Literature review
Various studies have provided insight on how hand hygiene prevents health-associated infections, but the care providers have poor adherence to the practice. Although there are various perceive barriers to the compliance of hand hygiene, the high workload is among the fundamental contributing factor. According to Pittet (2001, p.235), factors that deteriorate hand hygiene compliance include inaccessible supplies, skin irritation, patient needs, high workload, understaffing and insufficient time among others. Although the article does not emphasize on the workload as an important factor, it has highlighted that the excessive workload is perceived as a significant contributor of poor hand hygiene among nurses. Sharma, Sharma, Puri, and Whig (2011), found out that lack of motivation, less knowledge, and increased workload among the major factors influencing hand hygiene among nurses. To be specific, the study reveals, “Maximum opportunities and lowest compliance (40.4%) was seen in age group 21‑30 years that may be due to high number of subjects and increased workload on this age group both in case of nurses and doctors.” (Sharma et al. 2011, p.219). According to this study, the nurses aged between 21 years and 30 are more subjected to a high number of patients and increased workload hence less compliance to hand wash hygiene.
In support for the argument Gabbay et al (2009) and Knoll et al. (2010) agrees that stress caused by the shortage of the nurses in the health care negatively influence the compliance with hand hygiene. The workload among nurses is influenced by the factors like maximum capacity utilization, mainly due to the inadequate human resources. Knoll et al. (2010) suggests that to reduce this workload, which has an inverse relationship with compliance is to relieve nurses from duties that are not related to patient care. In addition, the study suggests that more attention should be paid to improve professionalism among nurses. Sharma et al. (2011), also suggest that internal factors such as professional status in relation to attitudes, knowledge, and perception towards hand hygiene should be considered. White et al. (2015) also argues that the effort to improve compliance should be based on the individual strategies of handling prioritization of hand hygiene in different situations.
However, some studies such as that conducted by White et al. (2015) are contradicting to the fact that both internal and external factors are important in enhancing the compliance. The hand hygiene compliance is not only enhanced by the internal factors such as individual behaviors but also the external factors such as adequate human resources. Therefore, the compliance to hand hygiene is not only about individual strategies as suggested by White et al. (2015). Another inconsistency is that many studies did not indicate the variation of hand hygiene compliance in relation the resources available for hand washing. For instance, some of the nurses are not subjected to excessive workload but yet they do not comply with the hand wash hygiene because of inadequate washing material and dryers. Some of the nurses also avoid washing hands frequently because they are discouraged by soring of their hand after frequent wash.
In conclusion, the studies provide a significant evidence that stress caused by the workload is among the factors that negatively influence hand hygiene. Nursing staffs who are assigned to an excessive number of patients are associated with stress and also cause time to comply with hand hygiene. Some of the studies suggest that both internal and external factors should be considered simultaneously to improve the compliance. However, some studies suggest that individual strategies highly influences hand hygiene, which contradict with the focus for both internal factors (such as individual behavior) and external factors (such as hand washing materials). Therefore, further study is required to prove whether the workload among nurses is a dominating factor and whether the stress are mainly caused by the workload.
Appendix
Literature review Summary table
References
Gabbay, U., & Bukchin, M. (2009). Does daily nurse staffing match ward workload variability? Three hospitals' experiences. International journal of health care quality assurance, 22(6), 625-641.
Knoll, M., Lautenschlaeger, C., & Borneff-Lipp, M. (2010). The impact of workload on hygiene compliance in nursing. British Journal of Nursing, 19(16), S18-S22.
Pittet, D. (2001). Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerging infectious diseases, 7(2), 234.
Sharma, S., Sharma, S., Puri, S., & Whig, J. (2011). Hand hygiene compliance in the intensive care units of a tertiary care hospital. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 36(3), 217.
White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W., & Paterson, D. (2015). Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses. BMC health services research, 15(1), 59.
