Transcript Hand Hygiene in Healthcare Settings

Hand Hygiene and Glove
Use for EMS
Centers for Disease Control (CDC)
World Health Organization (WHO)
Standard and Expanded
Isolation Precautions
Standard Precautions
• Previously called Universal Precautions
• Assumes blood and body fluid of ANY
patient could be infectious
• Recommends PPE and other infection
control practices to prevent
transmission in any healthcare setting
• Decisions about PPE use determined
by type of clinical interaction with patient
PPE Use in Healthcare Settings
PPE for Standard Precautions
• Gloves – Use when touching blood,
body fluids, secretions, excretions,
contaminated items; for touching mucus
membranes and nonintact skin
• Gowns – Use during procedures and
patient care activities when contact of
clothing/ exposed skin with blood/body
fluids, secretions, or excretions is
anticipated
PPE Use in Healthcare Settings
PPE for Standard Precautions
• Mask and goggles or a face shield –
Use during patient care activities likely
to generate splashes or sprays of blood,
body fluids, secretions, or excretions
PPE Use in Healthcare Settings
What Type of PPE Would You
Wear?
• Giving a bed bath?
• Suctioning oral
secretions?
• Transporting a patient
on a stretcher?
• Responding to an
emergency where
blood is spurting?
PPE Use in Healthcare Settings
• Drawing blood?
• Cleaning an incontinent
patient with diarrhea?
• Irrigating a wound?
• Taking vital signs?
What Type of PPE Would You
Wear?
• Giving a bed bath?
• Generally none
• Suctioning oral secretions?
• Gloves and mask/goggles
or a face shield –
sometimes gown
• Transporting a patient on a
stretcher?
• Generally none required
• Responding to an
emergency where blood is
spurting?
• Gloves, fluid-resistant
gown, mask/goggles or a
face shield
• Drawing blood?
• Gloves
• Cleaning an incontinent
patient with diarrhea?
• Gloves w/wo gown
• Irrigating a wound?
• Gloves, gown,
mask/goggles or a face
shield
• Taking vital signs?
– Generally none
Gloves
Ignaz Semmelweis,
1815-1865

1840’s: General Hospital
of Vienna
Divided into two clinics,
alternating admissions
every 24 hours:
– First Clinic: Doctors
and medical students
– Second Clinic:
Midwives
16
Maternal mortality, 1842

14
12
10
8
6
4
2
0
First Clinic
Second
Clinic
The Intervention:
Hand scrub with chlorinated lime solution
Hand hygiene basin at the Lying-In Women’s Hospital in Vienna, 1847.
Hand Hygiene: Not a New Concept
Maternal Mortality due to Postpartum Infection
General Hospital, Vienna, Austria, 1841-1850
Semmelweis’ Hand
Hygiene Intervention
Maternal Mortality (%)
18
16
14
12
10
8
6
4
2
0
1841
1842
1843
1844
1845
MDs
1946
1847
1848
1849
1850
Midwives
~ Hand antisepsis reduces the frequency of patient infections ~
Adapted from: Hosp Epidemiol Infect Control, 2nd Edition, 1999.
Colonized or Infected:
What is the Difference?

People who carry bacteria without evidence of
infection (fever, increased white blood cell count)
are colonized

If an infection develops, it is usually from bacteria
that colonize patients

Bacteria that colonize patients can be transmitted
from one patient to another by the hands of
healthcare workers
~ Bacteria can be transmitted even if the
patient is not infected ~
The Iceberg Effect
Infected
Colonized
Hand transmission
– Hands are the most
common vehicle to
transmit health careassociated
pathogens
– Transmission of
health careassociated
pathogens from one
patient to another via
health-care workers’
hands requires
5 sequential steps
5 stages of hand transmission
one
two
three
four
five
Germs
present on
patient skin
and
immediate
environment
surfaces
Germ transfer
onto healthcare worker’s
hands
Germs
survive on
hands for
several
minutes
Suboptimal or
omitted hand
cleansing
results in
hands
remaining
contaminated
Contaminated
hands
transmit
germs via
direct contact
with patient or
patient’s
immediate
environment
Why should you clean your hands?
■ Any health-care worker, caregiver or person involved in
patient care needs to be concerned about hand hygiene
■ Therefore hand hygiene concerns you!
■ You must perform hand hygiene to:
■ protect the patient against harmful germs carried on
your hands or present on his/her own skin
■ protect yourself and the health-care environment
from harmful germs
The “My 5 Moments for Hand Hygiene”
approach
How to clean your hands
■ Handrubbing with alcohol-based handrub is the
preferred routine method of hand hygiene if hands
are not visibly soiled
■ Handwashing with soap and water – essential when
when hands are visibly dirty or visibly soiled (following
visible exposure to body fluids)1
■ DO NOT use antimicrobial hand soaps – these disrupt
normal skin flora, increasing susceptibility to infection.
1 If
exposure to spore forming organisms e.g. Clostridium difficile is strongly suspected or
proven, including during outbreaks – clean hands using soap and water
How to handrub
To effectively reduce the
growth of germs on hands,
handrubbing must be
performed by following all of
the illustrated steps.
This takes only 20–30
seconds!
How to handwash
To effectively reduce the
growth of germs on hands,
handwashing
must last 40–60 secs
and should be performed by
following all of the illustrated
steps
Hand hygiene and glove use
■ The use of gloves does not replace the need to clean your
hands!
■ You should remove gloves to perform hand hygiene,
when an indication occurs while wearing gloves
■ You should wear gloves only when indicated – otherwise
they become a major risk for germ transmission
The impact of HCAI
HCAI can cause:
■ more serious illness
■ prolongation of stay in a
health-care facility
■ long-term disability
■ excess deaths
■ high additional
financial burden
■ high personal costs on
patients and their families
Most frequent sites of infection
and their risk factors
URINARY TRACT INFECTIONS
Urinary catheter
Urinary invasive procedures
Advanced age
Severe underlying disease
Urolitiasis
Pregnancy
Diabetes
SURGICAL SITE INFECTIONS
Inadequate antibiotic prophylaxis
Incorrect surgical skin preparation
Inappropriate wound care
Surgical intervention duration
Type of wound
Poor surgical asepsis
Diabetes
Nutritional state
Immunodeficiency
Lack of training and supervision
34%
13%
Most common
sites
of healthOF
careLACK
associated infection
HAND
and the
risk factors
underlying the
HYGIENE
occurrence of
infections
LOWER RESPIRATORY TRACT INFECTIONS
Mechanical ventilation
Aspiration
Nasogastric tube
Central nervous system depressants
Antibiotics and anti-acids
Prolonged health-care facilities stay
Malnutrition
Advanced age
Surgery
Immunodeficiency
BLOOD INFECTIONS
Vascular catheter
Neonatal age
Critical care
Severe underlying disease
Neutropenia
Immunodeficiency
New invasive technologies
Lack of training and supervision
17%
14%
Recovery of VRE from Hands
and Environmental Surfaces

Up to 41% of healthcare worker’s hands
sampled (after patient care and before
hand hygiene) were positive for VRE1

VRE were recovered from a number of
environmental surfaces in patient rooms

VRE survived on a countertop for up to 7
days2
1
Hayden MK, Clin Infect Diseases 2000;31:1058-1065.
2 Noskin
G, Infect Control and Hosp Epidemi 1995;16:577-581.
The Inanimate Environment Can
Facilitate Transmission
X represents VRE culture positive sites
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a
VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
What is the single most important reason
for EMS workers to practice good hand
hygiene?
1. To remove visible soiling from hands
2. To prevent transfer of bacteria from the
home to the ambulance
3. To prevent transfer of bacteria from the
ambulance to the home
4. To prevent infections that patients
acquire in the ambulance
What is the single most important reason
for EMS workers to practice good hand
hygiene?
1. To remove visible soiling from hands
2. To prevent transfer of bacteria from the
home to the ambulance
3. To prevent transfer of bacteria from the
ambulance to the home
4. To prevent infections that patients and
EMS staff acquire in the ambulance
How often do you clean your hands
after touching a PATIENT’S INTACT
SKIN (for example, when measuring a
pulse or blood pressure)?
1. Always
2. Often
3. Sometimes
4. Never
How often do you clean your hands
after touching a PATIENT’S INTACT
SKIN (for example, when measuring a
pulse or blood pressure)?
1. Always
2. Often
3. Sometimes
4. Never
Estimate how often YOU clean
your hands after touching a
patient or a contaminated
surface in the ambulance?
1. 25%
2. 50%
3. 75%
4. 90%
5. 100%
Which method do you use to
clean your hands at work?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
Which hand hygiene method
is best at killing bacteria?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
Which hand hygiene method
is best at killing bacteria?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
At least 60% alcohol concentration
Which of the following hand
hygiene agents is LEAST drying to
your skin?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
Which of the following hand
hygiene agents is LEAST drying to
your skin?
1. Plain soap and water
2. Antimicrobial soap and water
3. Alcohol-based handrub
How often do you clean your hands
after touching an ENVIRONMENTAL
SURFACE near a patient (for
example, a clipboard or radio)?
1. Always
2. Often
3. Sometimes
4. Never
How often do you clean your hands
after touching an ENVIRONMENTAL
SURFACE near a patient (for
example, a clipboard or radio)?
1. Always
2. Often
3. Sometimes
4. Never
Use of artificial nails by
healthcare workers poses no
risk to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Use of artificial nails by
healthcare workers poses no
risk to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Can a Fashion Statement
Harm the Patient?
% Recovery of gram
negative bacteria
40
35
30
Natural (n=31)
Artificial (n=27)
Polished (n=31)
ARTIFICIAL
20
10
10
0
5
POLISHED
NATURAL
p<0.05
Edel et. al, Nursing Research 1998: 47;54-59
When do you need gloves?

Whenever risk for exposure to bloodborne
pathogens exists
Definition of Bloodborne
Pathogens

Bloodborne
pathogens are
disease-causing
microorganisms
such as bacteria and
viruses found in:
– Blood
– Body fluids
containing blood
Definition of Blood

The term “blood”
applies to:
– Human blood
– Components of
human blood
– Any product
containing human
blood
OPIM

Other potentially infectious materials (OPIM)
include fluids such as those found:
– In the joints
– Around the heart
– In the abdomen
– In the chest cavity
– Cerebrospinal fluid
– Amniotic fluid
– Any fluid or unfixed tissues containing gross
visible blood
No-Risk Fluids

As long as there are NO
visible signs of blood,
no-risk fluids include:
–
–
–
–
–
–
Sweat
Tears
Saliva
Urine
Vomit
Sputum
Definition of an Exposure

An exposure
occurs when a
pathogen
makes direct or
indirect contact
with:
– Mucous
membranes
– Non-intact skin
Minimize the Risk

The best way to minimize the risk of
contracting a bloodborne pathogen is
to treat ALL body fluids as if they are
infectious.
Glove use for all patient care
contacts is a useful strategy for
reducing risk of transmission of
organisms.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
Glove use for all patient care
contacts is a useful strategy for
reducing risk of transmission of
organisms.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
The Glove Problem
Wilson J, Lynam S, Singleton J, Loveday H. The misuse of clinical gloves:
risk of cross-infection and factors influencing the decision of health care
workers to wear gloves. Antimircob Resis Infect Contr. 2013; 2(Suppl 1):03
The Glove Problem
• Gloves used inappropriately 42% of time
 Inappropriate = no risk of BBP exposure
• 39% uses involved cross-contamination
 More likely with inappropriate use (58% vs.
28%)
• 24% involved > 5 objects touched by
gloved hand prior to performing
procedure
Wilson J, Lynam S, Singleton J, Loveday H. The misuse of clinical gloves:
risk of cross-infection and factors influencing the decision of health care
workers to wear gloves. Antimircob Resis Infect Contr. 2013; 2(Suppl 1):03
Gloves
For people, not
equipment
The “My 5 Moments for Hand Hygiene”
approach – includes changing gloves
This presentation created in 2013 by Mike McEvoy using slide from CDC and
WHO. Power Point version available at www.mikemcevoy.com.