Hand Hygiene

Infection Prevention Team

May 2010
 Why Hand Hygiene?
FACT:
Hand Hygiene is the single most
important measure for preventing the
spread of infection
(Pittet et al 2001)
IT IS ESSENTIAL FOR PATIENT
SAFETY
Ignaz Philip Semmelweis (1818 1865)
Hungarian born doctor
Worked in Vienna
Mortality rate in
Doctor led ward 3
times higher than
Midwife led ward
Doctors worked in
autopsy room, then
delivered women
afterwards
Semmelweis identified
link in 1846 &
introduced chlorinated
lime for hand washing
Mortality rate fell
dramatically
Why carry out hand hygiene?:
To render hands socially clean and to
remove transient micro-organisms.
NB: Routine hand hygiene removes most
transient micro-organisms from soiled
hands.
What are your hands carrying?
Resident Transient
Flora: Flora:
Deep seated Superficial
Difficult to remove Transferred with
Part of bodys ease to and from
natural defence hands
mechanism Important cause of
Associated with cross infection
infection following Easily removed with
surgery/invasive good hand hygiene.
procedures.
Hand Hygiene includes:

Routine hand washing

Surgical hand scrub

Use of alcohol rubs/gels.

NOTHING BELOW THE ELBOWS
(NBE)
In line with national guidance (DoH, Sept 2007),
SUHT has chosen to adopt a Nothing Below the
Elbows policy for all staff working in the clinical
environment
Clinical environment to be defined as any area
where a patient is seen/treated e.g.
Wards
OPDs
Radiology
ED
These requirements apply even if the staff
member will not be having direct clinical contact
with a patient, as hand contamination & the need
for hand hygiene occurs due to contact with the
environment & equipment, as well as with
patients.
NBE Cont.
On arrival in the clinical environment
ALL staff (clinical & non-clinical),
volunteers & visiting staff must remove
jackets/cardigans/jumpers/coats & hang
them up in a designated secure area for
the ward/dept they are in
Wristwatches, bracelets (except Kara) &
all rings (except for a PLAIN wedding
band) must be removed
Long sleeves must be rolled up to above
the elbow
Hands must then be decontaminated with
alcohol hand rub/gel or soap & water
following the posters on display in the
clinical areas.
NBE Cont.
Any staff member with any portion of
their forearm, wrist and/or hand in a
bandage, splint, plaster cast and/or sling
of any description cannot be permitted
to work in the clinical environment as
hand contamination and the need for
hand hygiene occurs due to contact with
the environment and equipment, as well
as with patients.
Fingernails
Fingernails
Short
Clean
Free from nail varnish
Free from nail art
Free from nail extensions
Free from artificial fingernails
Harbour micro organisms that are not
easily removed during hand hygiene
(Larson, 1989)
Documented evidence of link between
artificial nails and a Pseudomonas
outbreak in a neonatal intensive care
unit in the USA
Jewellery
Jewellery worn on the hands &
wrists
become contaminated during
work activities
Prevent thorough hand
hygiene procedures
(Larson, 1985)
Permissible Jewellery
Plain wedding band
Ridges, stones or grooves harbour
higher levels of micro organisms
Could potentially damage the
integrity of a patients skin
Kara bracelet
A steel bracelet (usually worn on the
right wrist) by members of the Sikh
faith

Forms one of the five Ks

Fob watches or wrist watches worn
through a belt loop on a waistband
Unacceptable Jewellery
Rings other than a plain wedding band
Engagement rings
Eternity rings
Bracelets other than a Kara
Medic-Alert (may be worn as
necklace or anklet or attached to
uniform, but not on the wrist)
Charity bracelets
Friendship bands
Wrist Watches
RELIGIOUS
CONSIDERATIONS
Alcohol hand rubs most religions give
priority to health principles to ensure
patient safety. Consequently, no
objections have been raised against the
use of alcohol-based products for
environmental cleaning, disinfection or
hand hygiene by any religion (WHO,
2006; Allegranzi et al, 2009).
RELIGIOUS CONSIDERATIONS
CONT.
Nothing Below the Elbows It has been
established that all religions endorse the
principle that an individual should do no harm to
others. The wearing of long sleeves prevents
effective hand hygiene as it is not possible to
clean the wrists fully, and hand hygiene is
essential for safe patient care. Therefore, staff
who are required by their religion to wear long
sleeves must roll-up their sleeves to ensure that
the wrist & forearm are exposed in the following
circumstances:
When undertaking direct patient contact.
As part of Infection Control Standard,
Contact, or Protective Isolation
precautions.
When performing hand hygiene, using either
soap & water or alcohol hand gel.
WHO My five (KEY) moments for
hand hygiene
1. Before
touching a
patient
2. Before
clean/aseptic
procedure
3. After body
fluid exposure
risk
4. After touching
a patient
5. After touching
patient
surroundings
Additional Moments for Hand
Hygiene
Before commencing work/after leaving
work area
Before preparing or eating food
Before handling medicines
Before wearing & after removing gloves*
After handling contaminated laundry &
waste
After using the toilet
After contact with patients in isolation
After cleaning equipment or the
environment
Health-care & Patient Zones
Choice of cleansing agent.
Risk Assessment:
Likelihood that micro-organisms have
been acquired or transmitted.
Whether the hands are visibly soiled.
What procedure is about to take place.
Wash hands with soap & water following
contact with Clostridium difficile
diarrhoea/infective diarrhoea.
Alcohol rubs/gels
Use on visibly clean hands only
Rub into hands using same technique as
for hand washing
Continue rubbing until dry (emollient will
condition hands).
Not suitable for use following contact
with Clostridium difficile or suspected
infectious diarrhoea.
Routine Hand Washing.
Duration
Routine hand wash = 40 60 seconds.
Technique
Wash systematically, rubbing all parts
of hands and wrists with soap and water
careful to include areas of hands that
are most frequently missed.
Technique

palm to palm
backs of hands
interdigital
spaces
fingertips
thumbs and
wrists
nails
Areas most frequently missed:

Webs of fingers
Thumbs
Palms
Nails
Backs of fingers
& hands
Wrists
Drying:
CRUCIAL micro-organisms thrive
in a warm, moist environment
Use paper hand towels
When you dry your hands:
Work from fingertips to wrists
Dispose of used towel correctly (foot
operated bin)
Repeat until both hands are
completely dry.
Tips:
Remove jewellery, roll up sleeves &
remove wrist watches (should already be
compliant with NBE).
Always use running water at a
comfortable temperature
Wet hands thoroughly before applying
any soap (forms a protective barrier)
Use enough soap to get a visible lather
Tips:
MAKE SURE THAT YOU:
Clean all parts of both hands
Pay attention to thumbs, fingertips,
palms.
Clean and dry beneath wedding rings (&
Kara if worn)
Pay equal attention to dominant and non-
dominant hands.
Tips:
Rinse your hands thoroughly under
running water to ensure that all micro-
organisms and soap are washed away.
Leaving soap on your hands or failing to
dry properly will make them sore.
The only time you should use soap &
water followed by alcohol hand gel, is
when you are about to don a pair of
sterile gloves prior to performing a
(non-operative) aseptic technique.
Looking after your hands
Risk of skin problems (dermatitis) may increase
with frequent hand washing.
Bacterial counts increase when skin is damaged.
Risk reduced by:
Using alcohol gel instead of washing if
appropriate
Always apply soap to wet hands.
Thorough rinsing & drying
Moisturise (should be available in all clinical
areas)
Only using gloves when necessary
Always cover cuts and grazes
Report any skin rashes immediately to
Occupational Health (ext 4156)
Hand Care
Important to look after the skin &
fingernails
Damaged skin leads to loss of a
smooth skin surface & increases the
risk of skin colonisation with
resistant micro organisms
Continuing to work with damaged,
cracked or weeping skin may expose
the healthcare worker to increased
infection risk, which could ultimately
lead to sickness absence due to
dermatitis
Hand Care cont.
Appendix 8 (p. 24) of the Hand
Hygiene Policy details the action a
staff member must take if they
experience
Acute skin lesions/conditions/reactions
Chronic skin lesions/conditions/reactions
Possible dermatitis
The staff member must seek advice
from the Occupational Health
Department (OH)
Action is not optional:
Professional Codes of Conduct
Clinical Negligence Scheme for Trusts
(CNST)
NHSLA (NHS Litigation Authority)
Trust Policies (Terms & conditions of
employment)
Standards for Better Health core
standard 4a.
The Health Act 2006 (Revised 2008)
Any Questions?