The How-To’s of Hand Hygiene

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI

Slide 1: The How-To's of Hand Hygiene

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Training Module 1

Slide 2: Objectives

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Upon completion of this training module, long-term care staff will be able to demonstrate a working knowledge of—

  • Why hand hygiene is so important to prevent the spread of infections.
  • When and how to perform hand hygiene.
  • Key hand hygiene practices for prevention of health care-associated infections (HAI), particularly catheter-associated urinary tract infections (CAUTI).

Slide 3: Health Care Workers' Hands Spread Infections1

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  • 1-3 million serious infections estimated to occur every year in U.S. nursing homes.
  • Hand hygiene is one of most important ways to prevent the spread of infections.

Image: HCWs were colonized frequently with GNB (66%), Candida (41%), S. aureus (20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB P =.03) and S. aureus (P = .003). Nosocomial infection rates did not change.

1. Mody L, McNeil SA, Sun R, et al. Introduction of a waterless alcohol-based hand rub in a long-term-care facility. Infect Control and Hospital Epidemiology. 2003 Mar;24(3):165-71. PMID: 12683506.

Slide 4: Simplifying the Moments for Hand Hygiene2-3

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Image: Guide on hand hygiene in LTC facilities-

  1. Before initial resident/resident environment contact.
  2. Before aseptic procedures.
  3. After resident/resident environment contact.
  4. After body fluid exposure risk.

Source: Public Health Ontario

2. Guide on hand hygiene in outpatient and home-based care and long-term care facilities: A guide to the application of the WHO multimodal hand hygiene improvement strategy and the "My Five Moments For Hand Hygiene" approach. 2012. World Health Organization. Accessed on April 14, 2015.
3. Just Clean Your Hands educational resources. Ontario Agency for Health Protection and Promotion. Accessed on April 14, 2015.

Slide 5: Alcohol-Based Hand Rub (ABHR)4,5
Hand Hygiene Technique

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  1. Apply hand rub to palm of hand.
  2. Rub hands together, covering all surfaces.
  3. Focus on thumbs, tips of fingers, and under fingernails.
  4. Hands are clean when dry.
    • Usually takes about 15-20 seconds; follow manufacturer's guidance.

Image: WHO Hand Rub Poster

Source: World Health Organization

4. Centers for Disease Control and Prevention. Handy Hygiene in Healthcare Settings. Accessed on August 29, 2016.
5. World Health Organization. WHO Handrub poster. Accessed on April 14, 2015.

Slide 6: Soap and Water Hand Washing4,6,7
Hand Hygiene Technique

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  1. Wet hands with water.
  2. Apply soap to palm of hand.
  3. Rub hands together, covering all surfaces for at least 15 seconds.
  4. Rinse hands with water.
  5. Dry hands with paper towel and use towel to turn off faucet
    • Paper towel prevents hands from being recontaminated by faucet handles.

Image: WHO Hand Washing Poster

Source: World Health Organization

4. Centers for Disease Control and Prevention. Handy Hygiene in Healthcare Settings. Accessed on August 29, 2016.
6. World Health Organization. WHO handwash poster. Accessed on April 14, 2015.
7. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.

Slide 7: Notes About Hand Hygiene Products4,7

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  • ABHRs/gels are preferred for hand hygiene when hands are not visibly soiled or dirty.
  • Times when hands should be washed with soap (non-antimicrobial or antimicrobial) and water:
    • When hands are visibly dirty, contaminated, or soiled.
    • After care of residents with infectious diarrhea.

4. Centers for Disease Control and Prevention. Handy Hygiene in Healthcare Settings. Accessed on August 29, 2016.
7. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.

Slide 8: Efficacy of Hand Hygiene Preparations in Killing Bacteria7

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Image: Hand Hygiene Preparation for killing bacteria-

Plain soap is good.
Antimicrobial soap is better.
Alcohol-based hand rub is best.

Figure is an arrow pointing right, from good to better to best.

7. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.

Slide 9: Hand Hygiene and Clostridium difficile (C.diff)7-9

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  • Hand hygiene with soap and water is superior at removing the spore form of C. diff
  • ABHR is more effective for hand disinfection with other organisms No studies linking ABHR use with an increase in C. diff infection
  • Encourage soap and water after care of residents with acute diarrhea and use of gowns/gloves to prevent spore contamination of hands

7. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.
8. Pop-Vicas A, Baier R. Healthcare workers' hands and Clostridium difficile spores: Making progress? Infection Control and Hospital Epidemiology. 2014 Jan;35(1):16–17.
9. Yokoe DS, Anderson DJ, Berenholtz SM, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Am J Infect Control. 2014 Aug;42(8):820-8. PMID:25087135.

Slide 10: Important Points About Glove Use7

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  • Gloves play a key role in preventing hand contamination—but do NOT replace hand hygiene
  • Change gloves during care when moving from a contaminated body site to a clean body site
    • Do not wear the same pair of gloves for the care of more than one resident
  • Remove and discard gloves after use
    • Do not wash gloves

7. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.

Slide 11: Hand Hygiene Before Urinary Catheter Care

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Perform hand hygiene and wear gloves immediately before—

  • Placing or removing an indwelling catheter.
  • Accessing the drainage system to empty the drainage bag or collect a urine sample.

Why?

  • Interacting with the resident or environment before handling the urinary device may contaminate hands.
  • Reaching for gloves with unclean hands may contaminate the glove box and outside of the gloves.
  • Then, gloves will contaminate the urinary catheter or urine collection system.

Slide 12: Hand Hygiene After Urinary Catheter Care

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Remove gloves and perform hand hygiene immediately after—

  • Handling an indwelling catheter.
  • Accessing the drainage system to empty the drainage bag or collect a urine sample.

Why?

  • Hand contamination may occur as a result of small undetected holes in gloves.
  • Hand contamination may occur during glove removal.
  • Hand hygiene protects your hands and the environment from being contaminated.

Slide 13: Hand Hygiene Case Scenarios

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Let's Chat!

Review the three hand hygiene case scenarios as a group. As you discuss them, think about the following questions:

  • Does our facility staff experience similar challenges to performing hand hygiene at the appropriate times? Why or why not?
  • What could our facility do to reduce barriers to hand hygiene?
  • How can I help support a culture of safety around improving hand hygiene in our facility?

Slide 14: References

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  1. Mody L, McNeil SA, Sun R, et al. Introduction of a waterless alcohol-based hand rub in a long-term-care facility. Infect Control and Hospital Epidemiology. 2003 Mar;24(3):165-71. PMID: 12683506.
  2. Guide on hand hygiene in outpatient and home-based care and long-term care facilities: A guide to the application of the WHO multimodal hand hygiene improvement strategy and the "My Five Moments For Hand Hygiene" approach. 2012. World Health Organization. Accessed on April 14, 2015.
  3. Just Clean Your Hands educational resources. Ontario Agency for Health Protection and Promotion. Accessed on April 14, 2015.
  4. Centers for Disease Control and Prevention. Handy Hygiene in Healthcare Settings. Accessed on August 29, 2016.
  5. World Health Organization. WHO Handrub poster. Accessed on April 14, 2015.
  6. World Health Organization. WHO handwash poster. Accessed on April 14, 2015.
  7. Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory Committee, et al. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep. 2002 Oct 25;51(RR-16):1-45. PMID:12418624.
  8. Pop-Vicas A, Baier R. Healthcare workers' hands and Clostridium difficile spores: Making progress? Infection Control and Hospital Epidemiology. 2014 Jan;35(1):16–17.
  9. Yokoe DS, Anderson DJ, Berenholtz SM, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Am J Infect Control. 2014 Aug;42(8):820-8. PMID:25087135.
Page last reviewed March 2017
Page originally created March 2017
Internet Citation: The How-To’s of Hand Hygiene. Content last reviewed March 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementaion/education-bundles/infection-prevention/hand-hygiene/hand-hygiene-slides.html