1. AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Exploring Hand Hygiene Knowledge and Practice Training Module #1 for the CAUTI LTC Core Team

2. 2 Learning Objectives After completing this training, the facility core team members will be able to: Explain why hand hygiene is so important to prevent the spread of infections Reinforce when and how to perform hand hygiene Recognize challenges to hand hygiene in their facility, and identify possible solutions Discuss ways to monitor hand hygiene adherence and develop feedback reports

3. Front-line Staff Training Recap Hand hygiene is one of the most important ways to prevent the spread of infections Germs, especially gram-negative bacteria, are frequently found on health care worker hands following routine resident care WHO 4 moments are a simple framework to remember when staff should perform hand hygiene during any resident interaction Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16 Mody et al Infect Control Hosp Epidemiol; 2003:24:165-171 Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands Educational Resources: http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx 3

4. Hand Hygiene Technique 4 http://www.who.int/gpsc/en/ http://www.cdc.gov/handhygiene/Resources.html#HCP

5. Front-line Staff Training Recap Alcohol-based hand products are preferred for hand hygiene during almost all routine patient care activities Exceptions: When hands are visibly soiled After care of a resident with known or suspected infectious diarrhea Clarify hand hygiene expectations during care of a resident with C. diff ABHRs are appropriate on entry to room; use gloves appropriately to prevent hand contamination; wash with soap and water upon glove removal and exiting room Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16Oughton 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):628-645 5 Good Better Best Plain soap Antimicrobial soap Alcohol-based hand rub

6. Front-line Staff Training Recap Gloves play a key role in preventing hand contamination – but do NOT replace hand hygiene 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 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 6

7. Health Care Worker Challenges with Hand Hygiene Belief that hand hygiene guidelines aren’t applicable 30% wouldn’t change current practices; 20% said guidelines were impractical Lack of access to appropriate hand hygiene supplies 16.2% lack of available sink; 27.5% lack of alcohol-based hand rub No hand hygiene because of glove use 23% nurses, 17% CNAs, 26% other HCWs Forgot about hand hygiene because of workload 35% of nurses, 22% CNAs, 44% other HCWs Lack of access to hand hygiene feedback and/or education 55% never to rarely received personal feedback on HH practices Other HCWs less often received periodic education on HH (86.8% vs. 92% of nurses and CNAs, p=0.03) Ashraf MS et al. ICHE 2010; 31(7):758-762 7

8. Addressing Barriers to Hand Hygiene 8 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?

9. Hand Hygiene Adherence Monitoring Options MethodProsCons Direct observation of hand hygiene technique Educational moment Does not measure adherence during patient care Direct observation of hand hygiene adherence Captures information on product, technique Data summarized by staff type, shift, unit Educational moment Time and resource intensive Can influence performance Measurement of volume of AHBR or soap used Easy to track consistently Consumption may not correlate with appropriate use Could be biased by purchasing patterns Survey/self-report of hand hygiene adherence Captures perceptions and barriers Rates often inflated 9

10. Feedback and Dissemination of Hand Hygiene Rates Providing feedback on hand hygiene adherence to front-line staff is key to raising awareness and maintaining high compliance rates Consider opportunities for “just in time” education when incorrect practices are observed 10

11. Interactive Activities Demonstration of hand hygiene technique – Culture staff hands before and after hand hygiene Demonstration of germ transfer – Use glow powder on commonly touched objects to see how and where “germs” travel 11 BeforeAfter

12. Hand Hygiene Videos WHO - SAVE LIVES: Clean Your Hands Hand Hygiene Video New England Journal of Medicine Hand Hygiene Training Films and Slides O les mains Hand Hygiene Dance CDC—Hand Hygiene Interactive Education Video Public Health Ontario—Just Clean Your Hands NPSA Wi-Five Hand Hygiene Video Game 12

13. Hand Hygiene Posters Create your own! Have staff role model positive behaviors Other Resources: CDC and WHO Hand Hygiene Resources CDC and WHO Hand Hygiene Resources – Additional posters Additional posters Public Health Ontario – Just Clean Your Hands Public Health Ontario – Just Clean Your Hands 13 http://www.cdc.gov/handhygiene/Resources.html#HCP

14. Take the Pledge… 14

15. AHRQ Safety Program for Long-Term Care: HAIs/CAUTI website Login information Username: ltcsafety Password: ltcsafety TeamSTEPPS® for Long-Term Care Stay Updated with Useful Resources 15 Take the Pledge World Health Organization How to Handrub Poster World Health Organization How to Handwash Poster