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Infection Prevention, and Control Guidelines for Primary Care Physicians
Hand Hygiene
Introduction:
Hand carriage of bacteria is a significant route of transmission of infection between patients and health care providers. Hand hygiene refers to killing or removing microorganisms on the hands as well as maintaining good skin and nail integrity. The purpose of hand hygiene is to destroy or remove microorganisms that have been picked up from contact with patients or staff, contaminated equipment or the environment. Appropriate hand hygiene results in a reduction of health care associated infections.
Best Practices:
Hand Hygiene must be performed:
- Before initial patient/patient environmental contact
- Before performing aseptic procedures
- After patient body fluid exposure
- After patient/patient environmental contact
- After performing personal functions such as using the toilet, blowing your nose, or applying lip protection
Hand Hygiene with Alcohol-Based Hand Rubs is the preferred method for decontaminating hands when they are not visibly soiled. They provide a rapid kill of most transient microorganisms on the hands.
- Although alcohol-based hand rubs are available with an alcohol concentration of 60-90%, a minimum concentration of 70% alcohol is preferred
- Installing alcohol-based hand rub dispensers at the point-of-care improves adherence to hand hygiene. Point-of-care is the place where three elements occur together: the client/patient, the health care provider and care or treatment involving client/patient contact Hand hygiene products available at point-of-care are easily accessible to staff by being as close as possible (e.g. within arm’s reach) to where the client/patient contact is taking place. Point-of-care products should be accessible without leaving the zone of care/treatment.
Hand hygiene technique with alcohol-based hand rub:
- Using alcohol-based hand rubs may be used to decontaminate hands when they are not visibly soiled
- Apply 1 or 2 full pumps of product, onto one palm (use according to manufactures recommendations)
- Spread product over all surfaces of hands, concentrating on finger tips between fingers, back of hands, and base of thumbs
- Rub hands until product is dry (this allows time for the product to kill microorganisms on the skin)
- Should not rinse with water after applying alcohol-based hand rub
- Ensure the product is completely dry before coming in contact with an open flame because alcohol is flammable.
Hand hygiene with soap and water is the preferred method for decontaminating hands when they are visibly soiled. The combination of adequate friction, lather (for 15 seconds) and rinsing removes microorganisms from the hands.
- Hand washing for routine care may be done with plain liquid soap and water. Antimicrobial soap is not recommended for routine use in the Family Health Team setting. Bar soap must not be used.
- Antibacterial soap may be used prior to performing invasive procedures such as insertion of a central line
- Hand soap must be dispensed from disposable single use containers only. Liquid soaps may become contaminated if open bottles are open too long. Liquid products must be dispensed in a disposable pump dispenser that is discarded when empty. They should never be “topped-up” or refilled.
- Hand washing sinks are to be used for hand washing only
Hand hygiene technique with liquid soap and water:
1. Turn on sink taps to a comfortable temperature
2. Wet hands thoroughly
3. Pump soap onto wet hands
4. Lather for 15 seconds, include all areas
5. Rinse hands thoroughly, leaving taps on
6. Pat hands dry with paper towel
7. Use same paper towel to turn off taps (ensure not to recontaminate your hands)
8. Discard paper towel in nearest waste bin
Surgical hand preparation must eliminate the transient and reduce the resident flora of the hands. It should also inhibit growth of bacteria under the gloved hand.
- The spectrum of antimicrobial activity for a surgical hand preparation should be as broad as possible, so that it is active against bacteria and fungi.
- A prolonged antiseptic effect on the skin is desirable.
- Alcohols are effective for preoperative cleaning of the hands. The antimicrobial activity of alcohol-based hand rubs is superior to that of all other currently available methods of preoperative surgical hand preparation.
Surgical hand preparation technique:
1. Surgical hand antisepsis using either an antimicrobial soap (surgical hand scrub) or an alcohol-based hand rub with persistent activity (surgical hand rub) is recommended before donning sterile gloves when performing surgical procedures.
2. Nails should be clean, short, natural and healthy (artificial nails, extenders or artificial enhancers shall not cover natural fingernails)
3. All jewelry should be removed
4. Special attention should be given to nails and underneath the nail area. Cleaning under each fingernail shall be done before performing the first scrub of the day. Nail cleaners shall be used to remove soil from nails.
5. When performing surgical hand antisepsis using an antimicrobial soap, scrub hands and forearms for the length of time recommended by the manufacturer, usually 2 to 5 minutes. Long scrub times are not needed (e.g.10 minutes).
6. When using an alcohol-based surgical hand-scrub product with persistent activity, follow the manufacturer’s instructions. Apply the product to dry hands only. Do not sequentially combine surgical hand scrub and surgical hand rub with alcohol-based products. After application of the alcohol-based product, as recommended, allow hands and forearms to dry thoroughly before donning sterile gloves.
Skin Condition:
Finger Nails:
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Long natural nails, chipped nail polish, artificial nails or nail enhancements all result in more microorganisms and less effective removal of microorganisms. They have been associated with serious outbreaks.
- Nails should not extended beyond the fingertips
- If nail polish is worn, it must be in good condition
- Artificial nails or nail enhancements must not be worn in the Family Health Team setting
- Long nails may put the healthcare worker at risk by piercing gloves
Jewelry:
References:
Centers for Disease Control, 2002 Guideline for Hand Hygiene in Health-Care Settings
Health Canada (1998), Hand Washing, Cleaning, Disinfection and Sterilization in Health Care
Ontario Ministry of Health and Long Term Care, Core Competency Hand Hygiene Education Module
Ontario Ministry of Health and Long Term Care “Just Clean Your Hands” Program
PIDAC (2008), Best Practices for Hand Hygiene in all Health Care Settings
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