Hand Hygiene Procedure

To whom this document applies: All staff employed by Essex Rivers NHS Trust, Carrillion PLC, Volunteers and to all visiting staff including tutors, students and agency/bank/locum staff

Procedural Documents & Approval Committee Document reference: 090 Approved by: Procedural Documents & Approval Committee Date approved: 8th May 2007 Next Review date: May 2009 Version No: 7

Issue Date: November 2001 Version 3 Date(s) reviewed: January 2004 Version 4 February 2006 Version 5 September 2006 Version 6 May2007 Version 7

Responsibility for review: Senior Nurse Infection Control Contributors: See Procedural, Development, Consultation Proposal Form on page 2

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Archiving information held by Secretary of the Procedural Documents & Approval Committee

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Procedural, Development, Consultation Proposal Form Title: Hand Hygiene Policy Procedure 5 Tick the box

Guideline

Protocol

Standard

Name of person presenting document: Heather Dakin – Senior Infection control Nurse Essex Rivers NHS Trust Reason for document development: To comply with National Guidelines ‘Winning Ways’ DOH (2003) ‘Saving Lives’ DPH (2005) Names of development team (including a representative from all relevant disciplines): Heather Dakin – Senior Nurse Infection Control Dr Tony Elston – Director for Infection Prevention & Control Who has been consulted? Dr Tony Elston – Director for Infection Prevention & Control Dr Gillian Urwin – Consultant Microbilolgist Infection Control Team HICC members Infection Control link nurses

Specify groups of staff to whom the document relates: All staff employed by Essex Rivers NHS Trust, Carillion PLC, Volunteers and to all visiting staff including tutors, students and agency/bank/locum staff

Source of supporting evidence (references etc.) See page 8 of attached document for full list of references Are there resource implications? If yes please detail them:

Yes 5

No

Does the Procedure/Guideline meet latest Risk Management Standards & Standards for Better Health requirement? Yes 5 No

Does this Procedure/guideline include children, if applicable? Yes No 5 If yes has the relevant person been included? Yes No 5 A Trust review will occur every two years unless national guidance states otherwise. DATE: April 2007

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Page No.

Contents Review, updating and archiving of the document

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Procedural Development & Consultation Process

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Contents Page

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Introduction and Purpose

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Statement of Intent

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Definitions of terms

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Duties & Responsibilities

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Hand Hygiene Procedure

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Process for Monitor compliance with the document

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Dissemination, implementation and access to the document

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Bibliography

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Introduction and Purpose The spread of infection via hands is well established and expert opinions agree that effective hand decontamination results in significant reductions in cross contamination and logically decreases the incidence of preventable Hospital Acquired Infection. The evidence for this procedure is drawn mainly from the 'Epic' project (2001). Current expert opinion supports the rationale that hands need to be decontaminated immediately before each and every episode of direct patient contact/care and after any activity or contact that potentially results in hands becoming contaminated. HAND HYGIENE IS THE SINGLE MOST IMPORTANT MEASURE FOR PREVENTING CROSS INFECTION Statement of Intent • Staff compliance with guidelines for hand hygiene is often poor (Hand Hygiene Liaison Group 1999, Pittet et al 1999). The reasons why staff do not wash their hands include lack of available hand hygiene products, lack of time and the personal belief that they will not spread infection. In view of this, the National Patient Safety Agency has chosen hand hygiene as their national priority for action and are implementing a national programme to improve staff hand hygiene compliance in 2004 (NPSA 2004). •

This document has been written to provide staff with clear guidelines on the actions they must take in order to prevent cross-infection due to contamination of their own hands. It includes recommended techniques for hand hygiene.

1. Definitions of Terms Hand Hygiene is a term that incorporates the decontamination of the hands by methods including routine hand washing, surgical hand washing and the use of alcoholic hand rubs. 2. Duties and Responsibilities It is the duty and responsibility of all staff, whether contract or temporary to work within Trust policy, procedural procedures and guidelines and this is clearly stated on every job description. This applies to all clinical and non-clinical staff alike. Failure to so do may invoke the Trust disciplinary policy & procedure. This guideline applies to all staff employed by the Trust, plus Volunteer staff and also to all visiting staff including tutors, students and agency/locum/bank staff. Every member of staff has personal responsibility to ensure they comply with this document. 3. Hand Hygiene Procedure Hand Decontamination Agents • Liquid soap • Antiseptic hand cleansing agents • Alcohol based hand cleansing agents These products have varying degrees of efficacy and should be used in the appropriate situations. General Principles • Use liquid soap for routine use to wash physically soiled hands. •

Use alcoholic hand rub or gel for routine use to decontaminate physically clean hands and in conjunction with hand washing when undertaking aseptic procedures or caring for a known infected patient.

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Use antiseptic soap solution to remove resident flora before surgical or invasive procedures

Liquid Soap This is available from Housekeeping who will routinely replenish dispensers as required. Liquid soap is dispensed from a sealed container, which does not require venting or refilling, therefore preventing any risk of contamination of the product. Hands, which are visibly soiled or grossly contaminated with dirt or organic material, must be washed with liquid soap and water. Alcohol hand cleansing agents Each ward/ Department should order sufficient stocks from Pharmacy. Housekeeping staff will replenish the dispensers. Alcoholic hand rub is recommended where hands are not visibly soiled or contaminated with dirt or organic matter. Alcoholic hand rub should be applied to decontaminate hands between caring for different patients or between different caring activities for the same patient. When decontaminating hands using an alcoholic hand rub, hands should be free from dirt and organic material. The hand rub solution must come into contact with all surfaces of the hand. The hands must be rubbed together vigorously, paying particular attention to the tips of the fingers, the thumbs and the area between the fingers, and until the solution has evaporated and the hands are dry. Antiseptic Hand wash solution Antiseptic aqueous hand wash solutions ward/department staff replenish dispensers.

are

available

from

pharmacy

and

The use of an antiseptic hand wash solution will reduce transient micro-organisms and resident flora providing a residual action. This is advised for use when undertaking surgical and invasive procedures. Hand Hygiene Technique Preparation: • • • • •

Keep nails short and clean Do not wear false nails Remove all nail polish Avoid wearing jewellery e.g. wrist watches, bracelets, stoned or ridged rings Roll back sleeves and expose wrists and forearms

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3.7 Routine Hand Washing Routine hand washing removes dirt, organic material and most transient micro-organisms found on the hands. A 10-15 second hand wash following the technique as below is adequate for this purpose.

Effective hand washing technique involves three stages: preparation, washing and rinsing, and drying. Preparation requires wetting hands under tepid running water before applying liquid soap or an anti-microbial preparation. The hand wash solution must come into contact with all surfaces of the hand. The hands must be rubbed together vigorously for a minimum of 10-15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Hands should be rinsed thoroughly prior to drying with good quality paper towels. Hands should be washed using liquid soap before: • • • • •

Commencing shift Handling or eating food Having contact with a patient Commencing a non-aseptic procedure Going for break

And after: • • • •

Using the toilet Having contact with a patient Completing a procedure Completion of shift

This list is not exhaustive. Hygienic Hand Disinfection This is achieved by using and antiseptic soap, or by following the routine method with a metered application of alcoholic hand rub. • • •

Aseptic techniques During outbreaks of infection When caring for a patient with a known infection

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Surgical hand decontamination Surgical hand scrub is required prior to any surgical procedure or prior to the insertion of invasive devices e.g. Hickman Lines, PEG and Central Lines. Surgical hand decontamination destroys transient organisms and reduces resident flora. • • •

An aqueous antiseptic hand wash solution is applied to hands and forearms, which have been wetted, and well lathered for a minimum of 3 minutes. Scrubbing nails with a sterile nailbrush is only required at the beginning of each session. Hands and forearms should be rinsed thoroughly and then dried on a sterile hand towel.

Hand Drying Wet surfaces transfer micro-organisms more effectively than dry ones; therefore, attention to drying is important. Hand Cream This is ordered from pharmacy by each ward/department and replenished by Housekeeping staff as required. Hand Cream is dispensed from a sealed container, which does not require venting or refilling, therefore preventing any risk of contamination of the product. Skin Care Broken skin can harbour bacteria and increase the risk of cross infection. Soap should always be applied to wet hands to reduce the risk of irritation to the skin. It is recommended that hand cream is applied to newly washed and dried hands prior to breaks from the clinical area and at the end of a working shift. Communally used creams should not be used as they can provide a source of infection. Where a particular soap, anti-microbial hand wash or alcohol product causes skin irritation, Occupational Health advice should be sought. 4. Process for monitoring compliance with policy The process for monitoring compliance with the policy is multi-faceted to include a combination of the following: Observational audits The hand hygiene observational tools as supplied as part of the NPSA Cleanyourhands campaign will be the tool of choice to undertake hand hygiene observations. Observational audits will be undertaken monthly in as many clinical areas as possible by the Infection Control Team Observational self-audits will be promoted by participation within the NPSA campaign throughout all relevant clinical areas on a monthly basis. The self-auditing is aimed at encouraging local management of compliance with the policy. The aforementioned audits will be fed back through divisional leads to the Infection team; this will be evidenced through reports to the Hospital Infection Control Committee, Matrons meetings. These results are kept on a database managed within the Infection control department.

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Annual General Infection Control Programme Each clinical area is included within the annual infection control audit programme and the following aspects related to hand hygiene are audited: • Resources and facilities available • Observational audits at time of general audit There is an extensive circulation list for the reports generated from the audit programme, which includes the key stakeholders including Managers and Directors who can support the clinical teams. The results from these audits are kept within a database within the Infection Control Department. Results are feedback at Matron, Hospital Infection Control and Divisional governance meetings as evidenced within minutes. Training Records All staff attending the registered nurse, midwife and healthcare induction programme receive training on basic principles of infection control including hand hygiene. Yearly updates are available as part of the Mandatory Nurse Update Training day. There are also updates tailor made for departments at their request. The Trust Infection Control e-learning programme incorporates hand hygiene information, this programme is available for all staff groups. Upon successful completion this is recorded on the the OnCore database for all staff. Details of the aforementioned programmes are available in the Trust Training and development Prospectus. All training sessions undertaken by the Infection Control Team includes a hand hygiene update. Training records of sessions undertaken by the Infection Control Team are kept on: • a database managed within the Infection Control Department – these records are forwarded to department managers annually. •

OnCore database.

It is each line manger or Clinical Programme Directors responsibility to ensure that their teams undertake hand hygiene training and this is recorded. It is also a responsibility of the line manager to ensure any non attendance is followed up and a place is booked on the next available session. Training also takes place on an individual/team basis. Please contact the infection control team on ext: 4268 for further information. It is the responsibility of the training provider to ensure that a register of all attending is sent to the Training and Development Department to ensure that the session is recorded on the individuals training record via the OnCore system. Patient and Visitor Engagement The Trust is signed up to the NPSA Cleanyourhands campaign with one of the aims to engage patients and visitors promoting hand hygiene awareness by the following methods: • Alcoholic hand rub is available at all entrances and exits to wards/departments throughout the Trust.

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Posters at all entrances and exits to wards to draw staff, patient and visitors attention to the dispensers and their use Participation in a rolling campaign of posters throughout the clinical and main access areas to highlight the importance of hand hygiene in infection prevention

5. Dissemination, Implementation and access to the document Access Trust intranet. – Policies and procedures . Infection control page on Trust intranet. Dissemination • Trust intranet • Infection Control update – twice a month mandatory sessions • Ward based teaching • Via E-learning programme accessed onTrust intranet Implementation • Education – Infection Control Team • Infection Control link personnel Bibliography: Improving patient care by reducing the risk of Hospital Acquired Infection: A progress report (2004) London. National Audit Office. Pittet D, Hugonnet S, Harbth S et al (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. The Lancet 356: 12 Department of Health (2003) Winning Ways: Working together to reduce Healthcare Associated Infection in England. Report from the Chief Medical Officer. London. Department of Health. Pratt RJ, Pellowe C, Loveday HP et al (2001) The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare Associated Infections. Hand Hygiene Task Force (2002) Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Morbidity and Mortality Weekly Report. 51(16), 1-48 Infection Control Nurses Association (2002) Hand Decontamination Guidelines. Bathgate. ICNA Larson E (1995) APIC guideline for handwashing and hand antisepsis in healthcare settings. American Journal of Infection Control. 23(4), 251-269 National Patient Safety Agency (2004) Business Plan 2003-2004. NPSA. www.npsa.nhs.uk Parienti J, Thibon P, Heller R et al (2002) Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. Journal of the American Medical Association. 288(6), 722-727 Pittet D, Dharan S, Touveneau S et al (1999) Bacterial contamination of the hands of hospital staff during routine patient care. Archives of Internal Medicine. 159:821-826

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