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Point of Care Hand Hygiene
By Jane Kirk MSN, RN, CIC, Clinical Manager
Point of Care hand hygiene is defined by the World Health Organization (WHO) as the place where three elements come together: the patient, the healthcare worker, and care or treatment involving contact with the patient or his/her surroundings (within the patient zone).1
The WHO defines the patient zone as a concept related to the “geographical” visualization of key moments for hand hygiene.2 It contains the patient and all the surfaces that are touched by or in direct physical contact with the patient, such as bed rails, bedside tables, bed linen, infusion tubing or other medical equipment. Surfaces frequently touched by HCWs such as monitor buttons and knobs are also considered part of the patient zone.
For a practical application of Point of Care hand hygiene, consider the patient with a wound that cultures positive with Methicillin resistant Staphylococcus aureus. The nurse enters the room to perform the daily dressing change and sanitizes her hands upon entering the room. She proceeds to put down the bed rail and move the overbed table out of the way to access the patient’s dressing. At this point are her hands considered clean? No, according to the Ontario Ministry of Health and Long Term Care’s (MOHLTC) 4 Moments for Hand Hygiene.3 Unless a Point of Care hand hygiene product is readily accessible, she needs to step away from the bedside to perform hand hygiene. There is the issue of patient safety risk if she leaves a sedated patient with the bedrail down while she walks away to clean her hands.
A survey was conducted in 2007 in healthcare facilities in eastern Ontario, and it was determined that although alcohol based hand rub (ABHR) was available in acute care and long term care facilities, most dispensers are not provided at the Point of Care.4 When implementing Point of Care, the MOHLTC recommends forming a Point of Care assessment team which includes representation from the hand hygiene implementation committee, staff, and content experts.5 Members of the team should include:
- Occupational Health and Safety to address dispenser placement in relation to staff safety, ergonomics, and workflow patterns
- Risk Management/Quality and Resident Safety to address risks to residents and or visitors with respect to injury and ingestion of products and to consider fire hazards and ignition concerns
- Housekeeping to assess product leakage/spill issues and develop a maintenance process that involves monitoring, replenishing and cleaning of dispensers Environmental Services/Facilities Management to assess installation procedures and maintenance of dispensers
- Unit based staff to consider the workflow pattern and the ease of use with point of care products
- Purchasing to source the best product selection to address identified needs
- Infection Control to consider work flow and product interactions with personal protective equipment. The Infection Control staff should also assess the product for efficacy
The goal of Infection Control and Prevention is to prevent patients, employees and visitors from acquiring an infection while inside the healthcare facility. Although Infection Prevention is a multi-modal process, hand hygiene is the foundation of infection control. Moving beyond introducing and educating staff about point of care hand hygiene is essential. It needs to become a habit and a natural part of the patient interaction.