Hand Hygiene in Social Care Settings

Hands are the most common way in which microorganisms can be transported and subsequently cause infection. In order to prevent the spread of microorganisms to those who might develop serious infections by this route, hand hygiene must be performed effectively.

There is considerable evidence that Service User contact results in contamination of health care professional’s hands by pathogens that cause health care associated infections (HCAI). Effective hand hygiene is recognised as the single most important procedure for significantly reducing/preventing infection, leading to improved morbidity/mortality rates.

A recent study in France has shown that good hand hygiene practice was particularly valuable during periods where infections were active within the community. In the UK this winter we have seen increased pressures on our health services as a result of the influenza outbreak (the so called Australian Flu).

In France during January to March, France like the UK experienced a widespread influenza outbreak. Care homes that took part in the study which had implemented additional measures reported a 30% lower mortality rate than the control group.

It seems prudent then to continue to raise awareness of social care staff in the UK to the importance of effective hand hygiene in social care settings.

In most care settings, staff receive training in infection control including hand hygiene. But overtime, staff can become complacent and underestimate what poor hand hygiene can cause to vulnerable Service Users.

In 2017 the World Health Organisation ran a campaign designed to improve hand hygiene and highlighted:

The 5 moments of hand hygiene at the point of care:
1 Before Service User contact
2 Before Clean/ Aseptic procedures
3 After body fluid exposure/risk
4 After touching a Service User
5 After touching a Service User surroundings

Correct technique for hand hygiene

Bare Below the Elbow

The Department of Health (2007, 2010) state that hand hygiene is not performed effectively if sleeves and cuffs are close to wrists.

Bare Below the Elbow means:
• No long-sleeved clothing (or capacity to fold above elbow)
• No wrist watches
• No bracelets or wrist bands
• No rings except one plain wedding band
• No nail varnish, false nails, nail jewellery or nail extensions
• Natural nails must be kept short and neat

Hand decontamination using an effective technique, will ensure that all surfaces of the hands are covered. Clinical staff must use the Ayliffe (6 steps) hand hygiene technique. Lancaster university have produced a video on how to use the technique.

Protection of Service Users

An audit should be carried out to ensure alcohol hand gel units readily available. They should be easily accessible and available in sufficient quantities if they are to be used effectively.

Consideration should be given to the provision of additional dispensers if needed, or pocket-sized bottles of hand rub where required to supplement these, particularly during outbreaks. The Service should also ensure that sinks are equipped with a suitable hand sanitiser and paper towels to ensure hands can be washed thoroughly.

Regular spot checks should be undertaken to observe staff practice that ensures staff are sanitising their hands between all episodes of personal care. The spot checks should also include checks on hand washing technique and knowledge of when gloves and other personal protective equipment (PPE) should be used.

Staff Training

Although Infection prevention and control training (including hand hygiene) is a mandatory requirement for care staff. The manager should ensure that regular refresher courses are made available to staff to ensure the continuation of best practice.

Summary

There is a great deal of evidence that the failure of care staff to carry out correct handwashing techniques can have serious consequences in the spread of infection and on the lives of Service Users. The World Health Organisation, NICE and a whole raft of research including the French study show how important it is that care staff follow the correct procedures for handwashing.

Given the pressures that care staff are under it is easy for them to become complacent when carrying out correct hand washing techniques. It is the duty of managers to ensure that staff are following best practice and have the resources available to carry out the task. Increasing staff awareness of the importance of hand hygiene along with refresher training will help to prevent contamination and infection.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy