Hand hygiene is one of the most important procedures in the control of infections in various sectors. The infections that are associated with the healthcare is capturing the attention of the governments, insurers, regulatory agencies as well as the patients. This follows the high morbidity and mortality rates that associated with these infections. Similarly, infectious diseases are also associated with high cost of treatment. Individuals are now beginning to understand that these infectious diseases can be prevented. The medical fraternity has realizing in tandem unmatched improvements in the understanding the pathophysiology of infectious diseases. This comes in the wake of the spread of multi-drugs resistant (MDR) infections across the globe (Vermeil et al, 2019). The factors coupled with existence of novel antimicrobials calls for a need of relooking into the role played by basic practices of preventing infection in the present healthcare set up. Undisputed evidence that hand hygiene is capable of reducing the risk of cross-infections is now in existence following several scientific research. The increasing burden on the healthcare together with ballooning severity of illness as well as the complexity of the treatment due to Multi Drug Resistance (MDR), there is a need to reverse to the basic infections control measures such as hand hygiene. According to scientific evidence, proper implementation of hand hygiene results in the reduction of cross-transmission of infections within the health care set up (Sharif et al, 2016).
This essay shall expound on the hand hygiene in the control and prevention of Hospital Acquired Infections (HACIs) within the ABC hospital. From the audit of the 5 moments of hand hygiene, it was observed that there is still lower percentage of healthcare workers who are adhering to the hand hygiene before attending to a patient(moment 1) . From the statistics it is only 67% of the medical staff observes hand hygiene in Australia before coming into physical contact with the patients.
Two types of microbes which colonizes the hand are in existence. The two are resident flora and transient flora. Resident flora is made up of microorganisms which resides in the superficial cells of stratum corneum. On the other hand, the superficial skin layers are colonized by transient flora and routine hand hygiene can potential remove them. The skin supports the survival of the microorganism though they cannot multiply. Health care workers tends to acquire these microorganisms when they are in direct contact with the patients (Chassin, Mayer & Nether, 2015). Transient microorganisms may also be acquired when the health care workers comes into close contact with environmental surfaces which are contaminated with the infections.
The Benefits of Hand Hygiene
Within the ABC hospital the healthcare workers hands are usually colonized with pathogens such as methicillin resistant St… Aureus, vancomycin resistant Enterococcus, MDR-Gram Negative bacteria as well as Clostridium difficle. The survival time of these organisms can last up to 150 hours. The epithelial cells that contains viable micro-organisms are shed on daily basis from the normal skin. This may lead to contamination of bed linen, furniture and gowns which are objects in the close surrounding of the patient. The carriage of the resistant pathogens by the hand has been found to be associated with the nosocomial infections. The critical care area accounts for the highest infection rates through the contamination of the hand (Edmisten et al, 2017). Within this sector, cross-transmission is also very high. Contamination of the hands may occur just by touching either the intact skin of the patient or inanimate objects in the patients room mainly in clean procedures.
Hand hygiene is a method of controlling infections through cleansing of the hands. Hospital acquired infections presents an imminent danger to patients within the healthcare environment as well as the healthcare workers such as nurses who contributes to these transmissions. As by the WHO (2009), the rate of incidence and prevalence of hospital acquired infections has been on the rise amongst the world’s population with fourteen million people suffering from the infections. The transmission of these infections from one patient to the other is occurring through hands of the healthcare workers(World Health Organization, 2009). This means that hand hygiene has the potential of reversing this increasing trend. The patient safety in Australia is threatened by one of the factors being hospital acquired infections.
In Australia hand hygiene has been seen to reduce hospitalizations occurring due to Hospital acquired infections. Regardless of these efforts, there is still low compliance levels of hand hygiene in Australia. The rates of hand hygiene has not attained optimum levels. Although hand washing is effective for control of infections, an audit of the 5 moments of hand hygiene in Australia reveals some gaps(National Health and Medical Research Council (2019). It was observed that only 67% of the healthcare staff adheres to hand hygiene before attending to a patient ( HH moment one).
The World Health Organization in a bid of promoting hand hygiene it has promoted five moments of hand hygiene which are :
- Before client contact; hands should be cleaned before touching the patient or when approaching for protection against the germs which may be transmitted through the hand(WHO, 2007).
- Before Aseptic ; the hands should be immediately cleaned prior to aseptic task for protection of the clients against dangerous germs from being transmitted to their bodies.
- After the body fluids; hands should be immediately cleaned after being exposed to risk body fluids and removal of the gloves.
- After patient contact ; hands should be cleaned immediately after touching the patients when leaving the clients.
- After surrounding; it is advisable to clean the hands after coming into a touch with any object within the surrounding of the patient and when leaving do touch the patients.
Hand hygiene is being promoted because it comes with several benefits both for the patients and the healthcare staffs. The importance of hand hygiene include the following:
- It prevents the transmission of the nosomical infections
- It reduces the incidence and prevalence of Methicillin -resistant Staphylococcus aureus (MRSA).
Nosocomial Infections and Hand Hygiene
A nosocomial infection is a type of infection in which an hospital environment favors it. This type of infection can be developed by a patient after visiting an hospital set up or acquired by hospital staff. There are various nosocomial infections but the most common are; Staphylococcus aureus , MRSA, gastroenteritis, Clostridium difficle and hospital acquired pneumonia. Nosocomial infections are favored by the conditions within the hospital set up. Invasive devices in the hospital set up such as surgical drains, intubation tubes and catheters are bypassing the natural lines of the body defense against germs hence increasing their penetration((Sparksman, Knowles, Werrett & Holt, 2015). Patients who have been colonized already are placed at a higher risk when they are subjected to invasive devices.
MRSA is a bacterium that causes difficulties in breathing among humans.it is any strain of Staphylococcus aureus which is resistant to beta- lactam antibiotics. The infection is mainly transmitted through direct contact with either the wounds, discharge or soil areas. Besides these, they are other risk factors for this infection. The factors include; coming into close contact, poor personal hygiene , catheters and presence of breaks ups in the skin. However, when hand hygiene is practiced, it can be effective method of controlling these infections. Frequent hand washing before touching the mouth, or eyes will reduce the risk of this infection. (van, Reinhardt & Grimmelikhuijsen, 2022). Washing hands immediately after touching public installations like doors and knobs helps prevent the transmission of the infection. Wearing gloves when dealing with soiled objects followed by proper hand hygiene reduces the chances of contracting and transmitting this infection.
Hospital acquired pneumonia is a type of pneumonia which is developed by a patient within the hospital environment in a period between 48-72 hours following admission. This is the second most prevalent nosocomial infection accounting for fifteen to twenty percent of the nosocomial infections. It is the primary cause of death in ICU’s. Proper hand hygiene such as washing hands before touching the nose , eyes and parts of the body helps in reducing the transmission of this infection((Saitoh et al, 2020). Older persons are at higher risk of hospital acquired infections. Among them respiratory tract infections and urinary infections are common. Hospital acquired pneumonia is the most prevalent respiratory tract infection among the elderly. The elderly are more prone to this infections because their immunological competence is reduced due to age. As individuals grows old, they become more susceptible to comorbid conditions such as diabetes, arthritis and renal insufficiency(Azim & Claws, 2014). Comorbid conditions including the type and number predisposes individuals to infections. When individuals grow old, immunosenescence occurs hence the immune system does not functions well. The combination of high comorbid conditions and reduction in the immune system increases the vulnerability of the older people to these hospital acquired infections. Additionally, as people grows older, their body mass index also falls hence becoming susceptible to falls and injuries. All these things therefore predisposes them to hospital acquired infections(Hong et al, 2015). Older people also tends to be less compliant with hand hygiene thus increasing their vulnerability to these infections.
Prevention of MRSA
As mentioned earlier, the level of hand hygiene compliance within the Aged Care facilities are still very low(Prescott, Mahida, Wilkinson & Gray, 2021). This can be attributed to several barriers. One of these barriers is the stressful working environment causing the healthcare staff not to observe hand hygiene. Hence the staff should constantly be reminded to observe hand hygiene after assisting an individual. Another barrier to hand hygiene is the lack of instruments within the aged care facilities. The absence of education and training is also another barrier hindering the development of an enabling environment for practicing proper hand hygiene. Within the ABC healthcare set up, there are 52 beds in single room accommodation. Within this 52 bed facility, it is inclusive of 22 dementia specific wing. The residents houses comprises of single, double and four bedrooms with garden views. 22 individuals who are living independently hence granting the residents with a free maintenance and relaxing lifestyle. The facility provides medical coverage when need arises(Haque et al, 2017). It has recreational activity officers responsible for designing individual as well as group activity programs to foster enjoyment and self-esteem. It also have various denominations ministers who upon request they visit to minister for the residents having different spiritual needs.
Within the ABC hospital the staff are required to dry the hands with a towel after washing. This is because the friction aids in the removal of transient organisms from skin surface. Recently, following the advent of Covid-19, the organization recommended the use of disposable paper for drying the hand which is regarded by knowledgeable healthcare professionals as most effective and quickest way. In a situation in where the washing facilities are very poor, the risk of infection is very high. Within the ABC Hospital set up there are clinical hand wish sink in all the areas where clinical activities are carried out. The sinks have been placed in convenient places. To foster frequent and appropriate washing of hands, sinks have been placed in convenient places while soap and water has been provided in sufficient quantities. To boost the hand hygiene compliance, adequate and relevant facilities should be provided. The factors that hinder adoption of hand hygiene as a routine strategy include; poor facilities and methods as well absence of time (Hosseinialhashem et al, 2015). At the ABC hospital, the management has shown commitment for improving resources needed for the improvement of poor hand hygiene amongst the patients and the healthcare workers.
Hospital Acquired Pneumonia
To boost the chances of compliance, there is need for ease accessibility of hand hygiene either the sinks or alcohol handrub. Health care staff who are very busy tends to find it difficult to reach to the wash basin or even the antiseptic hand agents hence resulting to non-compliance. There are various antiseptic agents that are used in the cleaning of hands. Within the ABC , soap, water and antiseptics like chlorhexidine, tricosan and povidone iodine are used for hand washing(Gauge, Fischer & Lermer,2021). Alcohol which contains 60-90% ethanol is used commonly used. For the removal of transient microorganisms, liquid soap is being used. The reason why liquid soap is preferred to bar soap is for the avoidance of the contamination issues. Within this organization, it has been established that hand washing using liquid soap is sufficient for the most routine procedures. The handling of the equipment that has been used can be removed easily through 15- 30 seconds wash. The liquid soap dispenser prevents the contamination of lead (Tantum et al, 2021).
In order to boost the hand hygiene compliance as strategy to reducing hospital acquired infections, healthcare organizations should introduce an education program. The organizations should consider adopting a multi-modal educational strategies. Within this strategy, interventions for prevention and control are developed and healthcare workers are made aware of them through education and training. Professionals in the healthcare sector should be made aware of the theoretical knowledge. Most of the hand hygiene knowledge is acquired by the nurses and other healthcare staff in the workplace. This calls for the need of further education and training about the hand hygiene within the clinical environment.
Multi-modal educational strategy effectiveness in enhancing the compliance of hand hygiene has been the subject of interest for many researchers. For example the WHO multi- modal education program which is founded on ‘My 5 moments for Hand Hygiene’. The focus of this approach is on the improvement of the safety of the patient through prevention and control of the hospital acquired infections. The strategy has been confirmed to enhance compliance among the healthcare staff. Sufficient evidence exists on the hand hygiene effectiveness in enhancing compliance to both the federal and international requirements of hand hygiene. The educational program attains their efficacy for the improvement of hand hygiene by increasing the knowledge about hand hygiene amongst the healthcare staff. The strategy also instils a positive attitude about the hand hygiene which is an aspect improving compliance to both the national and international legislations principles.
An education program was designed and delivered by the author to address the problem identified in lack of adherence to moment XX of the 5 moments of hand hygiene. The education included use of the Glow Germ tool, which allowed staff to understand the best way to perform hand hygiene.
The education strategy was in delivered in various ways such as simulation, visual cues and through teamwork. Simulation is an effective method that can be used in enhancing compliance amongst the nurses at the ward. Through simulation nurses was taught in an interactive environment which provided room for instant feedback for them to ask questions or seek clarifications regarding the practice. The nurses were shown by the head nurses how they should practice hands hygiene, the length of time as well as what is being used. With this repetitive practice, the nurses will finally be competent in hand hygiene.
The education strategy was also delivered using visual cues. Visual cues were used to remind the nurses about of the infections as well as the importance of hand hygiene. Laminated posters were posted in labs and along the corridors for the nurses to see them on routine basis. Screens were mounted on the hospital corridors and played videos talking about hand hygiene practices occasionally. This ensured that the nurses did not forgot about hand hygiene even after wearing gloves.
The education strategy also emphasized the importance of team work in enhancing hand hygiene compliance. The education strategy was established not only to target nurses working in the wards but also the ward as a whole. Team work enabled nurses to discuss together the best simulation specifications and methods implemented in the wards. Older nurses were tasked with introducing student and new nurses for them to establish a culture of hand hygiene.
The education strategy also included the provision of products and sinks to enhance access to hand hygiene. The hand sanitizers should be placed in the washrooms and across the wards to enhance hand hygiene compliance. Hand sanitizers were also fixed on the walls and beds in the wards. This was aimed at boosting the education strategy of dispenser location.
To evaluate the efficacy of education on improvement of hand hygiene compliance, hand hygiene audit checklist will be used. The checklist will be used to ascertain whether the WHO Five Moments of Hand Hygiene has been adhered to. The overall compliance score of the staff will be measured. The following will also be done:
- The details of each healthcare staff will be specified
- Photos will be taken to support key findings during the audit of hand hygiene
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