ITC PART 2

BBTE, hand washing, alcohol hand gel, hand moisturiser

why is handwashing emphasised so much

hand hygiene is the single most effective strategy to reduce the risks of cross infection

when should you clean your hands (5)

• before patient contact

• before aseptic technique/ tasks

• after body fluid exposure risk

• after patient contact

• after contact with patient surroundings

when should staff be BBTE

• whenever they are in a clinical area where they can reasonably expect to come into contact with patients/ the immediate patient environment

• e.g. patient wards, theatres and out-patient departments

what is the guideline for ties in the clinical environment

ties should be removed or secured

when should soap and water be used to clean hands

1. when hands are visibly soiled

2. the patient is experiencing vomiting and/ or diarrhoea

3. there is direct hand contact with bodily fluids i.e. if gloves have not been worn

4. there is an outbreak of Norovirus, Clostridium difficile or diarrhoeal illnesses

5. after using the toilet

6. before and after preparing, handling, or eating food

7. before and after an aseptic technique

8. after removing gloves

9. at the start of a shift and at the end of a shift

10. after completing a task i.e. cleaning equipment

when should alcohol hand rub be used

The NPSA (2008) advises that:

• alcohol hand rub is the recommended product to use in the majority of patient care situations on non-soiled hands

• because it is more effective, quicker to use, better tolerated by hands and can be used at the point of care

pointers for handwashing

• hands must be wet before applying liquid soap

• good technique is more important than cleanser or length of time hand washing

• dry hands thoroughly with single use paper towels

• bar soap must not be used - cross infection risk

• cover any abrasions or cuts with a waterproof dressing

diagram showing areas of hands most commonly missed during handwashing

hand drying technique

• use disposable paper towels

• they effectively rub away transient organisms and the old, dead skin cells that are loosely attached to the surface of the hands

• dispose of paper towels in foot operated bin

when is hand disinfection necessary

where hands are more likely to be contaminated by microorganisms

how is hand disinfection achieved

• a thorough hand wash with soap and water

• followed by the use of alcohol hand rub

HANDS MUST BE PHYSICALLY CLEAN BEFORE ALCOHOL IS APPLIED

alcohol hand rub procedure

• follow hand washing technique once alcohol is dispensed

• it is unnecessary to rinse hands or use a paper towel

• allow to dry

why are medical gloves recommended

medical gloves are recommended to reduce the risk of:

• contamination of healthcare workers hands by blood and other bodily fluids

• microorganisms dissemination to the environment and of transmission from the healthcare worker to the patient and vice versa

guidelines for medical gloves

• always remove gloves immediately following completion of task for which they were worn

• glove usage is not a substitute for thorough hand hygiene

• hands should be washed with soap and water before donning gloves if carrying out any aseptic procedure

• hands should be washed with soap and water after removal of all gloves as hands may be contaminated during the removal of gloves

• ensure gloves fit snugly

• establish whether a patient has a latex sensitisation on or before each admission

why is persistent skin irritation a concern in healthcare

• bacterial count increases when the skin is damaged

• it can place patients at risk because hands cannot be adequately decontaminated due to breaches in skin integrity - this also places the healthcare worker at risk of infection

• hand cream should be used at the end of shifts, at break times and when off duty - communal jars of hand creams must not be used

what are transient microorganisms

transient microorganisms: microorganisms found on the surface of the skin

• “transient” because direct contact results in the transfer of these to and from the hands

• easily removed with hand washing » reduces chance of cross infection

• any damaged skin, moisture or ring increases the possibility of colonisation with microorganisms

what are resident microorganisms

resident microorganisms: microorganisms usually called normal flora or commensals

• located in the deep-seated epidermis, hair follicles, and sweat glands and beneath fingernails

• do not readily cause infections and are not easily removed - however during invasive procedures they could enter the patient’s deep tissues and establish an infection there