The environment and hand hygiene - The two go hand in hand

All healthcare workers play a part in infection prevention and control in healthcare settings.  The slogan ‘infection control is everybody’s business’ has been used by infection prevention and control professionals to promote key messages to healthcare workers over many years. This catch phrase is still relevant today, if not more so, in relation to measures such as hand hygiene and environmental cleanliness, writes Annie Wells.
The Australian Commission on Safety and Quality in Health Care (the Commission) was established in 2006 to lead and coordinate health care safety and quality improvements in Australia.  A focus of the Commission since this time is the Healthcare Associated Infection (HAI) Prevention Program.  Key initiatives under the umbrella of this program include the National Hand Hygiene Initiative (NHHI) and support for the development of a National Infection Control Program.
Hand hygiene is recognised globally as the single most effective measure for healthcare workers to prevent HAIs.  The NHHI in Australia has been adapted from the WHO – World Alliance for Patient Safety “Clean Care is Safer Care” Program.  Since its introduction in 2009 the NHHI has promoted a standard approach to hand hygiene practices and placement of alcohol based hand rub in every hospital in Australia.  Five moments for hand hygiene have been described as the most important times when hand hygiene should be performed by healthcare workers.  The moments are:

1. Before touching a patient


2. Before a procedure


3. After a procedure or body fluid exposure risk


4. After touching a patient


5. After touching a patient’s surroundings

In acute care hospitals a comprehensive auditing program that measures compliance with the 5 moments was established in 2009.  Data from this program is regularly published on the Hand Hygiene Australia website from over 695 public and private hospitals.  In less acute settings hand hygiene compliance can be monitored by using process indicators such as assessing correct technique and the availability of hand hygiene products.
In addition to the role of hand hygiene in the prevention of healthcare associated infections the role of environmental cleanliness has been a  focus for investigation in recent years.  In a report published by the Tasmanian Infection Prevention and Control Unit (2012), Evaluating environmental cleanliness in hospitals and other healthcare setting, the authors explain the importance of the environment and HAI prevention.  Patients who have an infection and patient who are colonised with microorganism contaminate the environment.  Microorganisms from these patients can be transferred to other sites, usually by the hands of healthcare workers, patients or visitors.  Subsequent to this, microorganism acquired from these sites may be responsible for infection in other patients.
There are a number of factors that may contribute to the likelihood that a contaminated surface leads to the transmission of a healthcare associated pathogen.  These include; the ability of a pathogen to remain viable on a variety of environmental surfaces and the handling frequency of surfaces as well as the level of contamination of these surfaces.

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“Highlighting hand hygiene and environmental hygiene as everybody’s business is a key message by infection control professionals.”
ANNIE WELLS[hr]
In support of the importance of environmental hygiene the authors of the TIPCU report highlight the following key points;

• the environment plays a role in transmission of microorganisms that may cause infection and therefore potentially has a role in prevention


• frequently touched objects are often contaminated with potentially  pathogenic microorganisms and therefore pose a risk for the transfer  of pathogens


• the risk of acquiring a specific organism is increased if a patient is admitted to a room previously occupied by a patient who had been colonised or infected with that organism


• environmental cleaning reduces the environmental contamination thus can reduce the risk of transmission of infection.

The Australian Guidelines for the Prevention and Control of Infection in Healthcare provide details in relation to routine cleaning of minimal touch surfaces and frequently touched surfaces in healthcare facilities.  The guidelines place emphasis on more frequent cleaning of surfaces that are in close proximity to the patient and also the importance of cleaning shared patient equipment between patient uses.
[hr]"Hand hygiene is recognised globally as the single most effective measure for healthcare workers to prevent HAIs.”
ANNIE WELLS[hr]
Both environmental hygiene and hand hygiene are important infection prevention strategies for all healthcare workers to be aware of and understand.  Highlighting hand hygiene and environmental hygiene as everybody’s business is a key message by infection control professionals.   The Australian College for Infection Prevention and Control provides a voice for infection prevention and control professionals (ICP) and is focused on providing leadership and promoting education and evidence based practice outcomes for a healthy community.  The College provides many opportunities for members including a range of Special Interests Groups for the sharing of information and resources, as well as the Annual National Conference where hand hygiene and environmental cleaning are hot topics for discussion amongst ICP.
Annie Wells
Annie Wells is the Assistant Director of Nursing for the Tasmanian Infection Prevention & Control Unit (TIPCU).  She commenced working at TIPCU in 2008 as a clinical nurse consultant.  Prior to this Annie worked as an Infection Control Coordinator at Calvary Health Care Tasmania for  a period of 10 years
Annie has a post graduate Masters in Advanced Practice (Infection Control & Prevention) and is a Credentialed Infection Control Professional.  Her interests within infection prevention and control include surveillance of healthcare associated infections, environmental hygiene and education and support of novice practitioners.
Annie is currently a board member of the Australasian College for Infection Prevention and Control (ACIPC) and Chair of the Special Interest Group Advisory Committee.
References
Australian Commission for Safety and Quality in Healthcare www.safetyandquality.gov.au
Hand Hygiene Australia www.hha.org.au
Mitchell, B., Wilson, F., McGregor, A., Dancer, S, editors.
Evaluating environmental cleanliness in hospitals and other healthcare settings. What are the most effective and efficient methods to use? Department of Health and Human Services, Hobart, 2012.
NHMRC (2010) Australian Guidelines for the Prevention and Control of Infection in Healthcare.  Commonwealth of Australia.