{INSERT PRACTICE GROUP LOGO}Name of Protocol: IPAC Suite: Hand HygieneName of Practice Group: {PRACTICE GROUP}Protocol Type: Infection Prevention

and ControlDate Approved: March 2018

Date of Most Recent Revision:

{DATE HERE} Date of Next Revision:

{DATE HERE}

1. Purpose and Background

Hand hygiene is one routine practice of infection prevention and control (IPAC), as outlined by {Practice Group}’s IPAC Suite of policies and the Routine Practices policy.

This policy describes hand hygiene and its importance within midwifery care as a routine practice that is performed with every client in every encounter.

Hand hygiene is the most important and effective infection prevention and control measure to prevent the spread of microorganisms. Health care providers’ hands are the most common vehicle for the transmission of microorganisms, and hand hygiene is the responsibility of all individuals involved in health care.

As Public Health Ontario notes:An effective hand hygiene program is based on using the right product in the right place at the right time by health care providers who have received education in appropriate hand hygiene indications and techniques, combined with a good hand care program. (1, p10)

2. Policy

As a group of health care professionals who provide care in various settings, our midwifery practice is committed to a multifaceted hand hygiene program, which includes:

Posters and reference materials about hand hygiene Access to hand hygiene options at point of care, including 70-90% Alcohol-

Based Hand Rub (ABHR) Access to moisturizer for hand care in numerous locations

a) Posters and Reference Materials

The practice posts hand hygiene resources, such as AOM hand hygiene posters or Public Health Ontario hand hygiene posters, in the clinic.

b) Access to Hand Hygiene at Point of Care

ABHR and/or a hand hygiene sink and hand lotion are available for use at the point of care in all contexts.

c) Completing Hand Hygiene

Midwives practice hand hygiene according to the Four Moments of Hand Hygiene with the most appropriate product for the context (see Appendix 1).

Hand hygiene with 70-90% ABHR is the preferred method for decontaminating hands in health care when hands are not visibly soiled (see Appendix 2) because ABHR:

is fast to use, significantly reduces bacterial and viral contamination, rapidly kills most transient microorganisms as it is able to denature proteins, is less irritating to skin than soap and water, and can be made readily accessible in different locations (1).

For individuals with sensitivities or allergies to ethanol-based hand sanitizers, isopropanol-based product may be used as an alternative. Both ethanol and isopropanol have similar antimicrobial action; however, ethanol has greater antiviral action (1).

Hand hygiene with soap and water is recommended when hands are visibly soiled, before and after eating and after using the toilet (see Appendix 3).

d) Hand Care

Midwives monitor the state of their hands to ensure that proper hand hygiene can be performed in all contexts. Dry skin, eczema, rings, watches, bracelets, nail polish, chipped nail polish, long fingernails, artificial nails and nail enhancements can harbour bacteria and act as barriers to effective hand hygiene (1). Midwives will care for their hands and frequently apply hand lotion in order to achieve proper hand hygiene.

3. Additional Resources:

Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Infection Prevention and Control in Perinatology. 2 ed. [Internet] Toronto, ON: Queen’s Printer for Ontario. Feb 2015. [cited 2018 Mar 21] Available from: http://www.publichealthontario.ca/en/eRepository/IPC%20in%20Perinatology_ENGLISH_Final_2012-05-25%5b1%5d.pdf

Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee (PIDAC). Routine Practices and Additional Precautions In All Health Care Settings. 3 ed. [Internet] Toronto, ON: Queen’s Printer for Ontario. Nov 2012. [cited 2018 Mar 21] Available from: https://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf

Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Cleaning, Disinfection and Sterilization of medical Equipment/Devices in All Health Care Settings. 3 ed. [Internet] Toronto, ON: Queen’s Printer for Ontario. May 2013. [cited 2018 Mar 21] Available from: http://www.publichealthontario.ca/en/eRepository/PIDAC_Cleaning_Disinfection_and_Sterilization_2013.pdf

References

1. Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Hand Hygiene in All Health Care Settings. 4th ed. [Internet] Toronto, ON: Queen’s Printer for Ontario. Apr 2014. [cited 2018 Mar 21] Available from: https://www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf

2. Hand Hygiene, Association of Ontario Midwives [Internet]. Toronto: Association of Ontario Midwives; Mar 2018. [cited 2018 Mar 21] Available from: https://www.ontariomidwives.ca/hand-hygiene

Appendix 1: Four Moments of Hand Hygiene

(2)

Appendix 2: How to Hand Rub with Alcohol-Based Hand Rub

(2)

Appendix 3: How to Hand Wash

(1, p45)