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Protocol for Hand Hygiene and Glove Use Observations

Goals

  1. Quantify the number of times a staff member performs hand hygiene (when indicated) over the total number of "opportunities" observed when hand hygiene was warranted.
  2. Quantify the number of times a staff member appropriately uses gloves (when indicated) over the total number of opportunities observed when glove use was warranted. Appropriate glove use also requires removing them at the appropriate time.

Recommendations

Hand hygiene

  1. About 30 or more observations should be made each month. Observers should try to ensure that observations are as representative as possible of normal practice at the facility. This might include observing many different staff members on different days and shifts. Observers should also consider observing at particularly busy times, such as during shift change, when staff are sometimes less attentive to proper practices.
  2. Observers should focus on an area of the unit where staff interactions with patients are clearly visible. This may include observation of several staff members. In general, hand hygiene should be performed prior to and following direct contact with patients (see #3 below for additional situations).
  3. Examples of situations when hand hygiene is indicated:
    1. Before and after direct patient contact
    2. After completing tasks at one patient station before moving to another station
    3. Before procedures, such as administering intravenous medications
    4. Before and after contact with vascular access
    5. Before and after dressing changes
    6. After contact with items/surfaces at patient stations

Remember - glove use does not preclude the need for hand hygiene after removing gloves.

Glove use

  1. In general, gloves should be worn prior to contact with patients at the treatment station and potentially contaminated surfaces (e.g., dialysis machine, environmental surfaces). Note: all items/surfaces at the dialysis station are considered potentially contaminated. Gloves should always be changed between patients and between clean and contaminated sites on the same patient. Holding a glove in one’s hand instead of wearing it is not considered acceptable. Glove use does not preclude the need for hand hygiene after removing gloves.
  2. Examples of situations when gloves should be changed:
    1. After contact with blood or body fluids
    2. After completing tasks at one patient station before moving to another station
    3. After contacting a potentially contaminated site before moving to a clean site

General comments

  1. When observing hand hygiene/glove use, observers should differentiate whether procedures were performed correctly. Proper hand hygiene procedures are described in the Hand Hygiene: Why, How & When? brochure [PDF - 466 KB]. Proper removal of personal protective equipment, including gloves is described here: Sequence for Donning Personal Protective Equipment (PPE) [PDF - 763 KB]
  2. Feedback of rates of adherence with proper hand hygiene and glove use is crucial to improvement. Facilities should consider posting and/or reporting aggregate rates to staff members regularly so that they may track rates over time. In addition, feedback (positive or negative) to individuals can be useful.
  3. As part of hand hygiene observations, observers should evaluate whether there are sufficient supplies of alcohol-based hand rubs, soap and paper towels and unrestricted access to sinks.

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