Ethical Declaration - fpnl.co.zafpnl.co.za/wp-content/uploads/2018/06/Helen-Loudon-H-Hygiene... · 5 components of the WHO Multimodal Hand Hygiene Improvement Strategy 1. System change

Ethical

Declaration

⚫ Independent Practitioner – may not

endorse products for ethical

reasons

⚫ Any reference to commercial products is

for illustrative purposes only

⚫ Current Advisory Board participation –

Coloplast, Safarmex, B Braun Medical,

Wound Healing Assoc. of SA (WHASA)

⚫ Speaker honoraria – BSN Medical,

3M Medical, B Braun Medical, SAFMED,

KCI Medical, Systagenix, Coloplast,

Smith & Nephew, Safarmex

FPNL Conference

Thursday 24th May 2018

Theme: PATIENT SAFETY

CLEAN HANDS are only

half the story …

Helen LoudonIndependent Infection Prevention

and Quality Management Specialist

Presentation overview

1. WHO Geneva: Prof Didier Pittet’s visit to SA to launch “paint Africa orange” initiative – March 2017

2. Risk management principles for product quality and safety

3. The WHO Multimodal H. Hygiene Improvement Strategy

4. Hazards in clinical practice

WHO ‘Train the Trainer’

‘TURN AFRICA ORANGE’March 2017

© Helen Loudon 4.2017

ALL RIGHTS RESERVED

THE

MESSAGE

World Hand

Hygiene

Day 5th May

2018

It’s in your hands – prevent sepsis in healthcare

AIM: a more integrated approach

featuring healthcare professionals

across all levels

As of April 2018, 20,614 health

facilities across 179 countries had

registered their commitment to the

campaign

Key Leadership aspects

▪ Legislation

▪ Procurement

▪ lmplementation

▪ Clinical hazards

Regulatory

compliance

© Helen Loudon 4.2018.

ALL RIGHTS RESERVED

Occupational Health and Safety Act 85 of 1993 (OSH Act)

Compensation for Occupational Injuries and Diseases

Act 130 of 1993 (COID Act)

Hazardous chemical substances regulations

Hazardous Biological Agents (HBA) risk assessment

National Health Act 63 of 1977

Any toxicological or

environmental concerns?

Physical and chemical

properties – pH, perfume,

colourants?

Packaging, stability and

reactivity – decanting?

Adequate product is dispensed

Independent microbiological

testing

Product registration – MCC?

Non-medicated liquid hand

soap for general hand hygiene

Reserve antibacterial for agents

for aseptic procedures

Alcohol based hand rub must be

compatible with institutional

hand soaps

Material safety data sheets

(MSDS) freely available from

supplier/ manufacturer?

© Helen Loudon 4.2017. ALL RIGHTS RESERVED

2009

© Helen Loudon 4.2018. ALL RIGHTS RESERVED

FIRST things first …

© Helen Loudon 4.2017. ALL RIGHTS RESERVED

5 components of the WHO Multimodal

Hand Hygiene Improvement Strategy

1. System change

1a. Alcohol based hand rub is available at point of care

1b. There is access to safe, continuous water supply,

soap and paper towels

2. Provide training and education

3. Give detailed evaluation and feedback to personnel

4. Post reminders in the workplace

5. Assess your institutional safety climate

© Helen Loudon 4.2018. ALL RIGHTS RESERVED

© Helen Loudon 4.2017. ALL RIGHTS RESERVED

© Helen Loudon 4.2018. ALL RIGHTS RESERVED NB! Partner document to

2009 H/Hygiene Guidelines

RISK BASED indications for hand hygiene

❖ Alcohol based hand rub is the first choice for hand hygiene when

hands are not visibly soiled.

BUT …

❖ Wash hands with soap and water –

➢ when visibly dirty or contaminated with proteinaceous

material

➢ after contact with blood or other body fluids

➢ when exposure to potential spore forming organisms

is strongly suspected or proven (C. difficile, Candida species)

➢ after using the toilet.

Use alcohol based hand

rub (ABHR) frequently

ABHR is recommended

when hands are visibly

clean

Faster, less drying and

microbiologically more

effective

FINGERTIPS 1st!

Root causes of common problems

© Helen Loudon 4.2018.ALL RIGHTS RESERVED

Contact dermatitis

Rinsing and drying properly?

pH balanced product?

Do not use ABHR immediately

after washing with antibacterial

hand soap

Allergic dermatitis

Additives – perfume, colourants?

A deadly risk to patients with

invasive devices

© Helen Loudon 4.2018.ALL RIGHTS RESERVED

23

Outdated and unsafe practices!

Scrubbing hands and forearms

Decanting/ topping up antiseptics from bulk containers

Transfer of used pump dispensers from bottle to bottle

Incomplete drying

Application of alcohol based antiseptic agents to wet skin

Mixing / using chlorhexidine and iodine based agents together

© Helen Loudon 4.2018. ALL RIGHTS RESERVED

Take home points …

Use ABHR in preference to hand

washing when hands are visibly clean

When used appropriately and

frequently, an ABHR requires less

time, is microbiologically more

effective, and is less irritating to

skin than traditional hand washing

with soap and water

Do not use ABHR concomitantly with

antibacterial hand soaps

Use PPE and gloves appropriately –

and practise hand-hygiene procedures

immediately after removal.

Studies have shown adherence of

health care workers to recommended

hand hygiene practices is less than

40% of the total opportunities for hand

hygiene …

References

1. WHO First Global Patient Safety Challenge: Clean Care is Safer Care

2009 Guidelines on Hand Hygiene in Health Care. Available from

http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf

2. Boyce JM, Pittet D. (2002) Guideline for Hand Hygiene in Health-Care

Settings. Recommendations of the Healthcare Infection Control

Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA

Hand Hygiene Task Force MMWR October 25, 2002; 51(RR16);1-44

3. IHI How-to Guide: Improving Hand Hygiene: A Guide for Improving

Practices among Health Care Workers

4. Kampf G, Loffler H. (2007) Prevention of irritant contact dermatitis

among health care workers by using evidence-based hand hygiene

practices: a review. Journal of Industrial Health 2007 Oct;45(5):645-52

5. Trampuz A, Widmer AF. (2004) Hand hygiene: a frequently missed

lifesaving opportunity during patient care. Mayo Clinic Proceedings

2004 Jan;79(1):109-16