Clean hands save lives

Reducing avoidable incidences of healthcare associated infection (HCAI) remains a key priority for the NHS as they cause unnecessary distress and harm to an estimated 5,000 patients each year.1, 2 However, even taking the devastating impact on patients out of the equation, it makes good business sense to prevent the spread of HCAIs. On average patients with MRSA bacteraemias stay an additional ten days in hospital. For Clostridium difficile (C.diff) it is even longer and the subsequent additional treatment costs £4,000 to £10,000 per patient.3  

Hand hygiene
One of the most effective ways of preventing the spread of HCAI is through good hand hygiene practice by healthcare staff. The cleanyourhands campaign was developed by the National Patient Safety Agency (NPSA) to improve the hand hygiene of staff and help the NHS tackle HCAIs.
    
The key message of the campaign is for staff to clean their hands at the point of care, which can be achieved through the use of either alcohol handrub or soap and water. The realities of healthcare delivery, however, mean that soap and water are not always easily accessible when and where care is being provided.
    
When staff come into contact with patients, often their hands do not usually feel ‘dirty’; therefore they often do not make the effort to walk to a sink. This is where alcohol handrub comes in; alcohol handrub enables healthcare staff to quickly and effectively clean their hands at the point of care and is recommended for the multiple times each day that staff have routine contact with patients.
    
Soap and water should always be used when hands are visibly soiled or have had contact with body fluids; when caring for someone with vomiting or diarrhoea; or there is an outbreak of diarrhoeal diseases such as Norovirus or C.diff.

Appropriate cleaning
During the delivery of care, staff will often need to clean their hands when there may be no apparent reason or incentive to do so. This is not to say that staff are indifferent to those in their care or are intentionally taking risks with them. Rather, staff are often unaware of the appropriate moments for hand hygiene and the consequences of inappropriate hand cleaning may not be immediate or directly linked to the actions of an individual healthcare worker.
    
To help staff better understand when they need to clean their hands, the World Health Organization developed the ‘Five Moments for Hand Hygiene.’ This concept identifies the five key ‘moments’ during patient care that healthcare staff need to clean their hands in order to keep patients and staff safe. These moments are based on risk minimisation and each incorporates a variety of indicators. The concept rationalises when hand hygiene needs to occur, thus eradicating unnecessary hand hygiene and ensuring that staff are cleaning their hands at the critical points for preventing the transmission of infection-causing microbes.
    
The concept of the ‘five moments’ is that the patient and his or her immediate environment becomes what is defined as the ‘patient zone’. This zone can differ according to where the patient is being treated and needs to be agreed by the staff working within that environment.
    
The idea is that staff need to clean their hands when they cross the imaginary line and enter the patient zone (moment one) and when they leave (moment four). They can then work within the patient zone without having to clean their hands every time they touch the patient unless they are doing one of two things: undertaking a clean or aseptic procedure (moment two) or may have had direct hand contact with body fluids (moment three).
    
The fifth moment is after contact with the patient surroundings and is when a healthcare worker enters the patient zone, does not touch the patient but does touch items within the zone, such as a bed or chair. Hand hygiene needs to take place after contact with items that are considered part of the patient zone to avoid the transfer of any microbes from this environment into another patient’s zone.

Campaign focus
The ‘five moments’ will be a key focus of the cleanyourhands campaign. Infection control teams will be trained in the concept and its application so that they are equipped and able to train frontline staff in their trusts. A series of ‘train the trainer’ style regional workshops took place from April to June 2009. This was supported by a variety of resources to support training; the main being a film that illustrates the application of the ‘five moments’ in different care settings during one patient’s journey through the NHS from ambulance to hospital and back home.
    
The other major development regarding the cleanyourhands campaign  is the reissue of the NPSA’s Patient Safety Alert: Clean hands save lives4 The updated alert, which applies to all providers of NHS care in England and Wales, outlines current best practice in hand hygiene including:

• reemphasising the point of care as the critical moment for hand hygiene;
• clear guidance on when alcohol handrub and when soap and water should be used;
• current recognised standard for hand hygiene products; and
• management of associated risks.

The alert also sets out a number of actions that need to be completed. These include auditing risk management strategies to ensure that healthcare staff are able to undertake hand hygiene at the point of care and that policies and processes are appropriately focused. Action plans are then required to address any issues identified through auditing. The NPSA is currently researching the extent to which the alert has currently been implemented to help assess what further action and support may be needed.

For more information
Web: www.npsa.nhs.uk/cleanyourhands

1 The operating framework for the NHS in England 2009/10
2 Improving patient care by reducing the risk of Hospital Acquired Infection, National Audit Office, 2004
3 Clean Safe Care: Reducing infections and saving lives, Department of Health, 9 January 2008
4 www.npsa.nhs.uk/nrls/alerts-and-directives/alerts/clean-hands-save-lives/