• 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
  

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 hand wipes

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 hand wipes can be used. It is recommended to wash hands with soap and water as soon practical.

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)”

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.

The Council of Ambulance Authorities has developed guidance for the zones of hand hygiene in the pre-hospital setting to determine when hand hygiene is needed. Performing hand hygiene when moving between zones will minimise the risk of contamination of patient care equipment and areas of the ambulance, and reduce cross contamination between patients and Ambulance personnel.

Prior to departure

An ambulance or transport vehicle is considered a Clean Health Care Worker Zone (green) when entering to attend a case. Always perform hand hygiene prior to entering a Clean Health Care Worker Zone (your vehicle). Hand hygiene prior to entering this area ensures there is no cross contamination from your previous activities to your clean area, and your patient.

On scene

A patient’s house, or the area they are located is considered a Patient Zone (red). Perform hand hygiene when entering these areas to protect patients from transmission of pathogens on your hands. After touching the patient zone, perform hand hygiene prior to touching any response kit equipment or defibrillator in order to reduce cross contamination to your Healthcare Worker Zone. Perform hand hygiene when leaving the Patient Zone to prepare for departure.

During transit

The front of the vehicle is considered a Clean Healthcare Worker Zone (green) and typically shouldn’t contain infectious pathogens. The Patient Zone (red) is considered contaminated and includes any devices attached to a patient or any surfaces they may have touched. Areas where healthcare workers access or where medical consumables or equipment is stored is considered a Healthcare Worker Zone (yellow). Hand hygiene must be conducted with any movement between these zones to prevent cross contamination for patient and staff safety.

At the hospital

The Patient Zone (red) is considered to be any area where the patient can touch or would have personal items, and should be considered contaminated. The Healthcare Worker Zone (yellow) is where medical equipment and consumables are stored. Hand hygiene between entering and departing these two areas is essential to avoid the contamination of the patient into the Healthcare Worker Zone and vice versa.

Following handover

Once a patient has left the vehicle, the entire back area is now considered a Patient Zone (red) and you will require hand hygiene upon entering and departing. This includes prior to applying and doffing gloves when cleaning and post cleaning the vehicle. The front of the vehicle is still considered a Clean Healthcare Worker Zone (green) and hand hygiene prior to entering this area is still required.
Follow these steps in order to prevent cross infection between patients and improve staff safety.

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 minimise 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 personnel 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 minimise the risk of harbouring 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 line Manager and seek medical advice from GP or Specialist.

Staff who have skin conditions such as exudative lesions or weeping dermatitis should be removed from direct patient care until the condition resolves.

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