1. The How To of Hand Hygiene
Training Module 1 for All Long-term Care Staff
May 2015
Nimalie D. Stone, MD, MS
Medical Epidemiologist
Division of Healthcare Quality Promotion
Centers for Disease Control and Prevention

2. Learning Objectives
Upon completion of this training module, long-term care staff will be able to demonstrate a working knowledge of:
why hand hygiene is so important to prevent the spread of infections;
when and how to perform hand hygiene; and
key hand hygiene practices for prevention of healthcare-associated infections (HAI), particularly catheter-associated urinary tract infections (CAUTI).

3. Health Care Workers’ Hands Spread Infections
1-3 million serious infections are estimated to occur every year in US nursing homes
Hand hygiene is one of the most important ways to prevent the spread of infections
Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674. Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Mody et al Infect Control Hosp Epidemiol; 2003:24:

4. Simplifying the Moments for Hand Hygiene
Adapted from World Health Organization Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands Educational Resources:

5. Alcohol-based Hand Rub (ABHR) Hand Hygiene Technique
Apply hand rub to palm of hand
Rub hands together, covering all surfaces
Focus on thumbs, tips of fingers, and under fingernails
Hands are clean when dry
Usually takes about seconds

6. Soap and Water Hand Washing Hand Hygiene Technique
Wet hands with water
Apply soap to palm of hand
Rub hands together, covering all surfaces for at least 15 seconds
Rinse hands with water
Dry hands with paper towel and use towel to turn off faucet
Paper towel prevents hands from being re-contaminated by faucet handles

7. Notes About Hand Hygiene Products
Alcohol-based hand rubs/gels are preferred for hang hygiene when hands are not visibly soiled or dirty
There are certain times when hands should be washed with soap (non- antimicrobial or antimicrobial) and water:
When hands are visibly dirty, contaminated or soiled
After care with residents with infectious diarrhea
Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

8. Efficacy of Hand Hygiene Preparations in Killing Bacteria
Good
Better
Best
Plain soap
Antimicrobial soap
Alcohol-based hand rub
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

9. Hand Hygiene and C. diff
Hand hygiene with soap and water is superior at removing the spore form of C. diff (compared to alcohol-based products)
AHBR is more effective for hand disinfection with all other organisms and there have been no studies linking ABHR use with an increase in C. diff infection
Encourage soap and water after care of residents with acute diarrhea and use of gowns/gloves to prevent spore contamination of hands
Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944.
Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):

10. Important Points About Glove Use
Gloves play a key role in preventing hand contamination—but, do NOT replace hand hygiene
Change gloves during care when moving from a contaminated body site to a clean body site
Do not wear the same pair of gloves for the care of more than one resident
Remove and discard gloves after use
Do not wash gloves
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16

11. Hand Hygiene Before Urinary Catheter Care
Perform hand hygiene and wear gloves immediately before:
Placing or removing an indwelling catheter.
Accessing the drainage system to empty the drainage bag or collecting a urine sample.
Why?
Interacting with the resident or environment before handling the urinary device, may contaminate hands.
Reaching for gloves with unclean hands may contaminate the glove box and outside of the gloves.
Then, gloves will contaminate the urinary catheter or urine collection system.

12. Hand Hygiene After Urinary Catheter Care
Remove gloves and perform hand hygiene immediately after:
Handling an indwelling catheter
Accessing the drainage system to empty the drainage bag or collecting a urine sample
Why?
Hand contamination may occur as a result of small, undetected holes in gloves.
Hand contamination may occur during glove removal.
Hand hygiene protects your hands and the environment from being contaminated.

13. Hand Hygiene Case Scenarios
Let’s chat!
Review as a group the three hand hygiene case scenarios. As you discuss them, think about the following questions:
Does our facility staff experience similar challenges to performing hand hygiene at the appropriate times? Why or why not?
What could our facility do to reduce barriers to hand hygiene?
How can I help support a culture of safety around improving hand hygiene in our facility?

14. Addressing Barriers to Hand Hygiene
Let’s Chat!
What challenges do you experience performing hand hygiene in your facility?
What solutions do you propose to address these challenges in your facility?
How can you support a culture of safety around hand hygiene?

15. Take the Pledge…

16. Take the Pledge… (to practice all infection prevention skills)
World Health Organization How to Handrub Poster
World Health Organization How to Handwash Poster

17. References
Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR Centers for Disease Control and Prevention. Hand Hygiene Resources. Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6): Mody et al. Infect Control Hosp Epidemiol; 2003:24: Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944. Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674. World Health Organization Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands. Education-and-training.aspx.