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Hand Hygiene And Patient Safety

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Discuss about the Hand Hygiene and Patient Safety.



Healthcare Associated Infections (HAIs) have been defined as those infections that either the patient or hospital staff acquire within the care setting (for example, from same day surgery, hemodialysis unit, or inpatient admission at the hospital among others) with evidence lacking that the person had the infection present or the infection was in the incubation stage when the person entered the hospital setting (Horan, Andrus & Dudreck, 2008). The increasing HAI rates along with evidence that suggests that infection control and active surveillance can help in the prevention of HAIs has resulted in the development of hospital infection and epidemiology programs. The role that these programs has continued to evolve even as HAIs and microbial resistance leads to increasing risks to patients and escalating costs of healthcare.

The IOM has defined patient safety as protection of patients against any harm.  More emphasis is placed on the care delivery system that enables prevention of errors, learns from any occurrence of errors; and is based on a safety culture that includes patients, organizations, and healthcare professionals. The AHRQ Patient Safety Network Web glossary expounds on what prevention of patients from any harm encompasses and defines it as freedom from preventable or accidental injuries that are as a result of medical care (AHRQ, 2007).

The patient defining attributes include medical errors prevention and adverse events that are avoidable, protecting of patients from any injury or harm, and well integrated strong healthcare system and individual healthcare service providers collaborative effort (Kim, Lyder, & Mc Neese et al., 2015).

According to the RNs standards off practice (6.1 and 6.6), the nurse is tasked with providing quality, comprehensive, safe care to achieve expected outcomes and goals that are in response to the needs of patients. The nurse should utilize the processes that are most appropriate in identifying and reporting actual and potential risks  as well as below par practice with regard to standards is identified.


The most significant role when it comes to patient safety within any healthcare setting, is the ability to integrate and coordinate the multiple quality aspects within the care that the nurse provides directly, and across the delivery of care given by others within the same setting. This function of integration is a component of  proper staffing (where the percentage of RNs is greater than that of other nursing staff) and is linked to lower mortality and fewer complications. In addition, when the significance of communication is put into consideration, or lapses in communication that result in error commission, the role that nurses play as links to communication within a healthcare facility, becomes obvious. The PSNet clearly defines the error chain where indications are given on the part played by communication and leadership in the event series that leads to patient harm. The errors' Root-cause analyses provides linked causes' categories and these include non-adherence to standard procedures of operations; poor leadership; teamwork or communication breakdown; ignoring or overlooking fallibility in individuals; and losing focus on objectives (AHRQ, 2007)

Why Hand Hygiene improves patient safety

Increasing attention to Healthcare Acquired Infections has been an issue among patients, regulatory bodies, governments, and insurers. This is not confined to the problem's magnitude with regard to mortality, morbidity, and treatment cost, but also because of the increasing awareness that majority of HAIs are preventable (Sharma & Ahmed, 2010). The healthcare industry is observing in tandem, the unprecedented progress in pathophysiology of infectious diseases' understanding and the worldwide spread of infections that are multi-drug resistant within healthcare facilities. These factors, along with the paucity of new antimicrobials availability, have called for a re-focusing of the role played by basic prevention of infection techniques in today's healthcare facilities. Among the most critical activities of infection control, hand hygiene is regarded as a critical element (Lin, Tien, & Sun, et al., 2010; Trick, Vernon, & Welbel, et al., 2007). The increasing burden that is associated with Hospital Acquired Infections, the increasing illnesses severity, treatment complexity, which are compounded by multi-drug resistant (MDR) superimposed pathogen infections, staff in healthcare facilities are now reverting to infection prevention basics through simple measures such as hand hygiene (Saint, Howell, & Krein, 2010). This approach is based on the evidence that supports hand hygiene where if implemented properly, can reduce infection cross transmission risk within healthcare facilities  Grayson, Russo, &  Cruickshank et al., 2011).

Evidence from a number of studies have shown that hand washing eradicates methicillin resistant S. aureus (MRSA) that may be present in an individual's hands and often occurs in most staffs providing care in ICUs( Miyachi, Furuya & Umezawa et al., 2007; Grayson, Jarvie, &  Martin et al., 2008). Increasing compliance in hand washing has been shown to result in decreased rates of MRSA (Marimuthu, Pittet,, & Harbarth, 2014).  In addition infections from Klebsiella sp. have been shown to decline with increased compliance to hand hygiene (Sydnor, & Perl, 2011). Further, studies have also shown that hand hygiene practice adherence minimizes the acquisition of disease carrying pathogens that may be present on the hands and which ultimately minimizes the Healthcare Acquired Infections rates ( Magiorakos, Leens , Drouvot, et al.,2015; Kirkland, Homa, & Lasky et al., 2012).

The “SAVE LIVES: Clean Your Hands” WHO program puts more emphasis on  the “My 5 Moments for Hand Hygiene” as a patient protection approach that is key within healthcare facilities, against spreading of pathogens and in reduction of Hospital Acquired Infections. This approach emphasizes and encourages healthcare workers to adopt a habit of cleaning their hands often: prior to touching a patient; prior to aseptic/cleaning procedures; after physical hand contact with a patient; after exposure or risk of exposure to body fluid; and after hand contact with patients' surroundings (Sax, Allegranzi, & Uckay et al., 2007).


Ways of maintaining hand hygiene

Soap and water is used in hand washing when: hands are visibly dirty or have been in contact with blood, proteinaceous material, or any body fluids and when one suspects or can prove to have come into contact with Bacillus anthracis (the physical washing and rinsing of one's hands in cases of B.anthracis contamination is recommended as antiseptic agents such as iodophors, chlorhexidine, and alcohols do not act effectively against spores);  after visiting a bathroom,  hands need to be washed with water and an antimicrobial soap; prior to and after having a meal (Dettenkofer, & Conrad, 2010).

Alcohol based hand rubs are most effective in routine decontamination of hands when there is no visible dirt or contamination (Gould, Moralejo, &  Drey et al., 2010). The alcohol based hand rubs should be used prior to any direct contact that a healthcare worker will have with a patient; prior to putting on sterile gloves before insertion of a central intravascular catheter; prior to insertion of any peripheral vascular or indwelling urinary catheters, or other non-surgical invasive devices; after physical hand contact with a patient's skin for example when lifting a patient, after taking a patient's blood pressure or  after checking the patient's pulse; after coming into contact with mucous membrane, body excretions or fluids, wound dressings, noon-intact skin, if hands are not soiled in a visible way; after coming into contact with objects that are within that patient's surroundings though inanimate such as medical equipment; when moving to a clean site form a contaminate site after caring for a patient; and after removal latex gloves.


When washing the hands, all jewelry needs to be removed prior to commencing and hands rinsed under warm running water. The soap should be lathered using friction with all fingers and hand surfaces covered adequately. The faucet should be turned off by using the elbow or wrist. The hands should be dried using a single use towel or hot air hand drying machine. The skin should be patted and not rubbed so as to prevent any cracking.

If one uses disposable towels, they should be discarded immediately after use. Excoriation on the skin may result in colonization of bacteria and increased possibility of blood borne viruses and other microorganisms' infection spread.

Compliance to hand washing may decrease when hands are sore, in such instances, an adequate amount of antiseptic rub should be dubbed on all surfaces and the antiseptic allowed to dry on its own (WHO, 2009).



The increasing HAI rates along with evidence that suggests that infection control and active surveillance can help in the prevention of HAIs has resulted in the development of hospital infection and epidemiology programs. Hospital Acquired infections are preventable and with adherence to hand washing protocols, the occurrence of HAIs can be reduced significantly. Nurses and other healthcare workers need to be compelled to follow strict hand washing guidelines as by doing so; the costs of patient care can be reduced. In addition, hand washing should be practiced regularly for the individual protection of the nurses and care staff from cross contamination resulting from contact with patients or the patients' surrounding environments.



AHRQ PSNet Patient Safety Network(2007). Error chain. [Accessed April 26, 2017].

Dettenkofer, M., & Conrad, A. (2010). Hand Hygiene for the Prevention of Nosocomial Infections. deutsches arzteblatt international, 107(8), 139-139.

Gould DJ, Moralejo D, Drey N, Chudleigh JH (2010) Interventions to improve hand hygiene compliance in patient care Cochrane Database of Systematic Reviews Issue 9. Art. No.: CD005186. DOI: 10.1002/14651858.CD005186.pub3.

Grayson ML, Jarvie LJ, Martin R, Johnson PD, Jodoin ME, McMullan C, Gregory RH, Bellis K, Cunnington K, Wilson FL, Quin D, Kelly AM, Kelly AM, Hand Hygiene Study Group and Hand Hygiene Statewide Roll-out Group, Victorian Quality Council(2008). Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust. 2008;188(11):633–640.

Grayson ML, Russo PL, Cruickshank M, Bear JL, Gee CA, Hughes CF, Johnson PD, McCann R, McMillan AJ, Mitchell BG, Selvey CE, Smith RE, Wilkinson I. (2011).Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust. 95(10):615–619. doi: 10.5694/mja11.10747

Horan, T. C., M. Andrus, and M. A. Dudeck. (2008). CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am. J. Infect. Control 36:309-332

Kim, L., Lyder, C. H., McNeese?Smith, D., Leach, L. S., & Needleman, J. (2015). Defining attributes of patient safety through a concept analysis. Journal of advanced nursing, 71(11), 2490-2503.

Kirkland KB, Homa KA, Lasky RA, Ptak JA, Taylor EA, Splaine ME. (2012). Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series. BMJ Qual Saf. 21(12):1019–1026. doi: 10.1136/bmjqs-2012-000800

Landers, T., Abusalem, S., Coty, M.B., & Bingham, J. (2012). Patient-centered hand hygiene: the next step in infection prevention. American Journal of Infection Control, 40(4), S11-S17.

Lin HC, Tien KL, Sun CC, Wang SH, Chen YC, et al. (2010) Promotion and achievement of a hospital-wide hand hygiene program implemented during 2004–2007 at a teaching hospital in Taiwan. J Infect Control 20: 146–162

 Magiorakos AP, Leens E, Drouvot V, et al. (2015) Pathways to clean hands: highlights of successful hand hygiene implementation strategies in Europe. (accessed on 26 April, 2017);Euro Surveill. 2010 15:ii–19560. Available from: .

Marimuthu, K., Pittet, D., & Harbarth, S. (2014). The effect of improved hand hygiene on nosocomial MRSA control. Antimicrobial Resistance and Infection Control, 3, 34.

Mitchell PH.(2008).Defining Patient Safety and Quality Care. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); Apr. Chapter 1. Available from:

Miyachi H, Furuya H, Umezawa K, Itoh Y, Ohshima T, et al. (2007) Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches. Am J Infect Control 35: 115–121

Saint S, Howell JD, Krein SL (2010) Implementation Science: How to Jump-Start Infection Prevention. Infect Control Hosp Epidemiol 31: S14–S17.

Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, et al. (2007) ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 67: 9–21.

Sharma JB, Ahmed GU (2010). Infection control with limited resources: why and how to make it possible. Indian J Med Microbiol. 2010;28:11–6.

Sharma JB, Ahmed GU. Infection control with limited resources: why and how to make it possible. Indian J Med Microbiol. 2010;28:11–6

Sydnor, E. R. M., & Perl, T. M. (2011). Hospital Epidemiology and Infection Control in Acute-Care Settings. Clinical Microbiology Reviews, 24(1), 141–173.

Trick WE, Vernon MO, Welbel SF, Demarais P, Hayden MK, et al. (2007) Chicago Antimicrobial Resistance Project. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 28: 42–49

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