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A CCRE DI TA TI ON STANDARD S Infection Prevention & Control HAND HYGIENE There is a global initiative focusing on hand hygiene as a primary measure to reduce nosocomial infections. Hand hygiene compliance among health-care providers is problematic worldwide. Organizations such as the World Health Organization, Provincial Infectious Diseases Advisory Committee (PIDAC), Health Canada and the Center for Disease Control all have produced guidelines or recommendations for hand-hygiene in health-care settings. Two hospital accreditation organizations, Accreditation Canada and the Joint Commission (USA), have also introduced hand hygiene standards as required organizational practice. When the Joint Commission began its hand hygiene project, hospitals thought that hand hygiene compliance was around 80–85%. When true non-biased measurement of hand hygiene was performed, it was discovered that compliance was around 48%. As a result, the original wording in hospital standards to achieve and sustain 90% compliance has been modified. Currently standards say that a hospital needs to work to improve compliance with hand hygiene. The Non-Hospital Medical and Surgical Facilities Program standards have not set a target for hand hygiene compliance. However, the standards require a comprehensive hand hygiene program which includes annual education and audits of hand hygiene compliance. A comprehensive hand hygiene program is implemented INDICATORS: Written policy and procedures regarding hand hygiene include but are not limited to: • Indications for hand hygiene • How to perform hand hygiene • Selection of products used for hand hygiene • Appropriate placement of hand hygiene products • Management of product dispensing containers • Hand care program (hand assessment and staff input on product selection) • Hand hygiene compliance and feedback Staff are educated regarding hand hygiene indications, techniques, agents and hand care at orientation, annually and when policy and procedures are updated HAND HYGIENE ACCREDITATION STANDARDS Infection Prevention & Control Hand hygiene policy and procedures are followed Hand hygiene practices are regularly audited and corrective actions taken The hand hygiene program is supported by the availability of suitable supplies INDICATORS: Alcohol-based hand rub (ABHR) in a concentration from 60 to 90% is present ABHR has a Drug Identification Number (DIN) or Natural Product Number (NPN) from Health Canada ABHR available is within the labeled expiry date ABHR present is suitable for health care facilities Hand washing soaps (liquid and/or foam) are present at each hand washing sink Hand washing soaps available are within the labeled expiry date Hand hygiene dispensers function adequately and deliver an appropriate volume of product Disposable paper towels are available for drying hands Hand hygiene products are provided for patients, visitors and staff The hand hygiene program is supported by the availability of suitable equipment INDICATORS: Hand hygiene products are easy to access and close to point of care Hand hygiene products are dispensed from either disposable containers or containers that are washed and dried thoroughly before refilling Sinks dedicated to hand hygiene are easy to access and close to point of care—staff do not need to walk more than 6.1 metres (20 feet) to reach the sink Surfaces near hand washing sinks are nonporous and are protected from splashes with impermeable back and side splashguards If hot-air dryers are used in non-clinical areas, taps must be hands-free Hand hygiene facilities are provided for patients, visitors and staff NHMSFP – College of Physicians and Surgeons of British Columbia January 2012 Page 2 of 6 HAND HYGIENE ACCREDITATION STANDARDS Infection Prevention & Control Placement and storage of alcohol-based hand rubs are in compliance with fire prevention guidelines INDICATORS: ABHR dispensers that are attached to the wall are not within 150 mm (6 in.) of a source of ignition (e.g. electrical outlet, light switch, heater) Maximum volume of ABHR at each point of care is 1.2 litres ABHR dispensers are not installed directly over carpeted surfaces Additional ABHR supply is located in a storage area protected with a one-hour fire separation or in a fire safety cabinet Hand hygiene is performed at essential moments INDICATORS: Hand hygiene is performed before initial patient/patient environment contact Hand hygiene is performed before a clean or aseptic/surgical procedure Hand hygiene is performed before preparing or handling food or medications Hand hygiene is performed immediately after removing gloves Hand hygiene is performed after a blood, body fluid or other infectious material exposure risk Hand hygiene is performed after patient/patient environment contact Surgical hand hygiene is performed using suitable supplies and equipment INDICATORS: Surgical hand hygiene using either an ABHR with persistent activity (“surgical hand rub”) or an antimicrobial soap (“surgical hand scrub”) is performed Appropriate antimicrobial soap (“surgical hand scrub”) and/or an ABHR with persistent activity (“surgical hand rub”) is located in the scrub sink area Antimicrobial soap and/or ABHR with persistent activity available are within the labeled expiry date Surgical hand hygiene products are single-use and/or dispensed from a single-use disposable pump container Scrub sink is located near the entrance to the OR Surgical scrub sink has hands-free taps NHMSFP – College of Physicians and Surgeons of British Columbia January 2012 Page 3 of 6 HAND HYGIENE ACCREDITATION STANDARDS Infection Prevention & Control Appropriate hand hygiene techniques are demonstrated INDICATORS: Technique for ABHR: • Hands appear visibly clean • Volume of product applied facilitates spread over all surfaces of hands • 15 seconds of rubbing of hands is needed for drying Technique for hand washing: • Hands are wet with warm water • Liquid or foam soap is applied • All surfaces of hands are lathered for a minimum of 15 seconds • Hands are rinsed under warm water using a rubbing motion • Hands are dried using paper towel • Taps are turned off using paper towel • ABHR is not used immediately after hand washing Technique for surgical hand antisepsis with antimicrobial soap • Appropriate attire is donned prior to beginning the surgical scrub • Jewelry including rings, watches and bracelets are removed • Hands and arms are wet with warm water • Hands and arms are scrubbed for the length of time recommended by the manufacturer (usually 2–5 minutes) • Hands and arms are rinsed under running warm water in one direction from fingertips to elbows • Hands are dried using a sterile towel • Hands and forearms are held higher than elbows and away from surgical attire • ABHR is not used after a surgical hand scrub Technique for surgical hand antisepsis with ABHR • Appropriate attire is donned prior to beginning the surgical scrub • Jewelry including rings, watches and bracelets is removed • Subungual areas of both hands are cleaned under running water using a disposable nail cleaner • ABHR with persistent activity (“surgical hand rub”) is applied to dry hands and forearms according to manufacturer’s written instructions • Volume of product applied facilitates spread over all surfaces of hand and forearms • Hands and forearms are rubbed until dry • Hands and forearms are held higher than elbows and away from surgical attire NHMSFP – College of Physicians and Surgeons of British Columbia January 2012 Page 4 of 6 HAND HYGIENE ACCREDITATION STANDARDS Infection Prevention & Control Hand hygiene compliance is supported and monitored INDICATORS: Annual hand hygiene education is completed and documented for all staff Patients and visitors are provided with educational guidance and support to adhere to recommended hand hygiene practices Hand hygiene performance is monitored and reported on a regular basis (minimum annually) to the facility leadership responsible for Infection Prevention and Control Sinks dedicated to hand-washing are appropriately identified Hand hygiene is supported by appropriate signage (steps to apply ABHR; steps to effective hand-washing; Stop! Clean your hands) REFERENCES Association of periOperative Registered Nurses (AORN). Perioperative standards and recommended practices for inpatient and ambulatory settings 2011 edition. Denver: AORN, 2011. Recommended practice for perioperative nursing –Section II, Recommended practices for hand hygiene in the perioperative setting; p. 73-86. Center for Disease Control and Prevention. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practice Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR [Internet]. 2002[cited 2012 Jan 31];51(No. RR-16): 1-56. Available from: http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf Community and Hospital Infection Control Association-Canada (CHICA-Canada). Position statement: hand hygiene [Internet]. Winnipeg: CHICA-Canada; 2008 [cited 2012 Jan 31]. Available from: http://www.chica.org/pdf/handhygiene.pdf Fraser Health Authority. Clinical practice guideline: infection control hand hygiene practice guideline [Internet]. Surrey: Fraser Health Authority, 2011 [cited 2012 Jan 31]. Available from: http://www.fraserhealth.ca/media/HandHygiene_CPG.pdf Health Canada. Hand washing, cleaning, disinfection and sterilization in health care. CCDR. 1998 Dec;24(S8):1-66. Ontario. Provincial Infectious Diseases Advisory Committee (PIDAC). Best practices for hand hygiene in all health care settings [Internet]. Toronto: Ministry of Health and Long-Term Care, 2010 [cited 2012 Jan 31]. Available from: http://www.oahpp.ca/resources/documents/pidac/2010-12%20BP%20Hand%20Hygiene.pdf NHMSFP – College of Physicians and Surgeons of British Columbia January 2012 Page 5 of 6 HAND HYGIENE ACCREDITATION STANDARDS Infection Prevention & Control World Health Organization. WHO guidelines on hand hygiene in health care [Internet]. Geneva: WHO, 2009 [cited 2012 Jan 31]. Available from: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf World Health Organization. WHO guidelines on hand hygiene in health care: a summary [Internet]. Geneva: WHO, 2009 [cited 2012 Jan 31]. Available from: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf NHMSFP – College of Physicians and Surgeons of British Columbia January 2012 Page 6 of 6
