1. Background

Hands are the principal route by which cross-infection occurs and hand decontamination is a simple and effective way in which Health Care Workers (HCW) can prevent the transmission of infection between patients and protect themselves.

Hands must be decontaminated before and after every episode of care that involves direct contact with the patient or their environment. Effective hand decontamination can significantly reduce infection rates leading to a reduction in patient morbidity/mortality (Pittet et al, 2000).

The current spread of antibiotic-resistant organisms can be attributed, at least in part, to a failure of HCW to perform hand hygiene either as often, or as efficiently as the situation requires (Heenan, 1996).

2. Microbiology of the Hands

Skin provides an environment that is acidic, arid, limited in nutrients and is constantly shed and renewed. Micro organisms can be classified as “resident” or “transient”.

Resident micro organisms are commonly termed normal flora. They live deeply seated within the epidermis - in skin crevices, hair follicles, and sweat glands and beneath fingernails. Their function is to protect the skin from invasion from more harmful micro organisms. These organisms do not readily cause infection and are not easily removed.

Transient micro organisms are located on the surface of the skin and beneath the superficial cells of the stratum corneum. They are termed transient because direct contact with other people, equipment and other body sites all result in the transfer of these micro-organism to and from the hands. These may cause infection if passed to patients.

3. Responsibility of All Personnel

NB. “All personnel” refers to all staff employed by the Trust, including non-executive directors, bank staff, agency staff, locums, volunteers, trainees and students and contract staff.

3.1 To adhere to this procedure.

3.2 To ensure that they have read and understood sufficient detail of this procedure and other documents relevant to their job to enable them to carry out their work.

3.3 To seek clarification from their line manager or the senior manager responsible for the initiation and review of this procedure if unsure about any part of the procedure or other document.

3.5 To attend yearly mandatory hand hygiene training

Training in the technique of hand washing will be provided in accordance with the Trust Hand Hygiene Training Procedure DN284

4. Gloves

Gloves should be worn when there is a risk of hands becoming contaminated with any body fluids e.g. urine, blood. Remove as soon as the patient contact episode is over and wash hands. Gloves should be changed for each episode of patient care

5. Hand washing Procedure

5.1 Adequate facilities must be provided to enable staff to wash their hands appropriately

5.2 Remove all wristwatches and engraved/stone rings at the beginning of each clinical shift. Cuts and abrasions must be covered with waterproof dressings.

5.3 Hands must be decontaminated immediately before each and every episode of direct patient contact / care and after any activity or contact that potentially results in hands becoming contaminated (Appendix 1)

Alcohol gel should not be used when in contact with diarrhoea, Norovirus or Clostridium difficile

5.5 Apply an alcohol-based hand gel or wash hands with soap and water to decontaminate hands between caring for patients, or between different caring activities for the same patient.

5.6 When decontaminating hands using an alcohol hand gel, hands should be free of dirt and organic material. The hand gel solution must come into contact with all surfaces of the hand. The hand must be rubbed together vigorously, paying particular attention to the tips of the fingers, the thumbs and the area between the fingers, and until the hands are dry.

5.7 Effective hand washing technique involves six steps (Appendix 2). Preparation requires wetting hands under tepid running water before applying liquid soap or an anti-microbial preparation. The hand wash solution must come in contact with all the surfaces of the hand. The hands must be rubbed together vigorously for a minimum of 10-15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Hands should be rinsed thoroughly prior to drying with good quality paper towels.

6. Hand Hygiene technique

6.1. Preparation

A six-step hand washing technique was devised by Ayliffe et al. (1978), using liquid soap (or antiseptic solution) and running water. Each step consists of five strokes forward and five backwards and should last a minimum of 15 seconds.

7. Alcohol-based hand rubs

8. Skin Care

  Do's

Don't s

Skin Problems

If you are experiencing skin problems or if you have a lesion, cut or graze that cannot be adequately covered, contact the Occupational Health Advisor.

8. Facilities

The trust has a responsibility to provide optimum facilities especially in clinical areas.

9. Audit

Audit of hand hygiene compliance must take place at the point of care

Compliance against a target of 100% will be audited and reported on across health care facilities ( Appendix 3 & 4)

References

Ayliffe, G.A.J., Lowbury, E.J.L., Geddes, A.M. & Williams, J.D. (1992). Control of Hospital Infection - A Practical Handbook. (3^rd ed). London Chapman & Hall.

Department of Health. (2006).EPIC 2 National Evidence Based guidelines for preventing Healthcare Associated Infections in England. Journal of Hospital Infection, Supplement 65s, S1-S64.

Department of Health (2006). The Health Act 2006.Code of Practice for the prevention and Control of Healthcare Associated infections. HMSO: London

Department of Health.(2007). Saving Lives: reducing infection, delivering safe, clean care. (Revised edition) .HMSO: London

Heenan .A. (1996). Hand washing solutions. Professional Nurse, 11(9): 615-622

Pittet .D. et al. (2000) Effectiveness of a hospital-wide program to improve compliance with hand hygiene. Lance, 2000 356: 1307-1312

Widmer, A.F & Dangel, M. (2004) Alcohol based handrub: Evaluation of technique and microbiological efficacy with International Infection Control Professionals. Infection Control and Epidemiology (25) 207-209.

Appendix 1

Appendix 2

Appendix 3

HAND HYGIENE WEEKLY OBSERVATION SHEET

The observation sheet is intended to look at all groups of staff. If necessary move around the ward so you can observe all staff groups. The audit of hand hygiene compliance should be undertaken at the point of patient care and after any activity or contact that potentially results in hands becoming contaminated, ie if in contact with anything within the patient curtain area.

Date ..................... Time …………….. Location of audit ………………………………

Observer's Name & Designation …………………………………………..………………

Percentage compliance for both unchallenged and challenged hand hygiene will be reported:

Unchallenged:

Compliance = observed hand hygiene (H) x 100 = ___ %

hand hygiene opportunities (O)

Challenged:

Compliance = observed hand hygiene (H+C) x 100 =___ %

hand hygiene opportunities

Appendix 4 : HAND HYGIENE MONTHLY OBSERVATION AUDIT TOOL

COMMENTS

Include issues relating to the availability and condition of facilities (eg type of taps, appropriate temperature control), and any patient or visitor involvement.

Example:

O - H

O - H

O - C (record name designation)

O - C (record name designation)

O - H

O - H

O (record name+designation)