HAND DECONTAMINATION Prepared by:
Kirklees Infection Control Team
Responsible Area: Approval Information:
Public Health Date Approved: COMMITTEE:-
Lead Director:
Dr J Hooper
Reference to Standards for Better Health Domain Core/Development standard
Infection Control 14th November 2007 PEC
Version No. Approved:
Three
Review Date:
September 2009
Department of Health 2004 Standards for Better Health First domain Safety
C4
Performance indicators To reduce incidence of cross infection History of Document
Version 1: November 2002 – superseded Version 2 September 2005 – superseded Version 3 September 2007
CONTENTS Section No.
Page No’s 1
1.
Introduction
2.
Associated Policies and Procedures
3.
Routine Hand washing
4.
Alternative Supplements to Hand Washing
5.
Surgical Hand Washing
6.
Public Hand Hygiene
3
7.
Hand Care
3
8.
General Advice
3
9.
Hand Hygiene Training
3
10.
References
4
1 1/2 2 2/3
Appendix One NICE Guidance Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgement. However, NICE Guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.
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1.
INTRODUCTION 1.1
The term hand decontamination is used so that hand washing and also use of alcohol-based solutions are included within this policy. Hand decontamination protects both the patient and health care worker. Hands are considered to play a major role in the transmission of infection between patients. Ayliffe (2000).
1.2
Hand decontamination is the single most important factor in preventing the spread of infection. Expert consumer groups agree that effective hand decontamination results in significant reduction in the carriage of potentially harmful micro-organisms on hands and so helps prevent cross infection.
1.3
Hands must be decontaminated immediately before each and every episode of direct patient contact/care and after any activity or contact that potentially results in hands becoming contaminated. Epic Guidelines (2001).
1.4
Some examples of when hands must be decontaminated are: • • • • • • • •
The intent of this ‘Hand Decontamination Policy’ is that it is implemented by all Kirklees PCT staff and can be used as a good practice guide for independent contractors and/or those members of staff to follow who work within Kirklees PCT area.
1.5
2.
Immediately before and after each episode of direct patient contact/care/clinical procedures. Before preparing, handling or eating food. After visiting the toilet. Whenever hands are visibly dirty. Before and after wearing personal protective equipment. Between each procedure when undertaking several consecutive procedures on one patient. Before and after administering medication. Before commencing work and after leaving work areas.
ASSOCIATED POLICIES AND PROCEDURES • • • •
PCT Universal Precautions Guideline PCT COSHH PCT Health and Safety PCT Incident Reporting • PCT Waste Management Guidelines • DH Essential Steps to Safe Clean Care
3.
ROUTINE HAND WASHING Despite the simplicity of hand washing, many studies have shown that healthcare workers do not frequently wash their hands after contact with patients. Pittet et al (1999).
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Routine hand washing removes transient micro-organisms acquired on the hands before they can be transferred. Hand washing with soap suspends transient organisms and allows them to be rinsed off. The correct technique for routine hand washing involves: • All wristwatches, bracelets and hand jewellery must be removed. • Cuts covered with waterproof dressings. Finger nails must be kept short, clean and free from nail polish/false nails. • Wet hands under running water. • Applying the soap covering all surfaces of the hand. • Vigorously rubbing the hands without adding more water. • Rinse hands thoroughly under running water to remove residual soap. • If elbow/wrist operated taps are not fitted, use a paper towel to turn tap off. • Dry hands with disposable paper towel. • Dispose of hand towel safely into waste disposal bin, using the foot pedal.
4.
ALTERNATIVES/SUPPLEMENTS TO HAND WASHING 4.1
Use of Alcohol Handrub Alcohol is an effective alternative to hand washing provided hands are not dirty. Pratt (2001). Alcohol is not a cleansing agent. Alcohol is not effective against bacterial spores, e.g. clostridium difficile. • • • •
5.
Dispense one application of alcohol handrub to clean dry hands (free of dirt and organic material). Ensure solution covers all hand surfaces. Rub hands together vigorously, paying particular attention to the tips of the fingers, the thumbs and the areas between fingers. Rub hands together until the alcohol handrub has evaporated and the hands are dry.
SURGICAL HANDWASHING 5.1
Surgical hand washing is intended to remove or destroy transient microorganisms and reduce detachable resident micro-organisms and is achieved by using an antiseptic hand wash. Surgical hand washing is essential before minor surgery, aseptic procedures and highly invasive procedures.
5.2
Suitable antiseptic solutions: - Chlorohexidine Gluconate 20% (Hibiscrub) - Povidone Iodine - Iodophors
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Either Wash hands for 3 to 5 minutes with an aqueous antiseptic solution • Rinse thoroughly under running water. • Thoroughly dry with sterile paper towel. Or
6.
Apply an alcohol-based product to clean hands for 3 minutes
PUBLIC HAND HYGIENE Hand decontamination when visiting patients in hospital is encouraged on entry, after any patient/environmental contact and on leaving. Alcohol gel is available on the entrance to acute trust wards and at Holme Valley Community Hospital for all visitors to use. Patients should also be encouraged to wash their hands when visiting Care Homes.
7.
HAND CARE Frequent hand washing, or a poor hand washing technique, or inadequate hand drying can result in dry sore hands. In addition, dry, cracked skin is more likely to harbour micro-organisms.
8.
GENERAL ADVICE • Ensure hands are rinsed and dried thoroughly. • An emollient hand cream should be applied regularly to protect the skin from the drying effects of regular hand decontamination (not communal jars). Hand lotions are advisable to prevent skin dryness. Oil based hand creams are not recommended as these are not compatible with latex gloves. • Keep nails short and clean. • Do not wear false nails while on duty. False finger nails are host potential pathogens, including yeasts. Moolenaar (2000) • Remove all nail polish. • Avoid wearing jewellery, e.g. wristbands, bracelets and stoned rings. • Always cover cuts with a waterproof dressing. • Ensure that there is an adequate supply of paper towels, soap, antiseptic solution hand wash and alcohol handrub. • If a particular soap, antimicrobial hand wash or alcohol/product causes skin irritation avoid using and contact the occupational health department for advice.
9.
HAND HYGIENE TRAINING Training on hand decontamination is delivered to Health Care staff and non clinical staff at a variety of training sessions and events, such as: • Mandatory training • Induction training • Every ‘ad hoc’ Infection control training session • Pro active awareness sessions, such as the ‘Hand Washing Road Show’ • Infection Control Study Days • As part of the Department of Health, ‘cleanyourhands’ campaign and ‘Essential Steps’ Programme.
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10.
REFERENCES Ayliffe, G A C (2000) Control of Hospital Infection A practice handbook 4th edition Arnold London Epic project 2001. Developing National Evidence Based Guidelines for Preventing Healthcare Associated Infections. Journal of Hospital Infection, Vol 47, Supplement. Infection Control Nurse Association (2002) Hand Decontamination Guidelines: ICN and Regent. Fitwise Bathgate Moolenaar R L Crutcher J M (2000) A prolonged outbreak of Pseudomonas aeruginosa in Neonatal intensive care unit. Infection Control and Epidemiology 21 (2): 80 to 85 NAO 2000. The Management and Control of Hospital Acquired Infection in Acute NHS Trusts in England. The Stationary Office, London. National Institute for Clinical Excellence 2003 Prevention of healthcare Associated Infections in Primary and Community Care. NICE London Pittet D, Dharan S, Touveneau S, 1999. Bacterial Contamination of the hands of hospital staff during routine patient care. Archive Internal Medicine 159 821 – 26. Pratt R J, Pellowe C., 2001. Standard Principles for preventing hospital acquired infections Journal hospital infection 47 531 – 537. Ward D, 2000. Hand washing Facilities in the Clinical Area : a literature review. British Journal of Nursing, Vol 9, 2, 82-66
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APPENDIX 1 SIX STEPS HANDWASHING TECHNIQUE
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