Best hand hygiene practice in aged care

Hand hygiene acts to cleanse hands and help stop the transfer of microorganisms which could lead to infections. The best hand hygiene regimes include the use of hand wash and hand sanitiser for cleansing, and hand moisturiser for treating dry and irritated skin. While practicing correct hand hygiene minimises microorganisms on hands (Hand Hygiene Australia 2018), best results can only be achieved when using products from the same brand as they have been formulated to work together.

Importance of Hand Hygiene

Hand hygiene is a critical component in preventing the transmission of infectious agents, such as bacteria and viruses. According to the World Health Organisation (2009b), knowing how and when carers and residents should clean their hands with sanitiser or hand wash, is the best strategy against healthcare associated infections. With an alarming number of long-term care residents being diagnosed annually with one to three infections on average (World Health Organisation 2012), higher importance has been attributed to the implementation of the WHO Multimodal Hand Hygiene Strategy across outpatient care settings (Word Health Organisation 2009a).

5 Moments of Hand Hygiene

The key stages for performing hand hygiene relate to the 5 Moments of Hand Hygiene developed by the World Health Organisation (NHMRC 2010). This primary auditing tool has been accepted by Hand Hygiene Australia to measure hand hygiene standards on a national and international scale (Grayson et al. 2011), which has proved invaluable for increasing hand hygiene compliance in healthcare facilities.

When considering the 5 Moments of Hand Hygiene in an aged care setting, the carer is responsible for performing hand hygiene before making any contact with the resident, before clean or aseptic procedures, after bodily fluid exposure risks and after touching the resident’s surroundings.

The World Health Organisation (2009b) provides a comprehensive list of examples applicable to an aged care setting, that helps carers better understand when each moment of hand hygiene is required:

  1. Before inserting an invasive medical device, e.g. nasal cannula.
  2. Before performing a physical non-invasive examination, e.g. blood pressure test.
  3. After inserting an invasive medical device, e.g. a catheter.
  4. After you have assisted the resident in personal care activities, e.g. bathing.
  5. After an activity involving physical contact with the resident’s immediate environment, e.g. changing bed linen.

Hand Hygiene Technique

According to NHMRC (2010), the key factors in effective hand hygiene and maintaining skin integrity include: the length of time taken to perform hand hygiene, the surface area covered on your hands and wrists when using hand wash and hand sanitiser, the act of rubbing your hands together for friction, and properly drying your hands once complete.

How to Wash Hands

Hand washing involves scrubbing your hands together with water and your choice of plain or anti-microbial soap to mechanically remove microorganisms. This technique is effective if you cover all surfaces of your hand with your choice of hand wash. The How to Hand Wash guide below illustrates the step-by-step process involved in washing your hands for a duration of 40 to 60 seconds.

How to Sanitise Hands

Applying an alcohol gel to your hands is very similar to the technique used for washing hands with soap. It is important to note that no water is required with hand sanitiser, and this process can be completed in 20 to 30 seconds.

How to Make Sure Your Hand Hygiene Compliant

To improve and sustain the correct hand hygiene practices and facilitate behavioural changes for nurses and carers at your aged care facility, you need to put into action a long-term plan that educates and guides your staff on the best practices for infection control and hand hygiene. The WHO Multimodal Hand Hygiene Improvement Strategy is the most comprehensive approach for increasing compliance rates.

The five phases covered in the WHO Multimodal Hand Hygiene Improvement Strategy (World Health Organisation 2009a), create a framework for your facility to test, evaluate and remodel each tactic for optimising hand hygiene compliance over a five year period. By repeating the process, you will discover more practical solutions moving forward for improving and sustaining hand hygiene habits.

1. System Change

Your facility must have accessible and available sinks in resident rooms for hand washing, with clean water, soap and single-use towels, as well as the safe placement of hospital grade hand sanitiser in high traffic areas for proper use at all points of care.

2. Education Programme

Create an ongoing training course by allocating staff members to assume the roles of trainers and observers, and actively engage everyone in the learning process by adopting correct hand hygiene techniques and the 5 Moments of Hand Hygiene in an aged care setting.

3. Observation and Feedback

Monitor hand hygiene practices through direct observation and assess the effectiveness of the educational programme with performance feedback surveys.

4. Workplace Reminders

Utilise educational resources, such as hand washing posters, in high visibility areas, such as resident rooms, to raise awareness about the importance of hand hygiene, when to perform it, and how to hand wash and use hand sanitiser. For example, reminding staff and patients about the role of hand hygiene to stop the flu from spreading in aged care facilities.

5. Hand Hygiene Safety Culture

By promoting a culture of hand hygiene safety amongst all levels of management at your facility, you will create a positive environment that encourages greater support and commitment to implement change.

  1. Grayson ML, Russo PL, Cruickshank M et al., Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust 2011; 195 (10): 615-619
  2. Hand Hygiene Australia 2018What is Hand Hygiene?, viewed 4 May 2018
  3. NHMRC 2010Australian Guidelines for the Prevention and Control of Infection in Healthcare, Commonwealth of Australia, viewed 9 May 2018
  4. World Health Organisation 2009aGuide to implementation of the WHO multimodal hand hygiene improvement strategy, WHO, Geneva, viewed 18 April 2018
  5. World Health Organisation 2009bHand Hygiene: Why, How & When?, WHO, Geneva, viewed 9 May 2018
  6. World Health Organisation 2012Hand hygiene in outpatient and home-based care and long-term care facilities: a guide to the application of the WHO multimodal hand hygiene improvement strategy and the “My Five Moments For Hand Hygiene” approach, WHO, Geneva, viewed 18 April 2018