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
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