It may seem simple to understand the rules for staff clothing. At the same time, point prevalence measurements often show that they are not fully complied with. It may be necessary to follow the entire process to see where the shortcomings are. By changing work clothes at least every day, the risk of spreading infections is reduced.

Many businesses handle their own laundry. Staff clothes should be washed at 60 degrees before being used again. If the staff clothes are not properly clean, there is a risk that a resident may become infected. Often, laundry rooms are cramped and there are not good enough spaces to sort larger amounts of laundry. There must be secure routines.

Not everyone understands the importance of handling the clothes so that they are hygienically clean when the next user is to take them. If clean clothes are put in a pile, end up on the floor or lie in the staff dining room waiting to be sorted, it is not at all certain that they are clean when they are to be used.
Often there is a risk that they have become unnecessarily wrinkled. Many employees feel better if they look neat in their work clothes.

Hygiene guidelines for care

• All staff categories participating in care work should be changed.
• Work clothes should be provided by the employer and used only at the workplace or during travel between workplaces.
• The employer is responsible for washing and storing work clothes.
• Work clothes should be washed at least 60° C,
• Work clothes should be short-sleeved, i.e. end above the elbow.
• Work clothes should be changed daily. If they get dirty or wet, they should be changed as soon as possible.
• Work clothes combined with private clothes are not allowed, except for underwear, socks, short-sleeved undershirt, vest and headscarf/veil.
• It is not allowed to smoke in work clothes.
Care staff should not, for example, sit outside in the grass in work clothes.

Rings, nail polish and more

As care staff, we are obliged to follow basic hygiene routines. Both staff and residents can be carriers of multi-resistant bacteria or viruses and the business must have secure routines so that infection does not spread. If there is the spread of infection, the business is often forced to extensive infection control measures to prevent further spread.

No long nails, false nails, rings and other things that risk contributing to the spread of infection may occur.
In connection with a business transition, a quality review of night work was carried out. An employee who worked there had a ring on her finger. It turned out that she had not taken off the ring for seventeen years.

There are ways to get rid of rings that are stuck. Thread a thread through the ring. Then wrap the finger with sewing thread below the ring. By then slowly winding up the thread from the top of the ring, you get the ring to move over the wrapped area until it comes to an area where the finger is narrower and you can take off the ring. There are videos on Youtube that show how to do it.

Many businesses do self-checks of compliance with the regulations on basic hygiene routines. In care work, good hand hygiene is fundamental. In the work, there should be no long nails and jewelry that can harm residents or staff. In work with care or in handling food, good hand hygiene should be maintained. Rings and bracelets that can contribute to the spread of infection are removed before work begins. Something that is often overlooked is nail polish. Nail polish often cracks and the cracks, which also occur in invisible nail polish, can provide space for the accumulation of viruses and bacteria and thus cause the spread of infection.

Long hair should always be tied up. Perfume and smoke smell can be troublesome for many, especially allergy sufferers. Resistant bacterial strains are becoming increasingly common, so we must assume that we ourselves can be carriers. If you work with patient-related work, you should have work clothes and protective equipment in contact with body fluids.

Basic hygiene routines include regular hand hygiene. The rules for hygiene also apply in connection with kitchen work and handling of food. In contact with body fluids, use disposable gloves and if necessary a protective apron or protective coat. Similarly, protective equipment should be used to avoid needle injuries.

If someone becomes sick or there are other signs of risks of infection spread in the business, a nurse should be contacted immediately. The nurse can then temporarily decide on additional hygiene rules.

What to consider here is that there are two different perspectives. One is about care hygiene aimed at protecting the resident from infection. Then there is an infection control perspective where it is about protecting employees based on the work environment responsibility and more generally preventing the spread of infection.

Gloves

Proper use of gloves in care is crucial for hygiene and limit infection and infection spread. There are basic hygiene routines that must be followed. Basically, the staff pose a greater risk than the residents and a resident with an infection should be treated with respect despite infection.

A nurse was worried about the hygiene knowledge at the elderly home where her father lives. She claimed that several in the staff group had poor or very poor knowledge of how and why gloves should be used.

Several employees first handled lower toilets and then continued to help the resident without changing gloves. They seemed more to believe that the gloves were to protect themselves than the resident. They could put on gloves to comb hair or fix clothes.

The importance of care hygiene is increasing. The number of people carrying resistant bacteria is increasing. Infection spread in the care environment is a recurring problem and in Europe the number of people who die as a result of infections that cannot be treated is increasing.

Hands should always be disinfected before and after contact with the resident. In dirty work, hands are washed before they are disinfected. To maintain good hand hygiene in the residents, they can be offered help with washing their hands under running water, both in connection with the morning toilet and at other times in connection with toilet visits.

It is good if there is hand sanitizer available in connection with the dining area so that the elderly can sanitize themselves. In case of signs of stomach sickness and if someone gets diarrhea or vomiting, the sick person should be isolated from the others. If winter vomiting disease caused by Noro or Rotavirus is suspected, the entire unit should be isolated until testing has shown something else.
Relatives are urged in these cases not to come and visit their relative.
Gloves are used to protect the elderly and staff from dangerous infections. Therefore, gloves should be used when coming into contact with body fluids, but otherwise gloves are not considered necessary to use.

New employees do not always get a good introduction to their work and therefore do not understand the importance of sticking to routines. The introduction should be followed up. Many businesses do self-assessments when it comes to how employees work with hygiene but these instruments do not capture those employees who have a lack of knowledge about the importance of following hygiene routines.

A nursing assistant describes that there is no time to teach basic knowledge about hygiene etc to newly employed substitutes. The nursing assistant said "unfortunately many substitutes have to learn these routines themselves". A lack of introduction can create extra costs. For example, it happens that washing labels are flushed down the toilet and cause blockages.

The nursing assistant expresses that it seems to be more important to teach the substitutes complicated schedule systems and control apps than that the staff perform the work in a safe way for the elderly. The introduction course is often too short and it happens that relatively newly employed staff are to introduce the substitute. She further tells about many who have worked for a while assuming that "everyone knows that", but it doesn't work that way she emphasizes. She has seen colleagues pour soap in the washbasin and then not rinse it off with clean water, but only wipe off the lather.
This nursing assistant eventually gave up and quit when she met resistance when she pointed out various shortcomings.

Drinking hand sanitizer

As the hand sanitizer needs to be available at the elderly home, the question sometimes arises, what happens if someone drinks the hand sanitizer? In addition to the person risking getting drunk, disinfectants are included in the hand sanitizer, which can cause stomach pain and nausea.

Reflection - staff clothes and hand hygiene
Care staff:
• Do you have good routines for handling work clothes?
• How do you help each other to do the right thing?
• Do you have a good and thoughtful introduction program?
• Does anyone have rings, painted nails or a watch when they work?

Manager, nurse, occupational therapist and physiotherapist:
• Do the routines for washing work clothes work as they should?
• Do you have a well-worked introduction program?
• Do you have good quality on your internal education regarding delegation, movement, information about aids, hygiene etc.?

Resident and relative:
• Do the employees use work clothes correctly?
• Are there employees who work with rings or nail polish?
• Do you feel safe with the staff having good knowledge of care hygiene?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day