Hand Hygiene
Hand Hygiene
There are a number of resources available to assist in the proper application of hand hygiene:
Public Health Ontario’s Just Clean Your Hands, which is a hand hygiene improvement program that includes instructional videos for both acute and long-term care practice settings
Provincial Infectious Diseases Advisory Committee (PIDAC) Best Practices for Hand Hygiene in All Health Care Settings, 4th edition which is best practice guideline on hand hygiene available through Public Health Ontario
Public Health Ontario’s Hand Hygiene Fact Sheet
Public Health Ontario’s Your 4 Moments of Hand Hygiene
Professional Accountabilities:
An integral part of an effective hand hygiene program is the promotion of hand hygiene by champions and role models within the health care setting. By being role models for best practices, these champions will take personal responsibility and hold others accountable as part of a facility’s internal responsibility system. Infection Prevention and Control | Public Health Ontario
The Four Moments for Hand Hygine
Adapted with the permission of Public Health Ontario
Hand Hygiene Considerations
Use of employer supplied lotions products regularly (3 times a day when cleaning hands several times per hour)
Things that can reduce the effectiveness of hand hygiene:
long nails
nail polish
artificial nails and nail enhancements
hands and arm adornments (associated with poor hand hygiene practices and result in more tears to gloves)
Did You Know?
It is estimated that approximately 30% of healthcare providers report symptoms or signs of dermatitis involving their hands and as many as 85% give a history of having chronic skin problems. Hand Hygiene Public Health Ontario p.16
Performing Hand Hygiene
First…
Remove hand and arm jewellery (watch must be worn above the wrist)
Clothing or other items that impede frequent and effective hand hygiene should be removed.
Professional Accountabilities:
If experiencing skin integrity issues, the Member is required to contact their employee Occupational Health to seek a solution (e.g., alternate skin care products)
Alcohol-Based Hand Rubs (ABHR)
e.g., gels and foams containing 70 – 90% alcohol
Is the preferred method of hand hygiene for hands that are not visibly soiled
Has been shown to be less irritating to skin than soap and water and may significantly decrease dermatitis due to emollients in the product
Must be used with employer-approved products that are compatible with the gloves being used
Did You Know?
ABHR should not be used with water, as water will dilute the alcohol and reduce its effectiveness. ABHR should not be used immediately after hand washing with soap and water as it will result in more irritation of the hands.
Handwashing Soaps…
Plain soap is recommended for routine hand hygiene when hands are visibly soiled
Should be in a liquid format in a dispenser that is discarded when empty (should not be refilled)
Bar soaps for hand hygiene must not be used in health care facilities
Antibacterial soap should be limited to specific settings (e.g., OR, ICU and burn units)
Essential components are soap, friction and lukewarm running water
Did You Know?
According to Public Health Ontario, the best evidence suggests that antimicrobial soap is equivalent to ABHR in terms of microorganism reduction but is harsher on the hands and more time-consuming to use.
References
Association for the Advancement of Medical Instrumentation (AAMI). (2015). FDA proposes new criteria for surgical gowns. Retrieved from Association for the Advancement of Medical Instrumentation website: www.aami.org/newsviews/newsdetail.aspx?ItemNumber=2650
Canadian Patient Safety Institute. (n.d.). Ventilator-associated pneumonia (VAP). Retrieved from Canadian Patient Safety Institute website: www.patientsafetyinstitute.ca/en/topic/pages/ventilator-associatedpneumonia-(vap).aspx
Centers for Disease Control and Prevention. (2011). Central line-associated bloodstream infections: Resources for patients and healthcare providers. Retrieved from Centers for Disease Control and Prevention website: www.cdc.gov/HAI/bsi/CLABSI-resources.html
Critical Care Secretariat. (2012). Ventilator associated pneumonia and central line infection prevention toolkit. Retrieved from Critical Care Services Ontario website: www.criticalcareontario.ca/EN/Toolbox/Performance%20Improvement%20Collaborative/VAP%20and%2 0CLI%20Toolkit%20(2012).pdf
Immunize Canada. (2016). ImmunizeCA app. Retrieved from Immunize Canada website: http://immunize.ca/en/app.aspx
Loeb, M., Dafoe, N., Mahony J., John, M., Sarabia, A., Glavin, V., Walter, S.S. (2009). Surgical mask vs N95 respirator for preventing influenza among health care workers: A randomized trial. JAMA, 302(17), 1865- 1871. doi:10.1001/jama.2009.1466. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=184819
PIDAC. (2012a). Best practices for infection prevention and control programs in Ontario (3rd ed.). Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/BP_IPAC_Ontario_HCSettings_2012.pdf
PIDAC. (2012b). Routine practices and additional precautions in all health care settings (3rd ed.). Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf
PIDAC. (2013). Annex B: Best practices for prevention of transmission of acute respiratory infection in all health care settings. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Annex_B_Prevention_Transmission_ARI_2013.pdf
PIDAC. (2014). Best practices for hand hygiene in all health care settings, (4th ed.). Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf
PIDAC. (2015a). Best practices for prevention, surveillance and infection control management of novel respiratory infections in all health care settings. Retrieved from Public Health Ontariowebsite: www.publichealthontario.ca/en/eRepository/Best_Practices_Novel_Respiratory_Infections.pdf
PIDAC. (2015b). Infection prevention and control for clinical office practice. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/IPAC_Clinical_Office_Practice_2013.pdf
PIDAC. (2016). Tools for preparedness: Triage, screening and patient management for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infections in acute care settings. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/PIDAC-IPC_Preparedness_Tools_MERS_CoV_2013.pdf
Public Health Agency of Canada. (2013). Canadian immunization guide. Retrieved from Public Health Agency of Canada website: http://phac-aspc.gc.ca/publicat/cig-gci/p03-work-travail-eng.php#a1
Public Health Agency of Canada. (2014). Canadian Tuberculosis Standards (7th ed.). Retrieved from http://www.phac-aspc.gc.ca/tbpc-latb/pubs/tb-canada-7/assets/pdf/tb-standards-tb-normes-prefeng.pdf
Public Health Agency of Canada. (2016). Summary of assessment of public health risk to Canada associated with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Retrieved from Public Health Agency of Canada website: www.phac-aspc.gc.ca/eri-ire/coronavirus/risk_assessment-evaluation_risque-eng.php
Public Health Ontario. (n.d.a). Chain of transmission and risk assessment: Glossary of terms. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/LearningAndDevelopment/OnlineLearning/InfectiousDiseases/IPACCore/Documents/CORE_Trainers_COT_and_RA_Module_Glossary_April _2014.pdf
Public Health Ontario. (n.d.b). Risk Algorithm to Guide PPE Use. Retrieved from Public Health Ontario website: www.publichealthontario.ca/en/eRepository/IPAC_Clinical_Office_Practice_Risk_Algorithm_PPE_2013.pdf
World Health Organization. (2015). Middle East respiratory syndrome coronavirus (MERS-CoV). Retrieved from World Health Organization website: www.who.int/mediacentre/factsheets/mers-cov/en/