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Read the Hand washing article from the CDC Emerging Infectious Diseases Journal and answer the following questions. This document is posted in the Read and Study section of this module.
When was this article published? (Hint: Check the bottom of the pages) March-April 2001
In the DEFINITIONS Section What are the two major groups of organisms? 1. Resident Flora – Normally reside on skin 2. Transient Flora – Contaminants
What is hand hygiene? Hand hygiene “is the simplest most effective measure for preventing nosocomial infections”. It includes actions, such as hand washing and hand disinfection, that will reduce the amount of transient flora and remove dirt from the skin in order to prevent the spread of infection.
Hand washing can be done using non-medicated soap and water or soap that includes antiseptic.
The latter is referred to as hygienic hand washing. Hand disinfection refers to use of an antiseptic solution to clean hands, either medicated soap or alcohol.
Hand washing is preferred over hand disinfection in certain situations such as when they are visibly soiled or contaminated by C-Diff.
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It typically takes 20-30 seconds using certain steps in order to perform it correctly.
What is hand disinfection? Hand disinfection is a form of hand hygiene that utilizes an antiseptic solution to clean hands. They not only reduce transient flora by mechanically removing them. Their antimicrobial properties also kill remaining microbes or reduce how quickly they can reproduce. Hand disinfectants are useful in situations when “microbiologically clean hands are required for extended periods”.
In the section Hand Hygiene Agents What agent has excellent activity and the most rapid bactericidal action of all antiseptics? Alcohol based cleansers have more rapid action than products containing other antiseptics such as; chlorhexidine gluconate or providone iodine.
Which alcohol is the most effective? N-propanol
Which alcohol is the least effective? Ethanol
After extensive reduction following hand disinfection with an alcohol preparation, how long does it take for the resident skin flora to become completely restored? Several hours
What were the factors associated with increased bacterial contaminations levels on the hands? Activities associated with higher microbe contamination levels are: Direct patient contact Respiratory care Handling of body fluids Disruption in the sequence of patient care Simple hand washing before patient care without hand disinfection was associated with bigger colony counts
In the section Factors Influencing Noncompliance with Hand Hygiene What factors were found to be causes of non-compliance with hand washing guidelines? Being a physician or a nursing assistant rather than a nurse Being a nursing assistant rather than a nurse
Being male Working in an ICU Working during weekdays rather than the weekend wearing gown and gloves Using an automated sink Performing activities with high risk for cross-transmission Having many opportunities for hand hygiene per hour of patient care
In the section Perceived Barriers to Hand Hygiene What were some of the factors found? Skin irritation Inaccessible supplies Interference with worker-patient relation Patient needs perceived as priority Wearing gloves Forgetfulness Ignorance of guidelines Insufficient time Inconveniently located or lack of sinks Lack of a role model High workload and understaffing Lack of scientific information showing positive impact of improved hand hygiene
In the section Risk Factors for Noncompliance What was the KEY barrier to motivation to comply with hand washing guidelines? Lack of knowledge and education
Looking at Table 1 in this study, what hospital setting
Had the highest compliance? Table 1 illustrates that ICU had the highest compliance – 81%.
However, the article states that in the largest hospital-wide survey ever conducted Pediatrics had the highest compliance rate – 59%.
Had the lowest compliance? Table 1 illustrates that Open Ward had the lowest compliance – 16%. The article states that ICU had the lowest compliance - 36%.
What overall recommendations are suggested to obtain higher hand washing compliance levels? The article states these overall suggestions for improvement:
“Improvement in infection control practices requires questioning basic beliefs, continuous assessment of the stage of behavioral change, interventions with an appropriate process of change, and supporting individual and group creativity… A framework for change should include parameters to be considered for hand hygiene promotion, together with the level at which each change must be applied: education, motivation, or system.”
More specific suggestions are listed in table 3 and include: -Routine observation and feedback -Make hand hygiene easy and convenient -Make available alcohol-based hand rub available in high demand situations -Patient education -Reminders in the workplace -Administrative sanctions/rewards -Promote and facilitate care for HCW hands -Obtain active participation at individual and institutional levels -Avoid overcrowding, understaffing, excessive workload
The hands are the most secondhand body organ and are exposed to pathogens at a higher level than any other part of our body. For people to maintain a state of health, we have to decrease the transmission to these pathogens. One tested method to interrupt the transmission is by keeping hand health The objective of this integrative review was to take a look at the relationship between hand cleaning and occurrence of healthcare associated infections (HCAIs) in healthcare settings and provide proof based suggestions for the future directions for healthcare service providers to avoid infections.
Significance of maintaining hand health. Evidence to support the importance of hand hygiene in infection avoidance 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 throughout medical facility stays might impact approximately 10% of clients in the USA. The World health Company (WHO) released national standards for hand hygiene in healthcare to increase client safety and restrict the spread/exposure to organisms. Medical personnel regularly skip hand washing between patients either because they were not near a sink or they just didn't have the time. Compliance for hand health by all health care workers on average is 50%. Literature review
I reviewed five journals on hand cleaning. Makie et al. (2013) identifies 4 main objectives to avoid infection that all need to be utilized in parallel: (1) hand washing; (2) protective barriers (3) decontamination of the environment, products and devices used for clients; and (4) antibiotic surveillance. One used with the other three will put your client at danger for exposure. Despite a substantial quantity of research/data and proof supporting these interventions, healthcare workers' translation into their daily practice is doing not have. The author promotes compliance and consistency of these goals to manage the spread of infections within their health care environment. According to Hiremath et al. (2012 ), hand cleaning 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.
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
Hand Hygiene Assignment. (2016, Sep 02). Retrieved from https://studymoose.com/hand-hygiene-assignment-essay
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