Hand Hygiene for Mental Health. 5 Moments for Hand Hygiene National Hand Hygiene Initiative was instigated by the Australian Commission for Safety and.

Hand Hygiene for Mental Health

5 Moments for Hand Hygiene

National Hand Hygiene Initiative was instigated by the Australian Commission for Safety and Quality in Health Care

Based on the World Health Organisation World Alliance for Patient Safety Campaign “Save Lives: Clean Your Hands”

Some adaptation may be necessary for the Mental Health setting

Health Care Associated Infection

Definition:

an infection that was not present at the time of hospital admission/ healthcare attendance, but was acquired via the delivery of healthcare

Healthcare Associated Infections

Healthcare associated infections are one of the most frequent and severe complications of hospitalisation in Australia

7-10% of patients will acquire 1 or more healthcare associated infections

Contributes to 7,000 deaths per annum

Approx. 6.1 infections/100 patients

Majority are preventableSource:Australian Council for Quality and Safety in Healthcare July 2003Yung, McDonald, Spelman, Street & Johnson 2001Victorian Surveillance System (VICNISS) Coordinating Centre Data 2007

Hand Hygiene

Hand Hygiene• Protects clients from harmful germs that are

carried on your hands• Protects you & the healthcare environment

from harmful germs

Effective Hand Hygiene is the single most important strategy in preventing

health care associated infections.

Hand Hygiene

HH means either:

using soap and water to wash with thorough drying when your hands are visibly soiled

or

using a waterless hand rubs

( e.g.. ABHR) when your hands are visibly clean

Hand Hygiene reduces transient micro-organisms

Before After

Following the 5 Moments

To achieve compliance with the 5 Moments for Hand Hygiene staff need:

Knowledge of the 5 Moments

Easily accessible facilities for Hand Hygiene

Sinks with soap dispensers

Alcohol based hand rub

Encouragement and support from management

Role modelling from all staff

Hand Hygiene in Mental Health Matters

Outbreaks of infective diseases still occur within MH facilities

Clients are transferred to/from acute facilities

Staff may work on acute wards also

Invasive procedures occur in MH facilities e.g. injections

MH unit may be within an acute facilityBugs don’t stop at the door

Infections can exacerbate MH conditions

RUBapply to palm

ROLLrub hands together covering all aspects of your fingers &

hands until dry

SQUIRT one squirt (3 ml) to

your hands

Simple Message - It’s quick and easy

Why use ABHR’s?

Reduces bacterial count on hands more effectively than soap and water hand wash

Reduces adverse outcomes and cost associated with healthcare associated infections

Requires less time

Less irritating to skin than soap and water as ABHRs contain an emollient

Can be readily accessible/portable

The 5 Moments may need to be adapted to allow for the characteristics of the client population and available facilities

Moment 1Before Touching a Patient

WhenHand Hygiene before touching a patient

Hand Hygiene on entering the patient’s room ORHand Hygiene on leaving the staff area

Hand hygiene before:

Any personal care activities Any non-invasive observationsAny non-invasive treatmentPreparation and administration of oral medications

WhyTo protect the patient against acquiring harmful germs from the hands of the HCW

What is a Procedure?

An act of care for a patient where there is a risk of direct introduction of a pathogen into the patient’s body.

Moment 2Before a Procedure

WhenHand Hygiene immediately prior to a procedure

Once Hand Hygiene has been done, nothing else in the patient’s environment should be touched prior to the procedure starting

Hand hygiene before:

Insertion of a needle into a patient’s skinPreparation and administration of any medications given via an invasive medical device eg. NG feedPreparation of sterile materialsAdministration of medications where there is direct contact with mucous membranesAny assessment, treatment and patient care where contact is made with non-intact skin or mucous membranes

WhyTo protect the patient from harmful germs (including their own) from entering their body during a procedure

Any situation where contact with body fluids may occur. Such contact may pose a contamination risk to either the HCW or the environment

What is a Body Fluid Exposure Risk?

Moment 3After a Procedure or Body Fluid Exposure Risk

When

Hand Hygiene immediately after a procedure or a body fluid exposure risk

As hands are likely to be contaminated with body fluid

Hand hygiene:

After any procedureAfter any potential body fluid exposure• Blood, Lochia, Saliva, Tears, Mucous, Wax, Pus, Breast milk,

Colostrum, Vomitus, Urine, faeces, Semen, Meconium • Tissue samples, including biopsy specimens, organs, bone marrow,

cell samples

Why

To protect yourself and the healthcare surroundings from harmful patient germs

Moment 4After Touching a Patient

When

Hand Hygiene after touching a patientHand hygiene on leaving the patient’s room ORHand hygiene on entering the staff area

Hand Hygiene After:

Any personal care activitiesAny non-invasive observationsAny non-invasive treatments

Why

To protect yourself and the healthcare surroundings from harmful patient germs

Moment 5After touching a patient’s immediate surroundings when the

patient has not been touched

When

Hand hygiene after touching the patient’s surroundings even when the patient has not been touched

Hand Hygiene:

After leaving the patient area On entering a staff area

Why

To protect yourself and the healthcare surroundings from harmful patient germs

ABHR Product Placement

A hand hygiene product should be easily accessible and as close as possible to where patient care or treatment is taking place

Given the nature of Mental Health illness it may not be appropriate to leave ABHR within reach of the client – this will be a decision for each facility/ward/patient

ABHR Product Placement

At a MINIMUM Place ABHR in:Nurses Station

Staff rooms – at exit doors, near desks

Treatment rooms – where procedures will occur, or where medication is dispensed

Portable treatment trolleys – permanently fix to the trolley

Carry portable bottles where appropriate

Important Areas to Focus on in Mental Health

Hand hygiene before and after a procedure

Hand hygiene on entering and leaving patient and staff areas

Encouraging regular patient hand hygiene

Product availability in staff areas

Product availability in all treatment areas

Patient Hand Hygiene

Encourage Mental Health clients to clean their hands:

Before and after eating

After smoking

After using the toilet

When they are visibly soiled

Looking After Your Hands

Skin Care:• Cover cuts, scratches, rashes with a water proof

dressing• Keep your hands healthy and avoid dryness - use

facility supplied compatible moisturiser a minimum of 3 times per shift

Finger nails should be kept short

No chipped polish

No acrylic nails in clinical areas

Limit jewellery worn to work - jewellery should not inhibit your ability to correctly perform Hand Hygiene

If you have issues with sore, cracked &/or dry hands, follow your facility guidelines.

Gloves

Gloves should be used as an adjunct to, not a substitute for hand hygiene.

Hand hygiene is to be performed before & after all glove use.

Gloves need to be changed & HH performed after each client procedure and when going from dirty to clean sites even on the same client.

Disposable gloves are to be used once only and never disinfected or washed.

“Clean Between”

Use the alcohol impregnated wipes/detergent wipes on all shared non critical equipment

Think about product placement to encourage use of wipes e.g near keyboards, on trolleys, in clinic areas, treatment rooms

Adhere to a regular cleaning schedule for shared equipment/furniture

Summary

Hand Hygiene is important in Mental Health

Follow the 5 Moments for Hand Hygiene but be mindful that the 5 Moments may need to be adapted to allow for the characteristics of the client population and available facilities