Standard Operating Procedure (SOP)
Hand Hygiene
Version: V[X]
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Job Title of author:
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Reviewed by Committee or Expert Group [expert group, virtual panel or sub-committee]
Equality Impact Assessed by: [job title & dept]
Related procedural documents [show all related document]
Review date: [2 years from date of ratification]
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In developing/reviewing this policy Provide Community has had regard to the principles of the NHS Constitution.
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Version Control Sheet
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1. Introduction
Hand hygiene performed correctly at the appropriate time remains the most important intervention in the prevention and control of the spread of infections in all health and care environments. This is reflected in the national hand hygiene policy (NHS 2019).
2. Purpose
To ensure that all Home Care staff understand the importance of hand hygiene in preventing the transmission of infection and to enable staff to know when and how to undertake correct hand decontamination in order to maintain service user, staff and visitor safety.
3. Target Group
All Home Care staff both directly and indirectly involved in the delivery of care including bank, agency and visiting staff. Staff should receive hand hygiene training both at induction and, where appropriate as part of mandatory update training.
4. Before performing hand hygiene
Expose forearms / roll up sleeves
Remove all hand and wrist jewellery
Ensure fingernails are clean and short
Do not wear artificial nails or nail products
Cover all cuts or abrasions with a waterproof dressing
5. When to Perform Hand Hygiene
There is no set frequency for performing hand hygiene. It is the responsibility of the individual to undertake a risk assessment adhering to the principle of “what have I just done and what am I about to do?” Page 5 of 15
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The World Health Organisation (WHO) (2009) lists 5 key moments when hand hygiene should be performed:
1. Before touching a client
2. Before clean / aseptic procedures
3. After body fluid exposure risk
4. After touching a client
5. After contact with client’s surroundings
6. Choice of Hand Decontamination Products
70% alcohol hand gel or rub –
Recommended for most hand decontamination because it is:
Quick and easy to use
Highly effective in reducing levels of micro-organisms rapidly
Contains emollients so helps to moisturize skin
Easy to carry around and to keep where it is needed without the requirement for water, hand-wash basin or hand towels
It is important to remember that alcohol gel/rub does not work if hands are dirty or soiled and it needs to be applied frequently. It is also important to know that alcohol gel/rub does not work well if the service user has diarrhoea that may be infectious. If in doubt, wash hands.
7. Liquid Soap and Water
Hand washing with liquid soap and water is the most thorough means of routine hand decontamination:
Can be used when alcohol gel/rub is not available
Removes dirt and soiling (from body fluids)
Can be used when a service user has diarrhoea and also during outbreaks of viral gastro-enteritis e.g. norovirus when alcohol-based hand rubs are known to be less effective
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8. Skin Care
Staff that undertake regular and frequent hand hygiene are susceptible to dry hands which may lead to skin damage. It may also discourage staff from washing their hands as frequently as required.
To prevent skin damage, ensure the following
Dry hands thoroughly after hand washing, using disposable paper towels or a clean towel supplied by the service user
Use a hand cream during work and when off duty
Keep your own supply of hand cream or use from a pump dispenser if available
If you have skin problems, seek advice from your GP
9. Jewellery
Jewellery should not be worn by staff providing direct care to a service user. Jewellery discourages proper hand hygiene and can carry bacteria and other germs especially rings. Only a plain wedding ring should be worn whilst working.
10.Hand Hygiene for service users
Hand hygiene is also important for service users, especially where they are unable to maintain their own personal hygiene.
Service users should be offered the opportunity to wash or wipe their hands whenever necessary but in particular at the following times:
After using a bedpan, toilet or commode
Prior to eating
If their hands are dirty or soiled
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11.Hand Decontamination Technique Using Soap and Water
Action
Wet hands, apply liquid soap
Rub your hands together palm to palm to create lather
Rub right palm over back of left hand with fingers interlaced, then left palm over back of right hand, fingers interlaced
Rub hands together palm to palm with fingers interlaced
Rub left fist into right palm, then right fist in left palm
Clasp and rotate left thumb in right palm, then right thumb in left palm
Rotate right fingertips into left palm, then left fingertips into right palm
Rub around each wrist with opposite hands
Rinse hands thoroughly under running water. Turn off tap using paper towel if used.
Thoroughly dry hands with paper towels and discard into waste bin.
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12.Hand Decontamination Technique Using Alcohol Hand
Rub/Gel
Action
Apply a palmful of product into a cupped hand then rub hands palm to palm
Rub right palm over back of left hand with fingers interlaced, then left palm over back of right hand, fingers interlaced
Rub hands together palm to palm with your fingers interlaced
Rub fist in right palm, then right fist in left palm
Clasp and rotate left thumb in right palm, then right thumb in left palm
Rotate backwards and forwards right clasped finger into left palm then left finger into right palm
Rub around each wrist with opposite hand
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13.Areas of the hand frequently missed when hand hygiene is not performed correctly
References
Loveday HP, Wilson JA, Pratt RJ et al. (2014) epic3: National Evidence Based Guidelines for Preventing Healthcare- Associated Infections in NHS Hospitals in England. Journal of Hospital Infection Volume 86 Supplement1 (S1-S70)
National Institute for Health and Care Excellence (2012) Infection: Prevention and control of healthcare-associated infections in primary and community care. NICE clinical guideline (CG139) London: NICE
NHS England and NHS Improvement (2019) Standard infection control precautions: national hand hygiene and personal protective equipment policy.
World Health Organisation (2009) WHO Guidelines on hand hygiene in health care: First Global Patient Safety Challenge clean care is safer care. Geneva: WHO
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EQUALITY IMPACT ASSESSMENT TEMPLATE:
Stage 1: ‘Screening’
Name of project/policy/strategy (hereafter referred to as “initiative”):
Provide a brief summary (bullet points) of the aims of the initiative and main activities:
Project/Policy Manager:
Date:
This stage establishes whether a proposed initiative will have an impact from an equality perspective on any particular group of people or community – i.e. on the grounds of race (incl. religion/faith), gender (incl. sexual orientation), age, disability, or whether it is “equality neutral” (i.e. have no effect either positive or negative). In the case of gender, consider whether men and women are affected differently.
Q1. Who will benefit from this initiative? Is there likely to be a positive impact on specific groups/communities (whether or not they are the intended beneficiaries), and if so, how? Or is it clear at this stage that it will be equality “neutral”? i.e. will have no particular effect on any group.
Q2. Is there likely to be an adverse impact on one or more minority/underrepresented or community groups as a result of this initiative? If so, who may be affected and why? Or is it clear at this stage that it will be equality “neutral”?
Q3. Is the impact of the initiative – whether positive or negative - significant enough to warrant a more detailed assessment (Stage 2 – see guidance)? If not, will there be monitoring and review to assess the impact over a period time? Briefly (bullet points) give reasons for your answer and any steps you are taking to address particular issues, including any consultation with staff or external groups/agencies.
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Guidelines: Things to consider
Equality impact assessments at Provide take account of relevant equality legislation and include age, (i.e. young and old,); race and ethnicity, gender, disability, religion and faith, and sexual orientation.
The initiative may have a positive, negative or neutral impact, i.e. have no particular effect on the group/community.
Where a negative (i.e. adverse) impact is identified, it may be appropriate to make a more detailed EIA (see Stage 2), or, as important, take early action to redress this – e.g. by abandoning or modifying the initiative. NB: If the initiative contravenes equality legislation, it must be abandoned or modified.
Where an initiative has a positive impact on groups/community relations, the EIA should make this explicit, to enable the outcomes to be monitored over its lifespan.
Where there is a positive impact on particular groups does this mean there could be an adverse impact on others, and if so can this be justified? - e.g. are there other existing or planned initiatives which redress this?
It may not be possible to provide detailed answers to some of these questions at the start of the initiative. The EIA may identify a lack of relevant data, and that data-gathering is a specific action required to inform the initiative as it develops, and also to form part of a continuing evaluation and review process.
It is envisaged that it will be relatively rare for full impact assessments to be carried out at Provide. Usually, where there are particular problems identified in the screening stage, it is envisaged that the approach will be amended at this stage, and/or setting up a monitoring/evaluation system to review a policy’s impact over time.
EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 2:
(To be used where the ‘screening phase has identified a substantial problem/concern)
Q1. What data/information is there on the target beneficiary groups/communities? Are any of these groups under- or over-represented? Do they have access to the same resources? What are your sources of data and are there any gaps?
Q2. Is there a potential for this initiative to have a positive impact, such as tackling discrimination, promoting equality of opportunity and good community relations? If yes, how? Which are the main groups it will have an impact on?
Q3. Will the initiative have an adverse impact on any particular group or community/community relations? If yes, in what way? Will the impact be different for different groups – e.g. men and women?
Q4. Has there been consultation/is consultation planned with stakeholders/ beneficiaries/ staff who will be affected by the initiative? Summarise (bullet points) any important issues arising from the consultation.
Q5. Given your answers to the previous questions, how will your plans be revised to reduce/eliminate negative impact or enhance positive impact? Are there specific factors which need to be taken into account?
This stage examines the initiative in more detail in order to obtain further information where required about its potential adverse or positive impact from an equality perspective. It will help inform whether any action needs to be taken and may form part of a continuing assessment framework as the initiative develops. Page 14 of 15
Q6. How will the initiative continue to be monitored and evaluated, including its impact on particular groups/ improving community relations? Where appropriate, identify any additional data that will be required.
Guidelines: Things to consider
An initiative may have a positive impact on some sectors of the community but leave others excluded or feeling they are excluded. Consideration should be given to how this can be tackled or minimised.
It is important to ensure that relevant groups/communities are identified who should be consulted. This may require taking positive action to engage with those groups who are traditionally less likely to respond to consultations, and could form a specific part of the initiative.
The consultation process should form a meaningful part of the initiative as it develops, and help inform any future action.
If the EIA shows an adverse impact, is this because it contravenes any equality legislation? If so, the initiative must be modified or abandoned. There may be another way to meet the objective(s) of the initiative.
Further information:
Useful Websites www.equalityhumanrights.com Website for new Equality agency www.employers-forum.co.uk – Employers forum on disability www.efa.org.uk – Employers forum on age
© MDA 2007 EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage One: ‘Screening’