Download Module 2 - Hand Hygiene Australia

Module 2
Section Title – Moment 1
Page title – Module 3 Objectives
Key Learning Outcome:
At the end of this module you will be able to analyse clinical performance and
determine correct hand hygiene practice enabling safe and competent care of
patients in a clinical setting.
Enabling Outcomes:
At the end of this module you will be able to:
Assess where hand hygiene should occur in clinical scenarios
Apply knowledge of the 5 Moments for Hand Hygiene in clinical scenarios
Select appropriate hand hygiene products for use in clinical scenarios
Page title – Moment 1 – the Definition
When
Perform hand hygiene on entering the patient’s room
Why
To protect the patient against acquiring foreign organisms from the hands of
the healthcare worker
In Detail:
HAND HYGIENE BEFORE:
EXAMPLES:
Touching a patient in any way
Shaking hands, Assisting a patient to
move, Allied health interventions,
Touching any invasive medical device
connected to the patient (eg. IV pump,
IDC)
Any personal care activities
Bathing, Dressing, Brushing hair, Putting
on personal aids such as glasses
Any non-invasive observations
Taking a pulse, Blood pressure, Oxygen
saturation, Chest auscultation,
Abdominal palpation, Applying ECG
electrodes, CTG
Any non-invasive treatment
Applying an oxygen mask or nasal
cannula, Fitting slings/braces,
Application of incontinence aids
(including condom drainage)
Preparation and administration of oral
medications
Oral medications, Nebulised medications
Oral care and feeding
Feeding a patient, Brushing teeth or
dentures
Contacts with a patient’s surroundings
before, during & After any of the above
Bedside table, Medical chart
Page title – Moment 1 – In Action
Video
Page title – Moment 1 – Before Touching a Patient
Slide show
Section Title – Moment 2
Page title – Moment 2 - The Definition
When
Once hand hygiene has been performed, nothing else in the patient’s
environment should be touched prior to the procedure starting
Why
To protect the patient from foreign organisms (including their own)
from entering their body during a procedure
In Detail:
HAND HYGIENE BEFORE:
EXAMPLES:
Insertion of a needle into a patients
skin, or into an invasive medical device
Venipuncture, Blood glucose level,
Arterial blood gas, Subcutaneous or
Intramuscular injections, IV flush
Preparation and administration of any
medications given via an invasive
medical device, Preparation of a sterile
field
IV medication, NGT feeds, PEG feeds,
Baby tube feeds, Dressing Trolley
Administration of medications where
there is direct contact with mucous
membranes
Eye drop instillation, Suppository
insertion, Vaginal pessary
Insertion of, or disruption to, the circuit
of an invasive medical device
Procedures involving the following:
ETT, Tracheostomy, Nasopharyngeal
airways, Suctioning of airways, Urinary
catheter, Colostomy/ileostomy, Vascular
access systems, Invasive monitoring
devices, Wound drains, PEG tubes, NGT,
Secretion aspiration
Any assessment, treatment and patient
care where contact is made with nonintact skin or mucous membranes.
Wound dressings, Burns dressings,
Surgical procedures, Digital rectal
examination, invasive obstetric and
gynaecological examinations and
procedures, Digital examination of a
newborn’s palate
Page title – Moment 2 – In Action
Video
Page title – Moment 2 – Before a Procedure
Slide show
Section Title – Moment 3
Page title – Moment 3 - The Definition
When
Hand hygiene immediately after a procedure or body fluid exposure risk as
hands could be contaminated with body fluid
Even if you have gloves on you should still perform hand hygiene after
removing them as gloves are not always a complete impermeable barrier
Why
To protect yourself and the healthcare surroundings from becoming
contaminated with foreign organisms
In Detail:
HAND HYGIENE AFTER:
EXAMPLES:
Any procedure
See HH Before a Procedure
Any potential body fluid exposure
Contact with a used urinary bottle /
bedpan, Contact with sputum either
directly or indirectly via a cup or tissue,
Contact with used specimen jars /
pathology samples, Cleaning dentures,
Cleaning spills of urine, faeces or vomit
from patient surroundings, After touching
the outside of a drain
Page title – Moment 3 – In Action
Video
Page title – Moment 3 – After a Procedure
Slide show
Section Title – Moment 4
Page title – Moment 4 - The Definition
When
Perform hand hygiene before you leave the patient room
Why
To protect yourself and the healthcare surroundings from harmful
patient organisms
Page title – Moment 4 – In Action
Video
Page title – Moment 4 – After Touching a Patient
Slide show
Section Title – Moment 5
Page title – Moment 5 - The Definition
When
Hand hygiene after touching a patient's surroundings even when the patient
has not been touched
Always hand hygiene before leaving the patient’s room
Why
To protect yourself and the healthcare surroundings from becoming
contaminated with foreign organisms
In Detail:
HAND HYGIENE AFTER:
After touching the patient’s immediate
surroundings when the patient has not
been touched.
EXAMPLES:
Patient surroundings include: Bed,
Bedrails, Linen, Table, Bedside chart,
Bedside locker, Call bell/TV remote
control, Light switches, Personal
belongings (including books, Mobility
aids), Chair, Foot stool
Page title – Moment 5 – In Action
Video
Page title – Moment 5 – Before Touching a Patient
Slide show
Section Title – Clinical Scenarios – Putting it all into practice
Page title – Curtains
Patient bed curtains are outside the patient zone and are frequently contaminated
Touching the curtains is considered to be touching something outside the patient
zone
Perform hand hygiene between touching the curtains and touching the patient so
foreign organisms are not transmitted from the curtains to the patient
Perform hand hygiene between touching the patient and touching the curtains so
that the HCW does not transfer further foreign organisms to the curtains for the next
HCW to pick up
Page title – Best Practice Hand Hygiene
The following photographic examples of clinical care are designed to give the reader
a clear understanding of how hand hygiene should be performed according to the 5
Moments for Hand Hygiene.
Some examples of clinical care will not be relevant to all health professions.
However, the examples given can be extrapolated to similar examples from the list
given in the individual Moments educational pages.
Some health care facilities will have specific policies and procedures on how to
conduct certain aspects of health care. This may differ from the below scenarios.
You need to comply with your health care facility policies and procedures, however
consider carefully where hand hygiene is required.
Scenario 1
The Health Care Worker (HCW) enters the patient bay through the curtains.
No hand hygiene is required prior to the curtains as curtains are considered to be
highly contaminated with multiple patient's flora and many other organisms ( Ohl M,
Schweizer M, Graham M, Heilman K, Boyken L, Perencevich E, et al. Hospital Privacy Curtains are
Frequently Contaminated with Potentially Pathogenic Bacteria. ICAAC; Geneva 2011.)
On arrival at the patient's bedside the HCW performs HH using the ABHR
Now the HCWs hands are clean and the HCW cannot pass any of the
organisms residing on their hands to the patient or the patient's environment
The HCW can touch the patient (having already completed Moment 1 - HH
before touching a patient)
On leaving the room the HCW performs HH using the ABHR
By performing HH after touching the patient(Moment 4) the HCW cannot
transmit any organisms from that patient to any other area of the healthcare
setting
Scenario 2
A HCW enters a patient zone bringing a blood collection trolley with them
The HCW performs HH using ABHR at the patient's bedside
The HCW is now able to set up the equipment required to be used for blood
collection, and then touch the patient (Moment 1) safely to check the patient's
name band and apply the tourniquet without passing on any organisms from
their own hands.
After setting up the patient the HCW returns to their trolley, performs HH using
ABHR, applies gloves, then begins the blood collection process
The HCW now has clean hands immediately prior to the procedure (Moment
2)
After completing the blood collection, and disposing of sharps the HCW removes
their gloves, and performs HH using ABHR
The HCW is now able to take their clinical trolley and continue on to their next
task without taking any of the organisms or blood from that patient on their
hands
Scenario 3
On arriving at the patient bedside a HCW picks up the patient's bedside chart to
record information. After competing this the HCW performs HH after touching the
patient's environment (moment 5)
The HCW now has clean hands and will not take any of the patient's
organisms from the bedside chart out of the room with them on their hands.
The HCW opens the curtains to leave the patient zone. The HCWs hands are now
potentially dirty from the curtains and the HCW should perform HH prior to their next
task.
Page title – Hand Hygiene in Clinical Care
Perform hand hygiene before touching a patient and after touching a patient before you leave the patient zone
Perform hand hygiene before touching a patient and after touching a patient
Perform hand hygiene before and after a procedure: connecting/disconnecting a NGT
Page title – More Hand Hygiene in Clinical Care
Hand hygiene immediately before attaching an IV line. Hand hygiene after removing gloves to remove any potential body fluid
from your hands. Hand hygiene after touching the IV pump before you leave the patient zone.
Hand hygiene immediately before assisting a patient onto a bedpan. Hand hygiene after disposing of bed pan and removing
gloves.
Hand hygiene before touching a patient's IDC (as this is considered to be part of the patient). Hand hygiene after touching the
IDC to remove any potential body fluid from your hands. Hand hygiene after touching the patient's bedside chart.
Hand hygiene before setting up a sterile field. Hand hygiene and apply gloves immediately before beginning a wound
dressing. Hand hygiene after disposing of used equipment and removing gloves.
Hand hygiene prior to finger prick test. Dispose of sharps and perform hand hygiene after the procedure.
Hand hygiene before touching a patient. Hand hygiene after touching a patient and before touching the next patient. Hand
hygiene after touching the second patient.
Page title – Still More Hand Hygiene in Clinical Care
Hand hygiene before touching a patient, and wear gloves where it is reasonable to expect contact with body fluids. Hand
hygiene after disposing of waste and removing gloves.
Hand hygiene before touching a patient. Hand hygiene on leaving a patient.
Hand hygiene before touching a patient. Hand hygiene on leaving a patient.
Hand hygiene before changing a baby's nappy. Hand hygiene after touching a baby.
Hand hygiene before touching a patient. Hand hygiene after touching a patient as you leave the patient zone.
Page title – Video Examples of Hand Hygiene in Clinical Care
Video
Section Title – Summary of Module 2
Page title – Summary of Module 3
The 5 Moments for Hand Hygiene are:
1.
2.
3.
4.
5.
Before touching a patient
Before a procedure
After a procedure or body fluid exposure risk
After touching a patient
After touching a patient's surroundings
If you perform hand hygiene according to the 5 Moments you will be protecting
yourself, your patients and your colleagues from potential life threatening infections.
Page title – Interactive Hand Hygiene Game