucous membranes, broken skin, and wound dressings. (Note: In addition, gloves should always be worn if there will be any contact with body fluids, broken skin, or excretions.) After: Making contact with a patient s non-intact skin Using the restroom Handling animals or animal waste Blowing the nose Coughing or sneezing into the hands Handling garbage Making contact with surfaces that are frequently touched, such as doorknobs, railings, and TV remotes, or inanimate objects in the immediate vicinity of a resident Removing gloves To perform hand hygiene with soap and water: Roll up your sleeves to avoid wetting them during hand washing. Remove your watch and other jewelry, if worn. Wet your hands and wrists with warm water, and apply a sufficient amount of soap. Lather the soap by rubbing your palms together. Scrub in between and around your fingers, fingertips, backs of both hands, and wrists for at least 20 seconds. Rinse your hands thoroughly, allowing water to run down the wrists to the fingertips. Ensure all soap is washed away. Wipe your hands and wrists dry with a paper towel. Also with a paper towel, turn off the faucets and open the bathroom door as you exit. This will help you avoid accumulating infectious germs from contaminated surfaces on your hands. Using alcohol-based hand sanitizers Infection control organizations now recommend that healthcare staff use alcohol-based hand sanitizers routinely. These sanitizers, which are available as gels, rinses, or foams, should be used between patient contacts when hands are not visibly dirty. More specifically, CNAs should clean their hands with an alcohol-based sanitizer before having direct contact with a patient and after any of the following events occurs: Direct contact with a patient s skin. Contact with body fluids, wounds, or broken skin. (Note: In addition, gloves should always be worn if there will be contact with broken skin; excretions; secretions; or body fluids, including urine.) Touching equipment or furniture near the patient. Removing gloves. Alcohol-based sanitizers are better than those without alcohol because they act fast to significantly reduce 2015 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400. HCPRO.COM 3

CNA Training Advisor September 2015 organisms on the skin. However, although the alcohol in these sanitizers kills germs quickly, the effects are not long-lasting, making repeated applications necessary. Sanitizers with at least 60% alcohol are excellent disinfectants in caregiving situations. Compared to many hand washing agents, these sanitizers can reduce the greatest amount of bacteria on hands. (Antiseptic soaps and detergents are less effective; non-antimicrobial soaps are the least effective.) Hand sanitizers also save busy healthcare workers valuable time. One study shows performing hand hygiene with sanitizer takes about one-third the time of traditional hand washing at a sink. However, despite the many benefits of hand sanitizers, washing with soap and water is essential when hands are visibly dirty or soiled with body fluids, such as blood. To perform hand hygiene with sanitizer: Before using an alcohol-based sanitizer, remove visible dirt from hands by washing with soap and water. Apply a sufficient amount of sanitizer to the palm of one hand. Refer to label instructions when deciding how much product to use. Rub hands together, ensuring the sanitizer covers all surfaces, including between and around fingers, fingertips, backs of both hands, and wrists. Continue rubbing hands together until they are dry. Towelettes and hand wipes Antimicrobial products kill or slow the spread of microorganisms. Antimicrobial towelettes and wipes may be used as an alternative to washing hands with non-antimicrobial soap and water. However, they are not as effective as other methods for reducing bacteria, so they should not be used in place of alcohol-based sanitizers or antimicrobial soap. Fingernails and jewelry Fingernails and jewelry play a key but easily overlooked role in hand hygiene. Freshly applied nail polish does not increase bacteria levels on hands, but chipped nail polish may support the growth of organisms and bacteria. While it is not known whether artificial nails can fuel infection spread, caregivers with artificial nails are more likely to harbor pathogens on their fingertips than those who have natural nails, even after performing careful hand hygiene. Similarly, studies show that the skin underneath rings and bracelets has more germs than the surrounding skin. For these reasons, CNAs should stick with natural nails that are less than one-quarter of an inch in length, clean under fingernails, and maintain cuticles. If possible, they should remove jewelry before washing hands or avoid wearing it altogether when providing patient care. Skin care Frequent hand washing can cause skin irritation and contact dermatitis. Dry, cracked skin may in turn deter CNAs from washing hands as often as necessary to prevent the spread of infection. Aides should consider using an oil- or fat-containing lotion or cream to increase skin hydration and improve the barrier function of normal skin after hand washing, which can help the skin to better withstand frequent cleaning. Other strategies to reduce skin irritation include: Using a mild soap with warm water during washing. Patting hands dry, rather than rubbing, after washing. Using sanitizers and lotions that contain emollients, which prevent contact dermatitis caused by irritants. Such products are absorbed into the superficial layers of the epidermis, where they form a protective layer that is not removed by standard hand washing. Reducing exposure to irritating agents (e.g., by wearing gloves while washing dishes and floors). Replacing irritating products with those that cause less damage to the skin. If you are sensitive to one hand sanitizer, try others. Key takeaways CNAs are vital members of the clinical team. Because close, intimate interactions occur between aides and residents, they must practice good hand hygiene throughout the workday to prevent the spread of infections an approach that centers on cleaning hands with soap and water and/or alcohol-based sanitizer between patient contacts. H 4 HCPRO.COM 2015 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.

SEPTEMBER 2015 Volume 13 Issue No. 9 CNA Professor Mark the correct response. Name: 1. Hand hygiene should be performed. a. only when the hands become visibly soiled b. three or four times a day c. before every new patient contact d. only upon a resident s request 2. A healthcare worker should wear gloves. a. during activities involving blood or body fluids contaminated with blood b. instead of performing hand hygiene c. when caring for patients with intact skin d. None of the above Date: 6. When is using an alcohol-based hand sanitizer an appropriate hand hygiene approach? a. Never b. When hands are not visibly dirty c. When hands are saturated with blood d. Always 7. Sanitizers with at least % alcohol are excellent disinfectants in caregiving situations. a. 40 b. 60 c. 80 d. 100 3. A nosocomial infection is. a. an infection acquired in a healthcare facility b. an infection that is unrelated to a patient s original need for treatment c. any infection present in a healthcare facility d. Both a and b 4. How long should healthcare workers scrub their hands when washing with soap and water? a. At least 5 seconds b. No more than 10 seconds c. At least 20 seconds d. Exactly 30 seconds 5. is the best form of soap for washing hands. a. Liquid b. Bar c. Plain d. All types of soap are equally recommended 8. Using antimicrobial wipes is the most effective hand hygiene method for reducing bacteria. a. True b. False 9. Caregivers with artificial nails are more likely to harbor pathogens on their fingertips than those with natural nails. a. True b. False 10. Which of the following is a viable way to prevent skin irritation while demonstrating hand hygiene best practices? a. Using non-alcohol-based hand sanitizer b. Rubbing hands together until they are very dry c. Applying fat- or oil-soluble lotions d. Cutting back on hand washing frequency A supplement to CNA Training Advisor