Hand Hygiene Toolkit Training Presentation Stop! Clean Your Hands | Hand Hygene Toolkit

Introduction Do you want your hands to offer hope and healing? Or do you want your hands to help spread hospital acquired infections? It’s as simple as that and It’s up to us to help make Canada’s Healthcare System a safer place for all of us!

Overview Canadian Patient Safety Institute established in 2005 In 2007 Canada joined the WHO’s Global Patient Safety Challenge Launched the “STOP! Clean Your Hands” Campaign 2009 Developed Human Factors Toolkit. 2009/10 Launched a review, update redesign and integration to Safer Healthcare Now!

Goals To promote the importance of hand hygiene in reducing the occurrence of healthcare associated infections (HCAI) in Canada. To educate healthcare workers, patients, and families about the importance of practicing optimal hand hygiene. To support organizations in making the delivery of healthcare safer for everyone!

Objectives To support the needs of healthcare organizations for capacity building, leadership development and/or the production of tools to help promote hand hygiene. To assist organizations in understanding how to meet Accreditation Canada’s “Required Organizational Practices” specific to hand hygiene. To engage participants across the continuum of care in understanding and practicing optimal hand hygiene

Available Materials A website designed to reach out to a broader audience and to disseminate information as rapidly as possible. (www.handhygiene.ca) Fact sheets: demonstrate the need for better hand hygiene, optimal techniques, and other related supportive materials. Variety of tools: online learning module, audit training, various types of assessment tools, a patient/family guide, and additional patient and family tools and information. A nationally consistent audit tool: Helps establish baseline performance on hand hygiene compliance Helps to monitor and report on improvements over time

System change Alcohol-based hand-rubs at point of care + An evidence based approach, made up of 5 core components, to improve hand hygiene in health-care settings Training and education of staff + Observation of hand hygiene and feedback to staff + Reminders in the workplace + Establishment of a safety climate Individual active participation and institutional support

Healthcare Associated Infections (HCAI) An infection occurring in a patient during the process of care in a hospital or other health care facility which was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. Ducel G et al. Prevention of hospital-acquired infections. A practical guide. WHO 2002

The Burden of HCAI’s More than 220,000 patients acquire healthcare associated infections (HCAIs) in Canada every year resulting in 8,000 – 12,000 deaths.1 At any time, over 1.4 million people worldwide are suffering from infections acquired in hospital.2 Up to 50% of HCAIs could have been prevented.3,4 Zoutman, D., Ford, B.D., Bryce, E., Gourdeau, M., Hébert, G., Henderson, E., and Paton, S. Canadian Hospital Epidemiology Committee, Canadian Nosocomial Infection Surveillance Program and Health Canada. Zoutman et. al, “The state of infection surveillance and control at Canadian acute care hospitals,” American Journal of Infection Control, 2003:31 , 266-275. WHO Information Sheet 1 “Clean care is Safer Care Challenge” Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000 Oct 14;356(9238):1307-12. Patient Safety and Hand Hygiene Matter ! – CPSW Week 2006 brochure

The Case for Hand Hygiene Hand hygiene is one of the most effective measures to reduce the occurrence of HCAI. Good hand hygiene saves lives and reduces the strain on our healthcare system. 1 It takes less than one minute to properly wash hands using soap and water and less than 30 seconds to properly clean hands with alcohol-based hand-rub. Both methods are effective. 1 Roth, Virginia, MD, FRCPC “Hands that harm, hands that heal” November 2006 PowerPoint presentation, slide 31

The Case for Hand Hygiene Cont. As a healthcare worker you should know ... You are also susceptible to carrying around infectious organisms 80% of staff who dressed MRSA wounds carried the organism on their hands for 3 hours afterward 60% of the hands of staff, within ½ hour of contact with patients with Clostridium difficile were contaminated without even touching the patient Meanwhile, washing with soap and water in these cases virtually eradicated these organisms! Stone, S.P. JR Soc Medicine 2001: 94(6); 278-281. Cited in Mitka, M. JAMA 2009: 302(17) reprinted.

Before you touch anything or anyone... Where Were Your Hands? Any time within 3 hours of completing a dressing change on a patient with MRSA or within ½ hour of making any contact in the room of a patient with C. difficile…? Did you eat? Did you have coffee? Did you cough, rub your nose or eyes? Did you approach and make contact with another patient or a family member? Before you touch anything or anyone... STOP! Clean Your Hands!

Obstacles to Hand Hygiene Too busy – It is essential that you make time Skin irritation – Use lotions & hand rub appropriately Glove use – is not a substitute for hand hygiene Not top of mind – needs to become as spontaneous as using aseptic technique and all other safety strategies.

So, Why Clean your hands? 1) to protect the patient against harmful pathogens carried on your hands or present on his/her own skin 2) to protect yourself and the healthcare environment from harmful pathogens

Key Concepts Hand hygiene must be performed at the point of care. During healthcare delivery, there are four moments when it is essential that you perform hand hygiene. Handrub is often preferable to handwashing. If isolation precautions are in place, always adhere to the hand hygiene activities described in those precautions. It is essential that everyone perform hand hygiene using the appropriate technique and time duration in order for it to be effective.

Point of Care The place where three elements align: The patient The healthcare worker The care of the patient involving any contact with the patient or the patient’s zone. A hand hygiene product should be as close as possible to the point of care. WHO Hand Hygiene Guidelines, August 2009

Four Times to Clean FOUR Moments of hand hygiene during healthcare have been identified and are crucial to preventing hand transmission of infections. Before initial patient/patient environment contact Before aseptic procedure After body fluid exposure risk After patient/patient environment contact This was adapted from the WHO’s 5 Moments of Hand Hygiene (Ontario Ministry of Health and Long Term Care).

Time Optimal hand hygiene using soap and water takes 40-60 seconds Optimal hand hygiene using an alcohol-based hand rub takes 20-30 seconds Optimal hand hygiene using soap and water takes 40-60 seconds Both are effective methods

Alcohol Based Hand Rub Apply a palm full of rub and cover all surfaces of the hand; rub together until the hands are dry.

How to Hand Rub To effectively reduce the growth of germs on hands, handrubbing must be performed by following all steps illustrated on the left. This takes only 20-30 secs!

Soap & Water Wet the hands first and apply enough soap to cover all surfaces of the hands. Make sure the hands are dry and the towels are not used repeatedly or by multiple people. Thorough drying of hands after hand washing has important protective benefits and helps to eliminate more pathogens from your hands.

How to Hand Wash To effectively reduce the growth of pathogens on hands, handwashing must last 40-60 secs and should be performed by following all steps illustrated on the left.

Gloves & Skin care Gloves do not replace the practice of optimal hand hygiene Avoid hand washing immediately before or after using an alcohol-based hand rub Avoid hot water Let hands dry completely before donning gloves Use hand lotions and creams Allergies or adverse reactions – use alternative products No artificial fingernails or extenders Keep natural nails short (0.5 cm) Remove jewelry

Resources World Health Organization: Guidelines on Hand Hygiene in Health Care. First Global Patient Safety Challenge, Clean Care is Safer Care. August 2009. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf WHO Clean Care is Safer Care: Tools and Resources: http://www.who.int/gpsc/5may/tools/en/index.html Canadian Patient Safety Institute: www.handhygiene.ca Community and Hospital Infection Control Association – Canada. http://www.chica.org/links_handhygiene.html#STANDARDS

Resources Public Health Agency of Canada, Hand Hygiene Recommendations for Remote and Isolated Community Settings. http://www.phac-aspc.gc.ca/alert-alerte/h1n1/public/handhygiene-eng.php?option=print Health Canada: The Benefits of Handwashing: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/hands-mains-eng.php Canadian Centre for Occupational Health and Safety: http://www.ccohs.ca/http://www.ccohs.ca/ http://www.ccohs.ca/pandemic/subject/handwashing.html The Art of Washing Hands: http://www.theartofwashinghands.com/index.html

Questions?

Introduction Do you want your hands to offer hope and healing? Or do you want your hands to help spread hospital acquired infections? It’s as simple as that and It’s up to us to help make Canada’s Healthcare System a safer place for all of us!

Overview Canadian Patient Safety Institute established in 2005 In 2007 Canada joined the WHO’s Global Patient Safety Challenge Launched the “STOP! Clean Your Hands” Campaign 2009 Developed Human Factors Tool Kit. 2009/10 Launched a review, update redesign and integration to Safer Healthcare Now!

Goals To promote the importance of hand hygiene in reducing the occurrence of healthcare associated infections (HCAI) in Canada. To educate healthcare workers, patients, and families about the importance of practicing optimal hand hygiene. To support organizations in making the delivery of healthcare safer for everyone!

Objectives To support the needs of healthcare organizations for capacity building, leadership development and/or the production of tools to help promote hand hygiene. To assist organizations in understanding how to meet Accreditation Canada’s “Required Organizational Practices” specific to hand hygiene. To engage participants across the continuum of care in understanding and practicing optimal hand hygiene

Available Materials A website designed to reach out to a broader audience and to disseminate information as rapidly as possible. (www.handhygiene.ca) Fact sheets: demonstrate the need for better hand hygiene, optimal techniques, and other related supportive materials. Variety of tools: online learning module, audit training, various types of assessment tools, a patient/family guide, and additional patient and family tools and information. A nationally consistent audit tool: Helps establish baseline performance on hand hygiene compliance Helps to monitor and report on improvements over time

System change Alcohol-based hand-rubs at point of care + An evidence based approach, made up of 5 core components, to improve hand hygiene in health-care settings Training and education of staff + Observation of hand hygiene and feedback to staff + Reminders in the workplace + Establishment of a safety climate Individual active participation and institutional support

Healthcare Associated Infections (HCAI) An infection occurring in a patient during the process of care in a hospital or other health care facility which was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. Ducel G et al. Prevention of hospital-acquired infections. A practical guide. WHO 2002

The Burden of HCAI’s More than 220,000 patients acquire healthcare associated infections (HCAIs) in Canada every year resulting in 8,000 – 12,000 deaths.1 At any time, over 1.4 million people worldwide are suffering from infections acquired in hospital.2 Up to 50% of HCAIs could have been prevented.3,4 Zoutman, Dick, MD, FRCPC, B. Douglas Ford, MA, Elizabeth Bryce, MD, Marie Gourdeau, MD,Ginette Hébert, RN, Elizabeth Henderson, PhD, and Shirley Paton, MN, Canadian Hospital Epidemiology Committee, Canadian Nosocomial Infection Surveillance Program and Health Canada. Zoutman et. al, “The state of infection surveillance and control at Canadian acute care hospitals,” American Journal of Infection Control, 2003:31 , 266-275. WHO Information Sheet 1 “Clean care is Safer Care Challenge” Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000 Oct 14;356(9238):1307-12. Patient Safety and Hand Hygiene Matter ! – CPSW Week 2006 brochure

The Case for Hand Hygiene Hand hygiene is one of the most effective measures to reduce the occurrence of HCAI. Good hand hygiene saves lives and reduces the strain on our healthcare system. 1 It takes less than one minute to properly wash hands using soap and water and less than 30 seconds to properly clean hands with alcohol-based hand-rub. Both methods are effective. 1 Roth, Virginia, MD, FRCPC “Hands that harm, hands that heal” November 2006 PowerPoint presentation, slide 31

The Case for Hand Hygiene Cont. As a healthcare worker you should know ... You are also susceptible to carrying around infectious organisms 80% of staff who dressed MRSA wounds carried the organism on their hands for 3 hours afterward 60% of the hands of staff, within ½ hour of contact with patients with Clostridium difficile were contaminated without even touching the patient Meanwhile, washing with soap and water in these cases virtually eradicated these organisms! Stone, S.P. JR Soc Medicine 2001: 94(6); 278-281. Cited in Mitka, M. JAMA 2009: 302(17) reprinted.

Before you touch anything or anyone... Where Were Your Hands? Any time within 3 hours of completing a dressing change on a patient with MRSA or within ½ hour of making any contact in the room of a patient with C. difficile…? Did you eat? Did you have coffee? Did you cough, rub your nose or eyes? Did you approach and make contact with another patient or a family member? Before you touch anything or anyone... STOP! Clean Your Hands!

Obstacles to Hand Hygiene Too busy – It is essential that you make time Skin irritation – Use lotions & hand rub appropriately Glove use – is not a substitute for hand hygiene Not top of mind – needs to become as spontaneous as using aseptic technique and all other safety strategies.

So, Why Clean your hands? 1) to protect the patient against harmful pathogens carried on your hands or present on his/her own skin 2) to protect yourself and the health-care environment from harmful pathogens

Key Concepts Hand hygiene must be performed at the point of care. During healthcare delivery, there are four moments when it is essential that you perform hand hygiene. Handrub is often preferable to handwashing. If isolation precautions are in place, always adhere to the hand hygiene activities described in those precautions. It is essential that everyone perform hand hygiene using the appropriate technique and time duration in order for it to be effective.

Point of Care The place where three elements align: The patient The healthcare worker The care of the patient involving any contact with the patient or the patient’s zone. A hand hygiene product should be as close as possible to the point of care. WHO Hand Hygiene Guidelines, August 2009

Four Times to Clean FOUR Moments of hand hygiene during healthcare have been identified and are crucial to preventing hand transmission of infections. Before initial patient/patient environment contact Before aseptic procedure After body fluid exposure risk After patient/patient environment contact This was adapted from the WHO’s 5 Moments of Hand Hygiene (Ontario Ministry of Health and Long Term Care).

Time Optimal hand hygiene using soap and water takes 40-60 seconds Optimal hand hygiene using an alcohol-based hand rub takes 20-30 seconds Optimal hand hygiene using soap and water takes 40-60 seconds Both are effective methods

Alcohol Based Hand Rub Apply a palm full of rub and cover all surfaces of the hand; rub together until the hands are dry.

How to Hand Rub To effectively reduce the growth of germs on hands, handrubbing must be performed by following all steps illustrated on the left. This takes only 20-30 secs!

Soap & Water Wet the hands first and apply enough soap to cover all surfaces of the hands. Make sure the hands are dry and the towels are not used repeatedly or by multiple people. Thorough drying of hands after hand washing has important protective benefits and helps to eliminate more pathogens from your hands.

How to Hand Wash To effectively reduce the growth of pathogens on hands, handwashing must last 40-60 secs and should be performed by following all steps illustrated on the left.

Gloves & Skin care Gloves do not replace the practice of optimal hand hygiene Avoid hand washing immediately before or after using an alcohol-based hand rub Avoid hot water Let hands dry completely before donning gloves Use hand lotions and creams Allergies or adverse reactions – use alternative products No artificial fingernails or extenders Keep natural nails short (0.5 cm) Remove jewelry

Resources World Health Organization: Guidelines on Hand Hygiene in Health Care. First Global Patient Safety Challenge, Clean Care is Safer Care. August 2009. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf WHO Clean Care is Safer Care: Tools and Resources: http://www.who.int/gpsc/5may/tools/en/index.html Canadian Patient Safety Institute: www.handhygiene.ca Community and Hospital Infection Control Association – Canada. http://www.chica.org/links_handhygiene.html#STANDARDS

Resources Public Health Agency of Canada, Hand Hygiene Recommendations for Remote and Isolated Community Settings. http://www.phac-aspc.gc.ca/alert-alerte/h1n1/public/handhygiene-eng.php?option=print Health Canada: The Benefits of Handwashing: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/hands-mains-eng.php Canadian Centre for Occupational Health and Safety: http://www.ccohs.ca/http://www.ccohs.ca/ http://www.ccohs.ca/pandemic/subject/handwashing.html The Art of Washing Hands: http://www.theartofwashinghands.com/index.html

Questions?