Healthcare-associated Infections
IHC, in cooperation with infectious disease specialists from across the state, has developed the following Healthcare-associated Infection Toolkit. The toolkit consists of outcomes measures, standardized reporting format, and tools to improve performance related to healthcare-associated infections.
We would like to thank those individuals and organizations who have shared their materials and who have agreed to serve as mentors. Please contact IHC if your organization would like to contribute materials to this toolkit.
Case for Change
Project Description
Tool Kit
The Toolkits section provides applications designed to help providers better execute this project. In each area, there is a formal definition of what is being measured. Where available, sample policies, signage, monitoring techniques, and implementation tools are included. The toolkit is designed to change and expand as new information becomes available. This section presents toolkits in four areas of focus:
- Influenza Vaccination Among Health Care Workers
- Central Line Infection Rates
- Surgical Site Infection Rates
- Hand Hygiene in Health Care
Influenza Vaccination Among Health Care Workers
Introduction
Influenza vaccination of Health Care Workers (HCWs) is an important staff and patient safety issue. The national rate of influenza vaccination of HCWs is approximately 40 percent and widely acknowledged to be unacceptably low. HCWs are at great risk to acquire and transmit influenza to patients, their families, and the community in general. Vaccination decreases the disease burden on HCWs, reduces absenteeism, and helps maintain the health care workforce during influenza epidemics. The Centers for Disease Control and Prevention advocates an aggressive approach to HCW vaccinations.
Influenza vaccination is an annual campaign at most Iowa hospitals. Our evaluation shows that hospitals are very aggressive at administration of the vaccinations through out the facility and the community. At-risk populations are identified and targeted by administration. Accurate tracking mechanisms for estimates of true effectiveness do not exist. This problem has been complicated in recent years by the variable availability of influenza vaccine, forcing rationing.
The Iowa Healthcare Collaborative is encouraging Iowa's hospitals to improve rates of HCW influenza vaccination by participating in a multi-year statewide project. We recognize vaccine availability will have dramatic effects on these numbers, but feel accurate tracking will improve both our effectiveness and the vaccine supply. The employee vaccination target with this measurement technique is 95%.
2007 Reporting Metric
Definitions
Numerator
- (number of employees vaccinated) + (number of total employees, defined as those individuals receiving a paycheck from October 1st through March 31st of the following year)
- The committee elected to recommend vaccination to all hospital employees for the following reasons:
- It is acknowledged that while some employees do not have direct patient contact, patients are often exposed to employees indirectly.
- Un-immunized employees place the hospital at risk for staffing shortages in the event of an epidemic.
- This committee also considered those employees with contraindications to vaccination. The committee elected not to include this population in the numerator. The infrequent incidence of true contraindication would not justify the administrative cost of measurement. Recognizing this exempt population, the target vaccination rate was set at 95% rather than 100%.
- It is important to include both employees that received vaccinations on-site as well as those who were vaccinated at other locations.
Denominator
- (number of total employees, defined as those individuals receiving a paycheck from October 1, 2006, through March 31, 2007)
- Influenza vaccination is a common practice given on an annual basis.
The committee felt the easiest way to track employee numbers was through the payroll system. This also recognizes the commitment to immunize all hospital employees.
- The measurement period was selected to coincide with the beginning of vaccine availability and the end of influenza season.
- The committee decided to focus only on employees at this time and not immediately pursue efforts to measure vaccination rates of other hospital populations including volunteers and students who do not receive a paycheck.
Reporting Period
The reporting period is from October 1st through March 31st of each successive year. The final numerator and denominator values are due to IHC by May 15th following the closing of the reporting period, to be included in the Iowa Report.
Sample Signage
- Influenza Poster (PDF 20KB)
Implementation
Immunization of Health Care Workers Toolkit
IHC has created a toolkit that provides guidance, resources, and success stories in the immunization of health care workers.
- (number of employees vaccinated) + (number of total employees, defined as those individuals receiving a paycheck from October 1st through March 31st of the following year)
- The committee elected to recommend vaccination to all hospital employees for the following reasons:
- It is acknowledged that while some employees do not have direct patient contact, patients are often exposed to employees indirectly.
- Un-immunized employees place the hospital at risk for staffing shortages in the event of an epidemic.
- This committee also considered those employees with contraindications to vaccination. The committee elected not to include this population in the numerator. The infrequent incidence of true contraindication would not justify the administrative cost of measurement. Recognizing this exempt population, the target vaccination rate was set at 95% rather than 100%.
- It is important to include both employees that received vaccinations on-site as well as those who were vaccinated at other locations.
- (number of total employees, defined as those individuals receiving a paycheck from October 1, 2006, through March 31, 2007)
- Influenza vaccination is a common practice given on an annual basis.
- The measurement period was selected to coincide with the beginning of vaccine availability and the end of influenza season.
- The committee decided to focus only on employees at this time and not immediately pursue efforts to measure vaccination rates of other hospital populations including volunteers and students who do not receive a paycheck.
-
The committee felt the easiest way to track employee numbers was through the payroll system. This also recognizes the commitment to immunize all hospital employees.
IHC has created a toolkit that provides guidance, resources, and success stories in the immunization of health care workers.
Surgical Site Infections
Introduction
Surgical Site Infections (SSIs) are the second most common type of adverse event occurring in hospitalized patients.(3) While nationally the rate of SSIs average between 2 and 3 percent for clean cases, an estimated 40-60% of these infections are preventable.(4) A medical record review of 34,133 charts performed under the auspices of the Centers for Medicare & Medicaid Services (CMS) demonstrated a significant opportunity for improvement in SSI prevention.(5) Considerable national attention has been focused on this area through CMS, Joint Commission for Accreditation of Healthcare Organizations, National Quality Forum, and Institute for Healthcare Improvement through the 100,000 Lives Campaign.
IHC is encouraging Iowa's hospitals to decrease SSI rates by participating in a multi-year statewide reporting project. This project aligns with other national initiatives. Participation includes sharing of best practices for effective SSI prevention and the reporting of select SSI rates.
Infection Control Practitioners agreed that the National Nosocomial Infections Surveillance System (NHSN) should be the reporting set to allow national benchmarking. In the beginning of this SSI rate reporting project, hospitals will share SSI rates for a few select procedures. Procedures selected to be reported in the 2007 Iowa Report include:
- Coronary Artery Bypass Grafts
- Colon Surgery
- Hip Arthroplasty
- Hysterectomy (both abdominal and vaginal).
Currently, some Iowa hospitals are monitoring SSI rates under CMS criteria, while others are using NHSN criteria. To include as many Iowa hospitals as possible, this 2007 Iowa Report will allow hospitals to report using either NHSN ICD 9 codes or the CMS ICD 9 codes. These will be presented as separate sections in the Iowa Report.
***Please note: the National Nosocomial Infection Surveillance System (NNIS) is now the National Healthcare Safety Network (NHSN)***
References:
(3) Brennan, N Engl J Med. 1991; 324:370-376
(4) 2006 IHI Getting Started Kit for Surgical Site Infection
(5) Bratzler, Arch Surg. 2005; 140:174-182
2007 Reporting Metric
Definition
Numerator:
- The number of surgical site infections
- Procedures selected to be reported in the 2007 Iowa Report include:
- Coronary Artery Bypass Grafts
- Colon Surgery
- Hip Arthroplasty
- Hysterectomy (both abdominal and vaginal).
- NOTE: Report infection in the month that the surgery was performed.
- Surgical Site Infections are defined as the following:
- (View Definitions) (PDF 15KB)
Denominator:
- The number of procedures in specified ICD-9-CM categories (Though NHSN (formerly NNIS) criteria are preferred, hospitals may choose to report in either NHSN or CMS reporting sets in 2007)
***Please note: the National Nosocomial Infection Surveillance System (NNIS) is now the National Healthcare Safety Network (NHSN)***
(View Sets) (PDF 12KB)
Reporting Period
The reporting period is from October 1st through March 31st of each successive year. The final numerator and denominator values are due to IHC by May 15th following the closing of the reporting period, to be included in the Iowa Report.
Measurement will continue on a monthly basis. Beginning with the 2008 Iowa Report, information will be presented for 12 month reporting periods.
Tricks for Implementation
- The number of surgical site infections
- Procedures selected to be reported in the 2007 Iowa Report include:
- Coronary Artery Bypass Grafts
- Colon Surgery
- Hip Arthroplasty
- Hysterectomy (both abdominal and vaginal).
- NOTE: Report infection in the month that the surgery was performed.
- Procedures selected to be reported in the 2007 Iowa Report include:
- Surgical Site Infections are defined as the following:
- (View Definitions) (PDF 15KB)
- The number of procedures in specified ICD-9-CM categories (Though NHSN (formerly NNIS) criteria are preferred, hospitals may choose to report in either NHSN or CMS reporting sets in 2007)
***Please note: the National Nosocomial Infection Surveillance System (NNIS) is now the National Healthcare Safety Network (NHSN)***
(View Sets) (PDF 12KB)
Measurement will continue on a monthly basis. Beginning with the 2008 Iowa Report, information will be presented for 12 month reporting periods.
Central Line Infections
Outcomes measures should be chosen for reporting based on the frequency, severity, and preventability of the outcomes and the likelihood that they can be detected and reported accurately.(2) An outcome measure meeting these criteria mentioned in the HICPAC Report is Central Line Infections (CLI).(2) The specific criteria will be central line-associated, laboratory-confirmed primary bloodstream infections (CLA-LCBI) in intensive care units (ICU).
***Please note: the National Nosocomial Infection Surveillance System (NNIS) is now the National Healthcare Safety Network (NHSN)***
2007 Reporting Metric
Definitions
Definitions from the National Healthcare Safety Network (NHSN) (previously National Nosocomial Infections Surveillance System or NNIS) will be used.
Numerator:
- Number of central line bloodstream infections
- Laboratory-confirmed bloodstream infection must meet at least one of the following criteria and have occurred in the ICU or within 48 hours of leaving the ICU: (6)
- Criterion 1:
- Patient has a recognized pathogen cultured from one or more blood cultures and
- Organism cultured from blood is not related to an infection at another site.
- Criterion 2:
- Patient has at least one of the following signs or symptoms: fever (>38°), chills, or hypotension and at least one of the following:
- Common skin contaminant (e.g., diphtheroids, Bacillus sp., Propionibacterium sp., coagulase-negative staphylococci, or micrococci) is cultured form two or more blood cultures drawn on separate occasions.
- Common skin contaminant (e.g. diphtheroids, Bacillus sp., Propionibacterium sp., coagulase-nagative staphylococci, micrococci) is cultured from at least one blood culture form a patient with an intravascular line, and the physician institutes appropriate antimicrobial therapy.
- Positive antigen test on blood (e.g. Haemophilius influenzae, Streptococcus pneumoniae, Neisseria meninitidis, or group B Streptococcus) and signs and symptoms and positive laboratory results are not related to an infection at another site.
-
Note: The patient is followed for 48 hours after transfer to another unit. If a BSI develops within that 48 hour period, the original unit is "credited" with the infection.
- Flowchart (PDF 115KB)
Denominator:
- Number of central line catheter days
- Central line days are the total number of days of exposure to the central line by all of the patients in the ICU during the selected time period. (6)
- Example: On the first day 5 patients had one or more central lines in place; 4 had central lines on day 2; and 2 had central lines on day 3; Adding the number of patients with central lines on days 1 through 3, we would have 5+4+2= 11 central line days for the first three days.
- Note: Add the number of patients with central lines NOT the number of central lines.
Central line:
- A central line: an intravascular catheter that terminates at or close to the heart or in one of the great vessels which is used for infusion, withdrawal of blood, or hemodynamic monitoring. The following are considered great vessels for the purpose of reporting central-line days in the NHSN system: Aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, and common femoral veins.
- Note: An introducer is considered an intravascular catheter.
- Note: Neither the location of the insertion site nor the type of device may be used to determine if a line qualifies as a central line. The device must terminate in one of these vessels or in or near the heart to qualify as a central line.
- Note: Pacemaker wires and other non-lumened devices inserted into central blood vessels or the heart are not considered central lines, because fluids are not infused, pushed, nor withdrawn through such devices.
- Flowchart (PDF 119KB)
Intensive Care Unit (ICU)
- An ICU is a hospital unit that provides intensive observation, diagnostic, and therapeutic procedures for adults who are critically ill. An ICU excludes bone marrow transplant units and nursing areas that provide step-down, intermediate care, or telemetry only.
- For reporting purposes, organizations will combine the rates of any Med ICUs, Surgery ICUs, or combined Med/Surg ICUs and report infection rates as a whole under the heading of "Med/Surg ICU."
- Note: When reporting infection rates, NICUs, PICUs, Burn Units, and stand-alone coronary care units will not be included. However, if coronary patients are a part of Med and/or Surg ICUs, this patient population will still be included. The Central Line Infection Work Group believed that the inclusion of some coronary care patients in already-mixed ICUs would not significantly affect the reported infection rates.
Frequently Asked Questions
GNYHA/UHF Quality Improvement Collaborative
Central Line Associated Bloodstream (CLAB) Infections
These Frequently Asked Questions were developed by the Missouri Department of Health and Human Services in conjunction with CDC.
- If a patient in an ICU has a temporary (Quinton) or tunneled (ASHE) hemodialysis catheter, is that device counted as a central line in the central line days? 5/20/2005
If a line meets the definition, then it is a central line and should be counted. The only exception to this would be an implanted device that is not used. In this situation, the line would only be counted beginning on the first day it is accessed (e.g., physician orders that the port-a-cath be flushed). Then it would be counted every day thereafter.
- Do central lines include the following: implantable-ports, non-tunneled TLC, Swan Ganz catheter, tunneled-Broviac, Groshong, Quinton, Hickman, ASHE catheter, PICC, and umbilical lines? If yes, would they be counted in central line days for that unit? 5/20/2005
Yes to all of the above if they meet the definition. Central lines are not defined by type of device.
- Is a dialysis catheter considered a central line since it isn't used for infusion? 5/20/2005
A dialysis catheter is considered a central line if it meets the definition of a central line. It is used for infusion of the patient's own blood.
- Are permanent shunts and balloon pumps considered central lines? 5/20/2005
Yes, if they meet the definition of a central line. Central lines are not defined by type of device.
- If a patient is admitted to the ICU with a central line in place, is it counted in the central line days? 5/20/2005
It must first be determined if it meets the definition of a central line. If it meets the definition and it is accessed, then it is counted (e.g., a patient is admitted with a central line that is not being used; the physician comes in on day three and flushes the line; the day of the flush is considered the first central line day).
- Please clarify the last sentence of the definition for CLAB infection that reads, "If the time interval was longer than 48 hours, there must be compelling evidence that the infection was related to the vascular access device." 5/20/2005
This means only that if the time interval between the removal of the line and the onset of bloodstream infection (BSI) is greater than 48 hours, the BSI should not be considered central line-associated unless there is evidence that it was related to the device.
- What if: a patient had a central line inserted in the ICU; 6 days later the patient has a positive blood culture; and the patient meets the definition for laboratory confirmed bloodstream infection (LCBI). Would this patient be counted as a CLAB infection? 5/20/2005
If the line was not discontinued, it would be counted as a CLAB. If the line were to be discontinued on day 4 or earlier, it would not be counted as a CLAB.
- How do you determine which unit to "credit" with a bloodstream infection (BSI)? E.g., on May 2 patient is in the medical ICU; on May 3 patient is transferred to the coronary ICU; symptoms develop on May 4. Which unit is "credited"? 5/20/2005
The patient is followed for 48 hours after transfer to another unit. If a BSI develops within that 48 hour period, the original unit is "credited" with the infection.
- In the laboratory confirmed bloodstream infection (LCBI) definition, it refers to "appropriate antimicrobial therapy" under Criterions 2 and 3. What is appropriate? 5/20/2005
This is not defined. If an antibiotic is appropriate for the microorganism identified (e.g., not resistant or used for that microorganism) then it is appropriate.
- What should be done if a device-day is not counted? 5/20/2005
Days should not be skipped. If days are not recorded (say on the weekend), then the staff should be interviewed and charts reviewed to determine what the counts were at the appropriate time.
- The following two questions/situations relate to an ICU patient undergoing dialysis: 6/8/2005
a. A patient with a dialysis catheter is in one of the ICUs under surveillance for CLABs. If this patient's dialysis catheter is only accessed in the dialysis center, are the central line days for this patient counted in the ICU's central line day count?
No, in this instance, the central line days would not be counted in the ICU central line
day count.
b. A patient with a dialysis catheter is in one of the ICUs under surveillance for CLABs. Someone from the dialysis center comes to the ICU to perform the dialysis. Will the central line days for this patient be counted in the ICU's central line day count?
Yes, in this instance, the central line days would be counted in the ICU central line day count.
Reporting Period
- The formal measurement period for 2007 will be January 1, 2007, through June 30, 2007. Data will be reported to the website on a monthly basis. Final information for this six month sample must be submitted by September 1, 2007, to be included in the 2007 Report.
- Measurement will continue on a monthly basis. Beginning with the 2008 Report, information will be presented for 12 month reporting periods.
Sample Policies
- Iowa Health-Des Moines CVC Placement Policy (PDF 18KB)
Tricks for Implementation
- IHI 100,000 Live Campaign Toolkit (WEBSITE)
- Guidelines for the Prevention of Intravascular Catheter-Related Infections (WEBSITE/PDF)
- Use of ATB Impregnated Lines (PDF 18KB)
References:
(6) Am J Infect Control 2004; 32:470-85
(7) Horan TC, Gaynes RP. Surveillance of nosocomial infections. In: Hotpital Epidemiology and Infection Control 3rd ed., Mayhall CG, editor. Philadelphia:Lippincott Williams & Wilkins, 2004:1659-1702.
- Number of central line bloodstream infections
- Laboratory-confirmed bloodstream infection must meet at least one of the following criteria and have occurred in the ICU or within 48 hours of leaving the ICU: (6)
- Criterion 1:
- Patient has a recognized pathogen cultured from one or more blood cultures and
- Organism cultured from blood is not related to an infection at another site.
- Criterion 2:
- Patient has at least one of the following signs or symptoms: fever (>38°), chills, or hypotension and at least one of the following:
- Common skin contaminant (e.g., diphtheroids, Bacillus sp., Propionibacterium sp., coagulase-negative staphylococci, or micrococci) is cultured form two or more blood cultures drawn on separate occasions.
- Common skin contaminant (e.g. diphtheroids, Bacillus sp., Propionibacterium sp., coagulase-nagative staphylococci, micrococci) is cultured from at least one blood culture form a patient with an intravascular line, and the physician institutes appropriate antimicrobial therapy.
- Positive antigen test on blood (e.g. Haemophilius influenzae, Streptococcus pneumoniae, Neisseria meninitidis, or group B Streptococcus) and signs and symptoms and positive laboratory results are not related to an infection at another site.
-
Note: The patient is followed for 48 hours after transfer to another unit. If a BSI develops within that 48 hour period, the original unit is "credited" with the infection.
- Flowchart (PDF 115KB)
- Number of central line catheter days
- Central line days are the total number of days of exposure to the central line by all of the patients in the ICU during the selected time period. (6)
- Example: On the first day 5 patients had one or more central lines in place; 4 had central lines on day 2; and 2 had central lines on day 3; Adding the number of patients with central lines on days 1 through 3, we would have 5+4+2= 11 central line days for the first three days.
- Note: Add the number of patients with central lines NOT the number of central lines.
- A central line: an intravascular catheter that terminates at or close to the heart or in one of the great vessels which is used for infusion, withdrawal of blood, or hemodynamic monitoring. The following are considered great vessels for the purpose of reporting central-line days in the NHSN system: Aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, and common femoral veins.
- Note: An introducer is considered an intravascular catheter.
- Note: Neither the location of the insertion site nor the type of device may be used to determine if a line qualifies as a central line. The device must terminate in one of these vessels or in or near the heart to qualify as a central line.
- Note: Pacemaker wires and other non-lumened devices inserted into central blood vessels or the heart are not considered central lines, because fluids are not infused, pushed, nor withdrawn through such devices.
- Flowchart (PDF 119KB)
- Note: An introducer is considered an intravascular catheter.
- An ICU is a hospital unit that provides intensive observation, diagnostic, and therapeutic procedures for adults who are critically ill. An ICU excludes bone marrow transplant units and nursing areas that provide step-down, intermediate care, or telemetry only.
- For reporting purposes, organizations will combine the rates of any Med ICUs, Surgery ICUs, or combined Med/Surg ICUs and report infection rates as a whole under the heading of "Med/Surg ICU."
- Note: When reporting infection rates, NICUs, PICUs, Burn Units, and stand-alone coronary care units will not be included. However, if coronary patients are a part of Med and/or Surg ICUs, this patient population will still be included. The Central Line Infection Work Group believed that the inclusion of some coronary care patients in already-mixed ICUs would not significantly affect the reported infection rates.
Central Line Associated Bloodstream (CLAB) Infections
These Frequently Asked Questions were developed by the Missouri Department of Health and Human Services in conjunction with CDC.
- If a patient in an ICU has a temporary (Quinton) or tunneled (ASHE) hemodialysis catheter, is that device counted as a central line in the central line days? 5/20/2005
If a line meets the definition, then it is a central line and should be counted. The only exception to this would be an implanted device that is not used. In this situation, the line would only be counted beginning on the first day it is accessed (e.g., physician orders that the port-a-cath be flushed). Then it would be counted every day thereafter. - Do central lines include the following: implantable-ports, non-tunneled TLC, Swan Ganz catheter, tunneled-Broviac, Groshong, Quinton, Hickman, ASHE catheter, PICC, and umbilical lines? If yes, would they be counted in central line days for that unit? 5/20/2005
Yes to all of the above if they meet the definition. Central lines are not defined by type of device.
- Is a dialysis catheter considered a central line since it isn't used for infusion? 5/20/2005
A dialysis catheter is considered a central line if it meets the definition of a central line. It is used for infusion of the patient's own blood. - Are permanent shunts and balloon pumps considered central lines? 5/20/2005
Yes, if they meet the definition of a central line. Central lines are not defined by type of device. - If a patient is admitted to the ICU with a central line in place, is it counted in the central line days? 5/20/2005
It must first be determined if it meets the definition of a central line. If it meets the definition and it is accessed, then it is counted (e.g., a patient is admitted with a central line that is not being used; the physician comes in on day three and flushes the line; the day of the flush is considered the first central line day). - Please clarify the last sentence of the definition for CLAB infection that reads, "If the time interval was longer than 48 hours, there must be compelling evidence that the infection was related to the vascular access device." 5/20/2005
This means only that if the time interval between the removal of the line and the onset of bloodstream infection (BSI) is greater than 48 hours, the BSI should not be considered central line-associated unless there is evidence that it was related to the device. - What if: a patient had a central line inserted in the ICU; 6 days later the patient has a positive blood culture; and the patient meets the definition for laboratory confirmed bloodstream infection (LCBI). Would this patient be counted as a CLAB infection? 5/20/2005
If the line was not discontinued, it would be counted as a CLAB. If the line were to be discontinued on day 4 or earlier, it would not be counted as a CLAB. - How do you determine which unit to "credit" with a bloodstream infection (BSI)? E.g., on May 2 patient is in the medical ICU; on May 3 patient is transferred to the coronary ICU; symptoms develop on May 4. Which unit is "credited"? 5/20/2005
The patient is followed for 48 hours after transfer to another unit. If a BSI develops within that 48 hour period, the original unit is "credited" with the infection. - In the laboratory confirmed bloodstream infection (LCBI) definition, it refers to "appropriate antimicrobial therapy" under Criterions 2 and 3. What is appropriate? 5/20/2005
This is not defined. If an antibiotic is appropriate for the microorganism identified (e.g., not resistant or used for that microorganism) then it is appropriate. - What should be done if a device-day is not counted? 5/20/2005
Days should not be skipped. If days are not recorded (say on the weekend), then the staff should be interviewed and charts reviewed to determine what the counts were at the appropriate time. - The following two questions/situations relate to an ICU patient undergoing dialysis: 6/8/2005
a. A patient with a dialysis catheter is in one of the ICUs under surveillance for CLABs. If this patient's dialysis catheter is only accessed in the dialysis center, are the central line days for this patient counted in the ICU's central line day count?
No, in this instance, the central line days would not be counted in the ICU central line day count.
b. A patient with a dialysis catheter is in one of the ICUs under surveillance for CLABs. Someone from the dialysis center comes to the ICU to perform the dialysis. Will the central line days for this patient be counted in the ICU's central line day count?
Yes, in this instance, the central line days would be counted in the ICU central line day count.
Hand Hygiene
For centuries, hand washing with soap and water has been considered a measure of personal hygiene, but the link between hand washing and the spread of disease has only been established in the last 200 years. Currently, hand hygiene is considered the most important measure for preventing the spread of pathogens in the healthcare setting.
Guidelines
- WHO guidelines on Hand Hygiene in Health Care (PDF 4.33MB)
- CDC Guideline For Hand Hygiene In Health Care Settings (PDF 402KB)
- Genesis Medical Center Hand Hygiene Policy (PDF 23KB)
- Genesis Medical Center Hand Hygiene Coordinator Duties (PDF 12KB)
Sample Signage
- Hand Hygeine (PDF 17KB)
- CDC Materials to Promote Hand Hygiene in your Healthcare Facility (WEBSITE)
- U.S. Dept. of Veterans Affairs Hand Hygiene Posters (WEBSITE)
Alcohol-Based Hand Rubs
- Waterless Hand Gel Flowsheet (PDF 23KB)
- Waterless Hand Antiseptic Evaluation (PDF 9KB)
- Hand Hygiene Resource Center's - Selecting The Right Alcohol Based Hand Rub (PDF 26KB)
Monitoring Techniques
- Hand Hygiene Resource Center's – Hand Hygiene Monitoring Tool (PDF 20KB)
- Genesis Medical Center – Hand Hygiene Observation Tool (PDF 12KB)
Resources
- Waverly Health Center, Waverly, Iowa - Hand Hygiene Management Team (PDF 258KB)
- Waverly Health Center, Waverly, Iowa - Jeopardy Hand Hygiene (PDF 41KB)
- Waverly Health Center, Waverly, Iowa - Hand Hygiene Compliance (PDF 69KB)
- Waverly Health Center, Waverly, Iowa - Germ Buster Orientation (PDF 441KB)
Success Stories
Clarinda Regional Health Center, Clarinda, IA
Genesis Medical Center, Davenport, IA
Resources
Articles
- 30 things you can do to eliminate infections (WEBSITE)
- HICPAC February 2005 Report on Public Reporting (PDF 152KB)
- Guidance on Public Reporting of Healthcare-Associated Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee (PDF 149KB)
- NQF National Voluntary Consensus Standards for the Reporting of Health-care Associated Infection Data (PDF 356KB)
- CDC- National Nosocomial Infections Surveillance System (NHSN) (WEBSITE)
- Hospitals Take Stronger Steps Against Bacteria, Wall Street Journal, March 8, 2006 (PDF 172KB)
- HICPAC Hand Hygiene Report (WEBSITE)
Websites