Module 1: Hand Hygiene. MOHLTC Core Competencies Adapted for placement students Infection Prevention & Control Department July 2012
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1 Module 1: Hand Hygiene MOHLTC Core Competencies Adapted for placement students Infection Prevention & Control Department July 2012
2 Hand Hygiene 30% of hospital-acquired infections can be prevented by following infection prevention and control strategies (1). In Canada, 220,000 incidents of Healthcare Associated Infections (HAIs)/YEAR (1) Responsible for 12,000 death/year in Canada MRSA infection costs CAD $ 27,661/each patient All people working in a healthcare facility play a vital role in implementing IPAC strategies which are designed to protect patients, staff and the community. YOU CAN MAKE A DIFFERENCE!
3 Hand Hygiene Refers to killing or removal of microorganisms on the hands that have been picked up by contact with patients, staff, contaminated equipment or the environment Includes maintaining good skin integrity
4 2 Methods of Hand Hygiene Hand Washing with soap & water performed when hands are visibly soiled (with organic matters, i.e., food, soil, blood, body fluid-urine, stool) Hand Sanitation with Alcohol-based Hand Rub (ABHR) preferred method in healthcare settings to clean hands that are not visibly soiled
5 1. Liquid soap Types of Hand Soap Used for most patient care Appropriate for most hand washing 2. Antibacterial Soap Not recommended for routine use at Providence Healthcare (used in critical care settings such as surgical suite, Intensive Care Unit)
6 Alcohol-based Hand Rub Why is it a preferred method in a healthcare setting? Provides a rapid kill or removal of most bacteria on hands Takes less time than using soap and water Contains emollients to reduce skin irritation Remember not to rinse off with water immediately after application
7 Steps in hand washing with soap & water (2)
8 Steps for hand hygiene using alcohol-based hand rub (ABHR)
9 The effectiveness of Hand Hygiene is adversely impacted by: 1. Skin Condition Healthy skin is the 1 st line of defense against infection Dry and cracked skin harbor more microbes Apply hand cream to protect skin after frequent hand washing
10 The effectiveness of Hand Hygiene is adversely impacted by: 2. Finger Nails & Jewelry Long nails, chipped polish, artificial nails, jewelry are reservoir for microorganisms. Artificial nails must not be worn in Health Care Facilities by those who do direct patient care and has been implicated in outbreaks Can tear gloves
11 4 Moments of Hand Hygiene (3)
12 Remember, do hand hygiene. Before putting on gloves. After removing gloves.
13 Patient Care Environment Everything within the curtain area in a shared room (washroom is a shared healthcare environment) Everything within the patient s single room, including the washroom
14 Healthcare Environment The environment (including equipment or articles) outside of the patient room or bedspace Shared space with other patients or healthcare workers
15 Examples of Healthcare Environment Nursing Station Shower Room Dirty Utility Room Medication Room Activity Room Clean equipment Room
16 Must perform hand hygiene when you are moving in between these two environment Patient Environment Healthcare environment
17 Point of Care the right way, in the right place Refers to three elements occur together and require hand hygiene: (patient + health care provider + care involving contact ) Where the healthcare worker provides care to patients: could be within the Patient or Healthcare environment Point of Care can take place anywhere at Providence Healthcare with our mobile population
18 Example of Point of Care Mobile patient on wheelchair/stretcher Dinning Room Activity Room Lobby Charting area in Gym: hand hygiene before and after in contact of patient
19 Module 2: Chain of Transmission MOHLTC Core Competencies Adapted for placement students Infection Prevention & Control Department July 2012
20 Chain of Transmission (4) There are six links in the chain of transmission for infection to occur To stop the infection one of the links needs to be broken
21
22 Chain 1: Infectious Agents Infectious agents are germs or organisms that are capable of causing disease These agents could be: Bacteria Fungi Viruses Parasites These agents are found everywhere, but not all bacteria cause infections; some are harmless and even protective
23 Chain 2: Reservoirs Where infectious agents live and reproduce Reservoirs could be Humans, (patients, staff, visitors) The environment (water, patient equipment, surfaces like keyboard, handrails) Animals (pets or wild animals)
24 Chain 3: Portal of Exit How they leave the reservoir Through blood, body fluids Saliva, wound drainage, feces, mucous, vomitus, semen
25 Chain 4: Mode of Transmission Three major modes of transmission: Contact by touching the infective material (feces, contaminated item) Droplet large droplets from the mouth or nose through coughing, sneezing, laughing Airborne very small droplets that remain suspended in air and inhaled e.g. TB, chicken pox
26 Other Modes of Transmission Skin puncture cuts, lacerations, injections Common vehicle contaminated source e.g. water, food, equipment Vector animal or insect bite e.g. malaria, rabies
27 Remember, the droplets can disperse to at least 2 meters or more
28 Chain 5: Portal of Entry Ways how the germs get in the body Examples: Breathing in microbes Eating or drinking contaminated food or water Broken skin Touching mucus membranes with dirty hands Sexual contact e.g. Hepatitis B, HIV
29 Chain 6: Susceptible Host Any person who is at risk of infection (that means, anyone) Risk factors: Age: very young or old Poor nutrition Weakened immune system Breaks in skin Lack of sleep High stress levels Poor personal hygiene
30 Breaking the Chain of Infection The aim of infection control is to stop the spread of infection by breaking one of the chains!
31
32 Breaking the Chain at the link Infectious agent: Medications antibiotics, antivirals, antifungals, antiparasitic agents Disinfection Sterilization
33 Breaking the Chain at the link Reservoirs: Cleaning of environment Proper food storage Get rid of standing water Water treatment
34 Breaking the Chain at the link Portal of Exit: Hand hygiene Cough etiquette (cover coughs/sneezes) Barrier protection - band aids, condoms Disposal of waste and contaminated materials
35 Breaking the Chain of the link Mode of Transmission: Hand hygiene Cleaning, disinfection and sterilization Barrier protection - mosquito nets, gown gloves, mask No sharing of drinks/cigarettes
36 Breaking the Chain at the link Portal of Entry: Hand hygiene Barrier protection - gown, gloves, mask, wound covering, condom
37 Breaking the Chain at the link Susceptible Host: Immunization Good nutrition, rest, low stress level Treatment of ill person
38 Module 3: Routine Practices MOHLTC Core Competencies Adapted for placement students Infection Prevention & Control Department July 2012
39 Routine Practices (5) The infection prevention and control practices should be applied routinely for all patients/residents at all times
40 Routine Practices in infection control start with Risk assessment before providing care: What is the risk of exposure (microbes, nonintact skin, body fluid & substance, mucous membrane, contaminated equipment, etc.) How is this organism transmitted? Is the patient cooperative? How can I prevent spreading the microbes to others?
41 Know the risk: Ask the question: What task am I going to perform?
42 Know the risk: Ask the question: What PPE do I need to wear to protect myself and help stop the spread of infection?
43 Assess your risk Will my hands be exposed to blood, body fluids or objects contaminated with these, or to broken skin? If yes, perform hand hygiene & wear gloves!
44 Assess your risk Will my face be exposed to a splash, spray, cough or sneeze? If yes, wear mask with eye shield!
45 Assess your risk Will my clothing or skin be exposed to splashes/sprays or items contaminated with blood or body fluids? If yes, wear a gown!
46 Routine Practices Prevent Transmission of Microbes From From From From patient to patient patient to staff staff to patient staff to staff
47 Routine Practices Include Hand hygiene Cleaning of shared equipment Laundry management Environmental cleaning Sharps management Waste management
48 Routine Practices include Appropriate use of Personal Protective Equipment Wear: (PPE) Gloves when touching non-intact skin, blood, body fluid, contaminated equipment Gown when risk of splashing on clothes Mask/face shield when taking care of coughing/sneezing patient, splashing of body fluids
49 Additional Precautions Precautions in addition to Routine Practices Used for patients identified with infectious organisms Based on Mode of transmission of the organism either Contact, Droplet/Contact, Airborne precautions
50 Additional Precaution Signs C-Diff./VRE Fever & Respiratory Symptoms, Influenza, Vomiting & Diarrhea MRSA/ESBL/ Diarrhea TB/Chicken Pox & Measles Placed on the door of the patient s room. Placed on the wall over the bed in multi-bed room
51 Important tips Hand hygiene before touching medication cart to prepare medication & after touching healthcare environments Remove any part of contaminated PPE and apron where they were used (Whatever belongs to that patient should stay in the same patient s room including pathogens) Put on any part of PPE immediately before providing care to keep it clean for the patient Staff with apron, gloves, isolation gown should not be at the nursing station Do not touch yourself, healthcare environment (clean linen carts, charts, hampers, etc.) with contaminated gloved hands Remove gloves that have come in contact with shared equipment, soiled linen, garbage bag, blood & body fluid before touching patient/pt environment again
52 Remember Infection Prevention and Control is EVERYBODY S business. Please do your part!
53 References: 1.Provincial Infectious Diseases Advisory Committee (PIDAC). Surveillance of health care-associated infections in patients and resident populations. Oct PIDAC. Best Practice for Hand Hygiene in All Health Care Settings. Revised Dec Ministry of Health and Long-term Care (MOHLTC). Just Clean Your Hands Program MOHLTC. IPAC Core Competency Education for all healthcare providers: The first three acute care modules. March, PIDAC. Ontario Agency for Health Protection & Promotion. Routine Practices and Additional Precautions in All Health Care Settings. Revised July 2011
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