|In all health care settings
This document deals with the performance of hand hygiene in health care settings across the continuum of care (see below) including, but not limited to, acute care, complex continuing care, rehabilitation facilities, long-term care, chronic care, pre-hospital care and home health care.
This document provides infection prevention and control practices for:
- Knowing why and when to perform hand hygiene
- Understanding barriers and enablers that might influence hand hygiene
- Choosing hand hygiene agents
- Applying the correct hand hygiene techniques.
|Evidence for recommendations
The best practices in this document reflect the best evidence and expert opinion available at the time of writing. As new information becomes available, this document will be reviewed and updated. Refer to Appendix A, “Ranking System for Recommendations,” for the grading system used for recommendations.
|How and when to use this document
The best practices for hand hygiene set out in this document must be practiced in all settings where care is provided, across the continuum of health care. This includes settings where emergency (including pre-hospital) care is provided, hospitals, complex continuing care facilities, rehabilitation facilities, long-term care homes, outpatient clinics, community health centres and clinics, physician offices, dental offices, offices of health professionals, public health and home health care.
This document should be used in conjunction with the Ministry of Health and Long-Term Care (MOHLTC)'s “Just Clean Your Hands” program.
|Assumptions and general principles for infection prevention and control
The best practices in this document are based on the assumption that basic infection prevention and control systems are in place in health care settings in Ontario. Collaboration with organizations that have infection prevention and control expertise, such as academic health science centres, regional infection control networks, public health units that have professional staff certified in infection prevention and control and local infection prevention and control associations (e.g. Community and Hospital Infection Control Association – Canada chapters), may be necessary to develop evidence-based programs.
In addition to the general assumption (above) about basic infection prevention and control, these best practices are based on the following additional assumptions and principles:
- Best practices to prevent and control the spread of infectious diseases are routinely implemented in health care settings, including Health Canada’s “Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Health Care” (Can Commun Dis Rep. 1999; 25 Suppl 4:1-142).
- Adequate resources are devoted to infection prevention and control in all health care settings. See the PIDAC’s “Best practices for Infection Prevention and Control Programs in Ontario.”
- Adequate resources are devoted to environmental services/housekeeping in all health care settings, including written procedures for cleaning and disinfection of client/patient/resident rooms and equipment; education of new cleaning staff and continuing education of all cleaning staff; and ongoing review of procedures.
- A climate that is conducive to following and maintaining Routine Practices in all health care settings is promoted. This includes the set up and organization of the health care setting in order to provide a system that supports and promotes effective hand hygiene.
- Regular education (including orientation and continuing education) and support to help staff consistently implement appropriate infection prevention and control practices is provided in all health care settings.
Effective education programs emphasize:
- The risks associated with infectious diseases
- Hand hygiene, including the use of alcohol-based hand rubs and hand washing
- Principles and components of Routine Practices as well as additional transmission-based precautions
- Assessment of the risk of infection transmission and the appropriate use of personal protective equipment (PPE), including safe application, removal and disposal
- Appropriate cleaning and/or disinfection of health care equipment, supplies and surfaces or items in the health care environment
- Individual staff responsibility for keeping clients/patients/residents, themselves and co-workers safe
- Collaboration between professionals involved in occupational health and infection prevention and control.
NOTE: Education programs should be flexible enough to meet the diverse needs of the range of health care providers and other staff who work in the health care setting. The local public health unit and regional infection control networks may be a resource and can provide assistance in developing and providing education programs for community settings.
- Collaboration between professionals involved in occupational health and infection prevention and control is promoted in all health care settings to implement and maintain appropriate infection prevention and control standards that protect workers.
- There are effective working relationships between the health care setting and the local public health unit. Clear lines of communication are maintained and public health is contacted for information and advice as required and the obligations (under the Health Protection and Promotion Act, R.S.O. 1990, c.H.7) to report reportable and communicable diseases are fulfilled. Public health provides regular aggregate reports of outbreaks of any infectious diseases in facilities and/or in the community to all health care settings.
- Access to ongoing infection prevention and control advice and guidance to support staff and resolve differences is available to the health care setting.
- There are established procedures for receiving and responding appropriately to all international, national, regional and local health advisories in all health care settings. Health advisories are communicated promptly to all staff responsible for case finding/surveillance and regular updates are provided. Current advisories are available from local public health units, the MOHLTC, Health Canada and Public Health Agency of Canada websites and local regional infection prevention and control networks.
- Where applicable, there is a process for evaluating personal protective equipment (PPE) in the health care setting, to ensure it meets quality standards.
- There is regular assessment of the effectiveness of the infection prevention and control education program and its impact on practices in the health care setting. The information is used to further refine the program.
|Occupational Health and Safety
Health care facilities are required to comply with applicable provisions of the Occupational Health and Safety Act (OHSA) and its Regulations. Employers, supervisors and workers have rights, duties and obligations under the OHSA.
The OHSA places duties on many different categories of individuals associated with workplaces, such as employers, constructors, supervisors, owners, suppliers, licensees, officers of a corporation and workers. Here is a guide to the requirements of the OHSA.
In addition, the OHSA section 25(2)(h) requires an employer to take every precaution reasonable in the circumstances for the protection of a worker.
Specific requirements for certain health care and residential facilities may be found in the Regulation for Health Care and Residential Facilities.
There is a general duty for an employer to establish written measures and procedures for the health and safety of workers, in consultation with the joint health and safety committee or health and safety representative, if any. Such measures and procedures may include, but are not limited to, the following:
- Safe work practices
- Safe working conditions
- Proper hygiene practices and the use of hygiene facilities
- The control of infections.
At least once per year the measures and procedures for the health and safety of workers shall be reviewed and revised in the light of current knowledge and practice. The employer, in consultation with the joint health and safety committee or health and safety representative, if any, shall develop, establish and provide training and educational programs in health and safety measures and procedures for workers that are relevant to the workers’ work.
A worker who is required by his or her employer or by the Regulation for Health Care and Residential Facilities to wear or use any protective clothing, equipment or device shall be instructed and trained in its care, use and limitations before wearing or using it for the first time and at regular intervals thereafter and the worker shall participate in such instruction and training. The employer is reminded of the need to be able to demonstrate training, and is therefore encouraged to document the workers trained, the dates training was conducted, and materials covered during training. Under the Occupational Health and Safety Act, a worker must work in compliance with the Act and its regulations, and use or wear any equipment, protective devices or clothing required by the employer.
For more information, contact your local Ministry of Labour office. A list of local Ministry of Labour offices in Ontario may be found online at: http://www.labour.gov.on.ca/.
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