Hand Hygiene for Mental Health

5 Moments for Hand Hygiene National Hand Hygiene Initiative was instigated by the Australian Commission for Safety and Quality in Health Care Based on the World Health Organisation World Alliance for Patient Safety Campaign “Save Lives: Clean Your Hands” Some adaptation may be necessary for the Mental Health setting

Health Care Associated Infection Definition: an infection that was not present at the time of hospital admission/ healthcare attendance, but was acquired via the delivery of healthcare

Healthcare Associated Infections Healthcare associated infections are one of the most frequent and severe complications of hospitalisation in Australia 7-10% of patients will acquire 1 or more healthcare associated infections Contributes to 7,000 deaths per annum Approx. 6.1 infections/100 patients Majority are preventable Source:Australian Council for Quality and Safety in Healthcare July 2003 Yung, McDonald, Spelman, Street & Johnson 2001 Victorian Surveillance System (VICNISS) Coordinating Centre Data 2007

Hand Hygiene Protects clients from harmful germs that are carried on your hands Protects you & the healthcare environment from harmful germs Effective Hand Hygiene is the single most important strategy in preventing health care associated infections.

Hand Hygiene HH means either: using soap and water to wash with thorough drying when your hands are visibly soiled or using a waterless hand rubs ( e.g.. ABHR) when your hands are visibly clean

Hand Hygiene reduces transient micro-organisms BeforeAfter

Following the 5 Moments To achieve compliance with the 5 Moments for Hand Hygiene staff need: Knowledge of the 5 Moments Easily accessible facilities for Hand Hygiene Sinks with soap dispensers Alcohol based hand rub Encouragement and support from management Role modelling from all staff

Hand Hygiene in Mental Health Matters Outbreaks of infective diseases still occur within MH facilities Clients are transferred to/from acute facilities Staff may work on acute wards also Invasive procedures occur in MH facilities e.g. injections MH unit may be within an acute facility Bugs don’t stop at the door Infections can exacerbate MH conditions

RUB apply to palm ROLL rub hands together covering all aspects of your fingers & hands until dry SQUIRT one squirt (3 ml) to your hands Simple Message - It’s quick and easy

Why use ABHR’s? Reduces bacterial count on hands more effectively than soap and water hand wash Reduces adverse outcomes and cost associated with healthcare associated infections Requires less time Less irritating to skin than soap and water as ABHRs contain an emollient Can be readily accessible/portable

The 5 Moments may need to be adapted to allow for the characteristics of the client population and available facilities

Moment 1 Before Touching a Patient When Hand Hygiene before touching a patient Hand Hygiene on entering the patient’s room OR Hand Hygiene on leaving the staff area Hand hygiene before: Any personal care activities Any non-invasive observations Any non-invasive treatment Preparation and administration of oral medications Why To protect the patient against acquiring harmful germs from the hands of the HCW

What is a Procedure? An act of care for a patient where there is a risk of direct introduction of a pathogen into the patient’s body.

Moment 2 Before a Procedure When Hand Hygiene immediately prior to a procedure Once Hand Hygiene has been done, nothing else in the patient’s environment should be touched prior to the procedure starting Hand hygiene before: Insertion of a needle into a patient’s skin Preparation and administration of any medications given via an invasive medical device eg. NG feed Preparation of sterile materials Administration of medications where there is direct contact with mucous membranes Any assessment, treatment and patient care where contact is made with non- intact skin or mucous membranes Why To protect the patient from harmful germs (including their own) from entering their body during a procedure

Any situation where contact with body fluids may occur. Such contact may pose a contamination risk to either the HCW or the environment What is a Body Fluid Exposure Risk?

Moment 3 After a Procedure or Body Fluid Exposure Risk When Hand Hygiene immediately after a procedure or a body fluid exposure risk As hands are likely to be contaminated with body fluid Hand hygiene: After any procedure After any potential body fluid exposure Blood, Lochia, Saliva, Tears, Mucous, Wax, Pus, Breast milk, Colostrum, Vomitus, Urine, faeces, Semen, Meconium Tissue samples, including biopsy specimens, organs, bone marrow, cell samples Why To protect yourself and the healthcare surroundings from harmful patient germs

Moment 4 After Touching a Patient When Hand Hygiene after touching a patient Hand hygiene on leaving the patient’s room OR Hand hygiene on entering the staff area Hand Hygiene After: Any personal care activities Any non-invasive observations Any non-invasive treatments Why To protect yourself and the healthcare surroundings from harmful patient germs

Moment 5 After touching a patient’s immediate surroundings when the patient has not been touched When Hand hygiene after touching the patient’s surroundings even when the patient has not been touched Hand Hygiene: After leaving the patient area On entering a staff area Why To protect yourself and the healthcare surroundings from harmful patient germs

ABHR Product Placement A hand hygiene product should be easily accessible and as close as possible to where patient care or treatment is taking place Given the nature of Mental Health illness it may not be appropriate to leave ABHR within reach of the client – this will be a decision for each facility/ward/patient

ABHR Product Placement At a MINIMUM Place ABHR in: Nurses Station Staff rooms – at exit doors, near desks Treatment rooms – where procedures will occur, or where medication is dispensed Portable treatment trolleys – permanently fix to the trolley Carry portable bottles where appropriate

Important Areas to Focus on in Mental Health Hand hygiene before and after a procedure Hand hygiene on entering and leaving patient and staff areas Encouraging regular patient hand hygiene Product availability in staff areas Product availability in all treatment areas

Patient Hand Hygiene Encourage Mental Health clients to clean their hands: Before and after eating After smoking After using the toilet When they are visibly soiled

Looking After Your Hands Skin Care: Cover cuts, scratches, rashes with a water proof dressing Keep your hands healthy and avoid dryness - use facility supplied compatible moisturiser a minimum of 3 times per shift Finger nails should be kept short No chipped polish No acrylic nails in clinical areas Limit jewellery worn to work - jewellery should not inhibit your ability to correctly perform Hand Hygiene If you have issues with sore, cracked &/or dry hands, follow your facility guidelines.

Gloves Gloves should be used as an adjunct to, not a substitute for hand hygiene. Hand hygiene is to be performed before & after all glove use. Gloves need to be changed & HH performed after each client procedure and when going from dirty to clean sites even on the same client. Disposable gloves are to be used once only and never disinfected or washed.

“Clean Between” Use the alcohol impregnated wipes/detergent wipes on all shared non critical equipment Think about product placement to encourage use of wipes e.g near keyboards, on trolleys, in clinic areas, treatment rooms Adhere to a regular cleaning schedule for shared equipment/furniture

Summary Hand Hygiene is important in Mental Health Follow the 5 Moments for Hand Hygiene but be mindful that the 5 Moments may need to be adapted to allow for the characteristics of the client population and available facilities