The hands are the most used body organ and are exposed to pathogens at a higher level than any other part of our body. For humans to maintain a state of good health, we have to reduce the transmission to these pathogens. One proven method to interrupt the transmission is by maintaining hand hygiene. The objective of this integrative review was to examine the relationship between hand washing and incidence of health care associated infections (HCAIs) in healthcare settings and provide evidence based recommendations for the future directions for health care providers to prevent infections.
Importance of maintaining hand hygiene
Evidence to support the importance of hand hygiene in infection prevention dates back to the early 1800’s with Ignaz Semmelweis. The significance of limiting the spread of infections has been emphasized from the days of Florence Nightingale. HCAIs acquired during hospital stays might affect up to 10% of patients in the USA. The World health Organization (WHO) published national guidelines for hand hygiene in healthcare to increase patient safety and limit the spread/exposure to organisms. Medical personnel frequently skip hand washing between patients either because they were not near a sink or they just didn’t have the time. Compliance for hand hygiene by all healthcare workers on average is 50%. Literature review
I reviewed five journals on hand washing. Makie et al. (2013) identifies 4 primary objectives to prevent infection that all need to be used in parallel: (1) hand washing; (2) protective barriers (3) decontamination of the environment, items and equipment used for patients; and (4) antibiotic surveillance. One used with the other three will put your patient at risk for exposure. Despite an extensive amount of research/data and evidence supporting these interventions, healthcare workers’ translation into their daily practice is lacking. The writer promotes compliance and consistency of these objectives to control the spread of infections within their healthcare environment. According to Hiremath et al. (2012), hand washing is one of the most effective means of preventing infections. The author feels “it’s a personal vaccine”. To foster support of the hand washing initiative on a global level we must raise awareness of its importance. People need to be educated and understand the risk of not washing their hand, when to wash their hand (after toilet use, diaper changes, food handling, or visibly soiled) and how others can become exposed to organisms.
They also need to understand the proper technique. Beggs, Sheperd et al. (2008), study used the Ross-Macdonald model to apply hypothetical data to a medical ward. This model simulated the transmission of staphylococcal infection by contact from colonized hands of heath care workers. The aim was to evaluate the impact of imperfect hand hygiene on infection. The study concluded that hand hygiene was an effective control measure, but little benefit was found for high levels of hand washing (>50% norm). 40% compliance was found to be enough to prevent an outbreak. Borges, Rocha et al. (2012), provides recommendations on improving hygiene inside the hospitals by promoting routine observation and feedback to healthcare workers. They promote implementation of a campaign: (1) repeated monitoring of compliance, (2) performance competency, (3) education, (4) visual cues and compliance feedback. These procedures by hospital will have been highly cost effect/justified. Inamulhaq & Haq (2012) observed hand washing among medical and paramedical professional in clinics. These authors also felt that hand washing was valued as an intervention to prevent infection but was often skipped. They promote staff education/training and soap dispensing tools/washing station insertion. They also suggested that senior team member set an example for all staff on proper techniques.
I feel that the articles by Borges et al. (2012) and Makic et al. (2013) well support hand washing initiatives we’ve found in research to be effective when implemented. As clinicians we find ourselves asking the “5 W’s” when we are faced with evidence that will drive our daily practice. They pull together the WHAT hand washing it, WHY we do it, WHEN and WHERE it should be done and by WHOM. The other four articles also support the findings but don’t have the complete package with all the elements need to support clinical compliance.
The article Borges et al. (2012) had the best research design of all five. It was a quantitative research study with meta-analysis synthesis over a 12 month period. It has well-defined hypotheses that the 2 observers were aware prior to the start of the data collection period. The method of data collection was observation only. The sample size was large enough (52 sessions and 119 opportunities) to provide statistical significant data for an effective conclusion to be made.
As I compare these five articles with the national guidelines review they all have the same element that hand washing is essential to the reduction of infection. The national guideline encouraged cleaning of patient environments, health care education, cueing for compliance, competency monitoring and documentation surrounding staff training. Conclusion
Evidence-based nursing practice is essential to the delivery of high-quality care that optimizes patients’ outcomes. Hand hygiene is one self-care practice that can go a long way in keeping many ailments at bay for both the healthcare worker and the patient. Healthcare workers should work relentlessly in promoting the self-care practices, holding their peers accountable if they aren’t compliant and hardwiring this practice into daily operations. This is a simple task that has some many benefits. As me move forward with federal reimbursement, healthcare organizations will see a decline in their reimbursement for care if patient get infections while hospitalized. So it all starts with us as healthcare workers to break the mode and start setting a good example by adhering to these simple hygienic practices of hand washing.
Beggs, C.B, Sheperd, S. Kerr, K (2008). Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in hospital ward. BMC Infectious Diseases; 8(114) Hiremath RN, Kotwal A, Kunte R, Hiremath SV, Venkatesh (2012). Hand Washing with Soap: The Most Effective “Do-It-Yourself” Vaccine? Natl J Community Med; 3(3):551-4 Lizandra Ferreira de Almeida e Borges, Lilian Alves Rocha, Maria Jose Nunes & Paulo Pino Gontijo Filho. (2012). Low Compliance to Handwashing Program and High Nosocomial Infection in a Brazilian Hospital. Interdisciplinary Perspectives on Infectious Disease; Article 579781, 5 pages Makic RN, Martin, RN, Burns, RRT, Philbrick, RN & Rauen, RN (2013).
Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by Evidence. Critical Care Nurse; 33(2):28-43 Mirza Inamulhaq, Azis S.A., Haq S.M. (2012). Role of Hand Washing in Prevention of Communicable Diseases and Practices Adopted in Private Clinics. Canadian Journal of Applied Sciences; 2(1): 196-201