Post on 21-Jun-2019
24/08/2016
SafePatientCare 2016
NiamhMcDonell & PatriciaCoughlan 1
Safe Patient Care “Keeping our Residents Safe”
2016
Standard Precautions: All Residents at all Times #safepatientcare
Hand Hygiene..Lets get practical
Niamh McDonnell, IPCN St Finbarrs Hospital Patricia Coughlan, IPCN, Disability Services
Infection Prevention & Control, Sept 2rd 2016
Standard Precautions: All Residents at all Times #safepatientcare
Build it
Check It
Live it Live it Live it Live it
Teach it
Sell it
WHO - My 5 Moments Approach
An approach for Hand Hygiene which
• focusing on the critical times for hand hygiene when there is a direct risk for Health care associated infection
• applicable to all areas where healthcare is delivered including primary care, LTCF and home based care.
Standard Precautions: All Residents at all Times #safepatientcare
Hand Hygiene - At the right timeWhat are the 5 moments for Hand Hygiene?
Identify the 5 Moments for Hand Hygiene , giving the reason whys it’s necessary at that time
1._______________Why___________________________
2._______________Why___________________________
3._______________Why___________________________
4._______________Why___________________________
5._______________Why___________________________
Standard Precautions: All Residents at all Times #safepatientcare
24/08/2016
SafePatientCare 2016
NiamhMcDonell & PatriciaCoughlan 2
Today Focus
Hand Hygiene
At the right time
and
In the right way
Standard Precautions: All Residents at all Times #safepatientcare
Standard Precautions: All Residents at all Times #safepatientcare
Standard Precautions: All Residents at all Times #safepatientcare
Remember to wet your hands thoroughly
before applying soap – 1 shot !
Standard Precautions: All Residents at all Times #safepatientcare
Remembering to rinse off all product after washing & then dry thoroughly with paper towels!
Standard Precautions: All Residents at all Times #safepatientcare
Are you hand hygiene ready?
Standard Precautions: All Residents at all Times #safepatientcare
24/08/2016
SafePatientCare 2016
NiamhMcDonell & PatriciaCoughlan 3
• Soap and running water must be used for hand washing when – hands are visibly soiled
– caring for persons with diarrhoeal illness or where there is potential for spread of microorganisms which are resistant to AHR e.g. C.difficile.
•Where healthcare is delivered alcohol-based hand rub(AHR) is the preferred method for hand hygiene when hands are not visibly soiled.
Standard Precautions: All Residents at all Times #safepatientcare
What products should we use for Hand Hygiene ?
Alcohol Based Hand Rub Products
“alcohol based hand rubs are the only known means for rapidly and effectively inactivating a wide array of potentially harmful micro-organisms on the hands. “
Pittet et al 2004
WHO recommends alcohol based hand rubs as there is growing evidence to show they are/have
� Fast acting
� Broad spectrum of antimicrobial activity with minimal risk of generating resistance
� Suitability in areas with limited facilities
� Capacity to promote compliance
� Economic benefit by reducing infection rates
Standard Precautions: All Residents at all Times #safepatientcare
Hand Hygiene Products Effectiveness
National Specification for AHR & Soap
Standard Precautions: All Residents at all Times #safepatientcare
Time Management
Hand washing
up to 1 ½
minutes for
entire procedure
Alcohol hand
rubs 20-30 secs,
can be done on
the move,
Standard Precautions: All Residents at all Times #safepatientcare
When using AHR – Remember
�Cover all surfaces once using
the 6 step technique
�Continue rubbing until hands are completely dry
�Duration 20-30 secs
�Once dry hands are safe
Standard Precautions: All Residents at all Times #safepatientcare
24/08/2016
SafePatientCare 2016
NiamhMcDonell & PatriciaCoughlan 4
5 Moments for Hand Hygiene
•A Moment is ……
when there is a perceived or actual risk of a micro-organism transmission from one surface to another on the hands
Standard Precautions: All Residents at all Times #safepatientcare
5 stages of Hand Transmission
Organisms present on residents/clients skin
and immediate environment surfaces
Organisms transfer onto health-care
worker’s hands
Organisms survive on hands for several
minutes
If hand hygiene isn’t carried out or not done
correctly this results in hands remaining
contaminated
Contaminated hands then transmit germs via
direct contact with residents or resident’s
immediate environment
one
two
three
four
five
Standard Precautions: All Residents at all Times #safepatientcare
HEALTH-CARE AREA
PATIENT ZONEMoment 2 –before clean/aseptic procedure
Moment 3-after handling blood and bodily fluids
Standard Precautions: All Residents at all Times #safepatientcare
OPTIMAL HAND HYGIENE
POINT-OF-CARE
•Patient/Resident
•HCW
•Care
SHOULD BE PERFORMED
Standard Precautions: All Residents at all Times #safepatientcare
Moment 1
•When? Clean your hands before contact with the resident / touching the patient
•Why? To protect the resident/patient from harmful germs on your hands with could lead to colonisation or infection
Moment 2
•When? Clean your hands before Clean or Aseptic Procedures
•Why? To protect the resident/patient from harmful germs including the patients own germs from entering his or her body
Moment 3
•When? Clean your hands immediately after contact with body fluids including after glove removal
•Why? To protect yourself and the health care environment from harmful germs contained in body fluids
Moment 4
•When? After contact with the resident
•Why? To protect yourself and the healthcare environment from harmful germs picked up on your hands when providing care
Moment 5
•When? After contact with the residents/patients immediate environment – bed, furniture – even without touching the patients environment
•Why? To protect yourself and the healthcare environment from harmful germs which maybe in the immediate environment or on equipment used by the resident.
Standard Precautions: All Residents at all Times #safepatientcare
Making this work in LTCF’s
�Where residents are cared for in a dedicated space with dedicated equipment – 5 moments apply
�Where residents are semi- autonomous they have their own room or shared room but they also move within the facility-4 moments apply to where healthcare is delivered
Remember 4 and 5 moments do not cover any social contacts with or among LTCF residents unrelated to
healthcare
Standard Precautions: All Residents at all Times #safepatientcare
24/08/2016
SafePatientCare 2016
NiamhMcDonell & PatriciaCoughlan 5
Social Settings
Shared activities areas –dining room, day room etc:
�In common areas where residents/clients gather, the environment is shared by many people.
�To reduce spread of organisms, staff and resident should clean hands before beginning and after ending the activity.
�Some residents may need help cleaning their hands before they begin and after they end an activity.
If staff provide any “HEALTHCARE” where shared activities occur, the 4 moments for Hand Hygiene are to be
followed.Standard Precautions: All Residents at all Times
#safepatientcareStandard Precautions: All Residents at all Times
#safepatientcare
Hand Hygiene
• At the right time and
• In the right way
• Helps Safe lives
• Its in our hands
Standard Precautions: All Residents at all Times #safepatientcare
Outpatients Setting 1
In outpatient settings moment 5 after touching the patient’s surroundings only applies where the patient is placed in a dedicated space for a certain amount of time (~>20mins) with dedicated equipment – in this case it is anticipated that the environment will become contaminated – e.g. dental treatment area, shedding in a wound care clinic Standard Precautions: All Residents at all
Times #safepatientcare
Outpatient Settings 2
• In the outpatient setting the patient is considered the patient zone as the space and equipment is not exclusively dedicated to the patient for any prolonged time e.g. vaccination clinic
Standard Precautions: All Residents at all Times #safepatientcare
References• Pittet, D. (2004). The Lowbury Lecture: behavior in infection control. Journal of Hospital Infection, 58: 1 – 13.
• HSE (2015). Guidelines for Hand Hygiene in Irish Healthcare Settings. Update of 2005 guidelines.
• World Health Organisation (WHO) (2009). WHO guidelines on Hand Hygiene in Healthcare: First Global Patient Safety Challenge, clean care is safer care. WHO Press, Geneva.
• World Health Organisation (2009). Hand Hygiene: Why, How & When? http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf
• World Health Organisation (2012) Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities A Guide to the Application of the WHO Multimodal Hand Hygiene Improvement Strategy and the “My Five Moments for Hand Hygiene” Approach http://apps.who.int/iris/bitstream/10665/78060/1/9789241503372_eng.pdf?ua=1
• National Audits of Hand Hygiene Compliance in hospitals in Ireland (HPSC) 2015 Accessed August 27th 2015 http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/EuropeanSurveillanceofAntimicrobialConsumptionESAC/PublicMicroB/HHA/a1.html
Standard Precautions: All Residents at all Times #safepatientcare