What is Hand Hygiene?

Hand hygiene is an action of hand cleansing. It refers to properly cleaning one's hands to remove pathogens, dirt, and contaminants. This is achieved in healthcare settings using either soap and water or alcohol-based hand sanitiser. This simple yet crucial action helps minimise the transmission of bacteria and viruses, pivotal in maintaining a safe environment for people receiving and working in health facilities (Duane, Pilling, Saget, Ashley, Pinhas, Lyne 2022).

Why is Hand Hygiene Important?

Hand hygiene is essential because it helps prevent the spread of harmful pathogens. It is relatively simple but crucial for reducing healthcare-associated infections. Anyone who enters a facility, including visitors and contractors, must be in good health and perform hand hygiene (SA Health 2024).

What is the Hand Hygiene Training Requirement?

In health, aged and community care settings, all staff must cleanse their hands with soap and water or alcohol-based hand sanitiser to effectively remove pathogens, dirt, and contaminants. Therefore, it is essential for anyone working in a Learning and Development (L&D), Quality or Education team to ensure they’re familiar with the regulatory requirements and can meet education and training requirements effectively. Furthermore, it is not just a regulatory requirement but best practice. The NSQHS explains that good hand hygiene practices ensure consistency with the current National Hand Hygiene Initiative.

Relevant Standards

What is the Importance of Audit Reporting?

Hand hygiene audit reporting in residential aged care facilities is critically important. Audit reports provide data that management teams can use to identify trends, training needs, and areas for improvement. It is also vital that aged care facilities benchmark against other providers. By understanding the benchmarks and striving to meet or exceed them, facilities can improve their standards and raise the bar for safety and quality across the aged care sector.

Hand hygiene can be measured in a few ways:

• Healthcare-associated infections (Staphylococcus aureus bloodstream infections)
• Hand hygiene compliance
• Hospital-acquired complications (AIHW 2022)

Five Moments of Hand Hygiene

According to the Australian Commission on Safety and Quality in Health Care, hand hygiene training is mandatory for all health workers. Hand hygiene is a national quality and safety priority, highlighted by Standard 3 of the National Safety and Quality Health Service Standards (Department of Health 2021).

Compliance with the "Five Moments for Hand Hygiene" is required. These moments are:

• Before touching a patient
• Before a procedure
• After a procedure or bodily fluid exposure
• After touching a patient
• After touching a patient's surroundings

Observing the 'Five Moments of Hand Hygiene’ consists of observational activities to ensure that staff are compliant and competent. But do we understand data? It’s great to have 100% compliance, but does it reflect what the data shows us?

Why is the Older Person at High Risk of an Infection?

The immune system of an older person becomes less effective at fighting infections. Residents from a residential aged care facility are six times more likely to be hospitalised when they acquire an infection. The more visitors a residential aged care facility receives, the greater the exposure to bacteria and viruses. The goal is to reduce the exposure and transmission of bugs to the older population and staff who care for them (Sepsis Alliance, 2023).

What is the Difference Between Healthcare-Associated Infections and Hospital-Acquired Infections?

The Australian Commission on Safety and Quality in Health Care defines Healthcare-associated infections as infections acquired in healthcare facilities or that occur due to healthcare interventions. They may become evident after a person leaves the healthcare facility. A hospital-acquired infection refers explicitly to infections contracted within a hospital setting and is a category of healthcare-associated infections(ACSQH 2018).

Each year, healthcare-associated infections (HAIs) affect about 165,000 patients in Australian health facilities, making them the most common complication in hospitals. HAIs can cause significant suffering for patients (Clinical Excellence Commission 2017). When an older person is unwell and, as a result, hospitalised, they are at risk of acquiring other bacteria and viruses that lurk in the rooms of a hospital. It is not a place for an older person.

Examples of Healthcare-Associated Infections?

• Urinary tract infection
• Surgical site infection
• Pneumonia
• Bloodstream infection
• Urinary tract infection
• Infections or inflammatory complications associated with peripheral/central venous catheters
• Multi-resistant organism
• Infection associated with prosthetics/implantable devices
• Gastrointestinal infections
• Other high-impact infections

As an L&D Manager, you must ensure all staff receive the necessary training and education to understand and implement effective, evidence-based hand hygiene practices. Everyone should be engaged with and committed to keeping our patients, residents, and health workers safe and free from harm. We must also maintain a clean healthcare environment and keep all equipment sanitised. Additionally, adhering to sterile techniques is essential when caring for wounds and managing urinary catheters, among other tasks.

How can we accomplish all of these critical safety measures effectively?

How Can You Prevent Infection in Your Workplace Through Effective Education?

Assigning education that directly reflects and impacts the care the health worker provides and is crucial to preventing infections in the workplace. In the list below, you will be able to identify learning opportunities you can assign to your staff that focus on hand hygiene as an isolated activity and how it relates to clinical practice scenarios.

Here are some measures:

1. Vaccinations: Ensuring staff and residents are up to date with their vaccinations to prevent the transmission of potentially avoidable diseases and reduce the severity of symptoms should they occur.
2. Wound care: Correct wound care, including wound cleansing and aseptic technique, is critical to preventing infections. Staff should receive regular training on the best-practice wound care management regularly.Staff must understand how to assess wounds, identify wound management goals, select and apply dressings, and recognise signs of infection early. Ensure competency through practical demonstrations and regular competency assessments to reinforce best practices in wound management and hand hygiene.
3. Treating bacterial infections: Nursing and health workers must understand when and how to use antibiotics to prevent antibiotic resistance. Educate your staff about antibiotic stewardship principles, including evaluating antibiotic prescription appropriateness and managing treatments effectively. Regular workshops and seminars can keep this knowledge fresh and applicable.
4. Viral infections: Not all viral infections require medical treatment. Managing symptoms and supporting the immune system may be sufficient. Provide training on recognising the differences between bacterial and viral infections to avoid unnecessary antibiotic use, which can lead to resistance.

While hand hygiene and infection prevention are often considered mandatory training, applying best practices and using education wisely is crucial for fostering a culture of continuous learning instead of mere compliance. Encourage staff to share knowledge and experiences related to infection prevention. This empowers employees and creates a proactive, prevention-focused environment. Target education and quality initiatives carefully. Select appropriate job roles, teams, or individuals based on validated data and clear needs. This approach goes beyond simple compliance, building a workforce engaged in infection control practices.

Identify Your Hand Hygiene Champions

Promoting hand hygiene champions within teams has proven to increase compliance and competence. These champions serve as peer educators, enhancing the learning environment and making it more inclusive and supportive. They help demystify the data collection and analysis process, ensuring everyone understands how their actions contribute to broader health outcomes. Notably, healthcare systems, including aged and community care organisations, should consider distinctly defining the role of these hand hygiene champions as dedicated individuals focused on overcoming resistance and improving hand hygiene compliance. Organisations should differentiate this role from a "compliance auditor," who systematically evaluates adherence to hand hygiene protocols (Goedken, Livorsi, Sauder, Vander Weg et al. 2019).

How to Assess Staff Competency in Hand Hygiene

Regular assessments are necessary to ensure that healthcare staff are competent in hand hygiene protocols. Techniques for evaluation include:

1. Direct observation: Managers, dedicated auditors, champions or infection control personnel observe staff during real-world conditions.
2. Self-assessment: Surveys sent to staff or basic quizzes can include questions about when and how to perform hand hygiene to test a staff member’s knowledge. The results of a self-assessment could be used to understand which staff require further education on basic topics and which staff may need to have their knowledge, skills, and practice further enhanced through more advanced education.
3. Competency assessment: Practical demonstrations allow staff to demonstrate their hand hygiene practices and alcohol-based hand rub techniques (SA Health 2024).

What Skills do Staff Need to Learn in Hand Hygiene?

Skill	Description
Psychomotor skills	Handwashing technique: To automate a psychomotor skill, we must practice it for 2 to 4 weeks, allowing us to perform it without conscious effort. It is more effective to have brief, regular training sessions interspersed with rest periods rather than one extended, intensive training session.
Cognitive skills:	Awareness of 'Five Moments': Healthcare workers should know the “Five Moments for Hand Hygiene” identified by the Australian Commission on Safety and Quality in Health Care to ensure timely and effective hand hygiene. Risk assessment: Ability to identify situations where hand hygiene is particularly crucial, such as before invasive procedures or after handling waste.
Communication skills	Reporting: Staff should know how to report potential hand hygiene risks or poor compliance. Peer-to-peer encouragement: Staff, education, and quality teams should foster a hygiene culture by reminding each other about the importance of hand hygiene.
Rationale-Based Learning	The why?: Integrating rationale-based learning involves educating staff on the 'how' and the 'why' behind each hand hygiene practice. This approach helps deepen understanding, ensuring that staff recognise the consequences of poor hygiene and the benefits of compliance. It also improves motivation and adherence to hand hygiene protocols.
Clinical skills	Simulated scenarios: Implementing simulations emphasising hand hygiene effectively during high-stress situations. This approach enhances staff preparedness for real-life scenarios where maintaining hand hygiene is crucial. Continuing Professional Development (CPD): CPD can assist staff, especially registered health professionals, in building on basic induction and mandatory training to adopt more complex, evidence-based practices related to hand hygiene and infection prevention and control.

By supporting staff in developing these skills, you will better equip them to engage in, learn about, and apply best-practice hand hygiene within your organisation.

Strategies to Improve Hand Hygiene Skills

Building competency in diverse, high-risk groups requires a multi-faceted approach. Below are some strategies to help support employees in this area:

• Hand hygiene champions: Champions serve as peer educators, enhancing the learning environment and making it more inclusive and supportive.
• Feedback sessions: Constructive feedback serves as a real-time learning tool. Frequent and scheduled feedback sessions help quickly identify and address gaps in understanding or skill sets.
• Education: Educational materials, such as printouts from online modules or approved posters from regulatory bodies, can be a quick reference while on the go.
• Meeting: Hand hygiene champions will run quick, frequent meetings to discuss, update, and involve the team in moving forward with ideas and feedback.

Sample Training Plan for the Hand Hygiene Requirement

This example can be used as a guide to build a training plan that ensures consistent, comprehensive training across your organisation. It streamlines resource allocation and preparation, enhances training effectiveness, and serves as a benchmark for continuous improvement.

Reducing planning time allows managers to focus more on delivering quality education and improving staff skills and organisational outcomes. However, it's essential to recognise that training plans should not be one-size-fits-all. Identifying the specific educational needs of staff is crucial, and in some cases, education alone may not be the complete solution.

Quarter	Topics	Resources
Q1	Clinical skills	Catheter-Associated Urinary Tract Infections: How Do You Prevent CAUTI? Vaccine preventable diseases Infection Prevention and Control The Relationship Between Chronic Conditions and Infection Surveillance of Healthcare-Associated Infections
Q2	Technical skills	Hand Hygiene 101 Hand Hygiene Essentials Infection Prevention in the Home Donning and Doffing PPE Correctly

Staff Competency Assessment for Hand Hygiene - Example

Surveys provide a rapid and effective method for gathering data on staff confidence in specific clinical areas. You can use the following example as a template to help get you started.

Conclusion

Effective hand hygiene is essential for infection control in healthcare, aged and community settings. By providing comprehensive training and regular assessments, such as surveys and audits, healthcare facilities can enhance safety and care quality. Empowering staff with Champions and the necessary skills and knowledge ensures consistent hand hygiene practices, safeguards patients, residents and healthcare workers, and promotes a culture of excellence in hygiene.

References

• Australian Commission on Safety and Quality in Health 2019, ‘3.10 Hand Hygiene’, Australian Government, viewed 15 June 2024, https://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-infections-standard/infection-prevention-and-control-systems/action-310#:~:text=Examples%20of%20evidence-,Action%203.10%20states,Hygiene%20Initiative%2C%20and%20jurisdictional%20requirements
• Australian Commission on Safety and Quality in Health 2019, ‘National Hand Hygiene Initiative - Audit Requirements’, Australian Government, viewed 15 June 2024, https://www.safetyandquality.gov.au/our-work/infection-prevention-and-control/national-hand-hygiene-initiative/national-audits-and-hhcapp-nhhi/national-hand-hygiene-initiative-audit-requirements
• Broadford, J & Noleen Bennett 2021, Hand Hygiene in Residential Aged Care Services, PowerPoint presentation, viewed 15 June 2024, https://www.vicniss.org.au/media/2410/hand-hygiene-aged-care-ipc-lead-qa.pdf
• Caris, MG, Labuschagne, HA, Dekker, M, Kramer, MH, van Agtmael, MA & Vandenbroucke-Grauls, CM 2018, ‘Nudging to improve hand hygiene’, Journal of Hospital Infection, vol. 98, no. 4, pp. 352-358.
• Duane, B, Pilling, J, Saget, S, Ashley, P, Pinhas, AR, & Lyne, A 2022, ‘Hand hygiene with hand sanitizer versus handwashing: what are the planetary health consequences?’, Environmental Science and Pollution Research, vol. 29, no. 32, pp. 48736-48747.
• Goedken, CC, Livorsi, DJ, Sauder, M, Vander Weg, MW, Chasco, EE, Chang, NC, Perencevich, E & Reisinger, HS 2019, ‘The role as a champion is not only to monitor but to speak out and to educate: the contradictory roles of hand hygiene champions’, Implementation Science, vol. 14, pp. 1-11.
• South Australia Health 2024, Hand Hygiene Competency Tool, Australian Government, viewed 16 June 2024, https://www.sahealth.sa.gov.au/wps/wcm/connect/229ba98045d6566c8396cb574adac1f8/HH+Competency+Tool_v2.7+%28May+2024%29.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-229ba98045d6566c8396cb574adac1f8-o-Zg-bi
• South Australia Health 2024, Hand Hygiene Clinical Guidelines, Australian Government, viewed 16 June 2024, https://www.sahealth.sa.gov.au/wps/wcm/connect/765d5d0046d2cefe9be0fb2e504170d4/Clinical_Guideline_Hand_Hygiene_v1.4+5.05.2020.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-765d5d0046d2cefe9be0fb2e504170d4-oe76zig

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