Staff providing patient care and services need to have hand hygiene products and supplies available for their use in the home. Depending on the type of care or services being delivered in the home, the hand hygiene products and supplies are either stored in a nursing bag, on the "person," or brought to the home by a supervisor for the staff's use. Some staff, such as those providing private-duty services, hospice chaplains, and social workers, don't use a nursing bag, yet need to have hand hygiene supplies available for their use. Regardless of how the hand hygiene products and supplies get to the home, the staff must have access to hand hygiene supplies.
The type of hand hygiene products and supplies needed by staff going into the home depends on the types of care or services that are to be performed, and the staff's reasonable potential risk for having contact with a patient's blood or other body fluids, and risk for exposure to pathogenic organisms, such as Clostridium difficile. The exposure risk may be low for a hospice volunteer or delivery personnel from a home infusion provider who places medication in a patient's refrigerator, or a durable medical equipment (DME) worker who sets up medical equipment in the home. The risk is higher for a physical therapist who performs wound care, or a nurse or aide who provides hands-on patient care, or a staff member from a DME supplier who picks up a used commode from a hospice patient who had a Clostridium difficile infection (CDI).
On a routine basis, when the staff's hands are not visibly soiled or the staff are not going to the home of a patient with a CDI, hand hygiene may be routinely performed with an alcohol-based hand hygiene product. Visibly soiled hands include showing visible dirt or visible contamination with proteinaceous material, blood, or other body fluids (e.g., fecal material or urine). Staff routinely at risk for exposure to patients' blood or other body fluids, or going to the home of a patient with a CDI, should minimally have an alcohol-based hand hygiene product, and soap and single-use hand drying material in their possession in the home.
If the hands become visibly soiled, an antimicrobial-impregnated wipe (i.e., alcohol-based towelette) may be considered as an alternative to washing hands with (either antimicrobial or nonantimicrobial) soap and water (Centers for Disease Control and Prevention, 2002). For staff who do not carry a nursing bag into the home, having space for storing soap is often a concern. Soap products that may be easier to store include travel-sized bar soap (for use on a one-time basis and discarded), individual liquid soap packets, or a small (e.g., 2 ounce) container of liquid soap.
Although not common, if running water is not available in the home and hand hygiene needs to be performed with soap and water, an alcohol-based hand hygiene product, in conjunction with clean cloth/paper towels, or antiseptic towelettes may be used as an interim alternative. The staff must wash their hands with soap and running water as soon after as feasible (Occupational Safety and Health Standards, n.d.).
As a final reminder, when going into the home of a patient with a CDI, soap and single-use hand drying materials need to be available and it is suggested that all staff wash their hands with soap and water before leaving the home (McGoldrick, 2015).
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