AHRQ Safety Program for Long-Term
Long-term Care: HAIs/CAUTI
The How-Tos of Hand Hygiene
Training Module 1 for All Long-term Care Staff
Objectives
Upon completion of this training module, long-term
care staff will be able to demonstrate a working
knowledge of:
• Why hand hygiene is so important to prevent the spread
of infections
• When and how to perform hand hygiene
• Key hand hygiene practices for prevention of health careassociated infections (HAI), particularly catheterassociated urinary tract infections (CAUTI)
2
Health Care Workers’ Hands Spread Infections
• 1-3 million serious infections estimated to occur every year in U.S. nursing homes
• Hand hygiene is one of most important ways to prevent the spread of infections
HCW Hand Colonization Following Routine Resident Care
70
Percent colonization
60
50
40
30
20
10
0
Gram-negative bacilli
Candida sp
Staph. aureus
Vancomycin-resistant
enterococci
Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674. Centers for Disease Control and Prevention. Guideline for Hand Hygiene
in Health-care Settings. MMWR 2002; vol. 51, no. RR-16. Mody et al Infect Control Hosp Epidemiol; 2003:24:165-171
3
Simplifying the Moments for Hand Hygiene
Adapted from World Health Organization Guide on Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities. Just Clean Your Hands Educational
Resources: http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands/Pages/JCYH-ltch-Education-and-training.aspx
4
Alcohol-Based Hand Rub (ABHR)
Hand Hygiene Technique
• Apply hand rub to palm of hand
• Rub hands together, covering
all surfaces
• Focus on thumbs, tips of
fingers, and under fingernails
• Hands are clean when dry
– Usually takes about 15-20
seconds
http://www.cdc.gov/handhygiene/Resources.html#HCP
5
Soap and Water Hand Washing
Hand Hygiene Technique
• Wet hands with water
• Apply soap to palm of hand
• Rub hands together, covering all
surfaces for at least 15 seconds
• Rinse hands with water
• Dry hands with paper towel and
use towel to turn off faucet
– Paper towel prevents hands from
being re-contaminated by faucet
handles
http://www.cdc.gov/handhygiene/Resources.html#HCP
6
Notes About Hand Hygiene Products
• Alcohol-based hand rubs/gels are preferred for hang
hygiene when hands are not visibly soiled or dirty
• Times when hands should be washed with soap (nonantimicrobial or antimicrobial) and water:
– When hands are visibly dirty, contaminated or soiled
– After care with residents with infectious diarrhea
Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
7
Efficacy of Hand Hygiene Preparations
in Killing Bacteria
Good
Plain soap
Better
Antimicrobial
soap
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
Best
Alcohol-based
hand rub
8
Hand Hygiene and C. diff
• Hand hygiene with soap and water is superior at removing the
spore form of C. diff
• AHBR is more effective for hand disinfection with all other
organisms
• No studies linking ABHR use with an increase in C. diff infection
• Encourage soap and water after care of residents with acute
diarrhea and use of gowns/gloves to prevent spore contamination
of hands
Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944.
Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628-645
9
Important Points About Glove Use
• Gloves play a key role in preventing hand
contamination—but do NOT replace hand hygiene
• Change gloves during care when moving from a
contaminated body site to a clean body site
• Do not wear the same pair of gloves for the care of more
than one resident
• Remove and discard gloves after use
• Do not wash gloves
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16
10
Hand Hygiene Before Urinary Catheter Care
Perform hand hygiene and wear gloves immediately before:
• Placing or removing an indwelling catheter
• Accessing the drainage system to empty the drainage bag or collect a urine
sample
Why?
•
Interacting with the resident or environment
before handling the urinary device may
contaminate hands
•
Reaching for gloves with unclean hands may
contaminate the glove box and outside of the
gloves
•
Then, gloves will contaminate the urinary
catheter or urine collection system
11
Hand Hygiene After Urinary Catheter Care
Remove gloves and perform hand hygiene immediately after:
•
Handling an indwelling catheter
•
Accessing the drainage system to empty the drainage bag or collect a
urine sample
Why?
•
Hand contamination may occur as a result of small
undetected holes in gloves
•
Hand contamination may occur during glove
removal
•
Hand hygiene protects your hands and the
environment from being contaminated
12
Hand Hygiene Case Scenarios
Let’s chat!
Review the three hand hygiene case scenarios as a group. As
you discuss them, think about the following questions:
•
Does our facility staff experience similar challenges to performing
hand hygiene at the appropriate times? Why or why not?
•
What could our facility do to reduce barriers to hand hygiene?
•
How can I help support a culture of safety around improving hand
hygiene in our facility?
13
Take the Pledge…
14
Stay Updated with Useful Resources
AHRQ Safety Program for Long-term Care: HAIs/CAUTI website
Login information
Username: ltcsafety
Password: ltcsafety
TeamSTEPPS® for Long-term Care
Take the Pledge
World Health Organization How to Handrub Poster
World Health Organization How to Handwash Poster
15
References
Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings.
MMWR 2002; vol. 51, no. RR-16.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm
Centers for Disease Control and Prevention. Hand Hygiene Resources.
http://www.cdc.gov/handhygiene/Resources.html#HCP
Dubberke E et al. SHEA/IDSA Practice Recommendation. J Infect Hosp Epidemiol 2014;35(6):628645.
Mody et al. Infect Control Hosp Epidemiol; 2003:24:165-171.
Oughton MT et al. J Infect Hosp Epidemiol 2009;30(10):939–944.
Strausbaugh LJ, Joseph CL. Infect Control Hosp Epidemiol. 2000;21:674.
World Health Organization Guide on Hand Hygiene in Outpatient and Home-based Care and
Long-term Care Facilities. Just Clean Your Hands.
http://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/JustCleanYourHands
/Pages/JCYH-ltch-Education-and-training.aspx
16