Introduction
The primary transmission route of all microorganisms, including the multi-resistant variety in healthcare facilities is the Health Care Workers’ unwashed hands. Infections affect an average of one in every ten admissions to hospitals. Hence, hand hygiene is considered the basis of any initiative designed to prevent and control infection. Hand hygiene is crucial to the prevention or reduction of infections associated with healthcare. Health care workers are required to maintain hand hygiene at some critical points in their duties. Nurses are among the Health Care Workers who have the greatest contact with patients. Hence, it is imperative for them to maintain hand hygiene. This essay looks at a practice observation of the nursing policy on hand hygiene and the adherence to its application in the workplace.
It is imperative for all nursing units to have a procedure or policy by which activities should abide. The purpose of this policy or procedure is to ensure uniformity and consistency in operations. These policies are even more important in critical areas in the hospital. Because the hands are transmission vectors between both people and inanimate objects, a hand washing policy is of vital importance to any nursing unit.
At the Johns Hopkins Hospital, hand hygiene is prioritized as a key intervention for the prevention of healthcare-associated infections. As such, the nursing unit at the hospital has a hand hygiene policy by which all nurses must abide. The hospital’s policy is easy to find since it on prominent display on the hospital website. Besides this, the system is displayed throughout all sectors of the hospital using posters that are strategically located in all areas where they are readily visible. The posters are part of the hospital’s WIPES campaign that aims at eliminating hospital infections.
All RN’s at the hospital are aware of where to find the policy, which helps in achieving compliance. Every year, the hospital conducts continuous training for its staff on the proper procedures. The training is part of an initiative titled Hopkins Hands, which ensures that all the hospital’s staff, regardless of their working department are aware of proper hand washing procedures. The Hopkins Hands training is the primary method of dissemination of hand hygiene information to the staff.
The hospital’s policy is molded on evidence-based research, with a good example being its introduction of dispensers for hand hygiene sanitizer outside all the rooms. This policy relies on the findings of the CDC study showing that the use of antiseptic hand wash significantly reduces contamination of hands by pathogens. This reduced contamination rate then ensures that the risk of transmission of infections to patients is minimal. However, the hospital still emphasizes on the use of soap and water as the primary hand wash mechanism. In doing this, they rely on research showing that use of soap and water as the primary hand washing mechanism is the most efficient method of killing pathogens.
At the Johns Hopkins Hospital, all RN’s must follow a specified procedure for hand washing. The procedure followed is dependent on whether the nurse is using soap and water or hand sanitizer in cleaning their hands. When using soap and water, the first step is to wet the hands. After this, the next step taken is to apply between 3 and 5 ML of soap to the hands. The third step is to rub the hands together for at least fifteen seconds making sure to cover the hands and fingers completely. After doing this, the RN should rinse his or her hands off and then use a paper towel to dry off the fingers and hands. Finally, the nurse must use the paper towel in turning off the water faucet. This last step is critical because it ensures that one does not contaminate himself or herself once again when turning off the water faucet.
During the observation, one important point noted was that the nurses sometimes deviated from the procedure. Specifically, the last step was one that many nurses forgot to take. Immediately after drying their hands, some nurses disposed of the used paper towels hence they had to turn off the faucet with their hands. By doing this, recontamination occurred, and this could mean onward transmission to patients. The nurses could have failed to follow proper procedure due to time constraints. The deviation mostly occurred in emergency cases where the nurses were in a race against time to save lives. This situation caused them to skip the last step in their rush to save lives.
Evidence-based nursing refers to the integration of the best evidence from research with clinical expertise, and the values of patients to facilitate decision making for the clinician. Whereas evidence-based nursing is critical to the improvement of quality in nursing, it is not always easy to implement. Challenges frequently come up during the implementation of evidence-based nursing procedures. One of the challenges or problems that affect this implementation is the lack of education. When nurses are unaware of the existence of these practices, they can obviously not implement them.
Another challenge to the implementation of evidence-based nursing problems is resistance to change. This challenge becomes greater when this resistance comes from the leaders. When the leaders do not model the change that they wish to see implemented and support it by providing the necessary tools, the change will most likely be unsustainable. From the nurses themselves, resistance may arise from the fact that the nurses feel that the traditional approach they have always used is the best. Hence, they may not feel inclined to alter their approach.
As a staff RN, the discovery that some unsafe procedures that are a deviation from the usual standards or policies are in use is quite challenging. However, it is imperative that one responds in the proper manner to this situation. The first response here should be to report the deviant behavior immediately to the relevant authority. Since patient safety is of critical importance and any actions that do not follow correct procedure jeopardize this safety, the nurse must report the deviation.
Reporting it will ensure that corrective measures are taken before the situation escalates. For example, at the Johns Hopkins Hospital, staff members have training on how to secretly monitor the whether healthcare workers are applying the proper procedure. Staff members secretly monitor the compliance to hand hygiene and submit their findings to a team of control experts. Whenever the staff members notice any deviance, they report it immediately, and corrective measures are instituted.
In conclusion, it is evident that hand washing is a critical process at the Johns Hopkins Hospital. Washing hands is one of the methods of containing the spread of infections and diseases. Hence, the hospital has developed a procedure, which all staff should follow to reduce the chances of infection. However, deviations sometimes occur from this procedure, and they may be the result of time constraints. Once such deviations are noted, a report to the relevant authority must be made so that remedial action may be taken.
References
Bloomfield, S. F., Aiello, A. E., Cookson, B., O'Boyle, C., & Larson, E. L. (2007). The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. American Journal of Infection Control, 35(10), S27–S64.
Centers for Disease Control and Prevention. (2010). Estimates of healthcare-associated infections. Retrieved July 21, 2015, from Centers for Disease Control and Prevention: http://www.cdc.gov/ncidod/dhqp/hai.html
Garbutt, M. J. (2011). Infection Control: Hand hygiene in the OR: Using evidence-based practices. OR Nurse, 5(2), 10 - 12.
Johns Hopkins Medicine. (n.d.). Hand Hygiene. Retrieved July 21, 2015, from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/heic/infection_surveillance/hand_hygiene.html
Johns Hopkins Medicine. (n.d.). Hopkins Hands: Improving Hand Hygiene Across Johns Hopkins Medicine. Retrieved July 21, 2015, from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/clean_hands/
World Health Organization. (n.d.). WHO guidelines on hand hygiene in healthcare. Retrieved July 21, 2015, from World Health Organization: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
