Transcript Bugs - Hand Hygiene Australia

Hand Hygiene
What it’s all about…
Hand Hygiene
Hand Hygiene (HH) is generally poorly
adhered to across the board by all levels of
Health Care Worker’s
THE UNWASHED HAND!
Hand Hygiene
The problem:
HAIs / MRSA, ESBLs, VRE etc
Majority are preventable
Costly to patient
Costly to health service
Ignaz Philipp Semmelweis
Maternal mortality rates,
First and Second Obstetrics Clinics,
GENERAL HOSPITAL OF VIENNA, 1841-1846
(%)
Semmelweis IP, 1861
Intervention
May 1847
Students and doctors were required to:
clean their hands with a chlorinated lime
solution when entering the labour room
in particular when moving from the autopsy
to the labour room
Maternal mortality rates,
First and Second Obstetrics Clinics,
GENERAL HOSPITAL OF VIENNA, 1841-1850
Intervention
May 15, 1847
Semmelweis IP, 1861
Ignaz Philipp Semmelweis before and after he insisted that
students and doctors clean their hands with a chlorine solution
between each patient
Evidence of Relationship
Between Hand Hygiene and
Healthcare-Associated
Infections
Substantial evidence that hand hygiene
reduces the incidence of infections
Historical study: Semmelweis
More recent studies: rates lower when
antiseptic hand washing was performed
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
What we Know
In summary we know:
Bugs are on our hands
Bugs can be washed off
Washing bugs off our hands saves lives
 So what is the problem???
 HCWs don’t wash their hands!!!
Why we don’t wash our hands
 Too busy/insufficient time
 Patient needs take priority
 Understaffing/overcrowding
 Sinks are inconveniently located or
lack of sinks
 Lack of soap and paper towels
 Hand washing agents cause
irritation and dryness
 Low risk of acquiring infection
from patients
HCW are not bad
just busy!
Poor design
Poor product
More education
Adapted from Pittet D, Infect Control Hosp Epidemiol 2000;21:381-386.
What can we do to help change
this
Provide easy access to hand hygiene
materials
Handrub solution
Conveniently located:
at the patient’s bedside
at the patient’s room entrance
in convenient / appropriate locations
in high traffic public areas
Working appropriately
Full of product
Within use by date
What the Austin did
Full culture change program in 3 parts
Alcohol Based Hand Rub(ABHR)
Moisturiser
Alcohol impregnated wipes
Aim:
Increase HH compliance
Reduce HAIs
How we did it
 Rolled out in one area (zone) at a time, then all
hospital
 Education/learning packages
 “Talking Walls” = participation, ownership ,fun &
reminders
 Monitoring before and after
 Handrub supply
 Hand hygiene compliance
 MRSA rates
 Feedback of results
 Recruitment of area champions
 Launch days, t-shirts,BBQ,wine etc
 Strong support from management
ABHR’s are literally the solution
Sample products only
Pittet
Geneva
Time Spent Cleansing Hands
One nurse per 8 hour shift
Hand washing with soap and water: 56 minutes

Based on seven (60 second) hand washing episodes per hr
Alcohol-based hand rub: 18 minutes

Based on seven (20 second) hand rub episodes per hr
~ Alcohol-based hand rubs reduce time needed
for hand hygiene ~
Voss A and Widmer AF, Infect Control Hosp Epidemiol 1997:18;205-208.
Hand Hygiene Definitions
Hand washing
The application of non-antimicrobial soap and water to the
surface of the hands
Antiseptic hand wash
Washing hands with water and soap or other detergents
containing an antiseptic agent
Alcohol-based hand rub
an alcohol-containing preparation designed for application to the
hands in order to reduce the number of viable organisms with
maximum efficacy and speed
Surgical hand hygiene/antisepsis
Hand washing or using an alcohol-based hand rub before
operations by surgical personnel
Indications for Hand
Hygiene
When hands are visibly dirty, contaminated,
or soiled, wash with non-antimicrobial or
antimicrobial soap and water.
If hands are visibly clean, use an alcoholbased hand rub for routinely decontaminating
hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Hand Hygiene Compliance
Compliance = using hand hygiene products
appropriately
Non compliance = failure to apply hand hygiene
products at the appropriate time
Is when HH is considered necessary & classified
according to one of the 5 Moments
Total moments observed=Y
Actual moments performed=X
X/Y x100%=% rate of HH compliance
Product Choice
HHA is non product specific
ABHR more effective than either
medicated/non medicated soap
Isopropanol alcohol has slightly greater
activity against bacteria than ethanol
Chlorhexidine has persistent activity
HCWs happy to use
Why Use ABHR ??
Reduces bacterial count on
hands
More effective for standard
hand wash
Reduces adverse outcomes
and cost associated with HAI’s
Requires less time
Less irritating
Can be readily accessible/
portable
What to use and When
When hands are visibly soiled use soap and
water to wash
If your hands are visibly CLEAN use ABHR
Before and after touching a patient
Before and after a procedure
After touching a patient’s surroundings
Before and after glove use
Program Organiser
Organise product selection
Product placement
Education
Marketing/promotions
Meeting (internal/external)
Funding
Reports(Gantt charts), proformas
Launch
Passion/energy/dedication
Steering Committee
High level chair/executive support
Heads of depts
Sentinel wards NUMs
Champions
Regular meeting
Minutes/agendas/meeting planners
Education
Varies depending on whom
Grand rounds/medical support
Handovers
Team meetings
NUMs groups
Allied health
Hospital orientation
Newsletters
Flyers/payslips/magazine
Easy Message
SQUIRT
one squirt (1-3 ml) to
your hands
RUB
apply to palm
ROLL
rub hands together covering
all aspects of your fingers &
hands until dry
Easy Message
Basic message always the same
“Clean you hands before and after every
patient touch”
Instructions always the same
Squirt
Rub
Roll
Champions
Ward liaison/link nurses
Staff with interest
Doctors with passion
Consultants
Dept heads
CEO
Involve all areas
Role Models
“Healthcare workers in a room
with a senior staff member or
peer who DID NOT wash their
hands were significantly less
likely to wash their own hands”
EMERGING INFECTIOUS DISEASES FEB 2003
Promotion
Area ownership
Area specific
Strap lines/slogans
Keep changing
Rewards/incentives
Posters,poetry and song competitions
Newsletters,payslips,local media
T-shirts,food,stickers,badges,giveaways
Accessibility
Skin irritation
- is an important barrier to compliance
- is more frequent with soap and water
-
than with handrubs
is reduced and can be treated by
emollient-containing solutions
Boyce et al. Inf Contr Hosp Epi
2000;21:442
Kramer et al. J Hosp Infect 2002;
51:114
Larson et al. Heart Lung 2000; 29:139
Pittet. Emerging Inf Dis 2001; 2:234
Consolidating Culture
Learning package mandatory for new staff
Annual Learning Package planned for all current
staff - to be linked to performance appraisal
Website: www.hha.org.au
Glove use
Hand hygiene is required regardless of whether
gloves are used or changed
Failure to remove gloves after patient contact or
between dirty and clean body site care in the
same patient has to be regarded as
noncompliance with recommendations
Gloves should not be washed or reused
Gloved HCWs can cause cross infections
Mythbusters
Absorption
 Local studies have demonstrated minimal rates of
cutaneous alcohol absorption.
 You cannot absorb enough through your skin to lose you
drivers license
Fire
 The overall risk of fires associated with ABHR is
extremely low
 Consult MSDS,local OH&S requirements & HHA
guidelines for placement of product
Mythbusters
Ingestion
 Unlikely as ABHR tastes unpleasant
 Risk of poisoning uncommon but some
diarrhoea/vomiting has been reported
Splashes
 Product should be placed at a height to minimise risk of
splashes
 If splash occurs don’t rub ,flush eye and seek help
ASAP
Children need to be supervised at all times in hospitals
References
 Guideline for Hand Hygiene in Health-Care Settings.MMWR
2002:vol,51,no RR-16
 Pittet D,Inf .Control Hospital Epidemiology 200:21:381-386
 Voss A and Widmer AF,Inf. Control Hospital Epidemiology
1997:18:205-208
 HHA 5 Moments for Hand Hygiene,Advanced draft, August 2008
 WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft)
April 2006
 Boyce et al.Inf. Control Hospital Epidemiology 2000:21:442
 Kramer et at,Journal Hospital Inf. 2002:51:114
 Larson et al.Heart Lung 2000:29:139
 Pittet.D.Emerging Inf Dis 2001:2:234