IPPOL03 Infection Control Hand Hygiene by Provide Community

Infection Prevention & Control Hand Hygiene Policy

Version: V8

Ratified by:

Infection Prevention Group

Date ratified: 13/04/2022

Job Title of author: Head of Infection Prevention & Control Deputy Director of Operations

Reviewed by Committee or Expert Group

Infection Prevention Group

Equality Impact Assessed by: Head of Infection Prevention

1. Introduction

The aim of this policy is to provide a standardised approach to hand hygiene The policy aims to minimise risk and maximise best practice in hand decontamination. Hand hygiene is an important component of the risk management strategy and is a key indicator of patient safety and the delivery of quality care.

2. Scope

The policy and associated procedure have been written for use by all Provide staff e.g. those working in and from health centres, clinics, community hospitals, departments, and all staff caring for patients in their own homes.

3. Policy Statement

Hand hygiene at the point of care will reduce the risk of microbial contamination in every day practice and ensure there is a managed environment that minimises the risk of infection to patients, clients, staff and visitors.

4. Responsibility & Accountability

All healthcare workers working for Provide must adhere to this policy and procedure.

All staff must be aware of the hand hygiene training they need to undertake plus any updates required, and are responsible for ensuring, with their manager, that they attend the appropriate training within the timescales set on the programme. All clinical staff must complete the hand hygiene training chapter in the training book (Green Card) as outlined on the training matrix.

A review of training attended will be a core discussion point at all annual appraisals and Personal Development Reviews (PDR).

This training will be monitored in accordance with the LDPOL3 Mandatory Training Policy.

5. Purpose

The purpose of this policy is to describe the organisations processes for ensuring that all Provide healthcare staff understand they must decontaminate their hands appropriately at point of patient care to reduce the risk of Healthcare Associated Infections (HCAIs).

6. Aim of Hand Decontamination

Hand decontamination has a dual role to protect both the patient and the healthcare worker (HCW) from acquiring micro-organisms which may cause harm.

HCWs have the greatest potential to spread micro-organisms that cause infection by:

• transfer from one patient to another/staff to patient/patient to staff

• transfer from the environment to patient

• transfer from equipment to patient

Hands must be decontaminated at critical points in order to prevent transmission of micro-organisms. Opportunities for hand hygiene have been described as 5 Key Moments by the World Health Organisation (WHO, 2009A).

7. When to Decontaminate Your Hands – the 5 Key Moments

To prevent the transfer of micro-organisms it is essential to decontaminate hands:

• Before patient contact

• Before an aseptic task

• After body fluid exposure risk

• After patient contact

• After contact with patient surroundings.

Hand hygiene must also be performed in the following situations:

• After using the toilet

• After sneezing or blowing your nose

• After handling patient notes

• Before handling food and drink

• Before entering and leaving clinical areas or wards

• After cleaning equipment or the environment

When moving from one procedure to another on a patient, it is important that hands are decontaminated (ideally by alcohol-based hand-rub) between each procedure.

A risk assessment of the activity intended or performed will determine the appropriate decontamination process (hand wash or hand rub) and choice of product (e.g. soap, alcohol or antiseptic preparation).

8. Hand Decontamination & Skin Care

Handwashing

Handwashing is widely acknowledged to be the single most important activity for reducing the spread of infection. The aim of handwashing is to remove transient microorganisms that accumulate on the skin as a result of activities undertaken by the individual. Transient micro-organisms do not form part of the skin flora and are easily removed by mechanical methods using soap and water (or hand-wipes). Transient micro-organisms include those found in body fluids that may contaminate hands if soiled or visibly dirty.

Hands must be washed using soap and water and an evidence-based technique (WHO) for 15-30 seconds, and then rinsed and dried thoroughly. Single use patient hand wipes should also be available for patients who are unable to access liquid soap and water for hand washing e.g. before meals or after using the toilet etc.

Facilities for staff hand hygiene i.e. hand wipes, bottle of liquid soap, bottles of alcoholbased hand rubs must be available for community staff if environmental risk

assessment identifies working conditions where liquid soap and water are not always available.

Surgical Hand Washing

Surgical hand washing uses chemicals to reduce or eliminate transient organisms as well as reducing the number of micro-organisms that live on the skin and are known as skin flora. It is only necessary to undertake this procedure before surgical procedures and some invasive procedures. If sterile gloves are required, then surgical handwashing is recommended.

Products used for surgical handwashing contain an aqueous antiseptic solution applied for a standard time (usually 2 minutes). Preparations currently available are 4% Chlorhexidine gluconate in a surfactant solution and 7.5% in Povidone - iodine in aqueous solution.

There are a number of alternative / additional methods for preparing the hands, nails and forearms prior to undertaking a surgical procedure which will be determined by local theatre protocols.

Hand washing techniques in three stages:

Preparation

Before washing hands, all wrist and hand jewellery should be removed. Cuts and abrasions must be covered with waterproof dressings.

Arms must be bare below the elbows to facilitate lathering with soap or the application of alcohol based hand rubs over the base of the hands and wrists (and lower arms as required for a surgical handwash).

Hands should be wet under tepid running water before applying liquid soap or an antimicrobial preparation.

Washing and Rinsing

When washing hands apply enough soap to cover all hand surfaces to ensure that the hands are well lathered.

The hands must be rubbed together thoroughly for a minimum of 10-15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Hands must be rinsed thoroughly under running water.

Hand Drying

This is an essential part of hand hygiene. Hands must be dried thoroughly using good quality paper towels. In clinical settings disposable paper towels must be used, as communal towels are a source of cross-contamination.

Hot air dryers are not recommended in clinical settings. However, if they are used in other areas, they must be regularly serviced and users must dry hands completely before moving away.

Decontamination of Hands Using Alcohol-Based Hand Rubs (ABHRs)

Alcohol-based hand rubs/gels/sanitisers are recognised (by WHO) as the gold standard method for hand decontamination at the point of care. ABHRs can be used when handwash facilities (basins, water and hand towels) are not readily available.

However, ABHRs are not effective against all micro-organisms (for example viruses such as Norovirus and spore forming micro-organisms such as Clostridium difficile) I these circumstances e.g. when caring for patients with infectious diarrhoea then hands should be washing using soap and water. ABHRs will not remove dirt or body fluids when hands should be washed using soap and water.

A risk assessment must be undertaken when the easy availability of ABHRs is considered unsafe e.g. paediatrics, mental health and special learning needs environment. These products are toxic if ingested.

When cleaning hands, 1 pump from the dispenser of ABHR will provide a 3ml dose, which is sufficient for covering all surfaces of the hands and wrists.

ABHRs must come into contact with all the surfaces of the hand. The hands must be rubbed together thoroughly, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers, until the solution has evaporated and the hands are dry.

Individually carried single-use dispensers (bottles) should be available for staff that don’t have easy access to dispensers e.g. community staff, domiciliary visits by GPs and podiatrists etc.

All hand hygiene products must be of medical grade and purchased via an approved supplier.

Religious Issues

All religions accept the use of alcohol as a medical agent and recognise the unique value of using alcohol-based hand-rub in healthcare settings

9. Types of Hand Washing/Hand Decontamination

The Table below illustrates different methods of hand washing and should be part of the hand hygiene risk assessment process. Method

1. Hand washing Liquid soap

2. Hand decontamination

Alcohol-based hand rub (ABHR) e.g. Purell, Deb Cutan

For all routine tasks (please refer to 8.3 in this Policy)

Rapid decontamination for hands not visibly soiled

Please refer to manufacturer’s instructions

3. Surgical scrub –hand disinfection

Chlorhexidine gluconate 4% aqueous surgical scrub solution

Povidone-iodine 7.5% surgical scrub solution

Alcohol-based hand-rubs containing 70% alcohol

10. Hand Moisturiser

Prior to surgical and other invasive procedures

Please refer to manufacturer’s instructions

Intact skin is a natural barrier to infection, consequently all staff need to be aware of the potential damaging effect of increased hand hygiene. Staff should protect and maintain skin integrity through regular use of moisturisers throughout the day.

Moisturisers should be provided in wall-mounted dispensers in areas accessible for staff (e.g. staff rooms).

Dispensers should not be placed in the sluice or toilet areas due to potential contamination. The use of communal tubes/tubs should be avoided as these can become easily contaminated.

If a particular product is thought to cause skin irritation, staff should report this to their clinical manager. Referral to Occupational Health may be required.

11. Hand Washing Facilities

Inadequate hand hygiene facilities contribute to poor hand hygiene compliance and appropriate facilities should be available in all clinical areas including inpatient wards (bays, side rooms, sluice, treatment rooms and ward corridors) as well as in clinical departments and all toilets.

Clinical hand wash basins are designed solely for the purpose of hand hygiene and must;

• Meet the standards required in national guidance – Health Building Note 00-10 Part C sanitary-ware assemblies

• Have elbow or wrist operated taps coming directly out of the wall with no swanneck

• Not be equipped with an overflow or a plug

• Have thermostatically controlled mixer taps

• Have wall-mounted liquid soap dispensers with disposable soap cartridges; these should be kept clean and replenished as soon as empty

• Have wall-mounted paper towel dispensers next to the basins

• Have a foot-operated, lidded and enclosed waste bin within reach of the hand wash basin

• Clinical handwash basins must not be used for other purposes (e.g. cleaning equipment

12. Signage

• Handwash posters demonstrating the correct technique should be available and positioned close to handwash basins in all areas accessed by staff. Posters should be laminated for protection

• Signage explaining the importance of hand hygiene compliance must be visible on entry to all inpatient health care facilities

• There must be clearly signposted hand hygiene facilities on entry and exit from inpatient/clinical areas

• Visitors and patients need to be encouraged to comply with requests for hand hygiene through the use of easily visible and clear signage and information leaflets

13. Hand Hygiene Audit

Provide monitors hand hygiene compliance monthly using an observational audit tool.

These audits are undertaken by the Link Practitioner or Associate Practitioner for the department/service. The audit results are reported to each Assistant Director and form part of the quality assurance process with results presented at the IPC Group as a standing agenda item. The continuous audit cycle supports improvement in hand hygiene and reviews compliance to the hand hygiene policy.

The infection prevention team also undertakes a schedule of verification audits.

Observational Hand Hygiene Audit Tool

The hand hygiene audit has a clear escalation standard ensuring that an immediate response occurs at a local level when compliance drops below the agreed set performance target, and a rapid improvement cycle is started until compliance is met (Please refer to the HII: Observational hand hygiene audit tool on the staff intranet).

14. Monitoring & Review of Policy

Provide will monitor the operation of this policy in order to:

• Measure its effectiveness

• Comply with Provides’ legal obligations

• Highlight practical issues and seek solutions

15. References

1. Department of Health (2008, 2015) Health and Social Care Act: Code of Practice for the prevention and control of healthcare associated infections. DOH, London.

2. World Health Organisation (2009a) Hand Hygiene Technical Reference Manual: To be used by health-care workers, trainers and observers of hand hygiene practices. WHO, Geneva.

3. Loveday HP, Wilson JA, Pratt RJ et al. (2014) Epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England, recommendation SP6.

4. National Institute for Health and Clinical Excellence (2012) Infection: Prevention and Control of healthcare associated infections in primary and community care. NICE Clinical guidance 139. Accessed at: www.nice.org.uk/cg139

5. NHS England & Improvement (2019) Standard Infection Control Precautions: national hand hygiene and Personal Protective Equipment (PPE) Policy DOH, London.

Appendix 1: DEB Handwashing Technique

Appendix 2: How to Handrub?

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage 1: ‘Screening’

Name of project/policy/strategy (hereafter referred to as “initiative”):

Infection prevention and Control Hand Hygiene Policy

Provide a brief summary (bullet points) of the aims of the initiative and main activities: Provide the aims of when and how to perform hand hygiene.

Project/Policy Manager: Specialist Infection Prevention Nurse Date: 28/3/2022

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.

Neutral

Q2. Is there likely to be an adverse impact on one or more minority/under-represented 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”?

n/a

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.

n/a

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)

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.

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?

n/a

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?

n/a

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?

n/a

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.

n/a

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?

n/a

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.

n/a

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.disabilitynow.org.uk – online disability related newspaper www.efa.org.uk – Employers forum on age

EQUALITY IMPACT ASSESSMENT TEMPLATE: Stage One: ‘Screening’