The purpose of this video is to provide general information and education about the care of
a critically ill child.
It is in no way a substitute for the independent decision making and judgment by a qualified
health care professional.
The information contained in this video should not be used to make a diagnosis or to overrule
the advice of a qualified health care provider, nor should it be used to provide advice for
emergency medical treatment.
Hand Hygiene by Deb Morrow.
Please note that, in this video, we will be following the guidelines used at Boston Children's
Hospital.
Some of this information may need to be modified based on the equipment, guidelines, and practices
in place in your institution.
Hi, I'm am Deb Morrow a Staff Nurse III and the Infection Prevention Coordinator for the
cardiovascular intensive care unit at Children's Hospital Boston.
Introduction.
The number one intervention for preventing the spread of infectious agents in health
care settings is careful hand hygiene by doctors, nurses, and other health care workers.
It is estimated that 80% of the transmission of infectious agents in the health care setting
is by the hands of doctors, nurses, and other health care workers.
It is important to remember that infectious agents can survive on hands for a few minutes
to more than an hour.
And these survival times clearly demonstrate the need for careful hand hygiene.
However, multiple studies have shown that hand hygiene compliance among health care
workers is low worldwide, ranging from 36% to 48%.
When doctors, nurses, and other health care workers are asked why they do not wash their
hands, they often say that they lack education on the importance of hand hygiene or they
do not know when to perform hand hygiene.
Hand hygiene products or sinks are located far away from patient care.
They may not like the hand hygiene products due to odor, allergies, or skin irritation.
They are too busy or the patient is too sick for them to stop and perform hand hygiene.
Or they simply forget.
World health organization initiatives.
Therefore, the World Health Organization has made improving hand hygiene the focus of its
program to reduce health care associated infections.
Hand hygiene means clean your hands using antiseptic soap, and clean water, or an alcohol
based hand sanitizer.
Hand hygiene compliance not only protects patients, it protects doctors, nurses, and
other health care workers.
For more than 15 years the World Health Organization has recommended the use of alcohol based hand
sanitizers as the primary form of hand hygiene in health care settings.
Alcohol based hand sanitizers have been shown to remove organisms more effectively, require
less time, and cause less skin irritation than hand washing with soap and water.
Soap and water should always be used when hands are visibly soiled, the patient has
Clostridium difficile or another infection caused by spore forming bacteria such as anthrax,
before eating, and after using the restroom.
This World Health Organization poster shows the five moments for hand hygiene.
Number one is before patient contact.
Number two before an aseptic task, such as changing a dressing, or touching an intravenous
catheter.
Number three is after exposure to body fluids.
Number four is after patient contact.
And number five is after contact with the patient's surroundings.
Doctors, nurses, and other health care workers should also remember to perform hand hygiene
when moving from a contaminated body site to a clean body site.
And before and after diaper changes, dressing changes, ostomy care, endotracheal tube suctioning,
and oral hygiene.
Doctors and nurses often forget that after stepping away from a patient and performing
other tasks in the room such as charting.
They must clean their hands again.
Before touching the patient.
Other important aspects of hand hygiene are to dry your hands before patient contact.
Moist hands transmit more microorganisms.
If you use soap, it should be from a dispenser, and the use of individual hand towels, either
paper or cloth, is recommended.
If bar soap is used, it should be kept in a holder that allows it to dry in between
uses.
Fingernails should be kept short, and artificial nails should not be worn by doctors, nurses,
or other health care workers who take care of patients.
Hand hygiene and the use of gloves was a large part of the teaching program here at Children's.
Gloves do not provide complete protection against hand contamination.
Therefore, the use of gloves does not replace the need for careful hand hygiene.
Gloves can be contaminated when putting them on, and hands can be contaminated when removing
dirty gloves.
So hand hygiene is necessary before and after wearing gloves.
Gloves should always be changed between patients, and between contact with patients supplies
or environment.
Gloves should be worn for one procedure only, and then changed.
Do not reuse gloves.
Culture of safety.
There are four main components to creating a culture of safety in your hospital.
Improving hand hygiene among doctors and nurses should be number one.
But you also want to implement practice bundles to decrease the occurrence of device associated
infections.
Initiate quality improvement programs that will create policy and audit practice.
And finally, improving team communication will assure that staff members are comfortable
speaking up when correct practice is not observed.
Culture of safety, Improve hand hygiene.
Initiatives to reduce infection and improve patient safety are important, but changing
practice is a difficult task.
Therefore, establishing a culture of safety within your hospital is paramount to the success
of the initiatives to reduce infection.
Forming a multi-disciplinary hand hygiene team will promote acceptance of practice changes.
Team members should include doctors, nurses, infection control experts, hospital leadership,
and other hospital staff.
Evaluate barriers to hand hygiene compliance, and address areas to be improved.
Is the hospital able to provide a reliable supply of hand hygiene products?
The World Health Organization recommends that there be a minimum of one sink for every 10
beds, with soap and disposable towels at every sink.
Are hand hygiene products available where patient care takes place?
Alcohol hand sanitizer at every bed space is the ideal situation.
You should allow staff to evaluate and choose their hand hygiene products.
Education will be the biggest factor in your success.
Infection control experts should educate hand hygiene teachers, who will educate remaining
staff on why hand hygiene is important, and when it is necessary.
The World Health Organization provides many educational materials on their website.
You should also educate staff to speak up in a professional manner when hand hygiene
is not performed.
Culture of safety, implement practice bundles.
The second component to create a culture of safety is to implement bundles of care.
A bundle is a combination of evidence based practices which will improve patient outcomes
when followed by every member of the health care team.
Bundles to prevent catheter associated bloodstream infections, surgical site infections, urinary
tract infections, ventilator associated pneumonia will be reviewed in upcoming videos.
Culture of safety, initiate quality improvement programs.
The development of quality improvement programs are the third area necessary to create a culture
of safety, and these programs should develop policies for the insertion in care of catheters.
Catheters should only be placed and cared for by trained personnel.
Implement audits to assess whether practice follows policy.
And it is important to share the results of these audits with staff, and provide education
on infection prevention for all doctors and nurses.
In the last 10 years implementing quality improvement programs has reduced infection
rate so successfully that health care associated infections are now considered a medical error
in the United States.
Many government programs and private insurance companies in the United States and Europe
are not reimbursing hospitals for the costs related to health care associated infections.
Culture of safety, improve team communication.
The final component to create a culture of safety is to improve communication among members
of the health care team by creating an environment where every member of the team feels comfortable
expressing their concerns in a professional manner.
The typical medical nursing relationship is very hierarchical, with nursing reporting
up the chain of command.
Some nurses are hesitant to voice their concerns, opinions, and knowledge, which can compromise
patient safety.
It may be necessary to introduce communication training and team building skills for both
the doctors and nurses to effectively empower staff.
Because every staff member has a moral responsibility to intervene and halt a procedure if safety
is being compromised.
Strategies to improve communication will be presented in a future lecture.
That concludes our video on hand hygiene.
Thank you.
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