Hand Hygiene General Practice 2018-19 matthew.richardson2@nhs.net Phone: 023 8062 2741 |  07768 838218 @ipcnurse Vivienne.oconnor@nhs.net Phone: 023 8062 2757 |  07876 858584

Why hand hygiene? Hands are the most common vehicle of transmission of organisms Lack of data around colonisation/infection in primary care (absence of evidence is NOT evidence of absence) Hand hygiene has been recognised as the single most important way to prevent the transmission of infectious agents

What are your hands carrying? Resident Flora: Deep seated Difficult to remove Part of body’s natural defence mechanism Associated with infection following surgery/invasive procedures Transient Flora: Superficial Transferred with ease to and from hands Important cause of cross infection Easily removed with good hand hygiene

National Institute for Health and Care Excellence (NICE) Infection guidance (2012) Everyone involved in providing care should be: trained in hand decontamination and the use of personal protective equipment Wherever care is delivered, healthcare workers must have available appropriate supplies of: materials for hand decontamination Hands must be decontaminated in all of the following circumstances: immediately before every episode of direct patient contact or care, including aseptic procedures immediately after every episode of direct patient contact or care immediately after any exposure to body fluids immediately after any other activity or contact with a patient's surroundings that could potentially result in hands becoming contaminated immediately after removal of gloves. Healthcare workers should ensure that their hands can be decontaminated throughout the duration of clinical work by: being bare below the elbow when delivering direct patient care removing wrist and hand jewellery making sure that fingernails are short, clean and free of nail polish covering cuts and abrasions with waterproof dressings.

Ensure you use soap and water if: your hands are visibly dirty or where you have had contact with a patient who has potentially/confirmed infectious diarrhoea and/or vomiting.

Standards for clinical practice Fingernails Short Clean Free from nail varnish Free from nail art Free from nail extensions Free from artificial fingernails Harbour micro organisms that are not easily removed during hand hygiene Documented evidence of link between artificial nails and a Pseudomonas outbreak in a neonatal intensive care unit in the USA Nail brushes Put micro-abrasions into the nail bed which are more likely to harbour bacteria Not indicated in primary care Nothing below the elbows Short sleeves or sleeves rolled up above elbows No wrist-watches, bracelets, stoned rings etc. Jewellery worn on the hands & wrists become contaminated during work activities Prevent thorough hand hygiene procedures Single plain band ring EPIC3 (2014) guidance states that 'Healthcare workers should ensure that their hands can be contaminated effectively by making sure that fingernails are free from false nails and nail polish' SP8 Page 20. This is supported by the Department of Health Uniforms and workwear guidance (2010) Pages 2,5 and the National Institute for Health and Care Excellence (NICE) Infection guidance (2012) Pages 14,27. 

Caring for your hands Do not work clinically if you have lesions or cuts (not covered with a waterproof dressing) on you hands or lower arms. Seek advice for skin lesions on your hands/lower arms Regularly use moisturiser to prevent/reduce skin damage from hand hygiene Do not over wear gloves and remove them as soon as possible Alcohol gel is less damaging to the skin than soap and water (in most cases) There is no maximum amount of times that you can use alcohol gel before you need to use soap and water, however when you hands start to feel sticky and grimy from the gel wash your hands with soap and water to remove the excess. Gloves can cause the skin to become moist, which can lead to skin damage

Good Better Best Damage to hands Least damaging

Alcohol hand rubs Not all rubs are equal Healthcare rubs contain ≥70% alcohol Some are virucidal Use on visibly clean hands only Rub into hands using same technique as for hand washing Continue rubbing until dry (emollient will condition hands) Not suitable for use following contact with Clostridium difficile or suspected infectious diarrhoea Alcohol hand rubs – most religions give priority to health principles to ensure patient safety Consequently, no objections have been raised against the use of alcohol-based products for environmental cleaning, disinfection or hand hygiene by any religion (WHO, 2006; Allegranzi et al, 2009)

Liquid soaps Not bar soap Non-perfumed healthcare soap Always use running water at a comfortable temperature Wet hands thoroughly before applying any soap (forms a protective barrier) Use enough soap to get a visible lather (single shot) Rinse your hands thoroughly under running water to ensure that all micro-organisms and soap are washed away Leaving soap on your hands or failing to dry properly will make them sore Micro-organisms thrive in a warm, moist environment Use paper hand towels When you dry your hands: Work from fingertips to wrists Dispose of used towel correctly (foot operated bin) Repeat until both hands are completely dry Don’t use soap followed by alcohol gel Not bar soap Non-perfumed healthcare soap Single cartridge, wall mounted (HBN) Preferably not pump operated Non-antibacterial Does not kill transient organisms but removes them

Click here to start video Hand hygiene video Click here to start video Right Click on link – open hyperlink – will open in you tube.

Light Box Apply the UV cream Places you hands under the UV light– did you miss any part of your hands and wrists (not glowing)? Now wash your hands with soap and water Place you hands under the UV light Did you miss any areas of your hands and wrists? (still glowing)? The applying of the cream can demonstrate how well they apply alcohol gel – if any area is not glowing they have missed it when applying the cream The second part of the session shows how well they have washed their hands, this time they are aiming for none of their skin to be glowing.

Any Questions?