1. Hand Hygiene
Workshop

2. Overview
Hand Hygiene Practices
Activity
Evaluation
Questions

3. Learning Objectives
At the end of this course, you will be able to explain:
When and how Hand Hygiene is expected to occur at Jefferson
Different types of thresholds in healthcare at Jefferson
Sequence of donning and doffing personal protective equipment

4. What are some of the challenges at Jefferson?
Infrastructure
Crowding
Availability
Time
Skin quality/integrity
Going “In and out” without touching

5. Why should I care? Protect your health Protect your families’ health
Protect our patients
Reduce infections (HAIs) and disease transmission
Better compliance rates at Jefferson

6. Serious about Hand Hygiene (video)

7. Meet Patient A
Patient A has been in the hospital for 8 days, he had heart surgery and is recovering well. Patient A is on enteric precautions for a Clostridium difficile (C.diff) infection.
Teaching Rounds occur at 10am
Nurse Tech Joe knocks and asks Patient A if he may enter. Patient A agrees.
The first thing Joe should do before he enters is:
Don gloves
Don their gown
Perform hand hygiene
Put on a mask

8. Meet Patient A
Patient A has been in the hospital for 8 days, he had heart surgery and is recovering well. Patient A is on enteric precautions for C diff.
Vital checks occur before breakfast
Nurse Tech Joe knocks and ask Patient A if he may enter. Patient A agrees.
The first thing Joe should do before he enters is:
Don gloves
Don their gown
Perform hand hygiene (soap and water or hand gel upon entry)
Put on a mask

9. Hand Hygiene Indications
Hand Hygiene is expected to occur at the Point of Entry of each patient room/zone
BEFORE and AFTER the threshold is crossed
Examples of Hand Hygiene Opportunities:
Before putting on gloves
After touching a patient’s surroundings/environment
Repeat hand hygiene/replace gloves when transitioning from “dirty” to “clean” activity while engaging in patient care

11. Everyday Hand Hygiene Compliance
When to wash
Before, during, and after preparing food
Before eating food
Before and after caring for someone who is sick
Before and after treating a cut or wound
After using the toilet
After changing diapers or cleaning up a child who has used the toilet
After blowing your nose, coughing, or sneezing
After touching an animal, animal feed, or animal waste
After touching garbage

12. Scrub Patterns
Give HANDOUTS

13. GIVE HANDOUTS

14. Which areas are most often missed by health care providers when using alcohol based hand gel?
Thumbs, fingertips, and between fingers
Fingertips, backs of hands, and wrist
Palms, thumbs, and between fingers

15. ANSWER
Which areas are most often missed by health care providers when using alcohol based hand gel?
Thumbs, fingertips, and between fingers
Fingertips, backs of hands, and wrist
Palms, thumbs, and between fingers

16. Hand Hygiene and Glove Use
** and DRY
IF:
THEN:
Gloves are damaged
Remove gloves and clean your hands
Moving from contaminated body site to clean body site
Gloves look dirty or have blood or bodily fluids on them after completing a task

17. Gloves are NOT a substitute for Hand Hygiene.

18. Sequence for Hand Hygiene when Putting on PPE
Perform hand hygiene before donning PPE
2. Don Gown – Must tie at waist.
1. Clean hands
3. Mask
4. Gloves

19. Sequence for Hand Hygiene when Taking off PPE
Perform hand hygiene after doffing PPE
1. Remove gloves
2. Remove gown (roll tightly to discard in trash)
3. Remove mask
4. Clean hands

20. Hands Full Guidance - Entering Room
Clean hands and don gloves upon entry to patient room/environment
4. Ready for patient or environment encounter
1. Enter room
2. Put down equipment
3. Clean hands and don gloves

21. Hands Full Guidance - Exiting room
Remove a glove before entering soiled utility room to touch key pad, clean hands before leaving soiled utility room
If moving directly to next patient room and nothing has been touched gel out can count as gel in for next crossing of threshold
Remove dirty linen from room
2. Remove glove when using key pad to enter soiled utility room
3. Place soiled linen in appropriate bin
4. Clean hands

22. What is a Threshold?
A Threshold is the point in which hand hygiene is required when entering a patient environment.

23. Thresholds -Acute Care Floors – Door Sweep
Across door sweep threshold =
Hand hygiene required
In door sweep threshold = No hand hygiene required

24. Thresholds – Critical Care Units– Sliding Doors
Stepping both feet over the threshold requires hand hygiene.
Both feet past threshold =
Hand hygiene required
Threshold
Outside of doorway = No hand hygiene

25. Thresholds – Procedural Areas/ ED – Privacy Curtain
Privacy curtain and curtain track = Threshold
Walking through privacy curtain and track threshold = Hand hygiene required
Patient zone
Hand hygiene in counts as hand hygiene out when crossing a threshold and nothing else is touched.
Common area

26. Virtual Thresholds
Patient areas that do not have doors, curtains, or curtain tracks.
Hand hygiene must occur when crossing a virtual threshold into the patient “Zone”
Any other examples of patient zones we could take pictures of?
Patient Zone
Virtual Threshold
Common Area
Common area

27. Hand hygiene when crossing patient zones
Common area
Zone boundary

28. Meet Patient B
Patient B (no isolation precautions) is served a meal by the dietary team. The nurse tech is in the room checking the patient’s vitals. The hostess drops the tray off in the patient’s room and exits. The hostess uses hand gel upon exiting. The nurse tech opens Patient’s B’s drink and asks Patient B if there is anything else they need before exiting the room. The patient says no and picks up the turkey sandwich to eat. The tech exits, using hand gel on the way out.
Was there a missed opportunity?

29. Meet Patient B
ANSWER: Patient Hand Hygiene!
A reminder: two Purell hand wipes are placed on every meal tray. Staff should encourage the patient to use hand hygiene before and after each meal via the Purell hand wipes.

30. Patients on Enteric Precautions
Check the door frame for yellow “Enteric” sign
Gloves and Gown are required for entry and are located in the yellow isolation cart or in the isolation closet
Bleach wipes are available for cleaning of re-useable equipment

31. Patients on Enteric Precautions Special Hand Hygiene Requirement
Correct sequence
Hand hygiene (soap and water or alcohol hand gel)
Don gloves Patient Care or Interaction
Hand hygiene following removal of PPE
ONLY soap and water upon exit from patient room

32. What can we do about C.diff?
Hand washing with soap and water every time leave a C.diff room… Improve hand washing compliance
All equipment that goes in and out of patient room wiped down with a PDI bleach wipe (orange top) (ie. Blood pressure monitors, glucometers, wheelchairs, etc)
Education to patient and visitors about importance of hand washing
Daily cleaning of all high touch surfaces and bathrooms
Actively working with EVS to ensure compliance

33. Until the surface is dry
What is the correct contact time for PDI Bleach wipes?
1 minute
3 minutes
4 minutes
Until the surface is dry

34. ANSWER What is the correct contact/wet time for PDI Bleach wipes?
1 minute
3 minutes
4 minutes
Until the surface is dry

35. Patient Care Equipment (eg. BP cuffs, dinamaps…)
Contact/Wet Time – Means how long a piece of equipment MUST remain wet.
Policy #113.65: All patient equipment must be cleaned after each patient.

36. Patient Care Equipment
Sani Cloth (Bleach) disinfection procedure:
Perform hand hygiene and don gloves prior to use of this product. Gown and face protection may be needed depending on use.
If visibly soiled carefully, without splashing disinfectant, dispense a Sani wipe and clean surface to remove soilage and bioburden from the surface cleaned. Then follow step 3.
Carefully dispense a second wipe and thoroughly wet surface to be disinfected; surface must be wet for 4 minutes. Repeated use of the product may be required to ensure the surface remains visibly wet for 4 minutes.**
Remove gloves and any other PPE, dispose of appropriately and perform hand hygiene.
**Note – if an item is NOT visibly soiled then you can skip step #2 and go right to step 3

37. Patient Care Equipment – Contact/Wet Time
Bleach = 4 minutes
Germicidal = 3 minutes

38. Roll the IV pole containing the pumps out into the hall for pick up.
What is the correct process for removing IV pumps after a discharge?
Take the pump off the pole and put it in the dirty utility red bin for SCL/CPD pick up.
Remove the pump, clean it with a sani wipe or bleach wipe and return it to clean utility.
Roll the IV pole containing the pumps out into the hall for pick up.
None of the above

39. ANSWER
What is the correct process for removing IV pumps after a discharge?
Take the pump off the pole and put it in the dirty utility red bin for SCL/CPD pick up.
Remove the pump, clean it with a sani wipe or bleach wipe and return it to clean utility.
Roll the IV pole containing the pumps out into the hall for pick up.
None of the above

40. In review 5 moments for hand hygiene Different types of thresholds
Sequence of PPE