Pat, a registered nurse, is working a 12-hour night shift on the orthopedic unit where she has worked for the past 20 years. She knows that hand hygiene is the most effective way of preventing the transmission of health care-associated infections to patients, staff, and visitors in all health-care settings.
Mrs. Johnson, who is 80 years old, was admitted to the unit today at 10 a.m. is waiting for surgery for a fractured hip and has been fasting since her arrival. Pat is caring for Mrs. Johnson on the night shift. The OR called at 9 p.m. to reschedule Mrs. Johnson’s surgery for tomorrow.
In preparation for surgery tomorrow and as per physician’s orders, Mrs. Johnson will need to begin fasting at midnight. Pat goes to Mrs. Johnson’s room to offer her something to eat. Mrs. Johnson requests a sandwich, or toast with peanut butter and jam.
Pat uses the alcohol-based hand rub from the dispenser located by the door as she leaves the patient room and proceeds to the patient kitchen to prepare Mrs. Johnson’s food. Located by the door in the patient kitchen is an alcohol-based hand rub dispenser as well as a sink and hand soap dispenser by the fridge. Taped to the fridge is the poster describing the four moments of hand hygiene. Above the sink is a poster on how to wash your hands.
Hand hygiene is performed in accordance with the four moments of hand hygiene.
According to the CARNA Guidelines for Hand Hygiene, hand hygiene is performed “after contact with a patient or patient’s environment”. As Pat is leaving the patient’s room she should perform hand hygiene. Additionally, hand hygiene is to be performed “before a clean or aseptic procedure”, which includes food handling.
Appropriate products are selected and used for hand hygiene. Alcohol-based hand rubs (ABHRs) containing 60-90 per cent alcohol are used for performing hand hygiene, except in the following situations where soap and water are required:
In this situation, it would be appropriate for Pat to use soap and water as she is in the process of preparing food for Mrs. Johnson.
The 2015 Alberta health infection prevention and control (IP&C) strategy outlines actions to be taken by health professional regulatory colleges to improve IP&C across Alberta’s health system.
One of the actions mentioned in the strategy is the development of IP&C resources for its members. Another action item is to collaborate with other stakeholders.
CARNA recently released Guidelines for Hand Hygiene which was developed in collaboration with the College of Physicians and Surgeons and the Alberta College of Pharmacists. More resources are in development that will support RNs and NPs in their practice related to IP&C.