Download Module 1: Hand Hygiene - Providence Healthcare

Module 1: Hand Hygiene
MOHLTC Core Competencies
Adapted for placement students
Infection Prevention & Control Department
July 2012
Hand Hygiene
• 30% of hospital-acquired infections can be prevented
by following infection prevention and control
strategies (1).
• In Canada, 220,000 incidents of Healthcare
Associated Infections (HAIs)/YEAR(1)
• Responsible for 12,000 death/year in Canada
• MRSA infection costs CAD $ 27,661/each patient
• All people working in a healthcare facility play a vital
role in implementing IPAC strategies which are
designed to protect patients, staff and the community.
YOU CAN MAKE A DIFFERENCE!
Hand Hygiene
• Refers to killing or removal of microorganisms
on the hands that have been picked up by
contact with patients, staff, contaminated
equipment or the environment
• Includes maintaining good skin integrity
2 Methods of Hand Hygiene
• Hand Washing with soap & water
– performed when hands are visibly soiled
(with organic matters, i.e., food, soil, blood, body fluid-urine, stool)
• Hand Sanitation with Alcohol-based Hand
Rub (ABHR)
– preferred method in healthcare settings to clean
hands that are not visibly soiled
Types of Hand Soap
1. Liquid soap
Used for most patient care
Appropriate for most hand washing
2. Antibacterial Soap
Not recommended for routine use at Providence
Healthcare (used in critical care settings such as surgical
suite, Intensive Care Unit)
Alcohol-based Hand Rub
Why is it a preferred method in a healthcare
setting?
• Provides a rapid kill or removal of most
bacteria on hands
• Takes less time than using soap and water
• Contains emollients to reduce skin irritation
• Remember not to rinse off with water immediately
after application
Steps in
hand
washing
with
soap &
water (2)
Steps for hand hygiene
using alcohol-based
hand rub (ABHR)
The effectiveness of Hand Hygiene is
adversely impacted by:
1. Skin Condition
•
•
•
Healthy skin is the 1st line of defense against
infection
Dry and cracked skin harbor more microbes
Apply hand cream to protect skin after frequent
hand washing
The effectiveness of Hand Hygiene is
adversely impacted by:
2. Finger Nails & Jewelry
•
•
•
Long nails, chipped polish, artificial nails,
jewelry are reservoir for microorganisms.
Artificial nails must not be worn in Health Care
Facilities by those who do direct patient care and
has been implicated in outbreaks
Can tear gloves
4 Moments of
Hand Hygiene(3)
Remember, do hand hygiene….
Before
After
putting on
gloves.
removing
gloves.
Patient Care Environment
• Everything within the
curtain area in a shared
room (washroom is a
shared healthcare
environment)
• Everything within the
patient’s single room,
including the washroom
Healthcare Environment
• The environment
(including equipment or
articles) outside of the
patient room or bedspace
• Shared space with other
patients or healthcare
workers
Examples of Healthcare Environment
Nursing Station
Shower Room
Dirty Utility Room
Medication Room
Activity Room
Clean equipment Room
Must perform hand hygiene when you are
moving in between these two environment
Patient Environment
Healthcare environment
Point of Care the right way, in the right place
• Refers to three elements occur together and require hand
hygiene:
(patient + health care provider + care involving contact )
• Where the healthcare worker provides care to patients:
could be within the “Patient” or “Healthcare environment”
• Point of Care can take place
anywhere at Providence
Healthcare with our mobile
population
Example of “Point of Care”
• Mobile patient on
wheelchair/stretcher
• Dinning Room
• Activity Room
• Lobby
• Charting area in Gym:
hand hygiene before and
after in contact of patient
Module 2: Chain of Transmission
MOHLTC Core Competencies
Adapted for placement students
Infection Prevention & Control Department
July 2012
Chain of
(4)
Transmission
• There are six links in the chain of transmission
for infection to occur
• To stop the infection one of the links needs to
be broken
Chain 1: Infectious Agents
• Infectious agents are germs or organisms that are
capable of causing disease
• These agents could be:
– Bacteria
– Fungi
– Viruses
– Parasites
• These agents are found everywhere, but not all
bacteria cause infections; some are harmless and
even protective
Chain 2: Reservoirs
• Where infectious agents live and reproduce
• Reservoirs could be
– Humans, (patients, staff, visitors)
– The environment (water, patient equipment,
surfaces like keyboard, handrails)
– Animals (pets or wild animals)
Chain 3: Portal of Exit
• How they leave the reservoir
• Through blood, body fluids
– Saliva, wound drainage, feces, mucous,
vomitus, semen
Chain 4: Mode of Transmission
• Three major modes of transmission:
– Contact – by touching the infective
material (feces, contaminated item)
– Droplet – large droplets from the mouth
or nose through coughing, sneezing,
laughing
– Airborne – very small droplets that
remain suspended in air and inhaled e.g.
TB, chicken pox
Other Modes of Transmission
• Skin puncture – cuts, lacerations, injections
• Common vehicle – contaminated source
e.g. water, food, equipment
• Vector – animal or insect bite e.g. malaria,
rabies
Remember, the droplets can disperse to
at least 2 meters or more
Chain 5: Portal of Entry
• Ways how the germs get in the body
• Examples:
– Breathing in microbes
– Eating or drinking contaminated food or
water
– Broken skin
– Touching mucus membranes with dirty
hands
– Sexual contact e.g. Hepatitis B, HIV
Chain 6: Susceptible Host
• Any person who is at risk of infection
(that means, anyone)
• Risk factors:
– Age: very young or old
– Poor nutrition
– Weakened immune system
– Breaks in skin
– Lack of sleep
– High stress levels
– Poor personal hygiene
Breaking the Chain of Infection
The aim of infection control is to
stop the spread of infection by
breaking one of the chains!
Breaking the Chain at the link…
Infectious agent:
• Medications – antibiotics, antivirals,
antifungals, antiparasitic agents
• Disinfection
• Sterilization
Breaking the Chain at the link …
Reservoirs:
•
•
•
•
Cleaning of environment
Proper food storage
Get rid of standing water
Water treatment
Breaking the Chain at the link …
Portal of Exit:
•
•
•
•
Hand hygiene
Cough etiquette (cover coughs/sneezes)
Barrier protection - band aids, condoms
Disposal of waste and contaminated
materials
Breaking the Chain of the link…
Mode of Transmission:
• Hand hygiene
• Cleaning, disinfection and sterilization
• Barrier protection - mosquito nets, gown
gloves, mask
• No sharing of drinks/cigarettes
Breaking the Chain at the link …
Portal of Entry:
• Hand hygiene
• Barrier protection - gown, gloves,
mask, wound covering, condom
Breaking the Chain at the link…
Susceptible Host:
• Immunization
• Good nutrition, rest, low stress level
• Treatment of ill person
Module 3: Routine Practices
MOHLTC Core Competencies
Adapted for placement students
Infection Prevention & Control Department
July 2012
Routine Practices(5)
The infection prevention and control
practices should be applied routinely for
• all patients/residents
• at all times
Routine Practices in infection
control start with
• Risk assessment before providing care:
– What is the risk of exposure (microbes, nonintact skin, body fluid & substance, mucous
membrane, contaminated equipment, etc.)
– How is this organism transmitted?
– Is the patient cooperative?
– How can I prevent spreading the microbes to
others?
Know the risk:
Ask the question:
“What task am I going to perform?”
Know the risk:
Ask the question:
“What PPE do I need to wear to protect
myself and help stop the spread of
infection?”
Assess your risk
“Will my hands be exposed to blood,
body fluids or objects contaminated
with these, or to broken skin?”
If yes, perform
hand hygiene & wear gloves!
Assess your risk
“Will my face be exposed to a
splash, spray, cough or sneeze?”
If yes, wear mask with
eye shield!
Assess your risk
“Will my clothing or skin be
exposed to splashes/sprays or items
contaminated with blood or
body fluids?
If yes, wear a gown!
Routine Practices Prevent Transmission of Microbes
From
From
From
From
patient
to
patient
patient
to
staff
staff
to
patient
staff
to
staff
Routine Practices Include
Hand hygiene
Environmental cleaning
Cleaning of shared equipment Laundry management
Sharps management
Waste management
Routine Practices include Appropriate
use of Personal Protective Equipment
(PPE)
Wear:
Gloves
when touching non-intact skin,
blood, body fluid, contaminated equipment
Gown
when risk of splashing on clothes
Mask/face shield
when taking care of
coughing/sneezing patient, splashing of body
fluids
Additional Precautions
• Precautions in addition to Routine Practices
• Used for patients identified with infectious
organisms
• Based on Mode of transmission of the
organism – either Contact,
Droplet/Contact, Airborne precautions
Additional Precaution Signs
C-Diff./VRE
MRSA/ESBL/
Diarrhea
Fever &
Respiratory
Symptoms,
Influenza,
Vomiting &
Diarrhea
TB/Chicken
Pox &
Measles
Placed on the door of the patient’s room.
Placed on the wall over the bed in multi-bed room
Important tips
• Hand hygiene before touching medication cart to prepare
medication & after touching healthcare environments
• Remove any part of contaminated PPE and apron where they
were used (Whatever belongs to that patient should stay in the
same patient’s room including pathogens)
• Put on any part of PPE immediately before providing care to
keep it clean for the patient
• Staff with apron, gloves, isolation gown should not be at the
nursing station
• Do not touch yourself, healthcare environment (clean linen carts,
charts, hampers, etc.) with contaminated gloved hands
• Remove gloves that have come in contact with shared
equipment, soiled linen, garbage bag, blood & body fluid before
touching patient/pt environment again
Remember…
Infection Prevention and Control is
EVERYBODY’S business.
Please do your part!
References:
1.Provincial Infectious Diseases Advisory Committee (PIDAC).
Surveillance of health care-associated infections in patients and resident
populations. Oct. 2011 http://www.oahpp.ca/resources/PIDACknowledge/best-practicesmanual/surveillance-of-health-care-associatedinfections.html
2. PIDAC. Best Practice for Hand Hygiene in All Health Care Settings.
Revised Dec. 2010. http://www.oahpp.ca/resources/pidacknowledge/handh-hygiene.html
3. Ministry of Health and Long-term Care (MOHLTC). Just Clean Your
Hands Program. http://www.oahpp.ca/services/jcyh/hospitals-educationtraining.html
4. MOHLTC. IPAC Core Competency Education for all healthcare
providers: The first three acute care modules. March, 2007
5. PIDAC. Ontario Agency for Health Protection & Promotion. Routine
Practices and Additional Precautions in All Health Care Settings. Revised
July 2011