trust policy - whatdotheyknow · hands should be moisturised regularly to maintain skin integrity....

Author/s: Helen O’Connor

Regn. No: CSEC 11 Version No: 4

Trus

HAND

A policy recommended for use

In: All Clinical Areas

By: Staff caring for patients wi

For: All staff and patients

Key Words: Handwashing, Hand D Antiseptic Solutions, Liquid

5 Moments of Hand Hygien

Written by: Helen O’Connor

Nurse Consultant Infection

Supported by: Trust Infection Control Tea

Approved by: Trust Infection Control Com

Ratified by: Clinical Governance

Policy issued: February 2009

To be reviewed before: February 2011

To be reviewed by: Infection Contro

Policy supersedes: Handwashing a

Location of archived copy: Microbiology La

Policy Registration No. CSEC 11

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Date of issue: February 2009 of 8

Valid until: February 2011

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Version No. 4

TRUST POLICY ON HAND HYGIENE East & North Herts NHS Trust

Author/s: Helen O’Connor Date of issue: February 2009 of 8

Regn. No: CSEC 11 Version No: 4 Valid until: February 2011

Introduction The aim of this policy is to engage all staff and members of the public in good hand hygiene practices. This policy is supported by the Trust Uniform and Dress Code Policy, the Annual Infection Prevention & Control Programme which includes education and audit as fundamental elements. This policy complies with the Health Act (2006) and meets the national standards required by the NHSLA, Healthcare Commission (standards for better health) and SHA Policy guidance on Hand Hygiene (2008). It is the aim of the Trust to inform the public of the need for hand hygiene when they are both patients and visitors to hospital. Hand hygiene facilities are clearly sign posted at ward level on entry and exit to all wards. Information leaflets are made available at ward level and in the main concourse of the hospital at the Infection Prevention & Control notice boards. A Public Awareness Week is held annually to inform and remind the public of the necessity to comply with hand hygiene practices when in any of our hospitals. 1. WHY HAND HYGIENE IS IMPORTANT

• ‘Healthcare workers are a major route through which patients become infected; micro-organisms are transmitted by staff from one patient to another or from the environment to the patient’

(Department of Health, 2003)

• Hospital acquired infection (HAI) affects around 8 - 9% of hospital patients in the United Kingdom (UK). Approximately 300,000 patients contract an HAI annually, resulting in at least 5,000 deaths.

(Plowman et al, 1999, National Audit Office, 2000, ICNA, 2002)

• There are two categories of micro-organisms found on the hands, both of which

may be implicated in the spread of infection: aim of hand hygiene is to remove or reduce the number of microorganisms present on the skin.

Transient Organisms Easily acquired and readily transferred.

Resident Organisms Not readily transferred, but may cause problems

if introduced into sterile body sites (e.g. during surgical or invasive procedures)

Principals of hand hygiene HAND JEWELLERY • Staff must keep finger nails short and clean with no false (acrylic) nails, nail

varnish or nail jewellery. • Hand jewellery should be removed with the exception of a plain wedding band.

(Refer to Trust uniform and dress code policy).




BARE BELOW THE ELBOWS - staff should be bare below the elbows when working in clinical areas. � Sleeves rolled up above the elbow or wear short sleeved shirts/blouses � Ties must be securely tucked in, or removed � No wristwatches are to be worn � Only one plain ring can be worn – no stones � White coats must not be worn (except in laboratories or when they are worn as a covering for theatre blues whilst moving between locations)

(Ref: Trust Uniform & Dress code Policy 2008)

2. WHEN TO DECONTAMINATE HANDS

‘Hands must be decontaminated immediately before each and every episode of patient contact/care and after any activity or contact that potentially results in hands becoming contaminated’ (epic Project 2001)

5 Moments of HAND HYGIENE (WHO 2006)

1. BEFORE PATIENT CONTACT

2. BEFORE AN ASEPTIC TECHNIQUE

3. AFTER BODY FLUID EXPOSURE RISK

4. AFTER PATIENT CONTACT

5. AFTER CONTACT WITH PATIENT SURROUNDINGS 3. WHAT TO USE

• Use an alcohol-based hand rub/gel or wash hands with liquid soap and water to decontaminate hands between caring for different patients, or between different caring activities for the same patient (The epic Project, 2001).

• Hands should be moisturised regularly to maintain skin integrity. Occupational Health Department advice should be sought in the event of skin problems Refer to Staff Health Issues in Infection Control Policy 2008). To avoid contamination, communal pots of hand cream should not be used. Hand cream must not be used as an alternative to liquid soap.

• Tottles of alcohol gel are provided for use in child health following risk

assessment of the area.




•




Which preparation for which activity?

Activity Liquid Soap Alcohol Gel/Rub (use on physically clean

hands)

Antiseptic Solutions

Decontaminate physically soiled hands

√

Routine use in clinical areas

√ √

Pre-operative hand preparation

√ √

Hand preparation before invasive procedures

√ √

Contact with patients who have diarrhoea

√ No

(Adapted from Wilson, 2001) 4. HOW TO WASH YOUR HANDS

Preparation

• Do not wear artificial nails or nail varnish. Keep nails short. • Do not wear wristwatches, bracelets or rings with stones (plain wedding ring

permitted) • Cover cuts/abrasions with a waterproof dressing and roll back long sleeves. • Use sink with elbow operated or automatic taps where possible.

Technique

a) Liquid Soap and Antiseptic Solutions (e.g., chlorhexidine for surgical Scrub).

• Wet hands under tepid running water. • Dispense liquid soap onto cupped hand, apply enough soap to cover all hand

surfaces and ensure the hands are well lathered. • Rub hands together vigorously for 15-30 seconds following 6 stage technique. • If wearing a wedding ring wash the area under the ring and the ring itself. • Rinse hands thoroughly under running water. • Turn taps off using elbows. Use a clean paper towel if elbow taps not present. • Dry hands thoroughly using disposable paper towels. b) Alcohol Gel/Rub • Apply alcohol gel/rub to physically clean dry hands. • Rub hands together vigorously, using six-stage technique, until gel dries.

c) Patients unable to access a hand-washing sink When patients cannot access a hand washing sink due to clinical need single use patient wipes must be available before and after meals and after using the toilet/commode.




d) Pre-Operative Hand Preparation (Antiseptic ‘scrub’ solution and water) Wet hands and forearms to the elbows with warm water. Open the scrub brush package. Use nail cleaner to clean under the fingernails. Apply scrub solution from the sponge side and work up an adequate lather on the skin, which should be worked into the hands/arms before washing off. Scrub for 2 minutes as follows:

• The brush side may be used to scrub nails and cuticles if required. • The sponge side may be used to work up an adequate lather to cover the

hands and forearms. • Rinse thoroughly with warm water. Repeat the scrub, using the sponge

side only for an additional 1 minute. Add water as necessary to produce the desired level of suds.

• Discard the used product and rinse hands and arms thoroughly. • Dry using the sterile towels provided. For subsequent cases 70% alcohol gel/rub maybe used instead of a full scrub unless hands become contaminated (HIS, 2001). Refer to theatres Infection Control Policy.

Hand hygiene facilities It is the responsibility of the Cleaning Services Department to clean, maintain and replenish liquid hand washing soap and paper towels. It is the responsibility of the ward or clinical area (this may be designated to the housekeeper) staff to ensure alcohol gel dispensers and hand cream dispensers are maintained, clean and replenished as required.) Refer to Weekly Cleaning Schedules. The ward is also responsible for highlighting estates issues related to hand hygiene facilities. There should be one accessible clinical hand washing sink per four beds (NHS Estates 2002). No more than five litres of alcohol gel should be stored in a clinical area at any one time. This does not include the amount at the patient bedside at any one time. NPSA Alert Notice (2008). Auditing compliance with Hand Hygiene Policy The Trust standard for hand hygiene compliance is set at 100%, this is monitored in all wards via an audit process.

Bi-weekly hand hygiene audits are to be performed by every ward and submitted to the Matron with in their division. The points of observation and audit relate to the 5 Moments of hand hygiene (DOH 2006). They do not include the visitors or relatives. See notes from clinical audit department on procedure.




Risk Assessment Risk assessment should be performed in all clinical areas in respect of hand hygiene facilities and the use of alcohol gel dispensers. Where deemed appropriate alcohol gel will not be readily available and staff will wear personal tottles.

6. PARTS OF THE HANDS MOST FREQUENTLY MISSED DURING HANDWASHING

(Taylor, 1978)

REFERENCES

Daniels Health Care Handwashing Guidelines (1999) Training Aids for Healthcare Professionals. A. C. Daniels &Co.

Department of Health (2003) Winning Ways. Working Together to Reduce Healthcare Associated Infection in England http://www.dh.gov.uk/assetRoot/04/06/46/89/04064689.pdf [online][6 September] Department of Health (2008) The Health Act (revised 2008) Code of practice for the prevention and control of Health Care Associated infections National Patient Safety Agency (2008) Patient safety alert clean our hands campaign/ alcohol gel.

http://www.dh.gov.uk/assetRoot/04/06/46/89/04064689.pdf




Hand Decontamination Guidelines (2002) Infection Control Nurses Association. Hospital Infection Society (2001) Behaviours and Rituals in the Operating Theatre http://www.his.org.uk/docs/Rituals-02.doc [online][25 May, 2004] National Audit Office (2000) The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England. The Stationery Office, London http://www.nao.org.uk/publications/nao_reports/9900230.pdf [online][25 May, 2004] National Patient Safety Agency (2008) Patient safety alert clean our hands campaign/ alcohol gel. NHS Estates (2002) Infection control in the built environment. Design & Planning. Plowman R., Graves N., Griffin M., Roberts J., Swan A., Cookson B. and Taylor, L. (1999) The Socio-economic Burden of Hospital Acquired Infection. Public Health Laboratory Service, London. Pratt R., Pellowe C., Loveday H., Robinson N. and Smith G. (2001) The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare Associated Infections. Journal of Hospital Infection 47 (supplement) S21-S37. Taylor, L. (1998) An evaluation of handwashing techniques. Nursing Times 74:108-110. Wilson J. (2001) Infection Control in Clinical Practice London, Baillière Tindall.

World Health Organisation (2006) Your 5 moments of hand hygiene.

http://www.nao.org.uk/publications/nao_reports/9900230.pdf

http://www.his.org.uk/docs/Rituals-02.doc

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