Canadas Hand Hygiene Challenge

Hand Hygiene Toolkit

Training Presentation

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Introduction
Do you want your hands to offer hope and
healing?
Or do you want your hands to help spread
hospital acquired infections?
Its as simple as that and
Its up to us to help make Canadas Healthcare
System a safer place for all of us!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Overview
Canadian Patient Safety Institute established in
2005
In 2007 Canada joined the WHOs Global
Patient Safety Challenge
Launched the STOP! Clean Your Hands
Campaign
2009 Developed Human Factors Toolkit.
2009/10 Launched a review, update redesign
and integration to Safer Healthcare Now!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Goals
To promote the importance of hand hygiene in reducing the
occurrence of healthcare associated infections (HCAI) in
Canada.
To educate healthcare workers, patients, and families about
the importance of practicing optimal hand hygiene.
To support organizations in making the delivery of
healthcare safer for everyone!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Objectives
To support the needs of healthcare organizations for
capacity building, leadership development and/or the
production of tools to help promote hand hygiene.
To assist organizations in understanding how to meet
Accreditation Canadas Required Organizational
Practices specific to hand hygiene.
To engage participants across the continuum of care in
understanding and practicing optimal hand hygiene

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Available Materials

A website designed to reach out to a broader audience and to

disseminate information as rapidly as possible.
(www.handhygiene.ca)

Fact sheets: demonstrate the need for better hand hygiene, optimal
techniques, and other related supportive materials.

Variety of tools: online learning module, audit training, various types

of assessment tools, a patient/family guide, and additional patient
and family tools and information.

A nationally consistent audit tool:

Helps establish baseline performance on hand hygiene
compliance
Helps to monitor and report on improvements over time

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands
System change
Alcohol-based hand-rubs at point of care

An evidence based
approach, made up
of
5 core
components, to
improve hand
hygiene in healthcare settings

Training and education of staff

+
Observation of hand hygiene and feedback to staff

+
Reminders in the workplace
+

Establishment of a safety climate

Individual active participation and institutional support

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Healthcare Associated Infections (HCAI)

An infection occurring in a patient during the process of

care in a hospital or other health care facility which was
not present or incubating at the time of admission. This
includes infections acquired in the hospital but
appearing after discharge, and also occupational
infections among staff of the facility.
Ducel G et al. Prevention of hospital-acquired infections. A practical guide. WHO 2002

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

The Burden of HCAIs

More than 220,000 patients acquire healthcare associated
infections (HCAIs) in Canada every year resulting in 8,000
12,000 deaths.1
At any time, over 1.4 million people worldwide are suffering
from infections acquired in hospital.2
Up to 50% of HCAIs could have been prevented.3,4
1.

2.
3.
4.

Zoutman, D., Ford, B.D., Bryce, E., Gourdeau, M., Hbert, G., Henderson, E., and Paton, S. Canadian Hospital
Epidemiology Committee, Canadian Nosocomial Infection Surveillance Program and Health Canada.
Zoutman et. al, The state of infection surveillance and control at Canadian acute care hospitals, American Journal of
Infection Control, 2003:31 , 266-275.
WHO Information Sheet 1 Clean care is Safer Care Challenge
Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV. Effectiveness of a hospital-wide
programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000 Oct 14;356(9238):130712.
Patient Safety and Hand Hygiene Matter ! CPSW Week 2006 brochure

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

The Case for Hand Hygiene

Hand hygiene is one of the most effective measures

to reduce the occurrence of HCAI.

Good hand hygiene saves lives and reduces the

strain on our healthcare system. 1
It takes less than one minute to properly wash
hands using soap and water and less than 30
seconds to properly clean hands with alcohol-based
hand-rub. Both methods are effective.

Roth, Virginia, MD, FRCPC Hands that harm, hands that heal November 2006 PowerPoint presentation, slide 31

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

The Case for Hand Hygiene Cont.

As a healthcare worker you should know ...
You are also susceptible to carrying around infectious organisms
80% of staff who dressed MRSA wounds carried the organism on their
hands for 3 hours afterward
60% of the hands of staff, within hour of contact with patients with
Clostridium difficile were contaminated without even touching the patient
Meanwhile, washing with soap and water in these cases virtually eradicated
these organisms!
Stone, S.P. JR Soc Medicine 2001: 94(6); 278-281. Cited in Mitka, M. JAMA 2009: 302(17) reprinted.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Where Were Your Hands?

Any time within 3 hours of completing a dressing
change on a patient with MRSA or within hour of
making any contact in the room of a patient with C.
difficile?

Did you eat?

Did you have coffee?
Did you cough, rub your nose or eyes?
Did you approach and make contact with another patient
or a family member?

Before you touch anything or anyone...

STOP! Clean Your Hands!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Obstacles to Hand Hygiene

Too busy
It is essential that you make time
Skin irritation
Use lotions & hand rub appropriately
Glove use
is not a substitute for hand hygiene
Not top of mind
needs to become as spontaneous as using aseptic
technique and all other safety strategies.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

So, Why Clean your hands?

1) to protect the patient against harmful
pathogens carried on your hands or present on
his/her own skin
2) to protect yourself and the healthcare
environment from harmful pathogens

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Key Concepts
Hand hygiene must be performed at the point of care.
During healthcare delivery, there are four moments when
it is essential that you perform hand hygiene.
Handrub is often preferable to handwashing.
If isolation precautions are in place, always adhere to the
hand hygiene activities described in those precautions.

It is essential that everyone perform hand hygiene

using the appropriate technique and time duration in
order for it to be effective.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Point of Care
The place where three elements align:
The patient
The healthcare worker
The care of the patient involving any contact with the
patient or the patients zone.
A hand hygiene product should be as close as possible
to the point of care.
WHO Hand Hygiene Guidelines, August 2009

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Four Times to Clean

FOUR Moments of hand hygiene during
healthcare have been identified and are crucial to
preventing hand transmission of infections.
1.
2.
3.
4.

Before initial patient/patient environment contact

Before aseptic procedure
After body fluid exposure risk
After patient/patient environment contact

This was adapted from the WHOs 5 Moments of

Hand Hygiene (Ontario Ministry of Health and Long Term Care).

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Time
Optimal hand hygiene using an alcohol-based

hand rub takes 20-30 seconds

Optimal hand hygiene using soap and
water takes 40-60 seconds
Both are effective methods

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Alcohol Based Hand Rub

Apply a palm full of rub and cover all
surfaces of the hand; rub together
until the hands are dry.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

How to Hand Rub

To effectively reduce the
growth of germs on hands,
handrubbing must be
performed by following all
steps illustrated on the left.
This takes only 20-30 secs!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Soap & Water

Wet the hands first and apply enough soap to cover
all surfaces of the hands. Make sure the hands are
dry and the towels are not used repeatedly or by
multiple people.
Thorough drying of hands after hand washing has
important protective benefits and helps to eliminate
more pathogens from your hands.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

How to Hand Wash

To effectively reduce the
growth of pathogens on hands,
handwashing must last 40-60 secs and
should be performed by following all
steps illustrated on the left.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Gloves & Skin care

Gloves do not replace the practice of optimal hand

hygiene
Avoid hand washing immediately before or after using an
alcohol-based hand rub
Avoid hot water
Let hands dry completely before donning gloves
Use hand lotions and creams
Allergies or adverse reactions use alternative products
No artificial fingernails or extenders
Keep natural nails short (0.5 cm)
Remove jewelry

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Resources
World Health Organization: Guidelines on Hand Hygiene
in Health Care. First Global Patient Safety Challenge,
Clean Care is Safer Care. August 2009.
http://whqlibdoc.who.int/publications/2009/97892415
97906_eng.pdf
WHO Clean Care is Safer Care: Tools and Resources:
http://www.who.int/gpsc/5may/tools/en/index.html
Canadian Patient Safety Institute: www.handhygiene.ca
Community and Hospital Infection Control Association
Canada.
http://www.chica.org/links_handhygiene.html#STANDAR
DS

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Resources
Public Health Agency of Canada, Hand Hygiene
Recommendations for Remote and Isolated Community
Settings. http://www.phac-aspc.gc.ca/alertalerte/h1n1/public/handhygiene-eng.php?option=print
Health Canada: The Benefits of Handwashing: http://www.hcsc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/hands-mainseng.php
Canadian Centre for Occupational Health and Safety:
http://www.ccohs.ca/http://www.ccohs.ca/
http://www.ccohs.ca/pandemic/subject/handwashing.html
The Art of Washing Hands:
http://www.theartofwashinghands.com/index.html

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Questions?

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Introduction
Do you want your hands to offer hope and
healing?
Or do you want your hands to help spread
hospital acquired infections?
Its as simple as that and
Its up to us to help make Canadas Healthcare
System a safer place for all of us!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Overview
Canadian Patient Safety Institute established in
2005
In 2007 Canada joined the WHOs Global
Patient Safety Challenge
Launched the STOP! Clean Your Hands
Campaign
2009 Developed Human Factors Tool Kit.
2009/10 Launched a review, update redesign
and integration to Safer Healthcare Now!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Goals
To promote the importance of hand hygiene in reducing the
occurrence of healthcare associated infections (HCAI) in
Canada.
To educate healthcare workers, patients, and families about
the importance of practicing optimal hand hygiene.
To support organizations in making the delivery of
healthcare safer for everyone!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Objectives
To support the needs of healthcare organizations for
capacity building, leadership development and/or the
production of tools to help promote hand hygiene.
To assist organizations in understanding how to meet
Accreditation Canadas Required Organizational
Practices specific to hand hygiene.
To engage participants across the continuum of care in
understanding and practicing optimal hand hygiene

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Available Materials

A website designed to reach out to a broader audience and to

disseminate information as rapidly as possible.
(www.handhygiene.ca)

Fact sheets: demonstrate the need for better hand hygiene, optimal
techniques, and other related supportive materials.

Variety of tools: online learning module, audit training, various types

of assessment tools, a patient/family guide, and additional patient
and family tools and information.

A nationally consistent audit tool:

Helps establish baseline performance on hand hygiene
compliance
Helps to monitor and report on improvements over time

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands
System change
Alcohol-based hand-rubs at point of care

An evidence based
approach, made up
of
5 core
components, to
improve hand
hygiene in healthcare settings

Training and education of staff

+
Observation of hand hygiene and feedback to staff

+
Reminders in the workplace
+

Establishment of a safety climate

Individual active participation and institutional support

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Healthcare Associated Infections (HCAI)

An infection occurring in a patient during the process of

care in a hospital or other health care facility which was
not present or incubating at the time of admission. This
includes infections acquired in the hospital but
appearing after discharge, and also occupational
infections among staff of the facility.
Ducel G et al. Prevention of hospital-acquired infections. A practical guide. WHO 2002

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

The Burden of HCAIs

More than 220,000 patients acquire healthcare associated
infections (HCAIs) in Canada every year resulting in 8,000
12,000 deaths.1
At any time, over 1.4 million people worldwide are suffering
from infections acquired in hospital.2
Up to 50% of HCAIs could have been prevented.3,4
1.

2.
3.
4.

Zoutman, Dick, MD, FRCPC, B. Douglas Ford, MA, Elizabeth Bryce, MD, Marie Gourdeau, MD,Ginette Hbert, RN,
Elizabeth Henderson, PhD, and Shirley Paton, MN, Canadian Hospital Epidemiology Committee, Canadian Nosocomial
Infection Surveillance Program and Health Canada. Zoutman et. al, The state of infection surveillance and control at
Canadian acute care hospitals, American Journal of Infection Control, 2003:31 , 266-275.
WHO Information Sheet 1 Clean care is Safer Care Challenge
Pittet D, Hugonnet S, Harbarth S, Mourouga P, Sauvan V, Touveneau S, Perneger TV. Effectiveness of a hospital-wide
programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000 Oct 14;356(9238):130712.
Patient Safety and Hand Hygiene Matter ! CPSW Week 2006 brochure

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

The Case for Hand Hygiene

Hand hygiene is one of the most effective measures

to reduce the occurrence of HCAI.

Good hand hygiene saves lives and reduces the

strain on our healthcare system. 1
It takes less than one minute to properly wash
hands using soap and water and less than 30
seconds to properly clean hands with alcohol-based
hand-rub. Both methods are effective.

Roth, Virginia, MD, FRCPC Hands that harm, hands that heal November 2006 PowerPoint presentation, slide 31

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

The Case for Hand Hygiene Cont.

As a healthcare worker you should know ...
You are also susceptible to carrying around infectious organisms
80% of staff who dressed MRSA wounds carried the organism on their
hands for 3 hours afterward
60% of the hands of staff, within hour of contact with patients with
Clostridium difficile were contaminated without even touching the patient
Meanwhile, washing with soap and water in these cases virtually eradicated
these organisms!
Stone, S.P. JR Soc Medicine 2001: 94(6); 278-281. Cited in Mitka, M. JAMA 2009: 302(17) reprinted.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Where Were Your Hands?

Any time within 3 hours of completing a dressing
change on a patient with MRSA or within hour of
making any contact in the room of a patient with C.
difficile?

Did you eat?

Did you have coffee?
Did you cough, rub your nose or eyes?
Did you approach and make contact with another patient
or a family member?

Before you touch anything or anyone...

STOP! Clean Your Hands!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Obstacles to Hand Hygiene

Too busy
It is essential that you make time
Skin irritation
Use lotions & hand rub appropriately
Glove use
is not a substitute for hand hygiene
Not top of mind
needs to become as spontaneous as using aseptic
technique and all other safety strategies.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

So, Why Clean your hands?

1) to protect the patient against harmful
pathogens carried on your hands or
present on his/her own skin
2) to protect yourself and the health-care
environment from harmful pathogens

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Key Concepts
Hand hygiene must be performed at the point of care.
During healthcare delivery, there are four moments when
it is essential that you perform hand hygiene.
Handrub is often preferable to handwashing.
If isolation precautions are in place, always adhere to the
hand hygiene activities described in those precautions.

It is essential that everyone perform hand hygiene

using the appropriate technique and time duration in
order for it to be effective.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Point of Care
The place where three elements align:
The patient
The healthcare worker
The care of the patient involving any contact with the
patient or the patients zone.
A hand hygiene product should be as close as possible
to the point of care.
WHO Hand Hygiene Guidelines, August 2009

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Four Times to Clean

FOUR Moments of hand hygiene during healthcare have
been identified and are crucial to preventing hand
transmission of infections.
1.
2.
3.
4.

Before initial patient/patient environment contact

Before aseptic procedure
After body fluid exposure risk
After patient/patient environment contact

This was adapted from the WHOs 5 Moments of Hand

Hygiene (Ontario Ministry of Health and Long Term Care).

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Time
Optimal hand hygiene using an alcohol-based

hand rub takes 20-30 seconds

Optimal hand hygiene using soap and
water takes 40-60 seconds
Both are effective methods

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Alcohol Based Hand Rub

Apply a palm full of rub and cover all
surfaces of the hand; rub together
until the hands are dry.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

How to Hand Rub

To effectively reduce the
growth of germs on hands,
handrubbing must be
performed by following all
steps illustrated on the left.
This takes only 20-30 secs!

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Soap & Water

Wet the hands first and apply enough soap to cover
all surfaces of the hands. Make sure the hands are
dry and the towels are not used repeatedly or by
multiple people.
Thorough drying of hands after hand washing has
important protective benefits and helps to eliminate
more pathogens from your hands.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

How to Hand Wash

To effectively reduce the
growth of pathogens on hands,
handwashing must last 40-60 secs and
should be performed by following all
steps illustrated on the left.

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Gloves & Skin care

Gloves do not replace the practice of optimal hand

hygiene
Avoid hand washing immediately before or after using an
alcohol-based hand rub
Avoid hot water
Let hands dry completely before donning gloves
Use hand lotions and creams
Allergies or adverse reactions use alternative products
No artificial fingernails or extenders
Keep natural nails short (0.5 cm)
Remove jewelry

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Resources
World Health Organization: Guidelines on Hand Hygiene
in Health Care. First Global Patient Safety Challenge,
Clean Care is Safer Care. August 2009.
http://whqlibdoc.who.int/publications/2009/97892415
97906_eng.pdf
WHO Clean Care is Safer Care: Tools and Resources:
http://www.who.int/gpsc/5may/tools/en/index.html
Canadian Patient Safety Institute: www.handhygiene.ca
Community and Hospital Infection Control Association
Canada.
http://www.chica.org/links_handhygiene.html#STANDAR
DS

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Resources
Public Health Agency of Canada, Hand Hygiene
Recommendations for Remote and Isolated Community
Settings. http://www.phac-aspc.gc.ca/alertalerte/h1n1/public/handhygiene-eng.php?option=print
Health Canada: The Benefits of Handwashing: http://www.hcsc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/hands-mainseng.php
Canadian Centre for Occupational Health and Safety:
http://www.ccohs.ca/http://www.ccohs.ca/
http://www.ccohs.ca/pandemic/subject/handwashing.html
The Art of Washing Hands:
http://www.theartofwashinghands.com/index.html

Canadas Hand Hygiene Challenge:

STOP! Clean Your Hands

Questions?