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Hospitals, clinics, nursing homes, schools, and other institutions in which nurses work often struggle to prevent the spread of pathogens such as bacteria, viruses, protozoans, and fungi. It has become apparent that proper hygiene is critical to prevent the spread of pathogens such as Clostrid¬ium difficile and Staphylococcus because they can lead to life threatening infections (Mody et al., 2008; Safi et al., 2018). Good hand hygiene is viewed as cornerstone of infectious disease control in health care settings, and hospitals, nursing homes, rehabilitation centers, schools, and other institutions that rely on good hand hygiene practices to protect their patients and themselves.
Shockingly, research has found that only 50% of nurses, doctors, and other health care personnel practice appropriate hand hygiene in hospitals (Lydon et al., 2017). Nurses, compared to other health care providers, spend more face to face time with patients and therefore good hand hygiene is even more important among nurses to help reduce the rate of infection among patients. Based on research as well as personal observations while volunteering in a local hospital, many nurses appear to lose sight of the importance of good hand hygiene within the first few years of work.
A variety of strategies have been used to try to increase good hand hygiene among nurses, nursing students, and other healthcare workers. For example, studies have compared the effectiveness of closed circuit television monitors placed in patient rooms and in the ICU, direct observation by others, education about the importance of handwashing, placement of the dispensing units, and others (e.
g., Gould et al., 2017; Labrague, et al., 2018; Livshiz-Riven et al., 2019; Pokrywka et al., 2017; Showbowale et al., 2016). Despite these efforts, hand hygiene compliance rates among nurses in the United States and around the world continues to be low (Chatfield et al., 2016; Waltman et al., 2011). For example, Biddle and Shah (2012) found that hand hygiene compliance rates among nurses and other staff in the Department of Nurse Anesthesia, Virginia Commonwealth University Medical Center in Richmond Virginia ranged from 7% to 34%. A study in Iran found that among 94 nurses in 500 “clinical moments” the hand hygiene compliance rate was only 12.8%. Interestingly, this rate jumped to 72% after exposure to patient’s body fluids (Mostafazadeh-Bora, Bahrami, & Hosseini, 2018). This finding suggests that nurses are aware that some situations are likely to be more hazardous for the spread of bacteria and their behavior does change depending on the situation. It is possible that “hidden bacteria” that can’t be seen on hands seems less harmful to nurses and therefore they are less likely to wash their hands in these situations.
Research has found that hand hygiene is a complex behavior that is influenced by various factors including individual, social, and administrative factors (Chatfield et al., 2016). For example, in some studies nurses have complained about the possible negative health effects of constantly using hand sanitizer, and other studies have found that some nurses prefer soap and water to foam or gel cleansers but these options may not be available to them (Chatfield et al., 2016; Martinello et al., 2019). Other studies have found that nurses who work in critical care units report that the main reasons for poor hand hygiene compliance include difficulty accessing sinks (not enough and/or poorly placed), high workload, understaffing, and lack of time (Sandule-Rios & Aguilera, 2017).
Based on studies that consistently find that nurses and nursing students do not practice good hand hygiene, it seems that student nurses are not being trained well enough about this issue. It also appears that hospitals and other institutions are not demanding good hand hygiene from nurses. To help improve good hand hygiene in nursing students Yano et al., (2019) developed to a simple, three hour practical experience to measure the effectiveness of handwashing on the amount of bacteria left on the hands of nursing students. Yano et al., found that this information improved nursing students’ awareness of “unseen bacteria” and their knowledge about how to prevent infections.
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