Thousands of people die every day from infections acquired while receiving health care. As we've already stated, hands are the main pathway of germs transmission in health care. Hand hygiene is the number one most important measure to stop the transmission of harmful germs and to prevent health care associated infections. Shown here are the five moments for hand hygiene developed by the World Health Organization. Let's take a minute to look at each moment in more detail. The first moment for hand hygiene occurs when you enter the resident zone and before touching the resident. Performing hand hygiene here protects the resident against colonization, and in some cases, against infections by harmful germs carried by your hands. An example of a situation where this would be appropriate is before assisting a resident with personal care activities. The second moment for hand hygiene occurs before you perform any clean or aseptic procedure. This is done to protect the resident against infection with bad bugs, including their own germs, entering his or her body. An example of a situation where this would apply would be before preparing food, medications, injections, or dressing a wound. The third moment occurs any time there is a body fluid exposure risk. Performing hand hygiene here protects you from colonization or infection with the resident's harmful germs and protects the healthcare environment from the spread of germs. A good example of this would be after cleaning an incontinent resident, emptying a urinary catheter bag, changing soiled bed linen or checking a blood sugar. The fourth moment happens after you have touched the resident. Hand hygiene at this moment protects you from colonization and infection and protects the health care environment from the spread of germs. A good example for this opportunity would be after performing a physical exam or assisting a resident with personal care needs. The fifth moment for hand hygiene occurs any time you touch the resident's surroundings. This protects you from colonization and infection with resident germs that may be present on surfaces or objects in the resident's surroundings and protects the healthcare environment against germs spread. A good example of this would be after any activity involving physical contact with the resident's immediate environment, like changing bed linens, holding a bed rail, clearing a bedside table, or even leaning against the bed. It is important that you take every opportunity to perform hand hygiene to keep a resident, yourself, and the environment free from germs. You should always use an alcohol based hand rub for hand hygiene unless your hands are visibly soiled. To effectively reduce the growth of germs on hands, you should have enough product in your hands to wet all surfaces of your hands for at least 20 to 30 seconds. You should wash your hands with anti bacterial soap and water when they are visibly soiled or after caring for a resident with diarrhea. Otherwise, use an alcohol based hand rub. You should was your hands for a minimum 15 seconds with soap and water. You should follow the steps described here to effectively wash your hands. Standard precautions are a cornerstone of infection control. They are based on the assumption that all moist body fluids from all residents are colonized or infected with one or more bad bugs. The general rule of thumb is that if it is warm, wet and not yours, standard precautions apply. We have already reviewed hand hygiene, the first element of standard precautions. We will review some of the elements of standard precautions that are important for preventing the spread of bad bugs. Gowns, gloves, and mask are also an important aspect of standard precautions and further prevent the spread of bad bugs when they are utilized appropriately. They are intended to protect the user from contamination and should always be used when there's potential for contact with blood or potentially contaminated body fluids such as urine or stool. Hand hygiene should always be performed before putting on personal protective equipment or PPE. And following removal. Gloves should be worn anytime there is anticipated contact with blood or other potentially infectious material. Glove should be changed during resident care if the hands move from a dirty body site like the groin to a clean body site, like the face. The same pair of gloves should not be used for more than one patient and should never be washed and reused. Hands should be washed after glove removal. Gowns are used to protect the user's clothes and bare skin from contamination that could occur during resident care. Like with gloves, gowns should be worn when there is the potential for contamination of the skin or clothes during resident care. Gowns should not be reused or used for multiple residents, even those in the same room. Mask and eye protection should be worn when there is potential for splash or spray of blood, respiratory secretions, or other body fluids. Masks should be changed if they become wet and discarded after care of the resident. You may be able to disinfect and reuse eye protection depending on the manufacturer. Another very important part of controlling the spread of bad bugs is room placement. A private room is preferred for residents who are colonized or infected with a bad bug. If a private room is not available, the next best option is to place the colonized or infected resident into a room with another resident with the same type of bad bug. Meaning MRSA positive resident rooms with an MRSA positive resident or VRE with VRE. Residents with two different bad bugs should never be put in the same room together. The third option is to place a resident with the bad bug in a room with the healthiest resident possible because the healthiest resident has the lowest risk for getting the bad bug. A clean resident care environment is as important as hand hygiene in preventing the transmission of bad bugs in nursing homes. We all ready know that residents with bad bugs such as MRSA and VRE, have the bacteria present on all or parts of their skin. These bacteria shed onto environmental surfaces such as bed rails and table tops and the resident's immediate environment. These organisms can survive on dry environmental surfaces from several hours to many weeks and serve as a source of hand, glove, and clothing contamination. All surfaces and equipment should be cleaned with an EPA registered hospital surface disinfectant. Daily cleaning of surfaces within the residents immediate environment, shared resident care equipment, and common areas, lowers the level of contamination and the risk of cross transmission is reduced. Similarly, thoroughly cleaning a room after a resident is discharged protects the next resident who will be occupying the room from potentially getting a bad bug. Soiled linens such as sheets, towels, incontinence pads and patient gowns, are contaminated with bad bugs even if visible soil is not evident. All linen should be handled with care and as little agitation as possible to avoid contamination of the air, surfaces, and people in the immediate area. Linen should be placed immediately into a leak resistant container and should not be sorted or placed in any surface prior to containment. Just as it is important for staff to maintain their hygiene, it is also very important that residents are able to maintain their hygiene. This includes bathing residents regularly, insuring that incontinence care is done appropriately and thoroughly, and residents wash their hands frequently, including before and after eating, before and after group activities and after using the bathroom. For relatively healthy residents, such as those who are mainly independent, standard precautions may be all that are needed. Making sure that gloves and gowns are used for contact with uncontrolled secretions, pressure draining wounds, stool incontinence and ostomy tubes or bags. When there are ill residents such as those totally dependent upon healthcare personnel for health care and activities of daily living and for those residents whose infected secretions or drainage cannot be contained, standard precautions alone may not be enough to control the spread of bad bugs. This is when additional measures are added to standard precautions, called Contact Precautions. Contact Precautions are an extension of standard precautions, in that gowns and gloves are required for all resident contacts, as well as contact with the environmental surfaces in the residents room. After viewing this program you know know that antibiotic resistant bacteria are common in nursing homes causing frequent colonization and 10% of all in factions in nursing homes. You also know that by practicing good hand hygiene and standard precautions, you protect the residents, yourself and the nursing home environment from the spread of bad bugs. If you have any questions related to infection control, you should contact your facility's infection preventionist for advice and assistance. Thank you for viewing this module and good luck with your infection prevention efforts.
