Hand Hygiene in Healthcare Facilities

The Importance of Proper Hand

Hygiene for Health-care Workers

Please Complete Your Pre-Test

Objectives:
Learn the role hand hygiene plays in HAI
prevention
Learn the right time and right way for Hand
Hygiene
Review the proper use of gloves to prevent
germ transmission
Learn to perform observational studies
Learn to evaluate your Hand Hygiene Program
Strategies for improvement

Hands and Germ

Transmission:
A health-care workers hands when not
clean are the main route of crosstransmission of potentially harmful
germs between patients in a health
care facility

Lack of Hand Hygiene +

Patient Care = Increased Risks
Increased risk for:
Hand contamination
Potential risk to patient safety

Hand Hygiene in Prevention of

HAIs
Hand hygiene is the undisputed single
most effective infection control
measure in prevention of HAIs

Increased Compliance with Hand

Hygiene means
Reduced numbers of patients
acquiring HAIs
Decreased waste of resources
Saving lives

Hand
Hygiene
right time
right way

Key Terms
The patient zone- includes the
patient, surfaces and items that are
temporarily and exclusively
dedicated to him/her
The Health care area- all surfaces
in the health care setting outside of
the patient zone

The patient zone

The patient zone contains:
Patient X
Immediate surroundings - surfaces that
are touched by or in direct physical
contact with the patient
-Bed rails
-Bedside tables
-Bed linens
-Tubing
-Medical equipment

The Patient zone is not a static

geographical area
Any item designed for reuse or temporarily exposed
to the patient should be decontaminated when
entering and leaving the patients surroundings
Things such as :
- Computers
- Shared bathrooms
- Tables or equipment used for physical
therapy
- Wheelchairs

The Health-care Area

Is everything outside of the patient
zone:
Hand hygiene while caring for patients
helps to protect the wider health care
environment from contamination by
patients germs

Right Time
To avoid prolonged hand
contamination:
Perform hand hygiene when
indicated

The 5 Moments for Hand

Hygiene
1.
2.
3.
4.
5.

BEFORE touching a patient

BEFORE clean/aseptic procedures
AFTER a body fluid exposure risk
AFTER touching a patient
AFTER touching a patients
surroundings

Your 5 Moments for Hand

Hygiene

BEFORE touching a patient

Why?

BEFORE touching a patient

Why?
To protect the patient against harmful
germs carried on your hands

BEFORE clean/aseptic
procedures
Why?

BEFORE clean/aseptic
procedures

Why?
To protect the patient against harmful
germs, including the patients own,
from entering his/her body

AFTER body fluid exposure

risk
Why?

AFTER body fluid exposure

risk

Why?
To protect yourself and the health-care
environment from harmful patient
germs

AFTER touching a patient

Why?

AFTER touching a patient

Why?
To protect yourself and the health-care
environment from harmful patient
germs

AFTER touching patients

surroundings
Why?

AFTER touching patients

surroundings
Why?
To protect yourself and the health-care
environment from harmful patient
germs

Your 5 Moments for Hand

Hygiene Film

Right Way
To avoid prolonged hand
contamination:
Use the appropriate technique
Use an adequate quantity
Use for recommended length of
time

How to Handwash

How to Handrub

Lets Practice!!!

Fingernails and
Artificial Nails
Natural nail tips should be kept to
inch in length
Artificial nails should not be worn
when having direct contact with
high-risk patients (e.g., ICU, OR)

31

Understanding Medical Gloves and

proper Glove use
Medical gloves disposable gloves
used during medical procedures
They include:
Examination gloves (non sterile or
sterile)
Surgical gloves that have specific
characteristics of thickness, elasticity
and strength and are sterile

Gloves DO NOT take the place

of hand hygiene
Glove use neither alters nor replaces
the performance of hand hygiene
Gloves should be removed and hand
hygiene performed when indicated
by the 5 moments of hand hygiene
and clean gloves put back on

Rationale for using medical

gloves
Recommended for two reasons:
1.To reduce the risk of contamination
of health-care workers hands with
blood and other body fluids
2.To reduce the risk of germ
dissemination to the environment and
of transmission from the health-care
worker to the patient and vice versa,
as well as from one patient to another

Inappropriate use of gloves

Use of gloves when it is not indicated is
a:
Waste of resources
Does not decrease cross-transmission of
germs
May result in missed opportunities for
hand hygiene
May actually result in germ transmission

The Glove Pyramid

And Now its time for

the
GLOVE GAME !!!

GLOVE GAME

Assisting a patient with using the bedpan

Taking Vital Signs
Removing a dressing from a wound
Catheter insertion
Delivering food trays
Emptying emesis basin
Changing the linens for a patient with MRSA
Changing a central line dressing
Administering oral Medications
Emptying a Foley catheter bag

Evaluating Your Hand Hygiene

Program
Why it is important
Measurement of the effectiveness of
current practices
Identifying areas needing increased
education
To be able to give feedback to
employees on their performance

How to observe Hand

Hygiene
Direct observation is the most accurate
method
Observer must conduct the observation
without interfering with ongoing work
Observer should be familiar with The 5
Moments for Hand Hygiene and the data
collection tool that is being utilized
Identify opportunities for hand hygiene and
then record if the worker being observed
performed hand hygiene at that time

Sample observation tool:

Sample Observational Tool

Calculating Compliance
Rates
Total number of times hand hygiene
was performed
_______________________________________
Total opportunities for hand hygiene
X100

Sample Observational Tool

Calculating Compliance
Rates
Total number of times hand hygiene
was performed
(4)
_______________________________________
Total opportunities for hand hygiene
(6)
4/6 = 0.667
0.667 x 100= 66.7%

Other Uses for

Observational Tool

Feedback to Staff
Why it is important:
Helps them recognize gaps in good
practices and knowledge
Can help raise awareness and can
convince them there is a problem
Ongoing feedback will demonstrate
improvement and sustain motivation

Tips for Improving Hand

Hygiene Compliance
Increase the availability of hand
sanitizers
Implement a buddy system
Place signs near sinks and hand
sanitizers with the 5 Moments for
Hand Hygiene or other reminders
Internal Newsletters

Answers to Pre-test
Which of the following is the main route of crosstransmission of potentially harmful germs
between patients in a health- care facility? (Pick
one answer only)
a.Health- care workers hands when not clean
b.Air circulating in the facility
c.Patients exposure to colonized surfaces (i.e.,
beds, chairs, tables, floors) between patients
d.Sharing non-invasive objects (i.e., stethoscopes,
blood pressure cuffs, etc.) between patients

Answers to Pre-test
Which of the following is the main route of crosstransmission of potentially harmful germs
between patients in a health- care facility? (Pick
one answer only)
a.Health- care workers hands when not clean
b.Air circulating in the facility
c.Patients exposure to colonized surfaces (i.e.,
beds, chairs, tables, floors) between patients
d.Sharing non-invasive objects (i.e., stethoscopes,
blood pressure cuffs, etc.) between patients

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes No

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes
b.Washing hands immediately after a risk of body
fluid exposure Yes No

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes
b.Washing hands immediately after a risk of body
fluid exposure No

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes
b.Washing hands immediately after a risk of body
fluid exposure No
c.Washing hands after exposure to the immediate
surroundings of a patient Yes No

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes
b.Washing hands immediately after a risk of body
fluid exposure No
c.Washing hands after exposure to the immediate
surroundings of a patient No

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes
b.Washing hands immediately after a risk of body
fluid exposure No
c.Washing hands after exposure to the immediate
surroundings of a patient No
d.Washing hands immediately before a clean/
aseptic procedure Yes No

Answers to Pre-test
Which hand hygiene actions prevent
transmission of germs to the patient?
a.Washing hands before touching a patient Yes
b.Washing hands immediately after a risk of body
fluid exposure No
c.Washing hands after exposure to the immediate
surroundings of a patient No
d.Washing hands immediately before a clean/
aseptic procedure Yes

Answers to Pre-test
What is the minimal time needed for
alcohol based hand rub to kill most
germs on your hands? (Pick one
answer only)
a.20 seconds
b.3 seconds
c.1 minute
d.10 seconds

Answers to Pre-test
What is the minimal time needed for
alcohol based hand rub to kill most
germs on your hands? (Pick one
answer only)
a.20 seconds
b.3 seconds
c.1 minute
d.10 seconds

Summary:
Increased compliance with Hand Hygiene
at the appropriate moment and in the
appropriate way will lead to reduced
numbers of patients acquiring HAIs and
save lives
Observational studies are key to
determining the effectiveness and
direction of your hand hygiene education.

WHO Hand Hygiene SelfAssessment Framework 2010

WHO Hand Hygiene Self-Assessment
Framework 2010 worksheet
Answer the following based on practices at
your facility:
3.4 and 3.5 from Evaluation and feedback
Entire section of 4 Reminders in the workplace
Entire section of 5 Institutional safety climate for
hand hygiene

Discussion Questions (3.4)

Does your facility use WHO My 5
Moments for Hand Hygiene?
How frequently is direct observation
of hand hygiene compliance
performed at your facility?
What is the overall hand hygiene
compliance rate in your facility?

Discussion Questions (3.5)

Do you use immediate feedback?
Describe your systematic feedback?
How often?
Audience?
Impact?

Discussion Questions (4)

Please share your experience with
hand hygiene workplace reminders?
What has worked well?
Or not?
Types of reminders or promotions?

Discussion Questions (5)

Does anyone have experience with:
Hand hygiene teams?
Visible support from leadership?
Hand hygiene champions or role
models?
Patient involvement?
Continuous improvement activities?

References
Center for Disease Control (CDC)
World Health Organization (WHO)

Questions?