Healthcare Staff
Issue Date:
Version: / Version 2
Version Date: / March 2009
Status: / e.g. Final Version
Review Date: / August 2011
Owner: / Chief Operating Officer, Citihealth NHS Nottingham
Author/Lead Clinician (Include Job Title/Key Contact Details) / Fiona Branton, Service Head/Infection Prevention and Control Matron
0115 8831440
Members of Policy Development Group: / Citihealth NHS Nottingham Infection Prevention and Control Team
Consultation Process: / Infection Prevention & Control Teams in the Acute Trusts.
Infection Control Link Clinicians.
Approved By: / e.g. Quality Assurance Forum / Date:
Ratified by: / e.g. Patient Safety Committee / Date:
Document Held:
Distribution List:
Method: / Intranet/
Paper Document Management
Copies System Other
Archived: / Date Archived: / Location:
10
CHANGES TO HAND HYGIENE POLICY
The hand hygiene policy has recently been updated as a result of a National Patient Safety alert in 2008. The following points indicate which areas of the policy have been updated.P2 / Firstly it has changed from guidance to a policy in line with the Health Act: Code Of Practice For The Prevention and Control of Healthcare Associated Infection (2008) now has policy aims and objectives.
P3 / The World Health Organisation 5 moments for hand hygiene.
· The importance of alcohol gel being available at the point of care e.g. treatment couch and not the sink.
P4 / Recommendation from National Patient Safety Agency that no more than 5 litres of alcohol gel should be stored in a health centre premise. This does not include what is already in the clinical areas.
10
POLICY for Hand Hygiene
The following must be considered in relation to any guideline or policy used as the organisation has a legal obligation to consider the impact of both equality and diversity and the mental capacity act for the public and staff using its services.
Citihealth NHS Nottingham is committed to ensuring that , as far as is reasonably practicable , the way we provide services to the public and the way we treat our staff reflects their needs and does not discriminate against individuals or groups on the basis of their ethnic origin, physical or mental abilities , gender , age religious beliefs or sexual orientation .
Citihealth NHS Nottingham is committed to ensuring that the public and our staff are given information in a clear and concise way and in a manner that people understand.
In situations where there are concerns about an individuals ability to understand information or consent to treatment because a medical condition has effected their cognitive functioning and mental capacity please refer to the Mental Capacity Act intra – agency guidance and complete appropriate documentation .
1) INTRODUCTION
Effective prevention and control of healthcare associated infections (HCAI’s) has to be embedded into everyday practice and applied consistently by healthcare staff in order to reduce HCAI levels. (DOH 2006).
Hand hygiene is the single most important means of preventing the spread of infection (Infection Control Nurses Association 2002). Much of the national guidance also recognises and reinforces the importance of good standard hand hygiene practices e.g. The Health Care Act 2006. Essential Steps to Safe Clean Care 2006. National Patient Safety Agency Alert, September 2008.
Policy Aim
This policy has been written for all healthcare staff within primary care and aims to: -
· Promote a good hand hygiene technique.
· Protect patients and staff from cross infection and to reduce the incidence of healthcare associated infection.
Policy Objectives
The following objectives will assist staff to achieve the above:
· Annual training and undertaking of the hand hygiene self-assessment tool (This is available to download on the intranet.)
· To be aware of when alcohol gel and when soap and water should be used and to be aware of the World Health Organisation (WHO) five moments for hand hygiene.
2) EVIDENCE BASE
See source documents and reference list.
POLICY for Hand Hygiene
3) RISK MANAGEMENT
Hand hygiene is essential to protect patients and staff from cross infection and should occur: -
· Before and after patient contact
· After using the toilet
· Before handling food
· Whenever hands are visibly dirty
· After removing gloves
· After handling waste
This list is not exhaustive and all staff have a responsibility to assess the need for hand hygiene in their daily practice.
The NPSA and World Health Organisation (WHO) endorse the five moments for
hand hygiene which are:
1. Before patient contact
2. Before an aseptic task
3. After body fluid exposure
4. After patient contact.
5. After contact with patient surroundings.
There should be no contraindications for healthcare staff in primary care to perform effective hand hygiene. Clinical environments as the direct points of care must have available liquid soap and paper towels and alcohol gel. Alcohol gel is available in small sizes to be taken out by all staff on domiciliary visits. It should be ordered in the same way as all other clinical supplies. It is important that within clinical areas the alcohol gel is placed near to the patient at the point of care e.g. treatment and couch not by the sink.
There are hazards associated with hand hygiene such as dry, irritated skin conditions, this may be due to a number of reasons: -
· Poor hand hygiene technique
· Harsh soap
· Not rinsing off soap adequately
· Poor hand drying technique
· Existing allergies and skin conditions, e.g. eczema and psoriasis. If flare-ups of these conditions occur on the hands then staff should seek advice from Occupational Health.
Any member of staff who is unable to use the appropriate hand cleansing agents, due to the development of a skin condition/allergy must seek advice from the Occupational Health Department.
QMC – 9249924 / 970962 extension 44342
City – 9691169 / 9627657 extension 46657
POLICY for Hand Hygiene
The following points create further hazards to effective hand hygiene techniques being performed: -
· Rings with stones or ridges must not be worn, as these do not allow thorough hand hygiene to occur. Studies have shown that bacterial counts are higher when rings are worn (Salisbury et al 1997). Also failure to remove jewellery may predispose to skin problems and eczema can begin under a ring and spread over the hand (Field 1998).
· The wearing of artificial nails and polish should not occur, as they discourage vigorous rubbing of the hands and nail polish can flake and becomes a source of contamination (Larson 1989).
· Wrist watches and bracelets compromise hand hygiene as the wrists will not be included (Gould 1994, NICE 2003) and therefore should not be worn.
There are also risks associated with the use of alcohol based hand rub
products such as fire, as it is a flammable material, ingestion and skin irritation (National Patient Safety Agency 2008). The National Patient Safety Agency recommend that no more than 5 litres should be held in storage. This does not include the hand rub at point of care, only that in store.
Minimise the risks by reviewing where products are stored (refer to Control of
Substances Hazardous to Health regulations) and where they are being
placed available for use.
For skin irritation problems advice should be sought from Occupational Health
see contact details above.
4) EQUIPMENT LIST
ROUTINE HANDWASHING IN HEALTHCARE SETTINGS
· Access to running water
· Liquid soap
· Paper towels
· Alcohol gel
· Hand cream
The above items in healthcare settings should be in wall mounted dispensers. These are available to order from Supplies in the Logistics Catalogue. The wall mounted dispensers for the alcohol gel should be at the point of care e.g. the treatment couch and not necessarily next to the sink.
POLICY for Hand Hygiene
DOMICILIARY VISITS
· Alcohol Gel – if liquid soap and a hand towel for the use of the healthcare worker only are not available then alcohol gel should be used in order to achieve effective hand hygiene. It must however be remembered that alcohol is not a cleaning agent and is not recommended in the presence of physical dirt (Kerr 1998).
SURGICAL HAND HYGIENE
· Access to running water
· Chlorhexidine Gluconate 4% (Hibiscrub)
· Povidone Iodine 7.5%
· Tricolsan 2% (Aquasept)
· Alcohol gel
· Single use scrubbing brushes
· Sterile towel
For procedures which involve contact with sterile body areas, the above aqueous antiseptic solutions and alcohol products should be applied for two minutes using the hand hygiene technique shown on page 5 which should also include washing and rinsing up to the elbows. A single use scrubbing brush can also be used for decontaminating the nails at the beginning of the initial scrub. This should then be discarded after use.
5) DESCRIBING THE CARE REQUIRED
MICRO-ORGANISMS
Micro-organisms on the skin can be classified into two groups – resident and transient.
· Resident micro-organisms are part of the normal human flora and live deep-seated within the epidermis. They protect the skin from invasion by more harmful organisms. They do not easily cause infections and are not easily removed.
· Transient micro-organisms are located on the surface of the skin. They are described as ‘transient’ because they are easily transferred to other people and equipment, via the hands after direct contact. They have the potential to cause infection and can be easily removed by good hand hygiene techniques.
HAND HYGIENE TECHNIQUE
Ayliffe et al (1978) produced the following six-stage handwashing technique that promotes coverage over all areas of the hands and can be used when applying any hand hygiene cleaning or disinfection products.
POLICY for Hand Hygiene
Remember to rub each wrist, rinse off the soap then dry hands and
wrists well.
POLICY for Hand Hygiene
HAND DRYING
Wet surfaces transfer micro-organisms more effectively than dry ones
(Hoffman and Wilson 1994). Thus, hand drying is an important step. Paper towels are quicker and more thorough at drying the hands (Redway et al 1994). If cloth hand towels have to be used as often occurs in the Community, then these should be for the use of the health care worker only.
POLICY for Hand Hygiene
6) EDUCATION / TRAINING PROGRAMME
Hand Hygiene is included in all the training sessions offered by the Infection Prevention & Control Team to Primary Care, accessed through Learning and Development at Standard Court, Tel: 0115 9123344, extension 49331.
It is also important that hand hygiene training occurs at a local level amongst individual teams, to encourage adherence to these guidelines promoting good standard practices.
A Hand Hygiene Facilitation Pack has been devised for staff to use as a
training aid which observes and reflects upon staff hand hygiene techniques.
This is available to download from the intranet site:
topic directory > clinical services> infection control
Any problems accessing the pack please contact the Infection Control Team on
0115 8831440.
Glo and tell machines are available at each City PCT Health Centre site and
the Resource Centre at Linden House. These can be used by teams to assess
hand hygiene technique and raise awareness of the importance of hand
hygiene.
7) PLANS FOR IMPLEMENTATION AND DISSEMINATION
The guidelines will be placed on the Trust’s local Intranet sites. Reference will be made to them at Infection Control training sessions.
Hard copies will be issued to be stored for reference in the “Guidance for Practice” folder and Infection Control Manuals.
Link Nurses will be informed at meetings and asked to disseminate information to teams.
8) MONITORING
Methods / Evidence source· Process (e.g. clinical practice observed, record keeping) / · Observation of practice, audit
· Use of the hand hygiene facilitation pack.
POLICY for Hand Hygiene
9) REFERENCES
Ayliffe GAJ, Lowbury EJL, Geddes AM and Williams JD (1999)
Control of Hospital Infection – A Practical Handbook, 3rd Edition, London Chapman Hall Medical.
Department of Health 2008 The Health Act 2006: Code of Practice for the Prevention and Control of Healthcare Associated Infections
Department of Health 2006 Essential Steps to Safe Clean Care.
The Epic Project Developing National Evidence-based Guidelines for Preventing Healthcare Associated Infections. The Journal of Hospital Infection Vol 47 January 2001.
Field E A (1998). Atopy and other risk factors for the dentists reporting on adverse reaction to latex gloves. Contact Dermatitis, 38: 132-136.
Finn L, Crook S (1998) Minor surgery in general practice – setting the standards. J Pub Health Med 20 (2) 169-74.
Gould D (1994) Making Sense of Hand Hygiene Nursing Times – The Journal of Infection Control Nursing 90 (30), pages 63 – 64.
Heenan ALJ (1996) Handwashing Solutions Professional Nurse 11 (9), pages
615 – 622.
Hoffman PN and Wilson J (1994) Hands, Hygiene and Hospitals PHLS Microbiology Digest 11 (4), pages 211 – 261.
Infection Control Nurses Association (2002). Hand Decontamination Guidelines.
Kerr J (1998) Handwashing Nursing Standard 12 (51) – 35-42.
Larson E (1989) Handwashing and Skin Physiologic and Bacteriologic Aspects. Infection Control 6 (1), Pages 14 – 23.
Larson E (1989) Handwashing: Its Essential – Even when you use Gloves American Journal of Nursing 89, Pages 934 – 939.
National Patient Safety Agency 2004 Clean Hands Saves Lives Alert.
National Patient Safety Agency (2008) Clean Hands Saves Lives Alert.
NICE Reference – National Institute for Clinical Excellence (2003) Infection Control. Prevention of Healthcare Associated Infection in Primary and Community Care. London. National Institute for Clinical Excellence.
Redway K, Knights B, Bozoky Z et al (1994) Hand Drying: A Study of Bacterial Types Associated with Different Hand Drying Methods and With Hot Air Dryers London University of Westminster.
POLICY for Hand Hygiene
Salisbury D.M, Hutfilz P, Treen L.M, Bollin G.E, Gautam S (1997) The effect of rings on microbial load of healthcare workers hands. American Journal of Infection Control 25 (1)