The Australasian College of Dermatologists and the Occupational Dermatology Research and Education Centre has put together this useful guide on what healthcare workers can do to maintain their hand skin care health.
Healthcare workers with artificial nails are more likely than those with natural nails to harbour gram-negative pathogens on their fingertips. The consensus recommendations from the World Health Organization are that healthcare workers do not wear artificial fingernails or extenders when having direct contact with patients and natural nails should be kept short (< 0.5cm long).
Any such targets should first be realistic and attainable, in view of the long-term efforts required to bring about improvements in hand hygiene behaviour. Aiming for complete compliance in the short term would obviously be difficult to achieve in facilities where initial compliance rate may be less than 40%.
What should be aimed for is the establishment of a baseline, and a steady, sustainable, month by month, year on year improvement.
If relatives and carers are helping to nurse a patient they should be shown how and when to clean their hands during a sequence of care. However, they are unlikely to touch other patients in a similar way so are unlikely to transfer infection to other patients.
Patients can transfer pathogens from one site on their body to another. If patients are having contact with their wound or the insertion site of a device, hand hygiene should be encouraged. In the same way visitors having contact with the patient should perform hand hygiene. In instances where visitors are likely to have physical contact with more than one patient, then hand hygiene should be performed before and after touching a patient, and after body fluid exposure (see The 5 Moments for further details).
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The first thing to do is to decide if your organisation is required to conduct hand hygiene compliance auditing. This decision will be based on the requirements set out by your accreditation standards, your jurisdictional requirements and/or your organisation's governing body. The NHHI Manual includes a range of useful information on implementation of a hand hygiene program.
If you need to conduct hand hygiene compliance auditing, then you will need to ensure that appropriately trained General and Gold Standard Auditors are available to support implementation and auditing.
If you do not need to conduct hand hygiene compliance auditing, then please review the NHHI Manual and decide which components of the 5 Moments for Hand Hygiene program are appropriate for your facility (for example, education, product placement, online learning, promotion).
A TGA-listed alcohol-containing preparation designed for reducing the number of viable micro-organisms on the hands without the use or aid of running water, and which is listed on the ARTG as a medicinal product.
An alcohol-containing wipe used to clean non-soiled shared patient equipment in between each patient use e.g. blood pressure cuffs.
The presence of bacteria in the blood.
Body Fluid Exposure Risk
Any situation where contact with body fluids may occur. Such contact may pose a contamination risk to either the healthcare worker or the environment.
Any substance secreted by the body with the exception of sweat. These include: blood, lochia, saliva, secretions from mucous membranes, pus, gastric and respiratory secretions, semen, tears, wax, breast milk, colostrum, urine, faeces, meconium, vomitus, pleural fluid, cerebrospinal fluid, ascites fluid, biliary fluid, bone marrow, organic body samples including biopsy samples, organ and cell samples.
Confidence intervals calculate the range in which the true compliance result lies, based on the data collected and the compliance measured, thus providing an indication of the reliability of the reported hand hygiene compliance level. When only a small number of moments are collected, the confidence interval will be larger, as it is more difficult to establish the true compliance level from a small sample of moments. If a large number of moments are collected the confidence interval will be smaller, meaning the reliability of the result is higher. The Commission calculates 95% confidence intervals, indicating the intervals in which 95% of the time the true compliance level lies.
The touching of any patient or their immediate surroundings or performing any procedure.
Application of either an antimicrobial soap/solution and water or an alcohol-based hand rub product, to the surface of the hands. This process reduces microbial counts on hands.
A detergent-containing wipe used for cleaning lightly soiled shared patient equipment in between each patient use.
Ingredient(s) added to hand hygiene products to moisturise and protect the skin from frequent product use.
Glove use by healthcare workers is recommended for two main reasons: to prevent micro-organisms which may be infecting, commensally carried, or transiently present on healthcare workers hands from being transferred to patients and from one patient to another; and to reduce the risk of healthcare workers acquiring infections from patients.
Actions to reduce the risk of skin damage or irritation. For example, using a moisturiser regularly throughout the day.
A general term applying to processes aiming to reduce the number of microorganisms on hands. This includes: application of a waterless antimicrobial agent (e.g. alcohol-based hand rub) to the surface of the hands; and use of soap/solution (plain or antimicrobial) and water (if hands are visibly soiled), followed by patting dry with single-use towels.
Hand Hygiene Action
A Hand Hygiene Action can be undertaken either by rubbing with an alcohol-based handrub, or hand washing with soap and water.
Hand Hygiene Compliance
A measurement of appropriate hand hygiene (HH). It is defined when HH is considered necessary and is classified according to one of the “5 Moments” (see below). If the action is performed when there is no indication and it has no impact in terms of preventing microbial transmission, then it is not considered to be an act of HH compliance. The number of Moments constitutes the denominator for assessing HH compliance. The actual HH actions undertaken are compared to the number of Moments observed to calculate the rate of HH compliance. HH non-compliance is defined when there is an indication for HH (i.e. a “Moment”) and yet no HH was undertaken.
Hand Hygiene inter-observer reliability
A measure of the agreement or consistency of ratings between two or more hand hygiene observers after observing the hand hygiene compliance on a series of subjects.
Hand Hygiene Moments
Moments are based on those defined by the WHO Guidelines on Hand Hygiene. Some minor modifications have been made for Australian healthcare conditions. A Moment is when there is a perceived or actual risk of pathogen transmission from one surface to another via the hands. HCWs’ hands will come in contact with many different types of surfaces while undertaking a succession of tasks.
The 5 Moments for HH are:
Moment 1: Before touching a patient
Moment 2: Before a procedure
Moment 3: After a procedure or body fluid exposure risk
Moment 4: After touching a patient
Moment 5: After touching a patient’s surroundings
Hand Hygiene Opportunity
In Australia the term ‘Moment’ is used.
However, the WHO defines a hand hygiene opportunity as the time between the moment when hands becoming colonised after touching a patient/surface and the moment in which hands touch the next patient/surface; that is, the opportunity when hand hygiene should be performed.
Hand Hygiene Product
Any product used for the purpose of hand hygiene, including soap and water.
The application of soap and water to the surface of the hands.
Health Care Worker (HCW)
All people delivering healthcare services, including students and trainees, who have contact with patients or with blood or body substances.
Refers to all regions outside of the Patient zone. This includes the curtains, partitions and doors between separate patient areas.
The healthcare surroundings contain multiple organisms from patients, staff and visitors.
Healthcare-Associated Infections (HAIs)
Infections acquired in healthcare facilities (‘nosocomial’ infections) and infections that occur as a result of healthcare interventions (‘iatrogenic’ infections), and which may manifest after people leave the healthcare facility
Inter-rater (or Observer) Reliability
A measure of agreement or consistency of ratings by two or more observers on a series of subjects.
A measure of agreement or consistency of two or more ratings by a single observer on a series of subjects.
Invasive Medical Device
Any piece of equipment that enters a patient’s skin or body cavity. This encompasses the entire device (eg. IV line, IV pump and IV pole).
Strains of Staphylococcus aureus that are resistant to many of the antibiotics commonly used to treat infections. Epidemic strains also have a capacity to spread easily from person-to-person.
Methicillin-susceptable Staphylococcus aureus
Staphylococcus aureus that is susceptible to methicillin/flucloxacillin.
Occupational Health and Safety (OH&S)
Is an area concerned with protecting the safety, health and welfare of people engaged in work or employment. The goal of all occupational safety and health programs is to foster a safe work environment.
Occupied Bed Days (OBDs)
Is the sum of the number of occupied beds for each day of the specified period.
A feature used to describe the effects of care on the health status of patients and populations (e.g. infection rate).
A person who is receiving care in a health service organisation.
Involves touching the patient and their immediate surroundings, or performing any procedure on the patient.
All inanimate surfaces that are touched by or in physical contact with the patient (such as bed rails, bedside table, bed linen, invasive devices, dressings, personal belongings and food) and surfaces frequently touched by healthcare workers while caring for the patient (such as monitors, knobs and buttons).
Includes the Patient and the Patient Immediate Surroundings.
The patient zone is a space dedicated to an individual patient for that patient's stay. This area is cleaned between the discharge of one patient and the arrival of the next to minimise the risk of transmission of organisms between patients.
Point of Care
The place where three elements come together: the patient, the healthcare worker, and the care or treatment involving contact with the patient or his/her surroundings. A hand hygiene product should be easily accessible and as close as possible – within arms reach of where patient care or treatment is taking place. Point of care products should be accessible without having to leave the patient zone.
An act of care for a patient where there is a risk of direct introduction of a pathogen to the patient.
Is a measurement of what is actually done in giving and receiving care, e.g. timing of surgical antibiotic prophylaxis, measuring how many times staff wash hands.
A guideline; sample suggestion; to advise
The extent to which a measurement is consistent and free from error.
A separation from a healthcare facility occurs anytime a patient leaves due to discharge, death, or transfer.
A task performed in such a way as to avoid microbial contamination or inoculation.
A method to quantify healthcare worker behaviour using a format that is structured in a manner that is likely to avoid bias and improve consistency. Structured observations provide information on what people actually do, rather than on what they say they do or did. They also provide information on the associated activities and behaviours that precede and follow hand hygiene compliance.
Surgical Hand Preparation
The process of eliminating transient and reducing resident flora prior to surgery. This comprises removal of hand jewellery, performing hand hygiene with liquid soap if hands are visibly soiled, removing debris from underneath fingernails and scrubbing hands and forearms using a suitable antimicrobial formulation.
Refers to the accuracy of a measure. It is the extent to which a measuring instrument actually measures what it is supposed to measure