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AHRQ Safety Program for Long-term Care: HAIs/CAUTI
Exploring Hand Hygiene
Knowledge and Practice
Training Module #1 for the CAUTI LTC Core Team
Insert Headshot
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Learning Objectives
Upon completion of this training, the facility core team members will be able to:
• explain why hand hygiene is so important to prevent the spread of infections;
• reinforce when and how to perform hand hygiene;
• recognize challenges to hand hygiene in their facility, and identify possible solutions; and
• discuss ways to monitor hand hygiene adherence and develop feedback reports.
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Front-line Staff Training Recap
• Hand hygiene is one of the most important ways to prevent the spread of infections
• Germs, especially gram-negative bacteria are frequently found on healthcare worker hands following routine resident care
• The WHO 4 moments provide a simple framework for remembering when staff should perform hand hygiene during any resident interaction
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16 Mody et al Infect Control Hosp Epidemiol; 2003:24:165-171 Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands Educational Resources: http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx
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Hand Hygiene Technique
http://www.who.int/gpsc/en/http://www.cdc.gov/handhygiene/Resources.html#HCP
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Front-line Staff Training Recap
• Alcohol-based hand products are preferred for hand hygiene during almost all routine patient care activities
Exceptions:
1. When hands are visibly soiled
2. After care of a resident with known or suspected infectious diarrhea
• It’s important to clarify hand hygiene expectations during care of a resident with C.difficile.
• Alcohol-based hand rubs are appropriate on entry to room; appropriate glove use to prevent hand contamination; washing with soup and water upon glove removal and exiting room
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944. Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628-645
Good Better Best
Plain soap Antimicrobial soap Alcohol-based hand rub
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Front-line Staff Training Recap
Gloves play a key role in preventing hand contamination – but, do NOT replace hand hygiene
Perform hand hygiene and wear gloves immediately before:
• Placing or removing an indwelling catheter
• Accessing the drainage system to empty the drainage bag
or collecting a urine sample
Remove gloves and perform hand hygiene immediately
after:
• Handling an indwelling catheter
• Accessing the drainage system to empty the drainage
bag or collecting a urine sample
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Health Care Worker Challenges with Hand Hygiene
Belief that Hand Hygiene guidelines aren’t applicable• 30% wouldn’t change current practices; 20% said guidelines were impractical
Lack of access to appropriate Hand Hygiene supplies• 16.2% lack of available sink; 27.5% lack of alcohol-based hand rub
No Hand Hygiene because of glove use• 23% nurses, 17% CNAs, 26% other HCWs
Forgot about Hand Hygiene because of workload• 35% of nurses, 22% CNAs, 44% other HCWs
Lack of access to Hand Hygiene feedback and/or education• 55% never to rarely received personal feedback on HH practices• Other HCWs less often received periodic education on HH (86.8% vs. 92% of nurses and
CNAs, p=0.03)
Ashraf MS et al. ICHE 2010; 31(7):758-762
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Addressing Barriers to Hand Hygiene
Let’s Chat!
• What challenges do you experience performing hand hygiene in your facility?
• What solutions do you propose to address these challenges in your facility?
• How can you support a culture of safety around hand hygiene?
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Hand Hygiene Adherence Monitoring Options
Method Pros Cons
Direct observation of hand hygiene technique • Educational moment • Does not measure adherence
during patient care
Direct observation of hand hygiene adherence
• Captures information on product, technique
• Data summarized by staff type, shift, unit
• Educational moment
• Time and resource intensive• Can influence performance
Measurement of volume of AHBR or soap used • Easy to track consistently
• Consumption may not correlate with appropriate use
• Could be biased by purchasing patterns
Survey/self-report of hand hygiene adherence
• Captures perceptions and barriers • Rates often inflated
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Feedback and Dissemination of Hand Hygiene Rates
• Providing feedback on hand hygiene adherence to front-line staff is a key component to raising awareness and maintaining high compliance rates.
• Also consider opportunities for “just in time” education when incorrect practices are observed.
Jan-12
Apr-12
Jul-1
2
Oct-12
Jan-13
Apr-13
Jul-1
3
Oct-13
Jan-14
0
40
80
Hand Hygiene ComplianceNursesCNAsPhysiciansRehab (PT/OT/ST)
% C
ompl
ianc
e
Jan-12
Mar-12
May-12
Jul-12
Sep-12
Nov-12Jan
-13
Mar-13
May-13
Jul-13
Sep-13
Nov-13Jan
-140
40
80
Hand Hygiene Compliance
Unit 1Unit 2
% C
ompl
ianc
e
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Interactive Activities
• Demonstration of hand hygiene technique– Culture staff hands before and after
hand hygiene
• Demonstration of germ transfer– Use glow powder on commonly
touched objects to see how and where “germs” travel
Before After
Hand Hygiene Videos
• WHO - SAVE LIVES: Clean Your Hands
• Hand Hygiene Video New England Journal of Medicine
• Hand Hygiene Training Films and Slides
• O les mains Hand Hygiene Dance
• CDC—Hand Hygiene Interactive Education Video
• Public Health Ontario—Just Clean Your Hands (based on WHO 5 Moments)
• NPSA Wi-Five Hand Hygiene Video Game
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Hand Hygiene Posters
Create your own!– Have staff role model positive
behaviors
Other Resources:– CDC and WHO Hand Hygiene Resou
rces• Additional posters
– Public Health Ontario – Just Clean Your Hands
http://www.cdc.gov/handhygiene/Resources.html#HCP
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Take the Pledge…
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AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project WebsiteLogin information
Username: ltcsafetyPassword: ltcsafety
TeamSTEPPS® for Long-term Care
Stay Updated with Useful Resources
Take the Pledge… (to practice all infection prevention skills)
World Health Organization How to Handrub Poster
World Health Organization How to Handwash Poster