Transcript Generic HH talk for GP Practices

The National Hand Hygiene
Initiative
www.hha.org.au
Australian Commission on Safety
and Quality in Healthcare
• The Commission was established by State and
Territory Governments
• Purpose – to develop a national strategic
framework to guide efforts in improving safety
and quality across the health care system in
Australia
www.hha.org.au
Australian Commission on Safety
and Quality in Healthcare
The Commission commenced on 1 January 2006.
The Commission's role is to:
– lead and coordinate improvements in safety and
quality in health care
– disseminate knowledge and advocate for safety and
quality
– report publicly on the state of safety and quality
including performance against national standards
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Australian Commission on Safety
and Quality in Healthcare
– recommend national data sets for safety and quality,
including data development, standards, collection and
reporting
– provide strategic advice to Health Ministers on best
practice
– recommend nationally agreed standards for safety
and quality improvement
www.hha.org.au
Australian Commission on Safety
and Quality in Healthcare
5 Key Initiatives
1.
National Surveillance System
•
2.
Updated National Infection Control Guidelines
•
3.
4.
To improve useability and provide permanent currency of
information
National Hand Hygiene Initiative - NHHI
Building clinician capacity
•
5.
To reduce harm to patients from hospital associated infections
through the use of surveillance
To increase the ability of infection control practitioners by
providing them with skills and resources to engage and educate
clinicians, managers and healthcare consumers to adopt a
collective HAI prevention mindset
Antibiotic Utilisation
•
Development of a national system to monitor antibiotic usage
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University curricula
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Statewide
Hand Hygiene
Compliance
Overall HH Compliance:
Baseline: 20% (95%CI 19-20%)
to12 mths: 53% (95%CI 52-53%)
Increases significant after 4-mths
and 12-mths (p<0.0001)
www.hha.org.au
Statewide - MRSA bacteraemias
Patients with MRSA bacteraemia per month per 100 separations
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Summary
HH Culture-Change Programs associated with:
1. Improved HH compliance from 18-21% to 47-53% after
12-24 months
2. 50% (approx.) reduction in rates of MRSA disease after
12-23 months
3. Generic, centrally coordinated HH Culture-Change
programs can be effective in a wide variety of urban and
rural healthcare institutions
4. Such programs represent the single most effective
initiative to reduce the burden of MRSA in hospitals
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Hand Hygiene Australia
• 3 years funding from ACSQHC to implement
National Hand Hygiene Initiative
• Report to ACSQHC
• Leverage off existing Hand Hygiene programs
• Directed by Prof Lindsay Grayson
• Independent of jurisdiction and hospital
• Based at Austin Health, Victoria
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Objectives of HHA
• Develop reliable indicators of hand hygiene
compliance
• Accurately measure hand hygiene
compliance
• Reduce rates of healthcare associated
infection
• Make hand hygiene ‘core business’ for all
health care workers
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HHA resources and support
Hand Hygiene Australia Manual
– Implementing HH program
– ABHRS information
– Detailed explanation of 5
Moments
• Supporting evidence
• Examples
– Outcome Measures
• HH compliance
• Data for Staphylococcus aureus
bacteraemia
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Moment 1
Definitions:
•
•
•
•
•
Touching a patient in any way
Any personal care activities
Any non-invasive observations
Any non-invasive treatment
Preparation and administration of oral
medications
• Oral care and feeding
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Moment 2
Definitions:
• Insertion of a needle into a patient’s skin, or into an
invasive medical device
• Preparation and administration of any medications given
via an invasive medical device, or preparation of a sterile
field
• Administration of medications where there is direct
contact with mucous membranes
• Insertion of, or disruption to, the circuit of an invasive
medical device
• Any assessment, treatment and patient care where
contact is made with non-intact skin or mucous
membranes
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Moment 3
Definitions:
• After any procedure
• After any potential body fluid exposure
•
•
•
•
•
•
•
•
Blood, Lochia
Saliva or tears
Mucous, wax, or pus
Breast milk, Colostrum
Vomitus
Urine, faeces, semen, or meconium
Pleural fluid, ascitic fluid or CSF
Tissue samples, including biopsy specimens, organs, bone
marrow, cell samples
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Moment 4
Definition:
• After touching a patient
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Moment 5
Definition
• After touching the patient’s immediate
surroundings when the patient has not
been touched
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Desired Outcome………..
INCREASE
INCREASE
HH Compliance
Awareness
DECREASE
Healthcare
associated infections
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The 5 Moments in a GP Practice
• Imagine a patient walks into your assessment
room, you shake hands, take the patient’s blood
pressure and temperature, then take a blood
sample, give the patient the paperwork to take
out to reception, they leave.
• Then you write in the medical history, return it to
reception and call for the next patient.
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The 5 Moments in a GP Practice
HH M1
• Imagine a patient walks into your
assessment room, you shake
hands, take the patient’s blood
pressure and temperature, then
take a blood sample, give the
patient the paperwork to take out
to reception, they leave.
• Then you write in the medical
history, return it to reception and
call for the next patient.
HH M2
HH M3
HH M4
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Choosing an ABHR
Product Selection
When selecting an ABHR product, HHA recommends:
• The Product meets the EN1500 testing standard for bactericidal
effect
• The Product has TGA approval as a hand hygiene product
However, product selection is ultimately the choice of each health care
facility, and other factors should also be considered, such as:
• Dermal tolerance
• Aesthetic preferences such as fragrance, colour, texture and ease of
use
• Practical considerations such as availability, convenience and
functioning of dispenser, and ability to prevent contamination
• Cost issues
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ABHR Placement
• Needs to be at the “Point of Care”
– The place where three elements come together: the
patient, the HCW, and the care or treatment involving
contact with the patient or his/her surroundings.
• A hand hygiene product should be easily
accessible and as close as possible – within
arms reach of where patient care or treatment is
taking place.
• Point of care products should be accessible
without having to leave the patient zone
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ABHR Placement
Examples:
• At entrance to clinic for patient’s to use on
arrival
• At reception desk for reception staff
• In assessment / treatment rooms
– On desk
– On wall near assessment bed
• On portable equipment trolleys
– Eg. Blood collection trolley
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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
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When to use ABHRs????
• When hands are NOT visibly soiled
• Before and after touching a patient
• After glove use
• After contact with the patient’s
belongings
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What can I use for 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
( eg. ABHR) when your
hands are visibly clean
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Compatible Moisturiser….
• Use a minimum of 3 times per shift
At coffee break
At meal breaks
At home time
• All HCW’s to use work supplied
compatible moisturiser (boys
included)
• Think about the whole 24 hours
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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 patient procedure and when going
from dirty to clean sites even on the same
patient.
• Disposable gloves are to be used once only and
never disinfected or washed.
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“Clean Between”
• Use the alcohol
impregnated
wipes/detergent wipes on all
shared non critical
equipment
• Think about product
placement to encourage use
e.g near keyboards, on
trolleys, in clinic
areas,therapy rooms
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HHA Education Tools
• On line learning
package
All healthcare workers
Basic hand hygiene information
• Why, how and when
• Multiple choice questions
• annual requirement?
HCW specific packages
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OH & S Concerns
• Splash
– Unlikely if a two handed action is used – risk Minor/Moderate
• Ingestion
– Unlikely during normal use - risk Minor/Moderate
• Fire
– Possible – but overall risk is extremely low
• Spillage / Splash on floor
– Possible/likely – risk insignificant
• Deliberate or unintentional misuse
– Possible by children or cognitively impaired – consider product
placement in supervised areas, or personal pocket bottles if
regular clientele
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OH & S Concerns
• Alcohol absorption
– Unlikely – local studies show that you cannot absorb
enough through your skin to lose you drivers license!
• Bulk storage
– Ensure that bulk storage complies with state fire
regulations and apply standard precautions for
flammable liquids (DG class 3)
• Skin irriatation
– Rare – Risk minor
• Patient infection from poor compliance with HH
regimen
– Almost certain – Risk Major/Severe
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OH & S and ABHRS
There are a number of risks to patients and staff associated
with the use of alcohol based handrub, however
the benefits in terms of its use
far outweigh the risks
Healthcare Settings are dangerous
Children need to be supervised at all times
**Generic HHA Risk Assessment and Management plan**
Safety Institute Australia
www.hha.org.au
Key messages
Alcohol Based Hand Rub
Point of Care
Before and After Touching a Patient
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