1. Preventing Medication Errors and Omissions
Are Key to Keeping Kidney Patients Safe

2. Facts About Hand Hygiene
Alcohol-based hand rubs are more effective and take less time to use than traditional hand washing.
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.1
27% of professionals reported observing staff fail to wash hands or change gloves before touching a patient’s access. 1
Gloves reduce hand contamination by %, prevent cross-contamination and protect patients and health care personnel from infection. 2
The use of gloves does not eliminate the need for hand hygiene.
1. Health and Safety Survey to Improve Patient Safety in End Stage Renal Disease 2. Centers for Disease Control and Prevention, Hand Hygiene Guidelines Fact Sheet

3. Facts About Hand Hygiene
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. 1
Hemodialysis patients tend to be among the first to experience antibiotic-resistant pathogens. 2
Alcohol-based hand rubs take less time to use than traditional hand washing. 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.
Alcohol-based hand rubs significantly reduce the number of micro- organisms on skin, are fast acting and cause less skin irritation.
Centers for Disease Control and Prevention, Hand Hygiene Guidelines Fact Sheet
M. J. Arduino, J. I. Tokars, "Why is an Infection Control Program Needed in the Hemodialysis Setting?" Nephrology News Issues 19, no. 7 (June 2005): 44,

4. 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.

5. Poor Hand Hygiene Contributing Factors
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

6. 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.
After removing gloves.
After touching items or surfaces in the immediate patient care environment regardless of patient contact.
Wash hands with soap and water when hands are visibly soiled. Rub hands together for at least 15 seconds, covering all surfaces, focusing on fingertips and fingernails.
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.

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

8. World Health Organization – Five Moments for Hand Hygiene
Before Patient Contact
Before Aseptic Task
After Body Fluid Exposure Risk
After Patient Contact
After Contact with Patient Surroundings

9. Why Use Alcohol-Based Hand Rubs?
Kill 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.
Bottles/dispensers can be placed at the point of care so they are more accessible.

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 seconds of rubbing until hands feel dry.

11. When to wash your hands
When hands are visibly dirty or contaminated with proteinaceous materials.
When infection with spore-forming organisms is suspected.
When alcohol rubs are not available.

12. 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

14. Which hand hygiene method is more effective at killing bacteria?
Regular soap and water  
Anti-bacterial soap and water
Alcohol-based hand rub (foam or gel)
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

15. Which hand hygiene method is more effective at killing bacteria?
Regular soap and water  
Anti-bacterial soap and water
Alcohol-based hand rub (foam or gel)
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

16. How long should you rub your hands together when washing with soap and water?
5 seconds
15 seconds        
1 minute
3 minutes
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

17. How long should you rub your hands together when washing with soap and water?
5 seconds
15 seconds        
1 minute
3 minutes
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

18. When is the use of alcohol-based hand rubs not appropriate?
Before touching a patient
Before manipulating an invasive device
C. When hands are visibly soiled
D. When surfaces in the patient care environment have been touched
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

19. When is the use of alcohol-based hand rubs not appropriate?
Before touching a patient
Before manipulating an invasive device
C. When hands are visibly soiled
D. When surfaces in the patient care environment have been touched
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

20. 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.
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

21. 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.
Which of the following is NOT a contributing factor to patient falls?
Poor physical functioning.
No record of prior falls.
Living Alone.
Impaired Cognition.
ID Fluid Removal.

22. Additional Resources
Centers for Disease Control and Prevention Guideline for Hand Hygiene in Healthcare Settings
World Health Organization Hand Hygiene Tools prevention/tools/hand-hygiene/en/