1. MODULE 2 Hand Hygiene

2. Hand Hygiene Is Key to Keeping Kidney Patients Safe MODULE 2 Hand Hygiene

3. Hand Hygiene Hand hygiene practices - the use of alcohol-based hand rubs or use of soap and water before and after patient contact, removal of gloves and contact with the immediate patient care environment - protect both healthcare personnel and patients from contact with infectious agents. Proper hand hygiene breaks the chain of infection transmission and minimizes micro organisms acquired by contact with infected surfaces. MODULE 2 Hand Hygiene

4. Facts About Hand Hygiene Hemodialysis patients tend to be among the first to experience antibiotic- resistant pathogens. Improved adherence to hand hygiene has been shown to reduce transmission of antimicrobial resistant organisms (e.g. methicillin resistant staphylococcus aureus) and reduce overall infection rates. 11% of patients report seeing nurses or technicians who fail to wash hands or change gloves before touching a patient’s access or change gloves before touching their access site. 27% of professionals reported observing staff fail to wash hands or change gloves before touching a patient’s access. Gloves reduce hand contamination by 70-80%, prevent cross-contamination and protect patients and health care personnel from infection. The use of gloves does not eliminate the need for hand hygiene. MODULE 2 Hand Hygiene

5. Hand Hygiene Best Practices Immediately before touching a patient, performing an invasive procedure, or manipulating an invasive device. Immediately after touching a patient, contaminated items or surfaces, or removing gloves. Before putting on gloves. After removing gloves. After touching items or surfaces in the immediate patient care environment regardless of patient contact. When using an alcohol-based hand rub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. When hands are visibly soiled, wash hands with soap and water. Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails. MODULE 2 Hand Hygiene

6. Handle of Cupboard in HD Clinic Blood Stains with Luminol MODULE 2 Hand Hygiene Luminol is used to detect trace amounts of blood as it reacts with iron found in hemoglobin. Bergervoit PWM et al, Application of the forensic Luminol for blood in infection control,* J Hosp Infection (2008), 68, 329-333.

7. Control Panel of HD Machine Blood Stains with Luminol MODULE 2 Hand Hygiene Luminol is used to detect trace amounts of blood as it reacts with iron found in hemoglobin. Bergervoit PWM et al, Application of the forensic Luminol for blood in infection control,* J Hosp Infection (2008), 68, 329-333.

8. Factors Contributing to Poor Hand Hygiene Inconvenient sink location Cleaning hands causes skin irritation and dryness Lack of soap or hand rub Too busy/lack of time Insufficient knowledge about risks of not practicing hand hygiene MODULE 2 Hand Hygiene

9. Why Use Alcohol-Based Hand Rubs? Alcohol-based hand rubs kill most microbes more effectively and more quickly than hand washing with soap and water. Less damaging to skin than soap and water, resulting in less dryness and irritation. Require less time than hand washing with soap and water. In an eight-hour shift, an estimated one hour of an ICU nurse's time will be saved by using an alcohol-based hand rub. Bottles/dispensers can be placed at the point of care so they are more accessible. Alcohol rubs cannot be used when hands are visibly soiled or have been exposed to Clostridium difficile. MODULE 2 Hand Hygiene

10. How to Use Hand Rubs Apply 1.5 to 3ml hand rub to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. If you have applied a sufficient amount of hand rub, it should take at least 10-15 seconds of rubbing until hands feel dry. MODULE 2 Hand Hygiene

11. When to use soap and water When hands are visibly dirty or contaminated with proteinaceous materials. When taking care of a patient with known or suspected Clostridium difficile (C diff.) diarrhea (the C diff. spores are not killed by alcohol) When alcohol rubs are not available. MODULE 2 Hand Hygiene

12. How to use soap and water Wet hands with running water. Rub hands together with soap and lather, covering all surfaces Weave fingers and thumbs together, and vigorously rub all surfaces of lathered hands for 15 seconds. Wash under and around rings, cuticles and under fingernails. Rinse hands under a stream of clean, running water until all soap is gone. Remember to point fingers down so water and contaminants won’t drip towards elbows. Pat hands dry, beginning at the wrist and moving down. Turn off water, using a paper towel. MODULE 2 Hand Hygiene

13. What About Hand Lotions? Hand lotions are important to prevent skin dryness and irritation. Use only hospital-approved hand lotions. Other lotions may: make hand hygiene less effective cause breakdown of latex gloves become contaminated with bacteria if dispensers are refilled MODULE 2 Hand Hygiene

14. Always, when caring for a patient When touching any machine, equipment, bloodlines, or medical device When to CHANGE gloves –Whenever dirty –When moving from contaminated areas to clean areas –When moving between patients When to Wear Gloves

15. Developing Policies and Procedures Review current policies and procedures to ensure they meet current recommendations for hand hygiene. Review CMS Conditions for Coverage for ESRD Facilities Consider using a process analysis fishbone to examine policies and procedures Review examples of Quality Improvement Projects (QIPs) and develop QIPS appropriate for your facility. MODULE 2 Hand Hygiene

16. CMS Conditions for Coverage for ESRD Facilities - ESRD Program Interpretive Guidance Version 1.1 Interpretive guidelines that address hand hygiene include: V113 Glove requirements Requires gloves when caring for a patient or touching the patient’s equipment. Must perform hand hygiene after removal of gloves between each patient or station. V114 Sufficiency of sinks to facilitate hand hygiene V132 Infection Control Training & Education Requires training and education for both new & existing staff members V147 Education & training for care of IV catheters V142 Biohazard & infection control policies & activities V625 Quality assessment and performance improvement (QAPI) Requires performance measures V637 Infection Control MODULE 2 Hand Hygiene

17. Process Analysis Fishbone A process analysis fishbone is a diagrammatic way to examine the policies, procedures, people, and equipment involved in a process leading to an outcome. Providers may use the process analysis to develop Quality Improvement Projects (QIPs) MODULE 2 Hand Hygiene

18. MODEL HANDWASHING POLICIES AND PROCEDURES REQUIRED HAND HYGIENE PRACTICES 1. PURPOSE: This Veterans Health Administration (VHA) Directive provides guidance for establishing the basic requirements for hand hygiene practices in VHA facilities. 2. BACKGROUND a. Hand decontamination has been shown to prevent the spread of infectious agents in clinical settings for over 150 years. b. In October of 2002, the Centers for Disease Control and Prevention (CDC) issued a new Guideline on Hand Hygiene in Health-Care Settings, which examined the evidence in over 400 publications and provided 44 recommendations for hand hygiene practices. The need to decontaminate hands before and after engaging in direct patient care activities by using an alcohol-based hand rub (in the absence of visibly soiled or contaminated hands), or as an alternative by using an antimicrobial soap and water, has been emphasized. c. In July of 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) issued national patient safety goals, which became effective January 1, 2004. Goal 7, reduce the risk of health care associated infections, requires compliance with the CDC recommendations that were supported by a high level of evidence or required by law (identified as category IA, IB, or IC recommendations in the Guideline). This goal has been retained by JCAHO as a national patient safety goal for 2005. d. In December of 2003, the Under Secretary for Health issued a memorandum to all Veterans Integrated Services Network (VISN) Directors and VA medical center Directors summarizing the CDC Guideline requirements and affirming the need to make any necessary changes to improve hand hygiene practices. 3. POLICY: It is VHA Policy that each VHA facility must have a written policy regarding hand hygiene and that policy must be implemented by March 1, 2005. 4. ACTION: Each VHA facility Director is responsible for ensuring: a. A hand hygiene policy (conforming to the Category IA, IB, and IC recommendations presented in the CDC Guideline as summarized in subpars. 4b-4i) is implemented by March 1, 2005. b. All health care workers in direct patient contact areas, i.e., inpatient rooms, outpatient clinics, etc., as well as those who may have direct patient contact in other settings, such as radiology technicians, phlebotomists, etc.,… MODULE 2 Hand Hygiene

19. Focused Education Program for Patients, Caregivers and Staff Provide in-service training to staff about hand hygiene procedures and policies Reinforce hand hygiene policies through newsletter articles, brochures and bulletin board postings Provide information on hand hygiene to patients and caregivers MODULE 2 Hand Hygiene

20. World Health Organization – Five Moments for Hand Hygiene 1.Before Patient Contact 2.Before Aseptic Task 3.After Body Fluid Exposure Risk 4.After Patient Contact 5.After Contact with Patient Surroundings MODULE 2 Hand Hygiene

22. Which hand hygiene method is more effective at killing bacteria? A.Regular soap and water B.Anti-bacterial soap and water C.Alcohol-based hand rub (foam or gel) MODULE 2 Hand Hygiene

23. Which hand hygiene method is more effective at killing bacteria? A.Regular soap and water B.Anti-bacterial soap and water C.Alcohol-based hand rub (foam or gel) MODULE 2 Hand Hygiene

24. How long should you rub your hands together when washing with soap and water? A.5 seconds B.15 seconds C.1 minute D.3 minutes MODULE 2 Hand Hygiene

25. How long should you rub your hands together when washing with soap and water? A.5 seconds B.15 seconds C.1 minute D.3 minutes MODULE 2 Hand Hygiene

26. When is the use of alcohol-based hand rubs not appropriate? A.Before touching a patient B.Before manipulating an invasive device C.When hands are visibly soiled D.When surfaces in the patient care environment have been touched MODULE 2 Hand Hygiene

27. When is the use of alcohol-based hand rubs not appropriate? A.Before touching a patient B.Before manipulating an invasive device C.When hands are visibly soiled D.When surfaces in the patient care environment have been touched MODULE 2 Hand Hygiene

28. True or False: Hand hygiene does not need to be practiced if you touched items or surfaces in the patient care environment, but didn’t touch the patient while you were there. MODULE 2 Hand Hygiene

29. True or False: Hand hygiene does not need to be practiced if you touched items or surfaces in the patient care environment, but didn’t touch the patient while you were there. FALSE Hand hygiene should be practiced after all contact. MODULE 2 Hand Hygiene

30. Additional Resources About Hand Hygiene Centers for Disease Control and Prevention Guideline for Hand Hygiene in Healthcare Settings - 2002 http://www.cdc.gov/Handhygiene/ http://www.cdc.gov/Handhygiene/ Hand Hygiene Resource Center http://www.handhygiene.org/ World Health Organization Hand Hygiene Tools http://www.who.int/gpsc/tools/en/ http://www.who.int/gpsc/tools/en/ MODULE 2 Hand Hygiene

31. Additional Resources About Hand Hygiene Free Quality Tools http://www.freequality.org/Default.aspx?page=27 http://www.freequality.org/Default.aspx?page=27 5-Diamond Patient Safety Program http://www.esrdnet5.org/5Diamond.asp http://www.esrdnet5.org/5Diamond.asp Veterans Health Administration, Required Hand Hygiene Practices http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1214 http://www1.va.gov/vhapublications/viewpublication.asp?pub_id=1214 MODULE 2 Hand Hygiene