Page title - Introduction to the online learning package
The Student Hand Hygiene Education Package has been developed to improve knowledge of hand hygiene practices required in clinical practice, prior to clinical placement as:
Effective hand hygiene is the single most important strategy in preventing healthcare associated infections
Hand Hygiene Australia aim to make hand hygiene "core business" for all healthcare workers
There are 3 modules in this program:
Module 1: Introduction to Hand Hygiene and the Patient
Module 2: Performing Hand Hygiene
Module 3: The 5 Moments for Hand Hygiene
Page title – Program Aims
The aims of the program are to:
Ensure students integrate evidence based practice related to hand hygiene into their clinical practices
Encourage awareness of personal hand hygiene practices
Educate students about outcomes for poor hand hygiene practices
On completion of the 3 modules you will have:
Completed an education package that is a part of the National Hand Hygiene
Initiative, a nationally endorsed program to improve hand hygiene practices in healthcare
Completed a hand hygiene education package which aligns with the World
Health Organisation - World Alliance for Patient Safety Campaign
The ability to identify the 5 Moments for Hand Hygiene in practice
The knowledge to incorporate sound hand hygiene practices into the clinical setting

Page title – Navigation Guide
A PDF version of each Student Hand Hygiene Education module can be found on the page which will allow you to refer to the contents of each package at any stage. Each document will include links to all the videos and references for further reading.
If you are completing this module on a public shared computer (e.g. library computer)
Once you commence a Module you will be unable to save your progress.
Therefore the entire module needs to be completed in one sitting to generate your certificate of completion.
If you are completing this module on a private computer
You cannot save your progress, however if you navigate away from the education module when you return to the webpage you will be given the option of
If you select you were last in
By selecting
you will be taken to the first page of the section
you will be taken back to the start
You can navigate through this program by:
Clicking on screen in the lower right hand corner to move to the next
Clicking on previous screen in the lower left hand corner to go back to the
Clicking on a number to move to a specific page in the section
Once all information pages have been read
Click on to move to the assessment section
It is anticipated that it will take approximately 45 minutes to complete this module

Page title – Assessment
Each learning module in this program has an online assessment component.
The assessment occurs between each section of a module. Once you have read each page of a section click on page.
which will start the assessment
Once all your answers have been entered press .
Each question must be successfully answered before you can progress to the next section. If you answer a question incorrectly you will be informed of the correct answer and will be asked to:
Review the section
Take the test again (the questions are randomly selected from the question pool)
At the end of each module you will be able to generate a certificate of completion.
Please follow the instructions on the congratulations page to generate a certificate successfully.
Page title – Module 1 – Learning Outcomes
Key Learning Outcome:
At the end of this module you will be able to recognise the value of hand hygiene practice in caring for patients in a clinical setting
Enabling Outcomes:
Recognise the effect of a healthcare associated infection on an individual
Appraise literature that informs evidence based practice in relation to hand hygiene in healthcare
Recognise the 5 Moments for Hand Hygiene
Demonstrate correct hand wash and hand rub techniques
Differentiate when to use ABHR vs. soap and water for hand hygiene
Recognise the effect jewellery, nails, and hand care have on hand hygiene
Demonstrate how to use gloves correctly with respect to hand hygiene
Now that you have completed this OLP Introduction please press the
button below to move to the next section.

Page title – A story from close to home
How Healthcare Associated Infections Can Impact on a Person's Life and Family
Page title – Healthcare Associated Infections
Healthcare associated infections (HAIs) are infections acquired in healthcare facilities and infections that occur as a result of healthcare interventions, which may manifest after people leave the healthcare facility
(1)
.
Each year in Australia there are about 200,000 HAIs
(2)
. Many of these infections are preventable. HAIs cause patients pain and suffering, and utilise valuable healthcare resources to manage. HAIs can cause significant harm to patients, some of whom die as a result. They can also prolong hospital stay, and create additional work for clinicians. Prevention of HAI is the responsibility of all healthcare workers (HCWs).
HAI is not considered an unpredictable ‘complication’, but rather a potentially preventabl e ‘adverse event’.
Many studies have identified that microorganisms implicated in HAI can be isolated from the normal intact skin
(3)
. These can be microorganisms present on the skin as resident flora, which live long term under the superficial cells of the epidermis. More commonly, they are part of the transient flora on the skin surfaces, which include bacteria, viruses and fungi that are acquired through direct skin contact (between patients, staff or visitors), or contact with contaminated environmental surfaces
(shared patient equipment, curtains etc).
These microorganisms can be easily transmitted from the hands of HCWs to patients or their environment. Microorganisms exist everywhere in the environment, but not all cause infection.
Colonisation is the sustained presence of replicating infectious agents on or in the body without the production of an immune response (infection) or disease, and is a potential source of transmission.
Infection is the successful transmission of microorganisms to the host with subsequent multiplication, colonisation and invasion. Infection may be clinical or subclinical and may not produce identifiable disease.
Patients particularly vulnerable to colonisation and HAI include those with severe underlying medical disease, recent surgery or indwelling devices, such as urinary catheters or endotracheal tubes.

Whether you work on the wards, visit a clinic or make a home visit, you are as capable of transmitting an infection as all other healthcare workers.
The hands of HCWs are the single most important source of preventable healthcare associated infections.
HCWs can unknowingly transmit microorganisms they have picked up on their hands from a previous patient contact or contact with the environment to the next patient or their environment if they do not perform hand hygiene in-between.

Page title – What is hand hygiene
Hand hygiene is the single most effective action to reduce healthcare associated infections (HAI).
Hand hygiene is a general term referring to any action of hand cleansing.
Hand hygiene includes o Washing hands with the use of a water and soap or a soap solution, o either non-antimicrobial or antimicrobial
OR
Applying a waterless antimicrobial hand rub to the surface of the hands
(e.g. alcohol-based hand rub).
When performed correctly, hand hygiene results in a reduction of microorganisms on hands.
Page title – The Patient’s Experience
VQC video
Page title – What can I use for Hand Hygiene?
When your hands are visibly clean When your hands are visibly soiled
An alcohol based handrub Soap and water
Dispense enough ABHR to cover your hands, then continue to rub until your hands are completely dry
Wash hands with soap and water and ensure you dry your hands thoroughly after washing them

Page title – Why use alcohol based hand rub?
A systematic review (1) of publications between 1992 and 2002 on the effectiveness of alcohol based solutions for hand hygiene showed the advantages of using alcohol based hand rubs when hands are visibly clean instead of handwashing are that they:
Substantially reduce bacterial count on hands
Require less time than handwashing
Are more accessible
Are self drying
Are gentler on skin and cause less skin irritation and dryness than frequent soap and water washes
Alcohol based hand rub has been a component of hand hygiene guidelines since
1995 in the USA (2). Since 2002 use of alcohol based hand rubs has been the recommended product for hand hygiene in healthcare settings. Hand washing should be reserved for particular situations only (3) (i.e. when hands are visibly soiled).
Most alcohol based hand rubs contain either ethanol, isopropanol or n-propanol, or a combination of these products. The antimicrobial activity of alcohols result from their ability to denature proteins. Alcohol based hand rubs have excellent antimicrobial activity against Gram positive and Gram negative vegetative bacteria, and good antimicrobial activity against enveloped viruses. Alcohol solutions containing 60-80% alcohol are most effective. It has been well established that alcohols effectively reduce the bacterial counts of hands better than soap and water (1).

Page title – Where should alcohol based hand rub be placed?
Ensuring Alcohol Based Hand Rub is available at the "point-of-care" improves hand hygiene compliance.
Point of Care Locations often include:
On the foot end of every patient bed where practicable
On mobile work trolleys (BP machines etc)
In high staff traffic areas such as the entry to the ward or department, nurse’s station, pan room, medication room & at the entrance to each patient room
Multi-use patient-care areas such as examination rooms, outpatient Consultation rooms
& gyms
Entrance to each ward, outpatient clinic or Department
Public areas such as waiting rooms, receptions areas, hospital foyers, near elevator - in high traffic areas
The placement of Alcohol Based Hand Rub needs to be aligned with a risk assessment of the client population e.g. Mental Health or Drug & Alcohol Units
"Point of Care"
The place where three elements come together: the patient, the healthcare worker, and the care or treatment involving contact with the patient or his/her surroundings. A hand hygiene product should be easily accessible and as close as possible - within arm’s reach of where patient care or treatment is taking place. Point of care products should be accessible without having to leave the patient zone.
Page title – How to Hand Wash
Animation

Page title – How to Hand Rub
Animation
Page title – Nails
A growing body of evidence suggests that wearing artificial nails contributes to the transmission of healthcare associated pathogens.
HCWs with artificial nails are more likely to harbour Gram negative pathogens on their fingertips than those who have natural nails, both before and after handwashing
(5-8)
or handrub
(5)
Artificial or false nails have been associated with higher levels of infectious agents, especially Gram-negative bacilli and yeasts, than natural nails
(9)
and have been implicated in several outbreaks of infection
(10-14)
Freshly applied nail polish does not increase the number of bacteria recovered from nails, but chipped nail polish may support the growth of larger numbers of organisms on fingernails
(15-16)
Artificial, painted and chipped nails should not be worn in clinical areas as they can harbour microorganisms and are linked with outbreaks of infections
(17)
WHO Consensus recommendations are that HCWs do not wear artificial
Page title – Jewellery
The WHO recommendations strongly discourage the wearing of hand and wrist jewellery, because:
Jewellery can inhibit your ability to perform correct hand hygiene. Observations have shown that most healthcare workers do not remove their jewellery when performing hand hygiene, and thus cannot perform correct hand hygiene technique.
Several studies have shown that skin underneath rings is more heavily colonised than comparable areas of skin on fingers without rings
(1,19-21)
Rupp et al found that having longer fingernails and wearing rings were associated with increased numbers and species of organisms on hands
(20)
Therefore remove excess jewellery prior to work (18)

Page title – Skin Care
Intact skin is a first line defence mechanism against infection.
Damaged skin can not only lead to infection, but can also harbour higher numbers of microorganisms than intact skin and hence increase the risk of transmission of these microorganisms to others. When HCWs have damaged skin they may be colonised by healthcare associated microorganisms and may become a vehicle for disseminating these organisms. Any damaged skin must be appropriately covered before work begins in any clinical area. To protect your skin use a healthcare supplied moisturiser regularly
Chapped and dry cracked hands can increase your risk of colonisation with potential pathogens (5, 22)
Use of an oil-containing lotion or a barrier cream three times a shift can substantially protect the hands of vulnerable healthcare workers against drying and chemical irritation, preventing skin breakdown (23)
The need for moisturising products will vary across healthcare settings, geographical locations and respective climate conditions, and individuals (1).
Improved skin condition from the frequent use of a skin moisturiser can lead to improved hand cleansing frequency among HCWs (23)
If you notice any significant changes in your skin condition report your concerns to your university health or OHS department
Hand hygiene technique should be reviewed if skin irritation occurs (11, 24)
If irritation persists, or if it is caused by a particular soap, antiseptic agent, or
ABHR, the person designated responsibility for infection control or occupational health should be consulted (11)
WHO consensus recommendation on skin care:
Provide HCWs with hand lotions or creams to minimise the occurrence of irritant contact dermatitis associated with hand antisepsis or handwashing
Provide alternative hand hygiene products for HCWs with confirmed allergies or adverse reactions to standard products used in the healthcare setting

Page title – Gloves
Inappropriate glove use undermines all efforts to sustain correct hand hygiene according to the 5 Moments.
There are two main indications for wearing gloves in the clinical setting. To :
1.
2.
Reduce the risk of contamination of HCWs hands with blood and other body fluids
Prevent the transmission of infectious microorganisms via the healthcare workers hands to the environment, to the patient, as well as from one patient to another.
Wearing gloves does not replace the need for hand hygiene. Gloves do not provide complete protection against hand contamination. Pathogens may gain access to the
HCWs hands via small defects in gloves, or by contamination of the hands during glove removal. Bacterial flora colonising patients may be recovered from the hands of ~ 30% of HCWs who wear gloves during patient contact (25)
When should gloves be changed?
Between episodes of care for different patients, to prevent transmission of infectious material
During the care of a single patient, to prevent cross-contamination of body sites
If the patient interaction involves touching portable computer keyboards or other mobile equipment that is transported from room to room
Sterile gloves must be used for surgical ANTT procedures and contact with sterile sites
Hand hygiene is required with glove use:
HH should be performed before putting on gloves
HH should occur after removing gloves
Gloves should be removed to perform HH during the care for a single patient as indicated by the 5 Moments for Hand Hygiene
Single use gloves should not be washed, but discarded.
Further Reading:
Further information about the use of gloves and personal protective equipment
(PPE) can be found in
NHMRC. Australian Guidelines for the Prevention and Control of Infection in
Healthcare. Commonwealth of Australia; 2010.
World Health Organisation. WHO Guidelines on Hand Hygiene in Health
Care. In: World Alliance for Patient Safety, editor. First Global Patient Safety
Challenge Clean Care is Safer Care. 1 ed. Geneva: World Health
Organisation Press; 2009.

Always ask yourself:
Why am I wearing gloves?
Who am I trying to protect?
Would frequent hand hygiene be better?
Page title – 5 Moments for Hand Hygiene
The 5 Moments for Hand Hygiene is an evidence based framework developed by the
WHO, and adapted by HHA, detailing when hand hygiene should be performed in the healthcare setting. The 5 Moments for Hand Hygiene:
Protect patients against acquiring infectious agents from the hands of the healthcare worker
Help to protect patients from infectious agents (including their own) entering their bodies during procedures
Protect healthcare workers and the healthcare surroundings from acquiring patients’ infectious agents.
The 5 Moments for Hand Hygiene are:
1.
2.
3.
4.
5.
Before touching a patient
Before a procedure
After a procedure or body fluid exposure risk
After touching a patient
After touching a patient's surroundings

Page title – The 5 Moments for Hand Hygiene Explained
Video
Page title – The 5 Moments for Hand Hygiene in Action
Video
Page title – Hand Hygiene Student Package
After you complete the final quiz for this Module and print your certificate please click on the Student Health Practitioners Link on the left hand menu to return to the
Student page. Then you are able to start Module 2.
You have not completed the Student Hand Hygiene Online Learning Package until you have completed both Module 1 and 2.
Page title – Summary of Module 1
After you complete the final quiz for this Module and print your certificate please click on the Student Health Practitioners Link on the left hand menu to return to the Student page. Then you are able to start Module 2.
You have not completed the Student Hand Hygiene Online Learning Package until you have completed both Module 1 and 2.
A healthcare associated infection (HAI) is defined as an infection that was not present at the time of hospital admission/ healthcare attendance, but was acquired via the delivery of healthcare
Each year in Australia there are about 200,000 HAIs. HAIs cause patients pain and suffering, and use up valuable healthcare resources.
Microorganisms can be easily transmitted from the hands of healthcare workers
(HCWs) to patients or their environment. Microorganisms exist everywhere, but not all cause infection.
Hand hygiene is considered to be the single most important intervention to prevent healthcare associated infections.
Regular and correct hand hygiene reduces the number of organisms on the hands and limits the spread of these microorganisms.

Prevention of infection must always be the priority of all healthcare workers and, as such, is a key component of patient safety programs. Cleaning your hands before & after touching a patient is one of the most important measures for preventing the spread of microorganisms.
Use an alcohol based hand rub for hand hygiene when hands are not visibly soiled
If hands are visibly soiled, wash hands with soap and water and dry them thoroughly.
Use alcohol based hand rubs because they - require less time than handwashing, are easily accessible, self drying, reduce bacterial counts on hands more than soap and water, and are less irritant on skin than handwashing
Alcohol based hand rubs should be found at the "point of care" - where practicable at the end of every patient bed
When performing hand hygiene ensure all surfaces of the hands and wrists are cleaned
A correct hand wash should take between 40-60 sec
A correct hand rub should take 20-30 sec
Artificial, painted and chipped nails should not be worn in clinical areas as they can harbour microorganisms and are linked with outbreaks of infections
The WHO consensus recommendation is to strongly discourage the wearing of rings or other jewellery during healthcare as jewellery can inhibit your ability to perform correct and effective hand hygiene.
Damaged skin can not only lead to infection, but can also harbour higher numbers of microorganisms than intact skin and hence increase the risk of transmission to others. To protect your skin use a healthcare supplied moisturiser regularly.
The use of gloves does not replace the need for hand hygiene by either hand rubbing or hand washing
Wear gloves when you anticipate contact with blood or other potentially infectious materials, mucous membranes, or non-intact skin
Studies have shown that there is minimal rates of cutaneous alcohol absorption from
ABHR
The 5 Moments for Hand Hygiene are:
1.
Before touching a patient
2.
Before a procedure
3.
After a procedure or body fluid exposure risk
4.
After touching a patient
5.
After touching a patient's surroundings

HAI prevention is best achieved by performing hand hygiene as per the 5 Moments within the patient zone
There are two critical sites where hand hygiene is imperative, clean sites where there is a risk of passing germs to the patient, and body fluid sites where germs can be taken away on the hands of HCWs.
After you complete the final quiz for this Module and print your certificate please click on the Student Health Practitioners Link on the left hand menu to return to the Student page. Then you are able to start Module 2.
Page title – References
Please see References on HHA Student Home Page