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About Just Clean Your Hands

A multi-faceted approach

For health care providers to improve their hand hygiene, clean hands must become part of their workplace culture. The Just Clean Your Hands program was developed to overcome the barriers to proper hand hygiene and improve compliance with hand hygiene best practices in hospitals. The program expanded to include long-term care and retirement homes.

It takes more than a single intervention such as a poster campaign to change hand hygiene behaviour. It takes a multi-faceted intervention.
 
Just Clean Your Hands Support

If you have any hand hygiene questions or would like to speak with someone about the Just Clean Your Hands program, please contact us at ricn@oahpp.ca.

Frequently asked questions

Is hand cleaning as important as the Just Clean Your Hands program suggests?

Hand hygiene is one important component in the battle against cross-infection. Minimizing risks of infection to patients depends on a range of factors. However, increasing hand hygiene alone can dramatically reduce the risk of a patient acquiring an infection. This is supported by scientific evidence, not just opinion, which demonstrates that the bacteria that cause infection in hospital are most frequently spread from one patient to another on the hands of health care workers.

What is the extent of the problem of infection in hospitals?

In Canada, approximately 250,000 people admitted to hospital each year pick up infections while being treated for something else and more than 8,000 die from these infections. Patients can acquire bloodstream infections, surgical site infections, urinary tract infections or respiratory infections. Once patients acquire an infection, there is a possibility of the microorganisms, which cause the infection, being passed on to other patients. This is heightened by the frequency and extent of contact which health care workers have with patients. Even patients who are not known to have an infection may be carrying microorganisms which can be carried on the hands of health care workers from one patient to another.

Why is hand hygiene compliance at such a low level?

There are many reasons: lack of sinks, activity levels on the unit, staffing levels, health care worker perceptions about soap and its irritant effect, lack of role models, lack of organizational support for hand hygiene. The Just Clean Your Hands program is designed to help hospitals address a range of reasons for low compliance.

How exactly do nurses, doctors and other health care workers play a part in the spread of microorganisms?

It is necessary to understand the complexity of clinical and patient care. In an average day health care workers do a range of tasks. Some essential yet simple tasks like helping patients become comfortable in bed can result in thousands of microorganisms being transferred onto the hands of health care workers. Taking a pulse or blood pressure results in transfer of equally large numbers of microorganisms. A quick squirt of alcohol-based hand rub and the process of rubbing this on the hands until they are dry will destroy almost all of these potentially harmful microorganisms in a short time (15-30 seconds). An absence of hand hygiene at this point would mean that whichever patient the health care worker touches next would receive these microorganisms if hand hygiene is not performed.

Sometimes the microorganisms from patients will be transferred by health care workers onto the environment or equipment in the area close to the patient. This should not be a problem if the environment or equipment is cleaned before contact with another patient. However, the microorganisms can potentially contaminate the hands of health care workers and then be spread to other patients if the health care workers don’t clean their hands.

Why don’t health care providers clean their hands?

  • It is not always easy for health care providers to clean their hands at the right moment.
  • This program addresses the barriers and enablers so that it is easier to clean hands with the right product at the right moment.
  • In many facilities, the environmental supports, role modelling, focused education on 4 Moments, timely feedback from validated auditing process and a hand care program have not been in place to support the health care provider to perform hand hygiene at the right moment with the correct product. This is a multifaceted approach that addresses human factors.
  • The importance of cleaning hands is not a new task and has been recognized as the single most important method to prevent infections in health care settings.
    • Hand hygiene is an integral component of safe patient care. It is as important to patient health and safety as making sure you administer correct medications.
    • It also is a health care provider safety issue, as it protects the health care provider from acquiring infections.
      • Point of care ABHR will make easier to clean hands at the right moment and take less time.

Does hand cleaning with soap and water or with alcohol-based hand rubs really make a difference?

The evidence has been described as ‘completely overpowering’. Studies dating back to the 1950s and 60s found hand hygiene to be critical in preventing the spread of microorganisms in hospitals.

It is crucial to be aware that alcohol-based hand rub (or indeed hand washing at the sink) in isolation, is not the sole answer to the problem of hospital infections caused by poor compliance with hand hygiene. What is needed is a multifaceted approach along with senior management commitment.

What’s the bottom line?

Improving hand hygiene compliance will help to save lives.

Is the Just Clean Your Hands program mandated?

  • No, but improving hand hygiene practices through system supports and education will decrease health care-associated infections.
  • Accreditation Canada’s (formerly known as CCHSCA) new accreditation program has a Required Organization Practice (ROP) for hospitals to show that they track infection rates, analyze data, and deliver education and training to health care providers on hand hygiene.
  • Improving hand hygiene is a patient and health care provider safety issue.
  • Each hospital will be required to do public reporting of hand hygiene compliance rates commencing in April 2009.

We have our own hand hygiene program in place. Why should we use Just Clean Your Hands program?

  • This program can be used to enhance or refresh your current program.
  • It is a multifaceted evidence-based program that has been developed in collaboration with provincial, national and global experts, with the goal to obtain a sustained improvement in hand hygiene.

What is the goal of a hand hygiene program?

The goal is to decrease health care-associated infections and the transmission of infections in health care settings. Hand hygiene is the single most important method of preventing infections in health care settings. Providing system supports and focused education on hand hygiene will assist in making hand hygiene easier for health care providers.

What are the benefits of the program for patients?

  • Patients are more confident about their care when a hospital has a hand hygiene program.
  • Improving hand hygiene is a patient safety issue.

Have other professional associations and experts been involved in this program?

The Implementation Advisory Committee included representatives from:

  • Ontario Hospital Association, Ontario Medical Association, Registered Nurses Association of Ontario, PIDAC, Chair IP&C subcommittee, Communications Information Branch, Ministry of Labour, human factors and social marketing experts.
  • Collaborating Advisors included: Canadian Patient Safety Institute, Public Health Agency of Canada, World Health Organization – Global Patient Safety Challenge, National Patient Safety Agency – UK, Swiss Hand Hygiene Campaign, CHICA – Canada, Scientific experts from USA.

What does Public Health Ontario provide with the Just Clean Your Hands program?

To help hospitals and long-term care homes improve hand hygiene, the Ministry of Health and Long-Term Care developed the Just Clean Your Hands program. The program has been transferred to PHO and includes:

  • A practical step-by-step implementation guide and materials, such as online training modules, a methodology for selecting and placing appropriate hand hygiene products, a hand care program, posters, and visual reminders. Tools can be downloaded from the website:
  • An audit process and tool to evaluate the program's impact and measure hand hygiene compliance rates.
References & Links

Resources

Reference Lists 

General

References follow table:

Association between improved adherence with hand hygiene practice and health care-associated infection rates

Year

Authors

Hospital Setting

Significant Results

Duration of follow-up

1977

Casewell & Phillips

Adult ICU

Reduction in HAI caused by Klebsiella spp.

2 years

1982

Maki & Hecht

Adult ICU

Reduction in HAI rates

N.S.

1984

Massanari & Hierholzer

Adult ICU

Reduction in HAI rates

N.S.

1989

Conly et al.

Adult ICU

Reduction in HAI rates

N.S.

1990

Simmons

et al.

Adult ICU

No effect (hand hygiene improvement did not reach statistical significance)

11 months

1992

Doebbeling et al.

Adult ICU

Significant difference in HAI rates between two different hand hygiene agents

8 months

1994

Webster et al.

NICU

Elimination of MRSA, when combined with multiple other infection control measures. Reduction of vancomycin use.

9 months

1995

Zafar et al.

Newborn Nursery

Elimination of MRSA, when combined with multiple other infection control measures

3.5 years

2000

Larson et al.

MICU/NICU

Significant (85%) relative reduction of VRE rate in the intervention hospital; no significant change in MRSA

8 months

2000

Pittet et al.

Hospital-wide

Significant reduction in the overall prevalence of HAIs and MRSA rates. Active surveillance cultures and contact precautions were implemented during the same time period

5 years

2003

MacDonald et al.

Hospital-wide

Significant reduction in hospital-acquired MRSA cases

N.S.

2004

Swoboda et al.

Adult intermediate care unit

Reduction in HAI rates did not reach statistical significance

2.5 months

2004

Lam et al.

NICU

No significant reduction in HAI rates

6 months

2004

Won et al.

NICU

Significant reduction of HAI rates

3 years

 

ICU = intensive care unit; NICU = neonatal ICU; MICU = medical ICU
HAI = health care-acquired infection; N.S. = not stated
MRSA = methicillin-resistant Staphylococcus aureus; VRE = vancomycin-resistant enterococci

Reproduced with permission from “WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft, April 2006)” (5)
[Table 1.19.1]

 

General references

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Alcohol-based hand rub

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Alcohol-based hand rub as a fire hazard

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Hand rubs and blood alcohol level

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Alcohol-based hand rub and cultural/religious objections

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Compliance

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Economic cost of infections

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Fingernails/rings

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Infection and quality of life

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Guidelines/best practices

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Role models

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Social marketing & behaviour change

 

 

For more information
email: handhygiene@oahpp.ca

 

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Page updated on [date/time] 26/10/2015 4:28 PM
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