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4CONTACT 2 BEFORE ASEPTIC PROCEDURE 3 EX BODY FLUID POSURE RISK AFTER www.ontario.ca/handhygiene Adapted with the permission of Public Health Ontario. Page 16 Hand Hygiene Considerations • Ensuring skin integrity (dermatitis, cracks, cuts or abrasions can trap bacteria) • Use of employer supplied lotions products regularly (3 times a day when cleaning hands several times per hour) • Things that can reduce the effectiveness of hand hygiene: o long nails o nail polish o artificial nails and nail enhancements o hands and arm adornments (associated with poor hand hygiene practices and result in more tears to gloves) Performing Hand Hygiene First... • Remove hand and arm jewellery (watch must be worn above the wrist) • Clothing or other items that impede frequent and effective hand hygiene should be removed (PIDAC, 2014, p. 16) Infection Prevention and Control CBPG www.crto.on.ca It is estimated that approximately 30% of healthcare providers report symptoms of dermatitis involving their hands and as many as 85% give a history of having chronic skin problems. (PIDAC, 2014, p.20) Professional Accountabilities: If experiencing skin integrity issues, the Member is required to contact their employee Occupational Health to seek a solution (e.g., alternate skin care products) Alcohol-Based Hand Rubs (ABHR) e.g., gels and foams containing 70 - 90% alcohol • Is the preferred method of hand hygiene for hands that are not visibly soiled • Has been shown to be less irritating to skin than soap and water and may significantly decrease dermatitis due to emollients in the product (PIDAC, 2014, p.16) • Must be used with employer-approved products that are compatible with the gloves being used Handwashing Soaps • Plain soap is recommended for routine hand hygiene when hands are visibly soiled • Should be in a liquid format in a dispenser that is discarded when empty (should not be refilled) o Bar soaps for hand hygiene must not be used in health care facilities • Antibacterial soap should be limited to specific settings (e.g., OR, ICU and burn units). • It has been shown that at least 15 seconds of lathering with soap is required to remove transient flora (PIDAC, 2014, p.21) • Essential components are soap, friction and lukewarm running water. ABHR should not be used with water, as water will dilute the alcohol and reduce its effectiveness. ABHR should not be used immediately after hand washing with soap and water as it will result in more irritation of the hands. (PIDAC, 2014, p.20) Page 17 www.crto.on.ca Infection Prevention and Control CBPG The best evidence suggests that antimicrobial soap is equivalent to ABHR in terms of microorganism reduction but is harsher on the hands and more timeconsuming to use. (PIDAC, 2014, p.22) RE S O U RCE Techniques for ABHR and Handwashing Public Health Ontario’s Just Clean Your Hands Educational Videos (ABHR & Handwashing) RE S O U RCE Public Health Ontario’s Risk Algorithm to Guide PPE Use Page 18 Personal Protective Equipment (PPE) General Principles • PPE is used to prevent: o contact with non-intact skin, blood, body fluid, excretions and secretions o the transmission of particular organisms that may be transmitted via the air, or by contact with intact skin (see section on Additional Precautions) • PPE is only effective in infection control and prevention when applied, used, removed and disposed of properly • Avoid any contact between contaminated PPE and surfaces, clothing or people outside the patient care area • Discard used PPE in the appropriate disposal bags • Do not share PPE • Remove PPE completely and thoroughly perform hand hygiene each time you leave a patient to attend to another patient or move to a non-patient care area. • The use of PPE does not replace the need for proper hand hygiene, which needs to be performed both before PPE is applied and after it is removed • It is essential to perform a risk assessment to determine the PPE needed Infection Prevention and Control CBPG www.crto.on.ca All regulated health care professionals have the authority to initiate additional precautions without a physician’s order (PIDAC, 2012a, p. 37) Professional Accountabilities: Increased