Evidence Based Research Paper
Hand Washing Adherence
Evidence Based Research Paper
Hand Washing Adherence
Introduction
The concept of cleaning the hands with antiseptic agents originated in the early 19th century. For the subsequent generations, there has been a profound consideration of the practice of hand washing as a depiction of personal hand hygiene in the hospital settings. The issue of hand hygiene emerged with different physicians and pharmacist conducting various studies on the same. For instance, in the early 19th century, a French pharmacist demonstrated the effectiveness of using solutions of soda or chlorides of lime in eradicating foul odors from human corpses. In the subsequent years, the pharmacist insisted on the importance of moistening hands using the liquid chloride solutions by physicians and other individuals before attending to patients with contagious diseases.
In the mid 20th century, the United States Public Health Service released a training film that depicted the techniques of washing hands recommended for use by the healthcare workers. Since then there have been numerous bodies and individuals advocating the significance of adherence to hand washing practices to prevent hospital-acquired infections and promote patient healthcare. For instance, the CDC, HICPAC, and the APIC are some of the bodies that formulated guidelines and recommendations for hand antiseptics and hand washing in hospital settings.
An understanding of the normal bacteria skin flora is essential for acknowledging the importance of various approaches to hand washing. Bacteria exist on the normal skin of an individual. Two distinct categories of bacteria colonize the normal skin: transient and resident. The transient flora colonizes the superficial layers of the normal skin and is susceptible to removal by the routine hand washing. Healthcare workers acquire these bacteria during contact with their patients or contaminated environments.
Literature Review
Clinical Implications, Procedural Changes, Administration Approval, and Cost
The first literary material on this issue of hand washing hygiene is a journal article by H. Sax, B. Allegranzi, I. Uckay, J. Boyce and D. Pittet entitled, “My Five Moments for Hand Hygiene: A User-Centered Design Approach to Understand, Train, Monitor and Report Hand Hygiene.” The authors present elemental information concerning hand hygiene in the hospital settings. They suggest that hand hygiene is an essential aspect of patient safety for preventing healthcare-associated infections and the spreading of antimicrobial resistance (Sax et al., 2007). However, the promotion of hand hygiene is a challenge that needs multimodal strategies of simple, robust and clear conceptual frameworks.
Their study describes the core points of reference for the healthcare workers in a framework that has a distinct time space. Moreover, their study designates various moments when there is a need for hand hygiene to interrupt the microbial transmissions effectively and efficiently during care sequences. Their concept applies to a variety of healthcare activities and patient care activities. It postulates a vision for the health care workers, the observers and the trainers that should increase adherence, minimize resource use and inter-individual variation, and facilitate education.
Their study suggested four negative outcomes that make up the prevention target for the hand hygiene practices. These negative outcomes include cross-colonization of the patients, exogenous and endogenous infection in the patients, infection in the healthcare workers and cross-colonization of the existent healthcare environments including the healthcare workers(Sax et al.,2007).
The study explains five distinct moments for hand hygiene. The first moment is before the patient contact. This moment integrates the concept of the two-zone to deduce the explanation of this moment. This moment takes place between the hand-to-surface last contact with an item that belongs to the healthcare zone and the initial within the zone of the patient. At this moment, hand hygiene will prevent the cross-colonization of the patients and the exogenous infections. The second moment is the before an antiseptic task (Sax et al., 2007). The third moment is the after body fluid exposure risk, followed by the after patient task and finally the after contact with patient surroundings.
For training, there are significant inter-personal differences in the existent effective styles of learning. Some people respond better to the conceptual grouping styles and will respond well to the existent risk-based constructs of zones and the critical sites for the five moments of hand hygiene. Monitoring involves the direct observation of the compliance with the optimal practices of hand hygiene. The monitoring process lays a grid of reference for the activities and minimizes the inter-observer variations. The reporting of the results of observation of hand hygiene to the healthcare workers is an elemental aspect of the multi-modal strategies of improving practices of hand hygiene.
Another literary material on the same topic of hand hygiene is a journal by Son et al. called,” Practically Speaking: Rethinking Hand Hygiene Improvement Programs in Health Care Settings. From this study, hand hygiene is a conventional concept and an effective way of reducing the healthcare-associated infection (Son et al., 2011). The implementation of the credible programs of hand hygiene and maintenance of high levels of compliance among the staff is both required and expected of hospitals. However, there have been insufficient resources to establish efficient institution-wide programs of hand hygiene that are both sustainable and successful over the long-term.
Best Practice – Hand Washing and Hand Rubbing
The involvement of patients in the process of hand hygiene is an important element of preventing infection and farming the patient hygiene in the existent context of patient-centered initiatives of safety. As such, the establishment and implementation of different approaches to including the patient hand hygiene as processes of routine care. Patient hand hygiene refers to practices of hand hygiene performed by the patients on their hands, especially suing hand washing techniques, ABHRs and disinfecting the hands with certain solutions.
In the hospital care settings today, policies and guidelines of hand hygiene focus more on the healthcare workers. The healthcare workers are in constant contact with the patients. As such, patients act as auditors or monitors of the hand hygiene practices of the healthcare workers. The primal goal of involving the patients in practices of hand hygiene has been to enhance the compliance rates of healthcare workers to hand hygiene. For instance, in the United States, programs such as the Joint Commission’s “Speak Up” are essential in urging patients to take roles in the prevention of healthcare errors of the healthcare workers by becoming informed, involved and active participants in the existent healthcare team.
In the international front, there have been numerous programs and initiatives to include patients as potential observers of hand hygiene. Some of these programs include the “Save Lives: Clean Your Hands” campaign. The WHO Patient Safety Challenge is another initiative that involved patients to facilitate hand hygiene practices in healthcare settings.
Another important aspect in the issue of hand hygiene is the protocols of chlorhexidine hand washing and alcohol hand rubbing. The CDC together with the WHO recommends using alcohol hand rubs to prevent the healthcare-associated infections. Nevertheless, there is a need for the evaluation of time effectiveness and efficacy of various protocols of alcohol hand rubbing. There are various protocols of alcohol hand rubbing that healthcare workers as well as individuals who are exposed to the patients can use. The first protocol is alcohol hand rubbing while covering all surfaces of the hand. The second protocol is hand using the conventional standard 7-step method in alcohol hand rubbing. The third protocol is hand washing with the chlorhexidine by using the standard 7-step technique.
There are also certain benefits and risks associated with hand washing techniques in the hospital settings. First, hand hygiene has numerous benefits to the healthcare settings. In order to understand the significance of hand washing, it is important to comprehend the role of hands in the transmission of nosocomial infections. The hands of the healthcare workers and medical personnel often transmit pathogens that cause the nosocomial infections. There is also a worldwide significance on hand hygiene. For instance, the World Health Organization places great importance and value on the issue of hand hygiene in healthcare settings for preventing nosocomial infections.
Hand hygiene is important because nearly all medical activities that involve patients require disinfection of the hands. Therefore, hand washing reduces the degree of hospital-acquired infections. Disinfection of the hands is an important aspect in reducing nosocomial infections. For instance, at the University Clinic of Geneva in Switzerland, the improvement in the compliance rate of hand hygiene from 48 to 66% in five years led to a considerable decrease in the degree of nosocomial infections by more than 40%(Kampf & Löffler, 2010).
On the other hand, there are certain risks associated with the hand washing practices in healthcare settings. The most common of these risks are hand dermatitis and skin irritation. Frequent washing of the hand can result in reduced skin hydration and a disturbance of the skin barrier function.
Leadership and Nursing Barriers - Compliance and Non-Compliance
Leadership in the hospital settings is important for the execution and implementation of hand washing programs in those settings. Leadership relates with compliance of hand hygiene among the healthcare workers. Specific activities that are team oriented have to address the existent barriers such as poor social culture, insufficient management involvement, and negative role models (Huis et al., 2011). Moreover, there should be more creativity in applying alternative measures in the improvement of hand hygiene management strategies.
The overall non-compliance of and hygiene is higher in most ICUs of hospitals. The demanding work setting in the ICU was an elemental aspect associated with the noncompliance. On the other hand, the hand hygiene is most likely to be higher among the technicians and therapists because of the fewer interactions with the patients, hence the fewer noncompliance with hand hygiene per person (Alsubaie et al, 2012).
Motivating the practices of hand hygiene among the healthcare professionals through focusing on patients is another important aspect. Failure of healthcare professionals to observe hand hygiene plays a role in the transmission of infections(Grant & Hofmann, 2011). Therefore, it is important to use variations in motivational messages in order to cultivate meaningful changes in the behavior of healthcare professionals concerning hand hygiene.
Meta-Analysis and Systemic Analysis
The prevention of the healthcare-associated infections is of utmost importance because of the associated morbidity, increase in the antibiotic resistance and the derailing supply of antibiotics in pharmaceutical pipelines. A meta-analysis of the hand hygiene issue through health care epidemiology presented relationship of the single interventions and bundled interventions. The bundled intervention included reminders, education, and feedback. Second, the intervention included improved administrative support and access to ABHR.
The WHO has its strategies of improving hand hygiene in five countries including Saudi Arabia, Pakistan, Mali, Italy and Costa Rica. The WHO uses sustainable and feasible implementation processes of hand hygiene across countries, which increases compliance rates and improvement of knowledge among the healthcare workers(Allegranzi et al.).
Hand Hygiene Adherence Policy
The existent healthcare agency does not have a distinct current policy in place. The lack of policies in the agency derails the implementation of hand hygiene programs in different healthcare settings. Therefore, it is important to formulate prompt policies to promote hand hygiene in the healthcare settings.
Policy
Hand Hygiene Policy and Procedure
Purpose
Proper techniques of hand washing lead to a considerable reduction in the occurrences of hospital-acquired infections in the hospital settings.
Policy
Every member of the exiting healthcare teams has to comply with the current guidelines of the CDC on hand hygiene matters.
Procedure
Indications for handwashing and hand rubbing
Indications for handwashing
When the hands of an individual become dirty, contaminated with various proteinaceous materials or soiled with body fluids such as blood, it is essential to wash the hands using either antimicrobial soaps and water or non-antimicrobial soaps and water. It is also important to use the antimicrobial or non-antimicrobial soaps and water prior to eating or after visiting the restrooms.
Indications for hand rubbing
If there is no visible soiling of an individual’s hands, it is essential to use alcohol-based hand rubs to decontaminate the hands routinely in different situations. Some of the situations encompass direct contact with the patients or their body fluids, wound dressings, mucous membranes, non-intact skins and excretions if there is no visible soiling of the hands.
Hand Hygiene Adherence Summary
Hand hygiene is important in the healthcare settings. Compliance with the hand hygiene practices in the healthcare settings includes proper leadership and motivational messages for the healthcare workers. Additionally, programs by international bodies like the WHO are important to influence adherence in the healthcare settings. Involvement of the patients in monitoring and auditing the hand hygiene procedures of health care workers is important.
Conclusion
Hand hygiene has been a continual issue affecting patients and healthcare workers in the healthcare settings. Despite measures to ensure proper hand hygiene in the hospital settings, the compliance rates among the healthcare professionals is still low. However, there has been an improvement in the rates of compliance to adherence in various sectors. Thus, it is important for healthcare workers to ensure that they follow hand hygiene procedures to reduce hospital-acquired infections.
References
Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M., & Moro, M. (n.d.). Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study.
Alsubaie, S., Bin Maither, A., Alalmae, W., Al-Shammari, A., Tashkandi, M., Somily, A., & Alaska, A. (2012). Determinants of hand hygiene noncompliance in intensive care units. American Journal of Infection Control, 41(2), 131–135.
Grant, A. M., & Hofmann, D. A. (2011). It’s Not All About Me: Motivating Hand Hygiene Among Health Care Professionals by Focusing on Patients.Psychological Science, 22(12), 1494–1499. doi:10.1177/095679761141917
Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & Van Achterberg, T. (2011). Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: A cluster randomised trial. International Journal of Nursing Studies.
Kampf, G., & Löffler, H. (2010). Hand disinfection in hospitals - benefits and risks.Journal Der Deutschen Dermatologischen Gesellschaft. doi:10.1111/j.1610-0387.2010.07501.x
Sax, H., Allegranzi, B., Uçkay, I., Larson, E., Boyce, J., & Pittet, D. (2007). ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection. doi:10.1016/j.jhin.2007.06.004
Son, C., Chuck, T., Childers, T., Usiak, S., Dowling, M., Andiel, C., . . . Sepkowitz, K. (2011). Practically speaking: Rethinking hand hygiene improvement programs in health care settings. American Journal of Infection Control. doi:10.1016/j.ajic.2010.12.008
