HealthStream Regulatory Script
Hand Hygiene
Release Date: June 2011
HLC non-CE Version: 603
HLC CE Version: 1
Lesson 1:
Lesson 2:
Lesson 3:
Lesson 4:
Introduction
Background & History
Importance of Hand Hygiene
Handwashing & Hand Antisepsis
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on hand hygiene.
As your partner, HealthStream strives to provide its customers with excellence
in regulatory learning solutions. As new guidelines are continually issued by
regulatory agencies, we work to update courses, as needed, in a timely
manner. Since responsibility for complying with new guidelines remains with
your organization, HealthStream encourages you to routinely check all relevant
regulatory agencies directly for the latest updates for clinical/organizational
guidelines.
If you have concerns about any aspect of the safety or quality of patient care in
your organization, be aware that you may report these concerns directly to The
Joint Commission.
Page 1 of 4
2
1002
Course Rationale
According to the Centers for Disease Control and
Prevention (CDC), proper hand hygiene is the single most
important way to stop the spread of infection.
This course will teach you how to do your part in:
• Promoting proper hand hygiene
• Helping to prevent the spread of infection in your
facility
You will learn about:
• The history of hand hygiene
• Why hand hygiene is so important
• How to keep your hands as clean and germ-free as
possible
Reference 1
Page 2 of 4
1003
Course Goals
After completing this continuing education activity, you should
be able to:
• List important milestones in the history of hand hygiene
that relate to current guideline recommendations for
patient safety.
• Recognize why hand hygiene in the healthcare setting
is important to control the spread of infection.
• Identify best practices for hand hygiene to control the
spread of infection and improve patient outcome.
NO IMAGE
Page 3 of 4
1004
Introduction
This introductory lesson gave the course rationale and goals.
Lesson 2 gives a brief background and history on hand
hygiene.
Lesson 3 discusses the importance of hand hygiene in the
healthcare setting.
Finally, lesson 4 describes best practices for hand hygiene.
Lesson 1: Introduction
Lesson 2: Background & History
• Early experiences with hand hygiene
• Hand hygiene guidelines
Lesson 3: Importance of Hand Hygiene
• Healthcare-associated infection
• Bacterial flora
• Risk of contamination & cross-contamination
Lesson 4: Handwashing & Hand Antisepsis
• Hand hygiene products
• Soap & water
• Alcohol rubs
• Surgical hand hygiene
• Other hand hygiene practices
Page 4 of 4
Lesson 2: Background & History
2001
Introduction
Welcome to the lesson on background and history of hand
hygiene.
Lesson 2: Background & History
• Early experiences with hand hygiene
• Hand hygiene guidelines
This lesson will discuss early experiences with hand hygiene
and the importance of complying with current guidelines.
Page 1 of 10
2002
First Evidence
In the 1800s, medical professionals first saw evidence of
the importance of hand decontamination.
In 1846, Ignaz Semmelweis noticed that many women
developed childbed fever [glossary] and died after
delivering babies in the clinic in Vienna where he worked.
References 1, 2
Page 2 of 10
2003
Cadaverous Particles
Semmelweis also noticed that physicians and students had
an odor on their hands when they left the autopsy area.
He guessed that healthcare workers were carrying
“cadaverous particles” from dead bodies to obstetric
patients. He thought these particles must carry disease.
This was happening even though workers washed their
hands with soap and water before leaving the autopsy
area.
References 1, 2
Page 3 of 10
2004
New Policy
In 1847, Semmelweis began a new policy.
Clinic workers would now clean their hands with a
chlorine solution between patient contacts.
After this policy was put in place, maternal death rates in
the clinic dropped.
This gave the first evidence of the importance of
disinfecting [link to glossary] hands between patient
contacts.
Disinfecting decreased the spread of disease more
effectively than handwashing with plain soap and water.
References 1, 2
Page 4 of 10
2005
Early Guidelines
In short, clinicians were looking at the importance of
disinfecting hands as early as the middle 1800s.
However, this did not affect early hand hygiene guidelines.
Until 1995, guidelines for hand hygiene in the United States
focused on the use of plain soap and water.
References 1, 3, 4
Page 5 of 10
2006
HICPAC Guidelines
In 1995, the Healthcare Infection Control Practices Advisory
Committee (HICPAC) first recommended hand antisepsis
[glossary].
After contact with a patient infected with a drug-resistant
[glossary] pathogen, healthcare workers were advised to
decontaminate their hands with either:
• Antimicrobial soap and water
• A waterless antiseptic agent
Reference 4
Page 6 of 10
2007
CDC Guidelines
Finally, in 2002, the CDC released an extensive Guideline for
Hand Hygiene in Health-Care Settings. The World Health
Organization (WHO) also published a guideline for hand
hygiene in 2009.
Both of these guidelines recommend alcohol-based hand rubs
for routine decontamination of hands in most clinical
situations.
Note: The Joint Commission allows hospitals to follow either
the CDC or WHO guideline recommendations. This course
will discuss CDC recommendations.
References 1, 5
Page 7 of 10
2008
Adherence to Guidelines
Many healthcare workers have poor compliance with
recommended practices. Compliance is still not at the level
needed for patient safety for several reasons.
These include:
• Skin irritation and dryness caused by washing hands
• Not enough sinks for washing hands
• Inconvenient location of sinks
• Not enough time to wash hands
• Individual preferences or habits
• Ignorance about the need for hand hygiene
Regardless of the reason, poor compliance increases the risk
of spreading infection.
References 5, 9
Page 8 of 10
2009
Review
Select the answer that best fits the question.
[CORRECT ANSWER: B]
The observations of Ignaz Semmelweis suggested that:
[RESPONSE FOR A: Incorrect. The correct answer is B.]
a. Washing with soap and water removes all germs from
the hands.
b. Germs remain on the hands even after washing with
soap and water.
c. More germs remain on the hands after cleaning with a
chlorine solution than after washing with soap and
water.
d. Both B and C
e. All of the above
[RESPONSE FOR B: Correct.]
[RESPONSE FOR C: Incorrect. The correct answer is B.]
[RESPONSE FOR D: Incorrect. The correct answer is B.]
Page 9 of 10
2010
Summary
You have completed the lesson on background and history.
NO IMAGE
Remember:
• In the 1800s, medical professionals first saw evidence
of the importance of disinfecting hands. Disinfecting
was more effective in preventing the spread of disease
than washing with plain soap and water.
• Over the years, there have been various guidelines for
hand hygiene in healthcare.
• Many healthcare workers do not comply with
recommended practices. This increases the risk of
spreading infection.
Page 10 of 10
Lesson 3: Importance of Hand Hygiene
3001
Introduction
Welcome to the lesson on the importance of hand hygiene.
This lesson will discuss tasks that put caregivers at risk of
hand contamination. The role of hand antisepsis in blocking
cross-contamination also will be discussed.
Lesson 3: Importance of Hand Hygiene
• Healthcare-associated infection
• Bacterial flora
• Risk of contamination & cross-contamination
Page 1 of 17
3002
Preventing the Spread of Disease
Remember: Medical professionals first saw the importance of NO IMAGE
disinfecting hands in the 1800s.
Disinfecting was more effective in preventing the spread of
disease than washing with soap and water
Preventing the spread of disease is just as important today as
it was in the 1800s.
Reference 1
Page 2 of 17
3003
Healthcare-Associated Infection
According to the CDC, each year in the United States, an
estimated 1.7 million hospitalized patients develop healthcareassociated infections (HAI).
Of these, up to 99,000 die as a result of the HAI.
Fortunately, proper hand hygiene can help:
• Stop outbreaks of HAI in healthcare facilities
• Decrease the overall HAI rate
Reference 10
Page 3 of 17
3004
Patient Care Tasks & Contamination
Most healthcare workers are aware of the risk of infection
during activities such as:
• Contact with a patient’s blood or body fluids
• Care of an infected or draining wound
• Intravascular catheter care
• Respiratory tract care
• Handling of patient secretions
• Changing diapers
But are you aware of the risk of infection with “clean” patient
care tasks?
Reference 10
Page 4 of 17
3005
Clean Patient Care Tasks & Contamination
Studies have shown that the hands of a caregiver can become
contaminated during routine, non-invasive, “clean” patient
care.
For example, contamination can result from:
• Lifting a patient
• Taking a pulse, blood pressure, or oral temperature
• Touching a patient’s hand, shoulder, groin, or other
body area
• Feeding an infant
• Playing with an infant
• Touching items in a patient’s room
How does this contamination happen?
Let’s answer this question by first considering the human
body’s flora.
References 1, 11, 12
Page 5 of 17
3006
Bacterial Skin Flora
“Flora” is the bacteria and other microbes that normally live
in and on our bodies.
All people carry millions of bacteria.
This includes you and your patients.
Let’s focus on skin flora.
Reference 13
Page 6 of 17
3007
Where Flora Live
Skin flora is often found in high numbers on the hands of
healthcare workers.
In most people, skin flora tends to be most concentrated in
the:
• Perineal [link to glossary] area
• Groin
• Armpits
• Trunk
• Arms
Reference 13
Page 7 of 17
3008
What Flora Do
Most of the body’s bacterial flora does not cause disease in
healthy people.
However, potentially pathogenic [glossary] bacteria can be
present.
For example, Staphylococcus aureus is common on intact
skin.
Reference 13
Page 8 of 17
3009
Colonization
Staph and other potentially pathogenic bacteria can live on the skin
for a long time without causing infection.
This long-term presence without infection is called colonization.
Reference 13
Page 9 of 17
3010
Shedding
Both you and your patients are likely to have some bacterial
colonization of intact skin. In addition, all people shed skin
with large amounts of viable [link to glossary] bacteria,
every day.
Thus, bacteria on a patient’s skin are also likely to
contaminate the patient’s:
• Gown
• Bed linens
• Bedside furniture
• Equipment
• Other nearby items
Bacteria are also likely to contaminate your:
• Hands
• Clothing
Reference 14
Page 10 of 17
3011
Contamination Risk
In short: Bacteria are everywhere, on and around you and
your patients.
As a result, there is a high risk that your hands will become
contaminated, even during “clean” patient care activities.
Page 11 of 17
3012
Cross-Contamination
When your hands become contaminated from one patient,
other patients are at risk for cross-contamination.
Cross-contamination happens as follows
1. Bacteria are present on a patient’s skin or items.
2. A healthcare worker touches the patient’s skin or
items. Flora is transferred to the worker’s hands.
Note that this transfer is especially likely if the skin
is wet.
3. The transferred flora survives on the worker’s hands
for several minutes.
4. The worker does not wash or decontaminate his or
her hands adequately.
5. The hands of the worker contact another patient.
This transfers bacteria to the second patient.
Note: A healthcare worker can also transfer bacteria to the
surrounding environment. A patient can then become
infected by touching the contaminated surface.
Reference 15
Page 12 of 17
3013
Cross-Contamination Risks
Remember: Bacteria are everywhere!
With this in mind, let’s think about the likelihood of each of
the steps in the process of cross-contamination.
Review the table to the right.
As you can see, all steps are likely, except for step 4:
inadequate handwashing.
This step depends on the healthcare worker.
In other words, the best way to block crosscontamination is to always disinfect hands between
patient contacts.
Reference 15
Page 13 of 17
3014
What about Gloves?
In certain cases, gloves should be used during patient care.
In these cases, gloves help to prevent:
• Transfer of microbes from caregiver to patient
• Transfer of microbes from patient to caregiver
• Cross-contamination between patients (if gloves are
properly removed and replaced between patient
contacts)
However, keep in mind that gloves and hand hygiene do not
replace one another.
Both should be used, as appropriate.
References 1, 15-17
Page 14 of 17
3015
5 Moments for Hand Hygiene
There are “5 Moments for Hand Hygiene.” They are:
1 Before patient contact
2 Before clean/aseptic tasks
3 After body fluid exposure risk
4 After patient contact
5 After contact with the patient’s environment
1
Before patient contact
2
Before clean/aseptic tasks
3
After body fluid exposure risk
4
After patient contact
5
After contact with the patient’s environment
Reference 5
Page 15 of 17
3016
Review
Select the answer that best fits the question.
[CORRECT ANSWER: D]
Choose the true statement(s):
a. S. aureus is common on intact skin.
b. Bacterial colonization always leads to infection.
c. Viable bacteria are shed with the skin every day.
d. Both A and C
e. All of the above
[RESPONSE FOR A: Not quite. The correct answer is
D.]
[RESPONSE FOR B: Incorrect. The best answer is D.]
[RESPONSE FOR C: Not quite. The best answer is D.]
[RESPONSE FOR D: Correct.]
E: Incorrect. The correct answer is D.
Page 16 of 17
3017
Summary
You have completed the lesson on the importance of hand
hygiene.
NO IMAGE
Remember:
• A caregiver’s hands may become contaminated
during “clean” patient-care tasks.
• All people have millions of bacteria in and on their
bodies at all times.
• Potentially pathogenic bacteria such as S. aureus
can be common on intact skin.
• Viable bacteria are shed with the skin every day.
This contaminates nearby items.
• Cross-contamination happens when a healthcare
worker spreads bacteria from one patient to
another.
• Cross-contamination may also occur from
equipment to healthcare workers and then to
patients.
• Proper hand antisepsis between patient contacts is
the best way to block cross-contamination.
• Gloves and hand hygiene do not replace one
another. Each should be used when appropriate to
prevent the spread of disease.
Page 17 of 17
Lesson 4: Handwashing and Hand Antisepsis
4001
Introduction
Welcome to the lesson on handwashing and hand
antisepsis.
This lesson will discuss hand hygiene products and their
use. Handwashing and decontamination will also be
covered.
Lesson 4: Handwashing & Hand Antisepsis
• Hand hygiene products
• Soap & water
• Alcohol rubs
• Surgical hand hygiene
• Other hand hygiene practices
Page 1 of 26
4002
Products
Products used for hand hygiene are:
• Non-antimicrobial (plain) soap
• Antimicrobial soap and non-alcohol
antiseptics
• Alcohol-based products
Click on each of the products to learn more.
Reference 1
Plain soap
Plain soaps are detergent-based. They remove dirt, soil, and organic
substances from hands. These soaps have little activity against microbes.
However, they can help remove loosely clinging skin flora.
Antimicrobial soaps and non-alcohol antiseptics
These products contain one or more antimicrobial agents. Each class of
antimicrobial agent has a unique spectrum [link to glossary]. Depending on
its spectrum, an agent may be active against:
• Gram-positive bacteria
• Gram-negative bacteria
• Mycobacteria
• Fungi
• Viruses
Iodine compounds and iodophors are the antimicrobial agents with the
broadest spectra. Quaternary ammonium compounds are least effective
against most types of microbe.
Alcohol-based products
These products include hand rinses, gels, and foams. They contain
isopropanol, ethanol, or n-propanol. All of these alcohols are highly
effective antimicrobial agents with activity against a broad spectrum of
microbes. Alcohol-based products are more effective than plain soap or
antimicrobial soap for standard hand hygiene in the healthcare setting. In
addition, they address some of the obstacles to hand hygiene that
healthcare workers face. Therefore, the CDC currently recommends
alcohol rubs for routine hand decontamination.
Page 2 of 26
4003
Products
The table here provides more detailed information about available hand hygiene preparations.
[[V/O for table – to be included same audio file as sentence above]]:
Notice that alcohols effectively reduce bacterial counts on hands and can prevent transmission of healthcare-associated
pathogens. Alcohol is more effective than soap. However, alcohol is not effective against all viruses. As we will discuss, use of
alcohol for hand hygiene is not appropriate when the hands are visibly soiled and can cause drying of the hands. Efficacy is
affected by contact time and may vary with formulation. It is important to note that alcohol is flammable.
Hand Hygiene Preparations
Preparation
Non-antimicrobial soap
Advantages
Disadvantages
•
•
Remove dirt, soil, some organic substances
Can remove loose transient flora
•
•
•
Has minimal antimicrobial activity
Associated with skin dryness and irritation
May become contaminated
Alcohols
•
•
•
Effectively reduce bacterial counts on hands
Can prevent transmission of healthcare-associated
pathogens
More effective than soap
•
•
•
Not effective against all viruses
Not appropriate when hands are visibly soiled
Efficacy is affected by contact time and may vary with
formulation
Can cause drying of the hands
Flammable
•
•
•
•
•
Has substantial residual activity
Has a good safety record
Skin irritation frequency is concentration-dependent
Not affected by presence of organic matter
Usually well-tolerated
•
•
•
•
•
•
•
Effective against S. aureus
Has residual activity
Not classified as safe and effective for antiseptic
handwash
•
•
Weak activity against gram-negative bacteria, fungi, and
viruses
Modest efficiency with single handwash
Iodine and Iodophors
•
Broad antimicrobial activity
•
•
Does not kill spores
Skin irritation
Triclosan
•
•
•
Broad activity
Has persistent activity
Has been associated with decreased MRSA infections
•
Bacteriostatic [glossary]
Chlorhexidine
gluconate
Chloroxylenol
Hexachlorophene
•
•
•
Immediate activity is slower than alcohol
Not as effective against gram-negative bacteria
Not sporicidal
Fair activity against gram-negative bacteria , mycobacteria,
and viruses
Studies are limited and some are contradictory
Reference 1
Page 3 of 26
4004
When to Use Soap and Water
Hands must be washed with soap and water:
• When hands are visibly dirty or contaminated
• Before eating
• After using a restroom
• If Clostridium difficile [glossary] is suspected or
proven
In these situations:
• Soap may be plain or antimicrobial.
• Antimicrobial wipes may be used as an alternative to
handwashing with soap.
References 1-5
Page 4 of 26
4005
When to Use an Alcohol Rub
If hands are not visibly soiled, use an alcohol-based rub for
routine hand decontamination.
Antimicrobial wipes contain less alcohol than rubs. They
should not be used for decontamination.
References 1, 5, 16
Page 5 of 26
4006
Routine Hand Decontamination
Routine hand decontamination includes:
NO IMAGE
• Before direct contact with patients
• Before putting on sterile gloves to insert a central
intravascular catheter
• Before inserting indwelling urinary catheters,
peripheral vascular catheters, or other invasive
devices that do not require a surgical procedure
• After contact with intact patient skin (e.g., after taking
a pulse or blood pressure, after assisting in a patient
lift or transfer)
• After contact with bodily fluids or excretions, mucous
membranes, non-intact skin, or wound dressings
• When moving from a contaminated body site to a
clean body site on a single patient
• After contact with items near a patient
• After removing gloves
References 1, 5, 16
Page 6 of 26
4007
How to Use Soap and Water
When using soap and water to wash hands:
1. Wet hands with warm water. Do not use hot water. Hot
water can contribute to skin irritation.
2. Apply soap. Use enough soap to give a good lather.
3. Rub hands together vigorously for at least 15 seconds.
Cover all surfaces of the hands and fingers. Do this
away from the running water so that you do not wash
the lather away. Remember to scrub between your
fingers and under your nails.
4. Rinse hands with water. Keep arms angled downward in
the sink, so that water from your hands goes down the
sink, not down your elbows.
5. Dry with a disposable towel.
6. Use the towel to turn off the faucet.
7. Dispose of the towel in an appropriate bin.
References 2, 5
Page 7 of 26
4008
How to Use an Alcohol Rub
When using an alcohol rub:
1. Apply the rub to the palm of one hand. Use the volume
of product recommended by the manufacturer. You
should have enough to wet all surfaces of the hands.
2. Rub hands together until they are dry. Be sure to rub
over all surfaces of the hands and fingers.
Do not wash hands after using an alcohol rub. This is not
necessary or recommended.
*Note: Rubbing the hands together until they are dry ensures
that the flammable alcohol in the product has evaporated and
is no longer a fire hazard.
References 1, 5
Page 8 of 26
4009
Surgical Hand Hygiene: Products
Prior to surgery, a surgical hand scrub with antimicrobial
soap or an alcohol rub with persistent activity is
recommended.
These products help to slow the growth of bacteria under
sterile surgical gloves.
This reduces the risk that bacteria will escape from gloves
onto the sterile field.
References 1, 5
Page 9 of 26
4010
Surgical Hand Hygiene: Jewelry
Prior to the surgical hand scrub, remove all:
• Rings
• Watches
• Bracelets
Clean underneath the fingernails, using a nail cleaner under
running water.
References 1, 5
Page 10 of 26
4011
Surgical Hand Hygiene: Soap Scrub
For surgical hand antisepsis using an antimicrobial soap:
• Scrub hands and forearms for the length of time
recommended by the product manufacturer (usually
two to six minutes).
• Extended scrub times (ten minutes or more) are not
necessary.
References 1, 5
Page 11 of 26
4012
Surgical Hand Hygiene: Alcohol Rub
For surgical hand antisepsis using an alcohol product:
• Choose a surgical hand-scrub product with persistent
activity [link to glossary].
• Before applying the rub, pre-wash hands and forearms
with plain soap and water. Dry completely.
• Apply the alcohol product according to manufacturer
instructions.
• Allow hands and forearms to dry completely before
putting on sterile surgical gloves.
Caution:
•
•
Products containing alcohol are flammable. They should be
placed away from flames and high temperatures.
Alcohol-based products may cause dry skin. Look for
products containing skin-conditioning agents.
References 1, 5
Page 12 of 26
4013
Other Hand-Hygiene Practices: Fingernails
Hand hygiene is not just about washing and decontaminating
hands when necessary.
In addition, do not wear artificial fingernails or nail
enhancements.
Keep natural nail tips less than ¼-inch long.
References 1, 5
Page 13 of 26
4014
Other Hand-Hygiene Practices: Gloves
Use gloves whenever you might have contact with:
• Blood
• Other potentially infectious materials
• Mucous membranes
• Non-intact skin
Always:
• Remove and dispose of gloves between patient contacts
• Decontaminate hands after removing gloves
Change gloves during patient care when moving from a
contaminated body site to a clean body site.
References 1, 5, 16
Page 14 of 26
4015
Compliance Issues
A recently published study cited several factors associated with
ineffective alcohol hand rub use. These included:
• Wearing rings other than a wedding ring
• Wearing a bracelet
• Having long nails
Reference 17
Page 15 of 26
4016
Your Role in Increasing Hand-Hygiene Compliance
Knowing the guidelines for hand hygiene is not enough.
To protect yourself and your patients from infection, you must
practice proper hand hygiene.
Give your employer input about hand-hygiene products.
Encourage your facility to purchase and provide products that
you will use.
References 1, 5
Page 16 of 26
4017
Your Role in Increasing Hand-Hygiene Compliance (2)
Many studies have shown that compliance with
hand hygiene recommendations is often low but
can be improved.
For example, a recent study documented increased
compliance with:
• Access to alcohol sanitizer
• Education
• Ongoing audit and feedback
Impact of multidimensional compliance improvement
project
Time Period
Compliance
Baseline
19-41% of 4,174 opportunities
Year 2
73-84% of 6,420 opportunities
Year 6
59-81% of 4,990 opportunities
As you can see in the table on the right,
compliance increased and remained improved 6
years after the multidimensional improvement
project.
Reference 18
Page 17 of 26
4018
5 Moments for Hand Hygiene
Remember: There are “5 Moments for Hand Hygiene.”
They are:
1 Before patient contact
2 Before clean/aseptic tasks
3 After body fluid exposure risk
4 After patient contact
5 After contact with the patient’s environment
For routine patient care:
• Perform hand hygiene with an alcohol-based
hand rub if hands are not visibly soiled.
• Perform hand hygiene after glove removal.
1
Before patient contact
2
Before clean/aseptic tasks
3
After body fluid exposure risk
4
After patient contact
5
After contact with the patient’s environment
Reference 5
Page 18 of 26
4019
Hand Hygiene Compliance
How often do healthcare workers comply with the 5
Moments for Hand Hygiene?
A study published in 2010 looked at compliance over a
24h period in two hospital wards.
Overall, compliance was:
• 78% for allied health professionals
• 75% for nurses
• 59% for other staff
• 57% for visitors
• 56% for patients
• 47% for doctors
Compliance during each of the 5 Moments for Hand
Hygiene also varied. Let’s take a closer look on the
next screen.
Reference 19
Page 19 of 26
4020
Hand Hygiene Compliance
Compliance varied from 50% to 100%. All workers in this study complied with recommendations for hand hygiene
before clean or aseptic tasks. However, only 50% of workers performed hand hygiene after contact with the
patient’s environment, as recommended. Less than 70% of workers performed hand hygiene before patient contact.
Moment
1 Before patient contact
Compliance
Moment
2 Before clean/aseptic
tasks
100%
68%
3
After body fluid exposure
risk
4
93%
5
Compliance
After patient contact
80%
After contact with the
patient’s environment
50%
Reference 19
Page 20 of 26
4021
Review
Select the answer that best fits the question.
[CORRECT RESPONSE: B]
Before inserting an indwelling catheter, wash your hands with
plain soap and water.
[RESPONSE FOR A: Incorrect. You should use
antimicrobial soap and water or an alcohol-based
hand rub. Then you should put on sterile gloves to
place the catheter.]
a. True
b. False
[RESPONSE FOR B: Correct. You should use
antimicrobial soap and water or an alcohol-based
hand rub. Then you should put on sterile gloves to
place the catheter.]
Page 21 of 26
4022
Review
Select the answer that best fits the question.
[CORRECT ANSWER: E]
Choose the true statement(s):
[RESPONSE TO A: Not quite. The best answer is E.
a.
b.
c.
d.
e.
Wash hands after removing gloves.
Change gloves between patient contacts.
Wear gloves when you might have contact with blood.
Both A and B
All of the above
[RESPONSE TO B: Not quite. The best answer is E.
[RESPONSE TO C: Not quite. The best answer is E.
[RESPONSE TO D: Not quite. The best answer is E.
E: Correct
Page 22 of 26
4023
Summary
You have completed the lesson on hand hygiene
recommendations.
NO IMAGE
Remember:
• Proper hand hygiene between patient contacts is the best
way to prevent cross-contamination.
• Alcohol rubs are recommended for routine hand
decontamination.
• Soap and water should be used when hands are visibly
soiled.
• Decontaminate hands at appropriate times.
• Fingernails should be kept short. Artificial fingernails
should not be used.
• Gloves should be used when appropriate. Gloves must
be changed between patient contacts.
Page 23 of 26
4024 - 4026
References
1. CDC. Guideline for hand hygiene in health-care settings: Recommendations of the healthcare
infection control practices advisory committee and the HIPAC/SHEA/APIC/IOSA Hand Hygiene Task
Force. MMWR. 2002;51(No.RR-16):1-45.
2. Lane HJ, Blum N, Fee E. Oliver Wendell Holmes (1809-1894) and Ignaz Philipp Semmelweis (18181865): preventing the transmission of puerperal fever. Am J Public Health. 2010;100:1008-1009.
3. Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985.
Infect Control. 1986;7:231-24343.
4. Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in
health care settings. Am J Infect Control. 1995;23:251-269.
5. WHO. WHO guidelines on hand hygiene in healthcare. 2009.
6. Keeping Germs Out. US News & World Report. July 18, 2005.
7. Joint Commission. Measuring hand hygiene adherence: Overcoming the challenges. Joint
Commission Monograph. 2009.
8. Alemagno SA, Guten SM, Warthman S, Young E, Mackay DS. Online learning to improve hand
hygiene knowledge and compliance among health care workers. J Cont Educ Nurs. 2010;14:1-9.
9. Haas JP, Larson EL. Compliance with hand hygiene guidelines: where are we in 2008? Am J Nurs.
2008;108:40-4.
10. CDC. Estimates of healthcare-associated infections. Available at:
http://www.cdc.gov/ncidod/dhqp/hai.html. Accessed September 1, 2010.
11. Morgan DJ, Liang SY, Smith CL, Johnson JK, Harris AD, Furuno JP, Thom KA, Snyder GM, Day HR,
Perencevich EN. Frequent multidrug-resistant Acinetobacter baumannii contamination of gloves,
gowns, and hands of healthcare workers. Infect Control Hosp Epidemiol. 2010;31:716-21.
12. Treakle AM, Thom KA, Furuno JP, Strauss SM, Harris AD, Perencevich EN. Bacterial contamination
of healthcare workers’ white coats. Am J Infect Control. 2008.
13. Ryan KJ, Ray CG. Sherris Medical Microbiology. 5th ed. McGraw-Hill Medical. 2010.
14. Treakle AM, Thom KA, Furuno JP, Strauss SM, Harris AD, Perencevich EN. Bacterial contamination
of health care workers' white coats. Am J Infect Control. 2009;37:101-5.
15. Rosdahl CB, Kowalski MT. Textbook of Basic Nursing. 9th ed. Philadelphia, PA: Wolter Kluwer
Health/Lippincott Williams & Wilkins. 2008.
16. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices
Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings. Available at:
http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. Accessed August 11, 2010.
17. Hautemaniere A, Cunat L, Diguio N, Vernier N, Schall C, Daval MC, Ambrogi V,Tousseul S, Hunter
PR, Hartemann P. Factors determining poor practice in alcoholic gel hand rub technique in hospital
NO IMAGE
workers. J Infect Public Health. 2010;3:25-34.
18. Mayer J, Mooney B, Gundlapalli A, Harbarth S, Stoddard GJ, Rubin MA, Eutropius L, Brinton B,
Samore MH. Dissemination and sustainability of a hospital-wide hand hygiene program emphasizing
positive reinforcement. Infect Control Hosp Epidemiol. 2011;32:59-66.
19. Randle J, Arthur A, Vaughan N. Twenty-four-hour observational study of hospital hand
hygiene compliance. J Hosp Infect. 2010;76:252-255.
Please remember that compliance is the responsibility of each organization. Provision of this list does not
imply that the content of this course wholly or partially addresses the guidelines and references provided here.
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Glossary
#
1.
2.
3.
4.
5.
6.
Term
Antimicrobial
Antisepsis
7.
8.
9.
10.
11.
12.
13.
14.
Decontaminate
Disinfect
Drug-resistant
Flora
HICPAC
Pathogenic
Perineal
Persistent activity
15.
Childbed fever
16.
17.
Spectrum
Spore
18.
Toxic shock syndrome
19.
Viable
Clostridium difficile.
Biostatic
Contaminate
Cross-contamination
Definition
capable of harming or killing microorganisms
the state of being free of pathogenic organisms
the organism that causes diarrhea
limiting the growth of bacteria
to make impure or unclean
transmission of microorganisms from one person, place, or item to another person,
place, or item
to rid of impurities
to destroy microorganisms or pathogens
unable to be harmed by certain drugs
microbial life normally found on and in the human body
Healthcare Infection Control Practices Advisory Committee
able to cause disease
of or relating to the area between the anus and the sex organs
prolonged or extended antimicrobial activity that prevents or inhibits proliferation
or survival of microorganisms after application of a hand-hygiene product
fever due to infection, occurring within ten days after a woman has a baby, and
lasting more than 24 hours
types of microorganisms against which an antimicrobial agent is effective
small, highly resistant, single-celled reproductive body produced by certain
bacteria
a potentially serious, sometimes fatal bacterial infection, commonly associated
with tampon use
capable of life or normal growth and development
ASSESSMENT
1. When did healthcare workers first use chlorine solution to decontaminate their hands?
a. In the 1600s
b. In the 1700s
c. In the 1800s
d. In the 1900s
Correct: In the 1800s
Rationale: In the 1800s, healthcare workers first used a chlorine solution for hand hygiene.
2. Until 1995, guidelines for hand hygiene in the United States focused on the use of:
a. Plain soap and water
b. Iodine-based solutions
c. Chlorine-based solutions
d. Antimicrobial soap and water
Correct: Plain soap and water
Rationale: Early hand hygiene guidelines in the U.S. focused on the use of plain soap and water.
3. In most people, skin flora tends to be most concentrated in particular areas, including:
a. The groin
b. The scalp
c. Behind the knees
d. The feet and ankles
Correct: The groin
Rationale: The groin is one area where skin flora is concentrated.
4. A healthcare worker is providing care to a patient without active infection. The healthcare worker's hands may become contaminated with
bacteria during:
a. "Clean" care activities only
b. Invasive care activities only
c. Either invasive or "clean" care activities
d. Neither invasive nor "clean" care activities
Correct: Either invasive or "clean" care activities
Rationale: All people have bacteria in and on their bodies. This is true whether or not the person has an active infection. Therefore, contamination
can happen during "clean" or invasive care on any patient.
5. To block cross-contamination, the best practice for healthcare workers is:
a. Disinfect hands between all patient contacts
b. Disinfect patient skin before all care activities
c. Avoid all direct contact with non-intact patient skin
d. Avoid caring for both infected and uninfected patients during the same shift
Correct: Disinfect hands between all patient contacts
Rationale: The best practice to block cross-contamination of patients is to disinfect hands between patient contacts.
6. The hand hygiene product with the LEAST activity against microbes is:
a. A plain soap
b. An iodine compound
c. An alcohol-based rub
d. An ammonium compound
Correct: A plain soap
Rationale: Plain soap has the least activity against microbes.
7. According to CDC guidelines, use ___________ for routine decontamination of hands that are not visibly soiled.
a. Antimicrobial wipes
b. Alcohol-based rubs
c. Plain soap and water
d. A stiff-bristled brush and water
Correct: Alcohol-based rubs
Rationale: The CDC recommends the use of alcohol-based rubs for routine decontamination of hands that are not visibly dirty.
8. According to CDC guidelines, when using soap and water to wash hands, apply soap and then rub hands together for at least:
a. 5 seconds
b. 15 seconds
c. 30 seconds
d. 60 seconds
Correct: 15 seconds
Rationale: Soap lather should be rubbed over all hand surfaces for at least 15 seconds.
9. A best practice for using an alcohol rub to decontaminate hands is:
a. Rinse hands with water after using the rub
b. Rub hands together until dry after applying the rub
c. Use only enough rub to wet the palms of the hands
d. Dry hands with a disposable towel after applying the rub
Correct: Rub hands together until dry after applying the rub
Rationale: To use an alcohol rub, apply enough of the product to wet all hand surfaces. Then rub hands together until dry. Do not wash hands
after using the rub.
10. For proper hand hygiene, natural nail tips should be kept:
a. Less than 1-inch long
b. Less than ¼-inch long
c. Between ½-inch and 1-inch long
d. Between ¼-inch and ½-inch long
Correct: Less than ¼-inch long
Rationale: Natural nail tips should be kept less than ¼-inch long. Artificial nails should not be worn.
11. In the 1800s, Ignaz Semmelweis found that removal of "cadaverous particles" was more effective when clinic workers:
a. Cleaned their hands with a chlorine solution
b. Washed their hands with plain soap and water
c. Scrubbed their hands with a stiff-bristled brush
d. Removed their gloves after leaving the autopsy area
Correct: Cleaned their hands with a chlorine solution
Rationale: Semmelweis noticed a high death rate in the maternal clinic. He asked workers to start disinfecting their hands with a chlorine solution
between patient contacts. With this new policy, maternal death rates dropped.
12. Becky’s hands are visibly soiled after contact with her patient. When washing her hands, she:
• First: Wets her hands with warm water.
• Second: Rubs her hands together vigorously for at least 15 seconds away from running water. Covers all surfaces of the hands
and fingers. Do this away from the running water so that you do not wash the lather away. She remembers to scrub between her
fingers and under her nails.
• Third: She rinses her hands with water. She keeps her arms angled downward in the sink.
• Fourth: She turns off the faucet with her wet hand,
• Finally: She dries her hands with a disposable towel and disposes of the towel in the trash.
Has Becky correctly washed her hands?
a. Yes
b. No
Correct: No
Rationale: Becky has not washed her hands correctly. She turned off the faucet with her wet hand. Becky should have turned off the faucet with
the paper towel she used to dry her hands.
13. Becky is using an alcohol hand rub for hand hygiene before providing patient care. Her hands were not visibly soiled. When using the rub,
Becky:
• Applies the rub to the palm of one hand.
• Uses the volume of product recommended by the manufacturer and has enough to wet all surfaces of the hands.
• Rubs her hands together until they are dry. She also ensures that all surfaces of her hands and fingers are rubbed.
• Then washes her hands to ensure that any residual rub has been removed from her hands.
Has Becky correctly sanitized her hands?
A. Yes
B. No
Correct: No
Rationale: Becky should not wash her hands after using an alcohol rub. This is not necessary or recommended.
14. Bacterial colonization is:
a. Killing bacteria using an antiseptic
b. Treating bacterial infection with antibiotics
c. Presence of active bacterial infection in a chronic non-healing wound
d. Long-term presence of bacteria on the body without causing infection
Correct: Long-term presence of bacteria on the body without causing infection.
Rationale: All people have some degree of bacterial colonization. This refers to bacteria that live on the body but do not cause infection
15. Cross-contamination happens when:
a. A patient has a drug-resistant infection.
b. A patient's skin is free of bacterial colonization.
c. A healthcare worker transfers bacteria from one patient to another.
d. A healthcare worker decontaminates his or her hands between patient contacts.
Correct: A healthcare worker transfers bacteria from one patient to another.
Rationale: Cross-contamination is the transfer of contaminating bacteria from one place to another. In the healthcare setting, cross-contamination
most often happens when a healthcare worker transfers bacteria from one patient to another, or from an environmental surface to a patient.
16. Regarding gloves and hand antisepsis: The best practice is to use gloves:
a. Together with hand antisepsis
b. As a substitute for hand antisepsis
c. As a replacement for hand antisepsis
d. Only when hand antisepsis is not performed
Correct: Together with hand antisepsis
Rationale: Hand antisepsis and gloves both should be used as appropriate. Hands should be decontaminated before and after glove use.
17. For routine hand hygiene in the healthcare setting, the MOST effective products are:
a. Plain soaps
b. Iodine compounds
c. Alcohol-based rubs
d. Ammonium compounds
Correct: Alcohol-based rubs
Rationale: For routine hand hygiene, the best product to use is an alcohol-based rub.
18. According to CDC guidelines, an acceptable substitute for an alcohol-based rub is:
a. Use of gloves
b. Antimicrobial wipes
c. Plain soap and water
d. Antimicrobial soap and water
Correct: Antimicrobial soap and water
Rationale: In situations calling for an alcohol-based rub, antimicrobial soap and water may be used instead.
19. For surgical hand antisepsis using an alcohol-based product, choose a surgical hand scrub product with:
a. Persistent activity
b. Antibiotic additives
c. A detergent component
d. Activity against bacterial spores
Correct: Persistent activity
Rationale: For surgical hand antisepsis, it is important to choose a product with persistent activity against microbes.
20. Regarding hand hygiene, spread of infection, and artificial fingernails:
a. Artificial fingernails are preferable to natural nail tips.
b. Artificial fingernails are compatible with good infection control.
c. Artificial fingernails are acceptable if kept less than ¼-inch long.
d. Artificial fingernails are associated with spread of Gram-negative bacteria.
Correct: Artificial fingernails are associated with spread of Gram-negative bacteria.
Rationale: Healthcare workers should not wear artificial fingernails. Gram-negative bacteria persist on artificial nails even after proper hand
hygiene is performed.