Hand Hygiene
Policy
Version: / 3Ratified by: / East Sussex Community Health Services Infection Control Committee
Date ratified:
Name of originator/author: / Infection Control Team
Name of responsible committee/individual: / East Sussex Community Health Services Infection Control Committee
Date issued: / October 07
Review date: / August 09
Next review / August 10
Target audience: / All ESCHS staff
POLICY VALIDITY STATEMENT
THIS DOCUMENT IS DUE FOR REVIEW ON 01/08/10
After this date, the Organisation-wide Policy for the Development and Management of Procedural Documents may become invalid.
Users should ensure they are consulting the current, valid version of the document
Change Control Details: Record any changes to this document in the table below to provide a documentation audit trail:
Date / Version / Reason for changesApril 08 / 2 / Updated post NHS LA 1b inspection
August 09 / 3 / Update to reflect recent guidance
Page 1 of 15
CONTENTS
PAGE
Page 1 of 15
1. Scope 4
2. Purpose 4
3. Links to other polices 4
4. Monitoring Compliance 4
5. Duties 4 - 5
6. Microbiology of the hands 6
7. Hand hygiene techniques 7- 8- 9
8. Skin care 10
9. Frequency of hand hygiene 10
10. Patient’s home 10
References 11
Appendix 1 (hand hygiene technique) 12
Appendix 2 (5 moments for hand hygiene ‘chair’) 13
Appendix 3 (5 moments for hand hygiene ‘bed’) 14
Appendix 4 (hand hygiene audit tool) 15
HAND HYGIENE POLICY
1. SCOPE
This policy applies to all staff employed by East Sussex Community Health Services (ESCHS)
2. PURPOSE
Hand washing is the single most important measure for preventing the spread of infection.
Without hand hygiene micro-organisms that are acquired during healthcare activity can be deposited directly onto vulnerable patients and present a direct clinical threat. (Pratt et al, 2007)
2.1 The purpose of the policy is to ensure that all health care workers understand the importance of hand hygiene in preventing the transmission of infection and carryout the correct technique at the correct time.
2.2 The Trust needs to demonstrate its commitment to hand hygiene through compliance with the Core standards C4a; and Health and Social Care Act (2009) (Hygiene Code)
3. LINK TO OTHER POLICES
· Infection control policies (available on the Trusts Extranet)
· Learning and Development policy (available on the Trust Extranet)
· Human Resources Disciplinary Procedure Policy and Dress Code policy
· Theatre polices
4. MONITORING COMPLIANCE
4.1 The Infection control hand hygiene audits use the Infection Prevention Society’s (formally known as Infection Control Nurses Association) audit tool. These audits are undertaken by the infection control team as part of the schedule of audit
4.2 ESCHS will be monitoring compliance with hand hygiene through the ‘Cleanyourhands Campaign’. This Campaign incorporates raising awareness to staff and visitors of the importance of hand hygiene as well as auditing staff groups. Infection control links and associate links in all inpatient units are responsible for supply monthly audits of hand hygiene. This data is collated and reported on the Trust Performance dash board. See (Appendix 4) for copy of hand hygiene audit tool.
4.3 Staff compliance will be monitored using the processes above and non compliance will be dealt with by the Locality Manager /Service Head who have access to utilising the HR disciplinary policies.
4.4 Reports will go to the Community Services Directorate Governance Committee, East Sussex Community Services Committee and the Joint Clinical Governance Committee.
4.5 Training records for infection control mandatory training will be monitored and reported by the Learning and Development Department
5. DUTIES
5.1 Organisational duties
5.1.1. The Chief Executive of the PCTs is ultimately accountable and responsible followed by the DIPC, Infection Control Operational Manager, Infection Control Nurses / Team. Accountability and responsibility are with the following committees: Infection Control Countywide Committee and Joint Clinical Governance Committee.
5.1.2 ESCHS will provide mandatory hand hygiene training for all staff as an integral part of mandatory training on induction and ongoing throughout employment.
5.2 Staff duties
5.2.1 All staff have a clinical and ethical responsibility to carry out effective hand hygiene and to act in a way, which minimises risk to the patient.
5.2.1 All ESCHS staff have a responsibility to ensure that they attend mandatory Infection Control training which incorporates hand hygiene training. Mandatory training is to be accessed through the Learning and Development Department. The Locality /Service head will receive reports via e-mail from Learning and Development so that they can monitor attendance and identify any staff not attending and to follow up. Learning and Development to monitor the effectiveness of this process. Refer to Learning and Development policy
5.3 Managers duties
5.3.1 Managers / Heads of Service / Clinical leads will ensure that all staff in their sphere of management receives appropriate training and understand the importance of hand hygiene
5.3.2 Managers / Heads of Service / Clinical lead should ensure that all patients and visitors in the hospital setting have access to products and facilities to perform effective hand hygiene. NB. Alcohol gel can be placed on entry/exit to wards/clinics after undertaking risk assessment to ensure that it is not miss used or risk to public.
5.3.3 It is the responsibility of Managers / Heads of Service / Clinical lead in conjunction with Estates and Facilities to ensure that adequate facilities and resources are available and safely maintained in every clinical area to enable staff to undertake hand hygiene at the point of care.
5.4 Infection Control Nurse Team duties
5.4.1 The role of the infection control nurse (ICN) is in the prevention and control of infection. The monitoring / auditing, reporting and training of hand hygiene is an integral part of the ICNs duties.
5.4.2 Hand hygiene compliance is facilitated through working with the infection control links nurses audits which requires the ICN to analyse findings, implement interventions and recommend actions where required .
5.4.3 The Infection Control Nurse provides support and advice through education and training initiatives.
6. MICROBIOLOGY OF THE HANDS
6.1 The purpose of hand hygiene is to remove dirt and / or reduce the levels of micro –organisms present on the skin. Micro-organisms maybe resident or transient:
· Resident Micro-organisms
These are commonly termed ‘normal flora’ or ‘commensals’. They live deeply seated within the epidermis in skin crevices, hair follicles, sweat glands and beneath fingernails. Their primary function is to protect the skin from invasion by more harmful micro-organisms. Resident micro-organisms rarely cause infections but a reduction in counts is required with highly invasive procedures such as surgery. They are not easily removed.
· Transient Micro-organisms
These are located on the surface of the skin and beneath the superficial cells of the stratum corneum. They are both easily acquired by touch and readily transferred to other people, equipment or surfaces. These are the bacteria that are most often implicated in episodes of cross-infection. Transient micro-organisms are easily removed by simple hand washing with soap and water or alcohol gel. However, damaged skin, false nails or wearing rings with stones in will make them more difficult to remove, transient organisms including, Meticillin-Sensitive and Meticillin-Resistant Staphylococcus aureus (MSSA/MRSA).
7. HAND HYGIENE TECHNIQUES
7.1.1 Research has shown that the most commonly missed areas during hand washing are the backs of the hands, between the fingers and the tips of the fingers (figure 1).
Figure 1: - AREAS FREQUENTLY MISSED
Taylor. L. (1978)
7.1.2 The hand washing technique should aim to cover all surfaces of the hands from the tips of fingers to mid-forearm.
7.2 Preparation
7.2.1 The following should be undertaken prior to hand hygiene
· Keep nails short.
· Do not wear nail varnish or artificial nails.
· Rings with ridges or stones not to be worn – Only one plain gold band ring can be worn. (refer to Dress code Policy)
· Remove wristwatches bracelets and roll up sleeves
· Apply hand creams regularly to help protect hands from soreness and maintain the integrity of the skin. This must be supplied as individual tubes or in a pump-action container. Communal jars of hand cream must not be used.
· Cover cuts and abrasions with a waterproof dressing.
7.3 Work clothing / uniform
7.3.1 In order to ensure hands can be effectively decontaminated clothing should be worn above the elbow level. Jackets and coats should be removed and sleeves if worn should be rolled up, allowing the forearms to be exposed. All health care staff in clinical contact are to be ‘bare below the elbow’ (Darzi, 2007). (Refer to Dress Code Policy)
7.4 Hand washing with soap and water
7.4.1 For most routine activities hand washing with soap and water is sufficient. It removes the transient micro-organisms from the skin rendering them socially clean.
7.4.2 In clinical areas, liquid soap should be provided in wall-mounted dispensers with disposable cartridges or disposable pump-action bottles. Re-fillable cartridges are not recommended. Dispensers must be kept clean and replenished.
7.4.3 Nail brushes are not to be used for routine hand washing as brushes remain moist and harbour bacteria
7.4.4 Hands should be washed with liquid soap:
· Before and after each work shift/ break
· Whenever hands are visibly dirty
· Before and after handling wounds, urethral catheters, intravenous lines and any other invasive devices
· Before preparing, handling or eating food
· After handling contaminated laundry and waste.
· Before wearing gloves
· After removing gloves or aprons
· Before and after caring for any patients
· After visiting the toilet
· After blowing nose
7.4.5
Wet hands under running water; apply the one dose of liquid soap into cupped hand rub hands together vigorously for 20-35 seconds to make a lather covering all surfaces of the hands using the technique shown in (Appendix 1)
7.4.6 Rinse the hands thoroughly under running water
7.5 Drying
· Turn off taps using elbow or wrist taps if available. Where wrist or elbow taps are not available use a clean paper towels to turn off the taps to prevent recontamination.
· Dry hands with a disposable paper towel.Communal towels are not recommended in clinical settings.
· Dry all surfaces of the hands thoroughly.
· Dispose of paper towel into a foot operated pedal bin; do not lift up the lid of the bin with hands, as this will re-contaminate them.
7.6 Hand disinfection using alcohol hand-rub
7.6.1 Alcohol hand rub may be used as an alternative to soap and water, if the hands are visibly clean.
7.6.2 They may also be used after hand washing if hand disinfection is needed.
7.6.3 Alcohol hand rub is not a cleansing agent and visible contaminants must be removed with soap and water.
7.6.4 Alcohol gels/rubs are particularly useful in situations where hand-washing facilities are limited. Staff visiting clients at home should carry a supply of alcohol hand rub/gel. A small amount of gel should be applied using the same sequence of movements as for hand washing and rubbing until dry. Wash hands after 5 to 6 applications to remove build-up.
7.6.5 Alcohol gel is to be available at the point of care either at the end of patient’s beds and / or personal dispenser. Risk assessment to be carried out to ensure that alcohol gel is positioned safely.
NB: Alcohol gel/rub is not recommended when dealing with any cases of diarrhoea and it is not intended for use on equipment.
7.7 Hand disinfection prior to invasive procedures
7.7.1 Hand disinfection with antiseptics (Chlorhexidine, providine, iodine or triclosan) is recommended prior to performing aseptic procedures.
7.7.2 Follow same technique as hand washing using antiseptic in place of soap (see Appendix 1).
7.8 Surgical scrub (eg. HIBISCRUB)
7.8.1 These are only required prior to surgical and other highly invasive procedures and should not be used for routine hand washing.
7.8.2 This removes or destroys transient micro-organisms and readily detachable resident micro-organisms. Hands and forearms are washed thoroughly for two minutes using an antiseptic solution containing either chlorhexidine, povidone-iodine or triclosan. Chlorhexidine and triclosan both have a residual effect which means that they continue to destroy bacteria for some time after application.
7.8.3 Sterile nail brushes may be used to clean the nails prior to the first operation of the day but are rarely required between operations. Frequent use of nail brushes damages the skin and may encourage microbial proliferation.
7.8.4 Hands should be dried using sterile towels before donning sterile gloves.
7.8.5 For theatre staff utilising scrubs - also see local theatre policy
NB: Any member of staff that has a skin reaction to hand hygiene agents should seek advice form the occupational health department
8. SKIN CARE
Bacterial counts increase when skin is damaged
Measures that can be taken to prevent skin damage include:
· Wet hands before applying soap
· Rinse hands well after washing
· Dry hands thoroughly
· Apply an emollient hand cream at frequent intervals
· Protect any damaged skin with impermeable waterproof dressing.
9. FREQUENCY OF HAND HYGIENE
As a general guide the World Health Organisation have produced 5 moments for hand hygiene as a guide to when healthcare workers must undertake hand hygiene. (See Appendix 2 & 3).
10. HAND WASHING FACILITIES
10.1 CLINICAL AREAS
· A separate designated hand-washing sink i.e. not used to wash instruments/cups etc, must be available.
· Each hand-washing sink must be equipped with warm running water, ideally from a mixer tap.
· Hand washing sinks in clinical areas should be equipped with lever mixer taps, (either wrist or elbow operated)
· Disposable paper hand towels and liquid hand soap in wall-mounted dispensers must be available at each hand washing sink.
· A foot operated pedal bin should be available at each hand washing sink for the hygienic disposal of paper hand towels. (Used towels should not be disposed of as clinical waste unless contaminated by blood or body fluids).
· A hand-washing poster demonstrating an effective hand washing technique should be displayed over hand washing sinks in each clinical area. (Appendix 1)