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Tackling hand hygiene and HCAIs

Rosanne Jepson discusses solutions to potential challenges in implementing AMS with regard to hand hygiene.
And so what have we been doing? Well, we’ve been reviewing and evaluating our current handwashing practices within our hospital. We’ve been thinking about the times when we should be washing our hands, rather than using the alcohol-based hand rubs. We’ve been thinking about specific situations that we face in our caseload and when we might apply these different strategies, and thinking about these in terms of the size of our hospital, so the staff load that we have and how we go about trying to educate our staff in terms of the importance of handwashing and hand rubbing.
We’ve been thinking about the location of handwashing points across the hospital, so looking at the availability of sinks and liquid soap and also the availability of hand rub dispensers, looking specifically at the location of these facilities, particularly in ward areas, how many hand rub stations we have per patient beds, making sure that these are kennel side facilities, which really helps with compliance in terms of hand hygiene. And we’ve also been looking at the role of individual dispensers, so making people actually be able to carry alcohol-based hand rub with them on their person to encourage its use. We’ve also been looking at when to perform hand hygiene in veterinary medicine.
And we spoke in the first webinar about the five points of hand hygiene, which is advocated both by the NHS and the World Health Organisation. And there’s very little guidance relating to this in veterinary medicine. But I think that many of the strategies in these five points where we’re talking about hand hygiene from human medicine are equally representative for our veterinary patients that are in the hospital. We’ve been considering who should be performing hand hygiene. And there are the obvious individuals that we hope will be adequately trained already including both the veterinary surgeons and the nursing team.
But I think we need to think about the other individuals that spend time in clinical areas, including the patient care assistants, owners, for example, when they’re visiting their pets within the hospital environments, and extending it out to also include members of the team who are perhaps in contact with, for example, clinical notes, such as the reception team.
We’ve been thinking about how we should provide adequate education within a large hospital system. And so we’ve been working on both informal seminars, webinars, to increase attendance and increase awareness. We’ve been looking at the signage that we have in our hospital that’s used to encourage appropriate hand hygiene and to make sure that the method for both handwashing and hand rubbing is available at the stations where that’s going to be performed. And we’ve been also looking at the role of compulsory training for all new staff entering the hospital.
But I think it’s important that we realise that actually, education should never be just a one-off event and that actually, we need to have continuous positive reinforcement and encouragement that hand hygiene needs to be continued not just for the few hours or days or weeks after you’ve undertaken some form of hand hygiene education.
And so we’re looking at the role of having champions of hand hygiene in all of the different areas of our hospital, who will be there to help prompt the process, help with the education, particularly of the undergraduate students who are coming through our hospital, and having the hand rubbing as part of something that we do in our round sessions just as a regular reminder about its importance. We’d also like to start implementing some audit of hand hygiene. It’s not something that we’ve been doing previously in our hospital. And there are lots of good studies that have been performed in human medicine and in human hospitals looking at auditing hand hygiene.
And so this is something which we’re hoping that some of our undergraduate students may be interested in being involved with. So just to summarise, in terms of application to all practices and not just to our hospital, I think that there is always room for improvement in terms of hand hygiene, that it’s very easy to undertake a review of the facilities and the types of materials that you have available in your hospital for hand hygiene, thinking both about the liquids antiseptic and soap dispensers, but also the use of alcohol-based hand rubs, which can help with compliance in terms of many patients in the hospital, and reviewing the importance of hand hygiene across all staff and not just veterinary staff and our veterinary nurses.
I think that it’s important to review the time points when hand hygiene is going to be of particular importance. And I think we can think about extrapolating from human medicine and the five points of hand hygiene that are applicable in human hospitals. And we need to think hand-in-hand not just about hospital hygiene and hand hygiene, but also about the indications for when we’re using not just hand hygiene, but also instituting PPE. So we’ll typically have some sort of poster systems that are available across our hospital encouraging not just the use of hand hygiene, but also making sure that it’s very clear when we should also simultaneously be thinking about the use of aprons and personal protective clothing as well.

In this video, Rosanne Jepson discusses their approach to improving hand hygiene at the Queen Mother Hospital for Animals, within the context of antimicrobial stewardship.

Step 1.12 discussed the various challenges associated with implementing antimicrobial stewardship in regards to hand hygiene. Watch the video above to hear how the Queen Mother Hospital for Animals evaluated their current hand washing practices and decided what steps to take next.

They asked themselves the following questions:

  • What hand washing/rubbing products should be used?
  • Where should hand washing points be?
  • When should we use hand hygiene?
  • Who should perform hand hygiene?
  • How do you educate a large hospital on hand hygiene?
  • How can we make this a continuous and lasting change?
  • Can we implement an audit of hand hygiene?

There is always room for improvement and it is crucial to undertake reviews of the facilities you have available for hand hygiene, the importance of hand hygiene across all staff and the time points that hand hygiene is particularly important at. We can take ideas about how to improve hand hygiene from human medicine.

The WHO and the NHS both have guidelines on hand hygiene:

Use the comments section to discuss what you think the most important factor for ensuring good hand hygiene is.

Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.

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Antimicrobial Stewardship in Veterinary Practice

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