Hand Hygiene
Policy
Produced by: Swindon & Marlborough Infection Control
Team for Swindon Intermediate Care Centre
Adopted as Trust Policy: 01/03/1992
Version Number: 4.3
Review Date: 01/05/2011
Policy to be Reviewed by: Swindon PCT Infection
Control Committee
Approved by: Swindon PCT Infection Control Committee
May 2009
Hand Hygiene Policy
Number: 2IPC-POL-001
Version: 4.3
Status Final
Dated: 14/05/2008
Table of Contents
1.
Document Definition .................................................................................................................... 2
1.1 Revision
History........................................................................................................................ 2
1.2 Review
and
Approval History ................................................................................................... 2
1.3 References ............................................................................................................................... 2
1.4 Glossary/Definitions.................................................................................................................. 3
1.5 Purpose .................................................................................................................................... 3
1.6 Scope........................................................................................................................................ 3
1.7 Regulatory Position................................................................................................................... 3
1.8 Special Cases........................................................................................................................... 3
1.9 Comments ................................................................................................................................ 3
2.
Policy Details ................................................................................................................................ 4
1. Document
Definition
1.1 Revision
History
Version Status
Reason for change
Date
Author
1.0
Issued
New Policy
March 1997
Ruth Lockwood
2.0
Issued
Following review
August 2000
Sue Thompson
3.0
Issued
Following review
July 2003
Helen Forrest
3.1
Draft
Review
Nov 2005
Jenny Wright
4.0
Final
March 2006
Jenny Wright
4.1
Final
Added Bear Below the Elbow
November 2007
Tina McCready
4.2
Final
Added training under ‘Responsibilities’
December 2007
Tina McCready
4.3
Final
2-yearly review
Aug 2008
Tina McCready
4.4
Final
PCT review
April 2009
Sharren Pells
1.2
Review and Approval History
Version
Reviewer/Approver
R/A
Scope
Date
3.0
Jenny Wright
R
Context, completeness and accuracy
Nov 2005
3.1
ICC, OH, HR, SNM/MMs,
A
Current and compliant
March 2006
H&S, ICLNs
4.1
ICC
A
12 Nov 2007
4.3
ICC
A
Current and compliant
Aug 2008
4.3
Tina McCready
R
Context, completeness and accuracy
Aug 2008
4.4
Sharren Pells
R
Context, completeness and accuracy
April 2009
1.3 References
Clean, safe care: reducing infections and saving lives. DH (2008)
The Health and Social Care Act 2008. Code of Practice for the NHS on the Prevention and Control of
Healthcare Associated Infections and Related Guidance. DH (revised 2008)
Swindon & Marlborough NHS Trust Dress & Personal Appearance Code. July 2007
Swindon & Marlborough NHS Trust Occupational Health latex policy
Swindon & Marlborough NHS Trust Occupational Health Skin care protocol
NPSA clean
yourhands campaign - www.npsa.uk/cleanyourhands
RCA Good Practice in Infection Control ‘Wipe it out’ campaign.
http://www.rcn.org.uk/__data/assets/pdf_file/0003/78654/002741.pdf
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Hand Hygiene Policy
Number: 2IPC-POL-001
Version: 4.3
Status Final
Dated: 14/05/2008
ICNA Hand Decontamination Guidelines (2002) - ICNA.
Infection Control, Standard Infection Control Precautions policy.
Taylor LJ (1978) An evaluation of hand washing techniques. Nursing Times 74: 108-10.
Further Reading
Ayliffe G, et al (2000) Control of Infection. A practical handbook. 4th Ed. Chapman & Hall, London.
Boyce J (2000) Rubs Vs Scrubs- Study of the compatibility of hand disinfectants. Infection Control in
focus, issue 4. Spring 2003: 6-8
Damani N.N (2003) Manual of Infection Control Procedures. 2nd edition. Greenwich Medical Media Ltd
Emmerson AM, Enstone JE, Griffin M et al (1996) The second national prevalence survey of infection in
hospitals - overview of the results. J Hosp Infect 32: 175-190.
Glenister HM, Taylor LJ, Cooke EM et al (1992) A study of surveillance methods for detecting hospital
infection, PHLS, London.
Heenan ALJ (1996) Handwashing solutions. Professional Nurse 1 (9) pp 615-622
Plowman R, Graves N, Griffin M et al (1994) The socio-economic burden of hospital-acquired infection.
PHLS, London.
Pratt RJ, Pellowe C, Loveday HP et al (2001) Standard principles for preventing hospital-acquired
infection. J Hosp Infect, 47 (Suppl): 531-537
Russell AD, Hugo WB, Ayliffe GAJ (2000) Disinfection, Preservation and Sterilisation. 3rd Edn. Blackwell
Science, Oxford.
http://www.healthcarea2z.org/index.aspx
1.4 Glossary/Definitions
Hand decontamination is defined as the removal, or killing, of micro-organisms acquired on the hands
before they can be transferred.
The following acronyms are used within the document
CHC
Carillion Health Care
CVC
Central Venous Catheter
HCAI
Health Care Associated Infection
NPSA
National Patient Safety Agency
PCT
Primary Care Trust
SLA
Service Level Agreement
1.5 Purpose
To provide clear guidelines on hand decontamination in order to reduce the risks of transmission of
infection within the healthcare setting.
1.6 Scope
Implementation within all wards/departments and health care settings within Swindon and
Marlborough NHS Trust and in-patient areas of other Trusts were SLAs are in place e.g. Swindon
PCT, Avon & Wiltshire Mental Health Partnership NHS Trust.
1.7 Regulatory
Position
Winning Ways (DOH 2003)
Saving lives (DOH 2005)
NPSA
clean
yourhands campaign (NPSA 2004)
The Health Act 2006. Code of Practice for the Prevention and Control of Healthcare
Associated Infections. DH (revised 2008)
1.8 Special
Cases
None
1.9 Comments
Any comments on this document should, in the first instance, be addressed to the PCT Infection
Prevention and Control Team.
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Hand Hygiene Policy
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2. Policy
Details
Why decontaminate your hands?
It is universally accepted that hand decontamination is the single most important measure for
preventing the transmission of infection.
Many clinical activities expose patients to an increased risk of infection, which can occur
when micro-organisms on the hands are introduced directly into a susceptible site such as a
wound or vascular catheter, or they colonise the patient’s skin and subsequently cause
infection. Therefore hand decontamination has a dual role to protect both the
patient and
the
health care worker from acquiring micro-organisms.
Healthcare associated infection (HCAI) has a direct effect on the quality of patient care and
is therefore a major issue in the context of clinical governance, with studies in the UK
suggesting that 9-10% of patients acquire an infection during their stay in hospital.
It is essential therefore that:
Hands are decontaminated immediately:
•
before each and every episode of direct patient care/contact
and
•
after any activity that would potentially result in hands becoming
contaminated
and
•
on entry and exit to wards/departments
Preparation of hands prior to decontamination:
To ensure the efficacy of hand decontamination the following principles must be observed.
Bare below the elbow
• The wearing of stoned rings; wristwatches and bracelets is not permitted as they prevent
effective hand decontamination and provide opportunities for bacterial colonisation, as
total bacteria counts, particularly of gram negative bacteria, are higher when rings are
worn. One plain wedding band poses the highest acceptable risk and may be worn.
Long sleeves must not be worn or be securely rolled up
• Nail varnish, artificial nails or nail extensions must not be worn as this prevents effective
hand decontamination. Nails should be kept short. Pay attention to nails when washing
hands as most microbes on the hands come from beneath the fingernails.
When to decontaminate your hands:
Risk Assessment
There is no set frequency for hand decontamination as it is determined by clinical activity. A
risk assessment of the activity intended or performed will determine the appropriate
decontamination process and the choice of agent eg alcohol, soap or antiseptic preparation.
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Hand Hygiene Policy
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Patients are put at risk of developing an HCAI when a health care practitioner caring for
them has contaminated hands.
In deciding when it is necessary to decontaminate hands, four key risk factors need to be
considered:
• The level of the anticipated contact with patients or objects.
• The extent of the contamination that may occur with that contact.
• The patient care actively being performed.
• The susceptibility of the patient
Levels of hand decontamination:
There are three main levels of hand decontamination:
Routine, Disinfection and Surgical.
The level of decontamination is determined according to the risk
(see chart in Appendix 1).
Routine hand decontamination:
The aim of routine hand decontamination is to remove transient micro-organisms and can be
achieved by:
• Rubbing socially clean hands systematically with Purell alcohol hand rub or equivalent,
covering all surfaces until the solution dries (approximately 15 seconds).
• Washing hands systematically with soap and warm water for 10-15 seconds, covering all
surfaces.
NB Routine hand decontamination is sufficient for most regular daily activities.
Must precede hand disinfection -
ie you cannot disinfect dirty hands.
Hand Disinfection:
The need for a higher level of decontamination is required in some clinical situations, ie hand
disinfection (eg using antiseptic solutions). Hands that are visibly soiled or potentially
grossly contaminated with dirt or organic material must always be washed with liquid soap
and warm water, prior to hand disinfection.
For example, caring for patients with severe neutropenia, before insertion of an indwelling
urinary catheter and prior to aseptic technique. (
See appendix 1 for further details)
Hand disinfection can be achieved by:
• Washing hands systematically with soap and warm water, drying hands, followed by an
application of Purell alcohol hand rub or equivalent (most commonly used method).
• Washing hands systematically with antiseptic solution eg Hibiscrub.
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Hand Hygiene Policy
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Surgical hand decontamination:
Surgical hand decontamination is used prior to surgical or other highly invasive procedures
(eg insertion of CVC) where extra care must be taken to prevent micro-organisms on the
hands being introduced into tissues should gloves be damaged.
Surgical hand decontamination aims to substantially reduce
resident micro-organisms and
to remove or destroy
transient micro-organisms. This process is achieved by using an
antiseptic hand cleansing preparation.
NB Persons undertaking any surgical intervention should follow the theatre policy for
surgical scrubbing.
Preparations available:
Purell Alcohol Hand Rubs or equivalent:
Alcohol based hand rub is now considered to be one of the most effective hand
decontamination agents for routine hand decontamination, on hands that are not visibly dirty.
Using the alcohol hand rub on hands will kill the transient organisms acquired from contact
with patients.
Alcohol hand rub is convenient for rapid bedside use and between patients and procedures.
(
See appendix 2 for decontamination technique)
It must be remembered, however, that alcohol hand rub is not a cleaning agent and is
not effective in the presence of physical dirt or organic material ie blood/body fluids,
some viruses and Clostridium difficile spores.
Liquid Soap: Soap assists in the physical removal of transient micro-organisms from the skin. These
organisms are acquired through direct contact with other people or equipment and are
readily transferred to and from the hands. (
See appendix 3 for technique)
NB Ward/Department supplies are available through CHC - contact the helpdesk if
sufficient supplies of soap and hand towels are not available.
Antiseptic Soaps: These are soap solutions with an antiseptic added (for example Hibiscrub). They will reduce
the number of resident micro-organisms that normally live on the skin as well as the removal
of transient ones. Antiseptic soaps may be inactivated if used in conjunction with ordinary
hand soaps.
Responsibilities for hand decontamination:
• All new starters will undergo hand hygiene training as part of the Trust Induction. All
trust staff will have a mandatory annual update for hand hygiene. This will be provided
by an ICLN, a member of the IP&C Team or other appropriate person and can be
accessed within scheduled clinical skills courses, ICLN workshops, via the intranet,
ward/department training sessions and ad hoc presentations. The appraisal process is
used to follow up staff who fail to receive education.
• It is the ward/department manager’s and CHC’s responsibility to ensure adequate
supplies of the preparations listed above are always available and replenished.
• All staff are asked to remind all visitors to their ward/department that hands must be
decontaminated on entry and exit and that the appropriate method is used in isolation
rooms.
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Hand Hygiene Policy
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How to wash your hands:
Handwashing, when performed correctly, is an infection control practice with clearly
demonstrated efficacy. A good technique covering all surfaces of the hands at the right time
is more important than the agent used or the length of time taken.
If using soap and water, hands should be dried thoroughly using disposable paper towels.
Particular attention should be given to the finger webs. The towels should be sterile if used
prior to a surgical procedure.
(For technique see appendix 3)
Gloves:
Gloves are not always a complete impermeable barrier, however they do reduce the transfer
of micro-organisms to and from the wearers hands.
It should be remembered that gloves are used in addition to hand decontamination,
not instead of.
• The right glove should be used for the procedure to be carried out
(see Glove Selection
Guidelines and Chart within the Swindon PCT Latex Policy). Refer to standard
precautions policy for when to use gloves.
• Gloved hands should
not be washed or cleaned with alcohol hand rubs, gels or wipes.
General Hand Care:
It is important to take particular care of your hands and nails at all times. Ensure your nails
are natural, clean and short and cover any cuts in your skin with a waterproof dressing.
You should ensure your skin is well moisturised. Hand Medic skin conditioner is provided in
ward/department areas. This protects particularly vulnerable areas like nail beds.
Communal hand creams should not be used. (For further advice refer to Occupational
Health’s skin information.)
Any health care worker who suffers any allergic reactions due to hand decontamination or
has any areas of broken skin eg rashes, eczema, psoriasis on their hands or forearms
should report to the Occupational Health Department where further advice may be obtained.
Audit
Observation and audit of compliance with the policy is the joint responsibility of all relevant
clinical teams and the IP&C Team. A weekly audit will be undertaken within both Forest and
Orchard Wards, with compliance scores and comments placed onto a dashboard reporting
system for the PCT Board Meetings and Clinical Governance and Patient Safety Forum.
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Hand Hygiene Policy
Number: 2IPC-POL-001
Version: 4.3
Status Final
Dated: 14/05/2008
Appendix 1
Hand Decontamination Process
Risk Group
Routine clean
Disinfection
Surgical
Method
ie high level
disinfection
High Risk
Surgical hand decontamination
• All surgical procedures
• Full surgical scrubbing
• Insertion of CVC
Medium Risk
Hand disinfection
• Before donning sterile gloves, prior to
manipulation of an IV or CVC.
• Washing hands with soap and warm water,
• Prior to peripheral venous cannulation
followed by application of alcohol hand rub
• Before caring for patients with severe
neutropenia
• Washing hands with antiseptic cleansing solution
• After providing care to a patient with a
eg Hibiscrub
highly transmissible organism
• When removing or changing a wound
dressing
• Before insertion of urinary catheter.
Low Risk
Routine hand decontamination
• Taking routine observations - TPR
• Application of alcohol hand gel to visibly clean
• Bed making
hands
• On entry or exit of ward/department
• Routine hand washing with soap and warm water
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Hand Hygiene Policy
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Appendix 2
Hand decontamination with alcohol hand gel
An effective technique must be learned, practised and always used in clinical
practice for the use of alcohol hand rub.
1 2 3 4
Palm to palm.
Palm to palm, fingers
Right palm over left
Back of fingers to
interlaced
dorsum. Left palm over
opposing palms with
right dorsum
fingers interlaced
5 6 7
Finally, clasp left
hand around right
wrist and vice versa
Rotational rubbing back-
Rotational rubbing of
NB Diagrams demonstrating an effective hand
wards and forwards with
right thumb clasped in
decontamination technique should be widely posted
fingers of right hand in
left palm and vice-
in all wards/departments
palm of left, and vice-
versa
versa.
It is important to pay particular attention to the areas most commonly missed eg thumbs, nails,
cuticles and finger webs.
Areas most commonly missed during hand decontamination
Most frequently
missed
Less frequently
missed
Not missed
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Hand Hygiene Policy
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Dated: 14/05/2008
Appendix 3
Hand decontamination technique for soap and water
An effective technique must be learned, practised and always used in clinical
practice for the use of soap and water.
1 Wet hands
2 Apply soap
3 Lather hands using the 6-step technique plus wrists.
4 Rinse hands well
5 Pat dry hands thoroughly
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