Keeping Hands Clean: A Guide for Hospice Clinicians

Keeping Hands Clean: A Guide for Hospice Clinicians

Clean hands are one of the most important ways you protect your patients, yourself, and your community. Let’s learn why hand hygiene is so vital and how to do it right.

A Quick Look Back:

Did you know that doctors didn’t always understand the importance of handwashing? Back in the 1800s, a doctor noticed many women were dying after childbirth. He realized that medical students, after working with deceased individuals, were going straight to deliver babies without washing their hands. The doctor figured out that something from the deceased individuals was making the new mothers sick. When he made the students wash their hands, the number of sick mothers dropped dramatically! This was a huge discovery.

Today, we know much more about germs and how they spread. We know that handwashing is a powerful tool to prevent infections.

What is Hand Hygiene?

Hand hygiene means cleaning your hands. You can do this in two ways:

  • Washing with soap and water: This physically removes germs from your hands.
  • Using hand sanitizer: This kills germs on your hands. For hand sanitizer to work, it needs to have at least 60% alcohol.

Germs: They’re Everywhere!

Germs are tiny living things that can make people sick. They’re on everything we touch – doorknobs, phones, food, and, of course, our hands. When you touch something with germs on it, the germs get on your hands. Then, when you touch something else, you can spread those germs. This happens everywhere, not just in healthcare settings, but also at home, in stores, and in the community.

Why is Hand Hygiene So Important?

Hand hygiene is essential because it stops the spread of germs. By cleaning your hands, you protect:

  • Your patients: Especially those who are already sick or weak.
  • Yourself: You can get sick from the germs you pick up.
  • The environment: You prevent germs from spreading to other people and places.

Hand Hygiene in Hospice Care:

In hospice care, hand hygiene is extra important. Many patients have weakened immune systems, making them more vulnerable to infection. As a hospice home health aide, you move between different homes and patients, so you must be extra careful not to spread germs. Think about all the surfaces you touch and the different people you interact with. Clean hands are your first line of defense.

When Should You Clean Your Hands?

Clean your hands often! Here are some key times:

  • Before and after touching a patient.
  • Any time you touch blood, body fluids (like saliva or mucus), or anything that might be contaminated.
  • After taking off gloves.
  • After using the restroom.
  • Before preparing food.
  • Any time your hands look or feel dirty.

Handwashing vs. Hand Sanitizer:

Hand sanitizer is quick and easy. It’s great for times when you can’t get to a sink right away. However, handwashing with soap and water is the best way to clean your hands, especially when they are visibly dirty.

When to Wash (Soap and Water):

  • When your hands are visibly dirty.
  • After using the restroom.
  • When caring for patients on special contact precautions (your supervisor will tell you when this is needed).

How to Wash Your Hands

  • Wet your hands with clean, running water.
  • Lather your hands with soap.
  • Scrub all surfaces of your hands – palms, backs, between fingers, under nails – for at least 20 seconds (sing “Happy Birthday” twice!).
  • Rinse your hands well under running water.
  • Dry your hands with a clean towel or air dryer.

How to Use Hand Sanitizer

  • Apply enough sanitizer to cover all surfaces of your hands.
  • Rub your hands together until they are dry (about 15-20 seconds).

Remember: Clean hands save lives. By following these hand hygiene guidelines, you’re making a real difference in the health and well-being of your patients, yourself, and your community.

Where Can You Find Out More?

  • See this video about hand hygiene
  • CDC: About Hand Hygiene for Patients in Healthcare Settings
  • CDC Clinical Safety: Hand Hygiene for Healthcare Workers
End-of-Life Pain Management

End-of-Life Pain Management

People with terminal illness experience pain at the end of life and for many, this pain goes untreated. One of the key elements of hospice care is effectively managing the patient’s pain. Untreated or undertreated pain results in needless suffering – due to physical pain and mental distress. However, family caregivers often have a difficult time assessing their loved one’s pain.  Further, they are often concerned with side effects of pain medications, including concerns of addiction to or tolerance of pain medications. Further, both patients and family caregivers often have trouble communication with the hospice team the degree and nature of pain that the patient is experiencing. This often leads to ineffective pain management and needless suffering in end-of-life.

What are some considerations when giving pain medication?

Respect

Respect the patient’s wishes regarding pain management. Understanding a patient’s goals and values guides the care team in providing personalized and compassionate care.

Consult

Pain medication decisions are made in consultation with the patient, considering their preferences, values, and goals for care.

Collaborate

The hospice team includes the primary physician, medical director, nurse, social worker, chaplain, hospice aide, caregivers, and patient. Everyone works together to create the right plan.

How should pain medication be administered and monitored?

Individualized and Regular Assessment

Pain medicine is administered based on individualized assessments of the patient’s pain levels. Regular assessments of pain are important for managing pain and ensuring the plan remains effective.

Address pain early

Addressing pain before it becomes too severe can contribute to more effective pain control and improved quality of life.

Communication

Encourage patients to communicate openly about their pain levels. This information is crucial for healthcare providers to make informed decisions about medication adjustments. Regular communication between caregivers and healthcare providers ensures an accurate understanding about the patient’s pain.

Low dose pain medicine

It is preferable to initiate low-dose medication to maintain alertness and minimize potential side effects.

Titration

Titrate pain medication up as needed, to achieve optimal pain relief. Regular assessments guide the titration process ensuring the right balance between pain control and functionality. Often a long-acting pain medication is given coupled with a breakthrough pain medication, if needed, to keep pain at or below goal level.

Timely administration

Administer pain medicine in a timely manner, adhering to the prescribed schedule. Consistent dosing helps maintain a baseline level of comfort.

Pain log

Use a pain log to track pain levels, related factors, what medicine was given, dosage of medication, and time medication was given.

Education

The hospice team should educate the patient and caregivers on the use of pain medication, including dosage, timing, and potential side effects.

Monitor

Monitor for potential side effects of pain medication and collaborate with the healthcare team to address any concerns. This includes a careful assessment of the patient’s overall well being.

Consider a holistic approach to pain management

Many hospice agencies advocate for a holistic approach to pain management, including physical, emotional, and spiritual care.  Alongside pain medications, this involves exploring and integrating non-pharmacological interventions such as massage, music therapy, aromatherapy, and relaxation techniques for a more comprehensive approach to pain relief.

Where can you find out more?