Introduction
A good number of health care workers have a low level of compliance with hand hygiene procedures. Observance of hand hygiene practices among health care workers has been observed to range from 30% to 60%, but rarely exceeds 50%. Health care workers who touch the skin of patients while providing care can harbor infectious organisms on their hands and spread them in such a way. Out of the 90,000 annual patients deaths due to health care associated infections, about 15% to 30% (13,500 to 27,000) are a result of poor hand hygiene. Proper hand hygiene is fundamental to patient health and safety and the most cost-effective way to reduce bacteria transfer (Biddle, 2009).
The World Health Organization has identified hand hygiene as a significant source of health care-associated infection. As a result, WHO called for global action to revolutionize rebelliousness with hand hygiene protocols. There are three dimensions of hand hygiene practices aimed at improving compliance with the hand hygiene standards for health care workers, namely behavioural, normative, and control beliefs (Biddle, 2009).
Literature review
According to previous research, compliance of health workers to proper hand hygiene practices is associated with the belief that good hygiene prevents infections (behavioral) that superiors expect adherence to hygiene standards (normative), and hand washing requires little effort (control) (Alemagno, Guten, Warthman, Young, & Mackay, 2010).
According to research conducted by the “cleanyourhands” campaign in England via implementation of the three dimensional approach, there was increased compliance through the introduction of alcohol wipes and marketing materials aimed at health care providers. Behavioral beliefs are dependent on educational programs and hand washing promotional materials to provide general knowledge about good hand hygiene. After an observational study, this conclusion was arrived at in four hospitals found that the inclusion of hand washing educational programs and the availability of alcohol-based hand sanitizer significantly reduced the presence of antimicrobial-resistant bacteria compared with control settings (Alemagno, Guten, Warthman, Young, & Mackay, 2010).
Individual normative beliefs about hand hygiene are largely influenced by community attitudes within the hospital setting. In a study of 60 nursing students, the greatest predictors of good hand hygiene were the mentor’s positive example of hygiene and positive attitude. To increase compliance, workers must believe that the process requires minimal time and effort. The adoption of proper hand washing practices has been attributed to the introduction of new easy-use hand cleaning products located near the patient being treated (Alemagno, Guten, Warthman, Young, & Mackay, 2010).
Importance of hand hygiene to children
According to (Bliss-Holtz, 2010), children are at high risk of acquiring diseases within their homes. A survey conducted on the infection rate of children in hospitals found that there was increased infection to the children whenever there was increased infection in the community as well. The high infection rates within the hospitals were attributed to the ignorance of health care providers to practicing hand washing. The survey indicated that not less than 1.5 million healthcare associated infections (HAIs) occurred annually resulting in more than 99,000 deaths (Bliss-Holtz, 2010).
Other research data indicated an increase in hospital-acquired Clostridium difficile infections of more than 40 percent between 1997 and 2006 and an increase of Clostridium difficile infections by 50% in hospitalized children in the period from 2001 to 2006. The research led to the conclusion that a sustained effort to increase hand washing compliance had to be maintained in healthcare organizations in order to ensure that community-acquired infections did not become healthcare-acquired infections in other patients. (Bliss-Holtz, 2010)
Studies on noscomial infection
Previous research on infections acquired during the administration of health care indicated that over 1.5 million people in the United States acquired such infections, and approximately 100,000 of these people died as a result of that. This high number of hospital acquired infections indicates the urgency with which safe patient care and the implementation of sound practises for the prevention and control of infections should be provided. Safe patient care should be provided in all the medical procedures that occur in a traditional operating room, an ambulatory surgery centre, or a physician’s office.
The current hospital setting allows use of state-of-the art technology to assist the caregiver in providing safer care by protecting both the caregiver and the patient from contracting or spreading infection. The chain of infection involves a microorganism, a reservoir or source where the pathogen can survive and multiply (e.g., blood), a mechanism of transmission (e.g., contaminated hands), and a way for that microorganism to enter someone who is susceptible (i.e., the host).
Principles of infection prevention and control
The principles of infection prevention and control include guidelines for both preventing and controlling the transmission of pathogens that may cause infections as well as selecting the equipment or supplies needed to accomplish this goal (Blanchard, 2009). Some of the procedures that are in place in the hospitals to prevent infection in health care facilities by selecting the correct equipment are indicated below.
Hand Hygiene
Hand-washing is a vital step in disrupting the chain of infection and stopping the spread of infection. Hands are a significant source of transient flora, which makes them a key vector in cross-contamination in health care. Decontamination of hands can be achieved using plain or antimicrobial soap and water or an antiseptic hand rub. If hands are not visibly soiled or contaminated, alcohol-based products are very effective for routine decontamination (Blanchard, 2009).
Water Supply
Clean water supply should be maintained by providing filters which have a 0.2 micrometer filtration capacity to remove bacteria. These filters should also be easily placed on faucets and shower heads.
Airborne Disease
Prolonged close contact or exposure to patients with TB should be avoided. Some precautions can also be taken when dealing with such patients, which include placing a surgical mask on the patient during transport, using an airborne isolation room with special air handling and providing ventilation for areas outside the surgical suite. In addition to this, health care personnel should wear N95 filtration masks when caring for these patients. Health care facilities that do not have airborne infection rooms in their perioperative suites can use portable anterooms which have high efficiency particulate air (HEPA) filters and can keep TB contained (Blanchard, 2009).
Seasonal Influenza
The spread of influenza can be achieved by placing the patient in a private room and requiring health care personnel and family members to wear a surgical mask. It is necessary to place the patient at a distance of at least three feet from the rest patients, and placing a surgical mask on the patient during transport.
AORN’s Recommended Practices
The AORN Standards, Recommended Practices, and Guidelines book contains many recommended practices (RPs) that can assist health care personnel in infection prevention and control (Blanchard, 2009). Some of the RPs include:
- cleaning and processing anesthesia equipment such as syringes and needles;
- selecting and wearing the proper surgical attire and caring for personal protective attire;
- determining at what level of disinfection or sterilization an item needs to be;
- cleaning, decontamination, maintenance, handling, processing, inspection and storage of endoscopes and endoscope accessories;
- keeping preoperative personnel safe by cleaning the environment, which in turn keeps patients safe;
- preparing the surgical site in a safe and thorough manner to prevent surgical site infection;
- maintaining a Sterile Field in order to prevent surgical site infections including maintaining constant observation of the field, labelling medications with sterile labels, and properly delivering medications and sterile solutions to the field;
- sterilization in the Perioperative Practice Setting, which deals with preparation, packaging, processing, storing, handling, and transporting sterile items to be used in patient care;
- prevention of Transmissible Infections (Blanchard, 2009).
Conclusion
Hand hygiene involves the use of water, pain soap or waterless antiseptic agents to minimize the colonized bacteria on our hands. The bacteria can either be transient, associated with contamination, or resident, which are attached to the skin. The method of hand hygiene is dependent on “the type of procedure, the extent of contamination and the required persistence of antimicrobial action on the skin” (Canham, 2011).
Effective hand washing is accomplished by wetting hands and applying an antimicrobial or plain soap and followed by “strongly rubbing hands together to create a lather covering all the surfaces of the palms, tops of the hands, between the fingers, base of the fingers and thumbs, backs of the fingers, wrists and fingernails” (Canham, 2011). Then, the hands should be rinsed thoroughly with cool water to remove all the lather. A paper towel should be used to turn the water off. It is also advisable to keep the finger nails short and focus more on washing areas with jewellery, such as rings. The hands should also be kept dry because wet hands easily transfer pathogens (Canham, 2011).
“The amount of time spent washing hands is vital to trim down the transmission of pathogens to other individuals and environmental surfaces” (Canham, 2011). The best way to prevent both community and health care acquired infections is to practise washing of our hands. (Canham, 2011)
References
Alemagno, S. A., Guten, S. M., Warthman, S., Young, E., & Mackay, D. S. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among Health Care Workers. Journal of Continuing Education in Nursing , 41(10), 463-471.
Biddle, C. (2009). Semmelweis Revisited: Hand Hygiene and Nosocomial Disease Transmission in the Anesthesia Workstation. AANA Journal , 77(3), 229-237.
Blanchard, J. (2009). Preventing Health Care–Associated Infections. AORN Journal , 86, 82-84.
Bliss-Holtz, J. (2010). Editorial: Nightingale, Hand Washing, and Restroom Observations. Issues in Comprehensive Pediatric Nursing , 33, 127–128.
Canham, L. (2011). The First Step in Infection Control is Hand Hygiene. The Dental Assistant Journal , 42-46.