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Hand Hygiene

Purpose

  • Effective hand hygiene is widely recognised as the single most important strategy for the prevention of healthcare associated infections.
  • Effective hand hygiene reduces or inhibits the growth of microorganisms and prevents the transmission of pathogens between patients and healthcare workers

Definition

Hand Hygiene is a general term referring to any action of hand cleansing. There are three ways hand hygiene can be performed:

  1. Applying a waterless antimicrobial hand rub to the surface of the hands e.g. alcohol based hand rub (ABHR). 
  2. Washing hands with the use of a water and soap or a soap solution, either non-antimicrobial or antimicrobial. 
  3. Use of the approved detergent wipes (this should always be followed with ABHR).

ABHR is gold standard for hand hygiene for all clinical situations where hands are visibly clean.

Wash with soap and water when hands are visibly dirty, when visibly soiled with blood or other body fluids, or when caring for patients with symptoms of gastroenteritis.

When there is no readily available access to hand washing facilities, the approved detergent wipes can be used, followed by ABHR. It is recommended to wash hands with soap and water as soon practical.

Indications

Five Moments for Hand Hygiene have been identified as the critical times when hand hygiene should be performed to protect:

  • Patients against acquiring infectious agents from the hands of healthcare workers
  • Patients from infectious agents (including their own) entering their bodies during procedures
  • Healthcare workers and the healthcare environment from acquiring patients’ infectious agents

“5 Moments for Hand Hygiene (Adapted by the Council of Ambulance Authorities)”

5momentsforhandhygiene

Moment 1:Examples:

Before Touching A Patient

  • To protect the patient against acquiring harmful micro-organisms from the hands of the healthcare worker
  • Shaking hands, assisting patient to move
  • Taking a pulse, taking a BP, chest auscultation, abdominal palpation, applying ECG electrodes
  • Applying an oxygen mask or fitting nasal cannula
  • Preparation and administration of oral medications
Moment 2:Examples:

Before a Procedure

  • To protect the patient from harmful micro-organisms from entering their body
  • Intravenous cannulation, intraosseous cannulation BGL, subcutaneous or intramuscular injections, cricothyrotomy, needle thoracocentesis
  • Insertion of an airway device
  • Preparation and administration of medications
  • Suctioning of the airways
  • Disconnecting vascular access giving sets
  • Wound/burn dressings
  • Obstetric procedures
Moment 3:Examples:

After a Procedure or Body Fluid Exposure

  • To protect the healthcare worker and the environment from harmful micro-organisms
  • After any moment 2
  • After contact with blood or any body fluid
Moment 4:Examples:

After Touching a Patient

  • To protect the healthcare worker and the environment from harmful micro-organisms
  • After any moment 1
Moment 5:Examples:

After Leaving the Patient's Environment

  • To protect the healthcare worker and the environment from harmful micro-organisms
  • When leaving the patient’s house
  • When leaving the bedside at the care facility or hospital
  • After touching the patient’s belongings

It is recognised in the pre-hospital setting there may be times in emergency situations where hand hygiene is secondary to patient safety, however once the risk has been resolved further deviation is not warranted.

Other opportunities to decontaminate hands include (but are not exclusive to): 

  • At beginning and end of shift
  • Before and after removal of gloves and other PPE
  • Before and after handling food
  • Before and after smoking
  • Before and after using the bathroom
  • After performing respiratory hygiene/coughing into hands 
  • Any time hands are visibly contaminated
  • After vehicle checking
  • After patient equipment/stretcher contact 
  • After cleaning equipment/vehicle
  • On entering (where practical) and leaving the Emergency Department

To minimize the possible barriers to hand hygiene

  • Keep fingernails short (i.e. the length of the finger pad) and clean. Nail varnish, artificial nails, extenders or tips are not to be worn.
  • Rings with ridges and stones must not be worn. A plain metal ring is acceptable.
  • It is recommended for all operational staff to be bare below the elbows however a wrist watch may be worn. The watch must be cleaned regularly and removed prior to washing hands with soap and water. It is advised that the watch be waterproof and made from a wipeable material, with a flat, smooth wrist band to minimize the risk of harboring pathogens.
  • Long sleeved jackets can easily become contaminated, and impede access to the wrist for hand hygiene. Long sleeved jackets must be removed, and sleeves shortened to mid forearm unless long sleeves are required as part of PPE such as the wearing of high visibility jackets, coveralls, helicopter paramedic uniform.

Hand/Skin Care

  • Healthy intact skin is an effective barrier against infection. It is important to take of your hands by using the correct hand hygiene method.
  • ABHR is recommended for routine hand hygiene, unless hands are visibly soiled.
  • Use warm water and not hot for hand washing.
  • Ensure hands are dried thoroughly after washing. Pat dry hands using a disposable paper towel.
  • Regularly use a hand moisturiser to prevent drying and cracking of the skin.
  • Cover cuts, abrasions and lesions with a water resistant, occlusive dressing and change as necessary whilst on duty.

Skin Irritation and Allergy

All clinical staff and volunteers are screened for skin irritation/conditions and latex sensitivity during the pre-employment interview process.

The main type of occupational skin irritation associated with hand hygiene is irritant contact dermatitis. Symptoms include dryness, irritation, itching, and sometimes cracking of the skin. Allergic contact dermatitis is rare and is due to an allergy from an ingredient in a hand hygiene product.

Report all skin conditions (e.g. dermatitis, allergic eczema, weeping lesions) to your Manager and seek medical advice from GP or attend a St John Health centre.

Staff who have skin conditions such as exudative lesions or weeping dermatitis should be removed from direct patient care until the condition resolves. Seek guidance from your Manager and Safety team.

Refer to Skin Irritation flowchart, adapted from Occupational Dermatology Research and Education Centre flowchart for healthcare workers

WHAT TO DO IF YOU HAVE SKIN IRRITATION
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Report problem to your Manager and Safety Team
  • This facilitates monitoring of skin problems across the organisation.
  • Report skin problems early to allow early intervention.
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Good Skin Care Practice

Use ABHR

Reduce handwashing (unless hands visibly soiled) and use ABHR where possible. ABHR may sting hands if split/cracked. It does not mean you are allergic to it. At home, use soap substitutes where possible.

Use Moisturiser

Moisturise hands regularly while at work – before the start of the shift, during meal breaks and at end of shift. Moisturise hands regularly at home.

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See GP or Attend a St John Health Clinic
If the previous advice has not improved your skin integrity, you will need to assessed by a doctor:
  1. You may need script for topical corticosteroid ointment or cream to apply to your hands.
  2. You may need to have a blood test to determine if you are allergic to latex (RAST).
  3. You may need some time off to let your skin heal, or a rostering change
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Referral to a Dermatologist
If there has still not been improvement, you may need a referral from your GP to see a dermatologist. You may be referred to a special clinic for patch testing. Patch testing is used to diagnose an allergy to something that your skin is coming into contact with.

References
References

Key Terms & Links

Further Reading:

Government of Western Australia. (2013). Operational Directive 0429/13 National Hand Hygiene Initiative in Western Australian Hospitals. Perth: Department of Health.

Hand Hygiene Australia. (2017). Retrieved from http://www.hha.org.au/

Occupational Dermatology Research and Education Centre. (2017). Retrieved from http://www.occderm.asn.au/

World Health Organization. (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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Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

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