Hand Hygiene re-audit. Handwashing Facilities Audit Audit Report May Trustwide. April 2008

Transcription

1 Handwashing Facilities Audit Audit Report May 2006 Trustwide Hand Hygiene re-audit April 2008 Authors: Margaret Boden, Public Health Advisor (Infection Control), And Clinical Governance Network Team. Pam Tester, Clinical Audit & Effectiveness Facilitator Margaret Boden Public Health Advisor (Infection control) Amber Bateman, Project Lead, Clean Your Hands Campaign Hand Hygiene re-audit. April Final version 1

2 Contents Background 3 Aims 3 Guidelines 3 Standards 4 Methodology 4 Results Hand washing facilities 5 Results direct observation 6 Discussion 7 Conclusion 8 Recommendations 8 Next steps 8 Appendix one Handwashing facilities audit tool, audit tool Appendix two Observation of hand hygiene, audit tool Hand Hygiene re-audit. April Final version 2

3 Background Winning Ways: Working together to reduce healthcare associated infection in England (December 2003) states that to bring about an improvement in infection control practice, it is important that measures known to be effective in reducing the risk of infection are rigorously and consistently applied. Hand washing is known to reduce patient morbidity and mortality from hospital acquired infections. It causes a significant decrease in the carriage of potential pathogens on the hands. Patients are put at potential risk of developing a hospital-acquired infection when a health care practitioner has contaminated hands. Hand washing is the single most important procedure for preventing hospitalacquired infections 1. Body secretions, surfaces and hands of all healthcare workers can carry bacteria, viruses and fungi that are potentially infectious to them and others. This audit appraised the provision of adequate hand washing facilities, with the aim of enabling Clinicians to be able to decontaminate their hands properly. The audit also observed handwashing technique to ensure that the optimum procedure was followed. Aims 1. To establish if the facilities are appropriate, accessible, clean and in working order 2. To ensure sufficient supplies of paper towels, soap and alcohol gel are available 3. To identify if staff follow the optimum handwashing technique 4. To improve the cleanliness of ward areas for staff and patients Guidelines Health and Safety at Work Act, 1974, the stationary office Guidelines for Preventing Hospital Acquired Infections Standard Principles (EPIC 2000) Winning Ways Working Together to Reduce Healthcare Associated Infection in England. Report from the Chief Medical Officer (DH 2003) NHS National Patient Safety Agency. Patient Safety Alert 2004 National Standards of cleanliness for the NHS, 2001, The stationary office. Infection control in the built environment. NHS Estates, Infection control in the build environment. NHS Estates 2002 Hand Hygiene re-audit. April Final version 3

4 Standards for handwashing facilities 1. The handwash basin must be accessible 2. Taps should be mixer taps and either wrist or elbow operated 3. Taps must be in good working order, i.e. taps turn on and water flows into the sink 4. There must not be an overflow in clinical handwash basins 5. The handwash basin must be empty i.e. no cups in the basin 6. Handwash basin and taps should be clean 7. Soap should be in the dispenser and the dispenser must work 8. A pedal bin must be clean, available and functional 9. Paper towels must be available Standards for handwashing technique 1. Hands must be decontaminated immediately before each and every episode of direct patient contact 2. Alcohol gel may be used to decontaminate hands between caring for different patients and different caring activities for the same patient 3. Hands must be washed if they are visibly or potentially contaminated with dirt or organic material 4. Hands must be washed with soap and water after removing gloves Methodology Part one Identifying if hand-washing facilities are available and functioning The Infection Control Nurses Association (ICNA) developed an audit tool (appendix one) to reflect the infection control standards. Infection Control Link Practitioners were asked to audit the hand washing facilities in their own areas. The majority of areas (73%) complied with this and returned completed audit tools. A list of wards that did not complete the audit is given in appendix C. Although this is a re-audit, it should be noted that some wards and units may have been closed since the initial audit, so results may not provide an accurate comparisons with last years audit. In addition last years audit looked at all sinks, whereas this year concentrated on those used by staff. Part two - direct observation of hand washing practice During routine visits to the wards, the Clean Your Hands Campaign Co-ordinator carried out some informal observation of hand washing techniques. Opportunities were identified from observing staff on wards, in teams and clinics. Staff were not aware of this at the time, but were given constructive feedback at the end of the visit. The available data on page 5 of this report should be read with the caution that very few activities were actually observed; therefore overall percentages may make the data look more favourable than was actually occurring in practice. Hand Hygiene re-audit. April Final version 4

5 Results: Total patients sinks (n=273): NB a full breakdown of wards has been given to the Facilities Dept and the Public Health Advisor (Infection Control) Standard Yes No The handwash basins are accessible 259 (95%) 14 (5%) Taps are mixer taps 99 (36%) 174 Taps should be elbow operated 99 (36%) 174 Magic eye taps are in place 24 (9%) 249 (91%) Taps must be in good working order 254 (93%) 19 (7%) There should not be an overflow 126 (46%) 147 (54%) The handwash basin must be empty 267 (98%) 6 (2%) Handwash basin and taps should be clean 261 (96%) 12 (4%) Soap should be in the dispenser 266 (97%) 7 (3%) The soap dispenser should be in good working order 267 (98%) 6 (2%) A pedal bin must be available and functional 189 (69%) 84 (31%) The pedal bin should be clean 186 (68%) 87 (32%) Paper towels must be available 238 (87%) 35 (13%) Hand Hygiene re-audit. April Final version. 5

6 Results direct observation of handwashing technique A total of 29 hours were spent observing a range of wards / clinics across LCT. The table below reflects where an activity was observed. Wards audited Area Number of activities % Compliant? % Effective? observed Balmoral North 3 100% 0% Bickerstaffe West 1 100% 100 Burnley PICU East 1 100% 100% Charnock Central 1 100% 100% Fairoak Secure 1 0% 0% Hyndburn East 1 100% 100% Latham West 2 100% 100% Manx North 3 33% 33% Mossview North 1 0% 0% Oak Central 1 100% 0% Oaklands North 5 80% 80% Scarisbrick West 6 0% 0% Silverdale North 3 100% 100% Ward 1 Central 3 100% 100% Ward 2 Central 5 100% 100% Wards 18 East 5 0% 0% Ward 19 East 3 33% 33% Ward 22 East 2 100% 100% Willow Central 1 100% 100% Total Trust wide (65%) 24 (50%) Hand Hygiene re-audit. April Final version 6

7 Results direct observation of handwashing technique A total of 29 hours were spent observing a range of wards / clinics across LCT Area Wards audited Wearing hand gel? Access to hand gel? Patients encouraged to wash their hands? North Balmoral No No Yes West Bickerstaffe No Yes No East Burnley PICU Yes Yes Yes Secure Calder No No No Central Charnock No No No North Conway No No Yes East Darwen Yes Yes No Secure Elmridge Yes Yes No Secure Fairoak Yes Yes No Secure Greenside No No No North Halton No No No Central Healey No No No East Hyndburn No No No West Latham Yes Yes No North Lonsdale Yes Yes No Secure Mallowdale Yes Yes No North Manx No No No North Mossview Yes Yes No Central Oak No No Yes North Oaklands Yes Yes No North Pharos No No No West Scarisbrick Yes No No North Silverdale Yes Yes No North Stirling No No No Central Sycamore No Not known No North Talbot Yes Yes No Central Ward 1 Yes Yes Yes Central Ward 2 Yes Yes No East Wards 18 No No No East Ward 19 Yes Yes No East Ward 20 Yes Yes No East Ward 22 No Yes Yes North Warwick No No No Central Willow Yes Yes No Central Yarrow No Available but not for use (?) No Hand Hygiene re-audit. April Final version 7

8 Discussion Hand washing facilities available Across the Trust, 95% of hand basins were accessible, however, only 36% of taps were mixer taps and 36% of these were elbow operated. Taps and soap dispensers were in good working order in over 97% of areas, and paper towels were available in 87% of hand washing facilities. Pedal bins were available, functioning and clean in 75% of areas. In the initial audit, a recommendation was made by the Public Health Advisor (Infection Control), that magic eye taps be made available across the Trust. This has yet to be fully implemented as magic eye taps are in place in only 9% of sinks. This is due to difficulties with siting / fitting the new taps. In terms of the hand wash basins being empty, the majority of basins (98%) met this standard, overflows were present in 54% of sinks. A high number of basins and taps number (96%) were clean. The results for this were consistent across the Trust. Observation of hand washing technique A total of 48 opportunities for handwashing / hand decontamination were witnessed during the ten hours of covert observation. Of the 48 opportunities that could have been taken to hand wash, only 31 (65%) were taken, and only 50% of these were effectively carried out. Staff do need to be more mindful of the need to wash hands between every form of patient contact. The Public Health Advisor (Infection Control) has already commenced work on addressing this issue through a clean hands campaign. The Clean Yours Hands co-ordinator has visited wards and teams as part of this project, demonstrating how the correct way to decontaminate hands. This work will continue throughout Comments in relation to the re-audit The initial audit found that hand basins were as accessible as they were in the initial audit, and that paper towels and soap were as available as last year. The data also shows that an increased number of wards (15% higher) reported their sinks now had mixer taps installed. The number of staff taking opportunities to wash their hands is comparable to this years data, however the amount of wards that had ready access to alcohol gel has decreased. It is thought this is due to problems with re-ordering stock, and the Public Health Advisor (Infection Control) will put together packs of information for Managers about how and where to re-order supplies of alcohol gel. Hand Hygiene re-audit. April Final version 8

9 Conclusion The key aims of this audit were to establish if the facilities are appropriate, accessible, clean and in working order and to identify if staff follow the optimum hand washing technique. The audit has found that hand washing facilities are available, although some further work needs to be undertaken to install the magic eye taps as requested. Staff are still not taking every opportunity to decontaminate their hands, however, it is anticipated that the Clean Your Hands Campaign will help to improve this issue. Recommendations 1. The Estates and Facilities department to ensure that any new sinks fitted comply with the relevant regulations 2. The Public Health Advisor (Infection Control) and Clean Your Hands Campaign Co-ordinator to put together packs of information for Ward Managers and Team Leaders on how to order stocks of alcohol gel 3. Ward Managers and Team Leaders to ensure an adequate supply of alcohol gel is maintained on the ward / team 4. The Clean Your Hands Campaign Co-ordinator to provide posters to ward and teams for display purposes, reminding staff, patients and visitors of the importance of hand washing. Ward Managers to ensure these continue to be displayed and changed as appropriate. 5. A re-audit to adopt the audit tool developed by the National Patient Safety Agency (NPSA) which will standardise hand hygiene compliance in line with national standards Next steps Disseminate the audit results to Network Directors, Modern Matrons, Ward Managers, Infection Control Link Practitioners and Ward Housekeepers. The Public Health Advisor (Infection control) and Clean Your Hands Campaign Coordinator will develop an action plan to address and monitor all recommendations included in this report. Re-audit in 12 months time Hand Hygiene re-audit. April Final version 9

10 Appendix one audit tool A AUDIT OF HANDWASHING FACILITIES Auditor: (BLOCK CAPITALS) Grade/Post held: (HANDWASH BASINS, SOAP, PAPER TOWELS, PEDAL BINS) WARD/DEPT: DATE: TIME: 1. LOCATION ROOM OR BAY NO. 2. HANDWASH BASIN NO. 3. ACCESSIBLE Y/N MIXER TAP Y/N 5. ELBOW TAPS Y/N 6. FUNCTIONAL Y/N 7. OVERFLOW PRESENT Y/N 8. HANDWASH BASIN EMPTY Y/N 9. HANDWASH BASIN & TAPS CLEAN Y/N 10. SOAP IN DISPENSER Y/N 11. FUNCTIONAL Y/N 12. CLEAN Y/N 13. PEDAL BIN AVAILABLE & FUNCTIONAL Y/N 14. PEDAL BIN CLEAN Y/N 15. PAPER TOWELS AVAILABLE Y/N HANDWASHING FACILITIES B

11 HANDWASH BASINS Auditor: (BLOCK CAPITALS) Grade/Post held: LOCATION ROOM OR BAY NO. HANDWASH BASIN NO. 16. SKIN ANTISEPTIC Y/N WARD/DEPT: DATE: TIME: PUMP DISPENSER Y/N 18. BRACKET Y/N 19. ELBOW OPERATED Y/N 20. CLEAN Y/N 21. FUNCTIONAL Y/N TYPE OF SKIN ANTISEPTIC *H, A, B, AQ TOTAL HANDWASH BASINS CHECKED NUMBER WHERE PROBLEMS IDENTIFIED = = ACTIONS TAKEN TO ADDRESS PROBLEM & DATES = * H = Hibiscrub A = Alcohol Hand Gel/Rub B = Betadine/Povidone Iodine AQ = Aquasept Add additional sheet of paper to record actions as appropriate

12 Hand Hygiene Observation Infection control audit Ward / Unit Date of observation: / / Health Economy Time : to : OBSERVED OPPORTUNITY COMPLIANCE TECHNIQUE EFFECTIVE STAFF Activity: Yes No Yes No Type MITIGATION Name of Auditor(s) Did staff encourage patients to wash their hands? Yes No Are staff wearing alcohol gel? Yes No Up to date campaign posters visable? Yes No

13 DEFINITION OF OPPORTUNITY TO WASH HANDS WITH SOAP AND WATER OR TO USE ALCOHOL GEL Hands must be decontaminated immediately before each and every episode o direct patient contact Alcohol gel may be used to decontaminate hands between caring for different patients and different caring activities for the same patient Hands must be washed if they are visibly or potentially contaminated with dirt or organic material Hands must be washed with soap and water after removing gloves Effective techniques thorough hand decontamination and protects skin integrity Comments

14 Appendix C Ward that did not complete the audit: Network Area Ward Adult East Burnley PICU Adult East Calder Adult Central Charnock Adult Central Healey Adult East Hyndburn Adult West Latham Adult Central Oak Adult West Scarisbrick Adult Central Sycamore Older adult Central Ward 1 Adult East Ward 20 Older adult East Ward 22 Adult Central Willow Adult Central Yarrow