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Strategies For Achieving Hand Hygiene In A Clinical Setting

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Discuss about the Strategies For Achieving Hand Hygiene In A Clinical Setting.



In every clinical setting, a safe delivery of healthcare is essential to enable a positive outcome for the patients and nurses. Clinical risk management helps in improving safe delivery and the quality of healthcare, as it introduces systems which aid in the identification and prevention of circumstances that can put patients at risk of any harm (Whitcomb, 2014). The knowledge and role of nurses in the management of clinical risks are hence very important so as to enable the identification of any possible risks not only to the patient but also to the general clinical setting. The aim of this paper is to show a clear demonstration of the evaluation and understanding regarding the role of nurse leadership based on managing clinical risks as well as the Australian Commission for Quality and Safety in the healthcare standards forAustralians. The paper focuses on the identification of relevant strategies that can be adopted within a clinical setting to improve the compliance of hand hygiene and the implications of nurses in ensuring thatthe identified strategies are implemented.

Strategies for Effective hand Hygiene

According to Stock et al. (2016), healthcare-associated infections often occur when the disease-causing organisms are transferred when the hands of healthcare providers come into contact with patients and the infected areas during the process of duty. The same study points out that most of the common infections are related to surgical sites and urinary tract infections while infections of the bloodstream and pneumonia occur as a result of multi-drug resistant germs like MRSA. On the other hand, Waltman et al. (2011) denote that in every 100 patients hospitalized in a clinical setting, at least ten in developing countries and seven in developed countries will often acquire infections associated with healthcare. However, the figure often rises to thirty perhundredadmitted patients. For these reasons, Alemagno et al. (2011) indicate that practicing effective and continuous hand hygiene is essential in reducing these infections as well as any possible spread of antimicrobial resistance within the workplace.

With the increase in the level of resistance to key medicine and antibiotics in healthcare settings, Pan et al. (2016) point out that it is more necessary than ever to aim to reduce the number of avoidable hospital infections. As a result, prevention of cross-transmission of disease-causing germs is the best way of reducing the number of infections of this kind, as well as antimicrobial resistance. Ensuring hand hygiene is one essential strategy that can be adopted in a healthcare setting to protect staff from the related infections thus preventing the spread of resistant germs. Mortland (2016) also denotes that infection control and prevention is one of the key policy pillars recommended by the Australian Commission for Quality and Safety to combat the growing challenge of antimicrobial resistance. Other pillars recommended by the organization include appropriate and relevant national disease policies and plans as well as improving the surveillance of the pathogens causing resistant infections. The organization also recommends an uninterrupted access to high-quality and essential medication, proper use of prescribed medicine the patients, in addition to more training and research on new treatment developments.


For effective hand hygiene strategies, the compliance by the Australian Commission for Quality and Safety consists of five major components. These include ensuring that the healthcare providers have access to alcohol-based hand rub for disinfection during hand washing, education and training forhealthcare workers on the essential times in the healthcare for hand hygiene, effective monitoring and feedback on compliance, creating a culture of attention to the safety of both healthcare workers and patients within healthcare institutions, and the use of visual reminders at different points of care in the workplace. In this scenario, the hand hygiene strategies recommended for healthcare include;

Education: In many cases, Chhapola and Brar (2011) denote that many people often suffer due to a lack of understanding on the essentiality of hand hygiene,both inhospitalsand residences alike. Despite knowing the importance of hand hygiene in a clinical setting and the risks involved when it is not practiced, most clinical staff only practice hand washing after some specific procedures while ignoring other vital but risky roles within the healthcare setting. In a systematic review, Rahim and Barnett (2011) point out that the knowledge on hand hygiene should not be ignored despite medical staff having a professional awareness of the risks involved. According to the Australian Commission for Quality and Safety guidelines, hand washing should be practiced in five key areas when working with patients and preferably using an alcohol-based rub as a detergent or soap with water in a visibly dirty hand.

Hands should be washed before touching any patients; before any cleaning or aseptic procedure, after the nurses’ contact withbody fluids, subsequent to touching a patient, and after touching the surrounding environment where the patient isin. The aforementionedstrategies of the Australian Commission for Quality and Safety are recommended by the Joint Commission International,the European and the US Centers for Disease Control, and all other health professional guidelines. In their review, Aunger and Schmidt (2012) also point out that these compliance guidelines to hand washing and hygiene have been implemented globally in over 15700 clinical settings in over 168 countries globally. The same study denotes that over 68 governments have based their hand hygiene campaigns on these guidelines. 


Installation of stainless steel sinks in designated areas of the hospital for hand-washing: The uses of stainless steelclinical sinks are some common healthcare fixtures known in hospitals and healthcare. According to Marques (2017), the sinks have a hard metallic surface that reduces the ability of the bacteria to adhere to the walls and survive when properly maintained, hence reducing the chances of microorganisms and molds that can cause infections. The same study denotes that it is often the first choice for use in strict hygienic conditions due to its cleanabilitythus recommended for hospital installations and healthcare. 

The use of Medi Sinks (figure 1) can also be adapted for easy use and maintenance, as it offers accessible facility for hand-washing, at a lower cost than what could have been quoted for installing plumbing materials (Deyneko et al., 2016). The strategy will also enable the organization to meet the requirement for hand-washing as per the Australian Commission for Quality and Safety guidelines for body art and personal care for healthcare providers. These sinks are easy to access, use, and maintain and often used as a cost-effective solution for hospitals with low budget according to Lorenzi (2017). Kotay et al. (2017) also denote that the sinks can be fixed or positioned at any appropriate location giving the users flexibility thus allowing the hand-wash basin to be placed where it is needed.

Strategic relationship with the national standards and how they will increase compliance

In their study, Lee and Greig (2010) signify that infections are often caused by various factors that are related to processes and systems of care provision and human behavior. These behaviors are often conditioned by economic, political, and educational constraints in addition to societal beliefs and norms. However, most of these infections are often preventive according to Kotay et al. (2017). The same studyshows that hand hygiene is the primary measure that should be adopted in hospitals, workplaces, and residential areas to reduce preventable infections. In their study, Rahim and Barnett (2011) denotethat proper hand hygiene compliance is a major challenge faced by many global healthcare providers. As a result, many approaches and strategies are recommended that can influence hand hygiene compliance in addition to new approaches and promotional strategies (Duval, 2010).

In the case study, education will help in creating awareness amongst staff and the public who interact within the organization. Through education, they will have a clear evaluation and understanding of the nature of disease transmission while nurses will be more updated on drug resistance infections that can be easily prevented through simple but regular hand-washing. Education will also help in advocating for other essential health compliance guidelines that might have been neglected by staff but can have a direct or indirect effect on their health as well as that of the patient. The management of the organization together with the staff will also have education forums, campaigns, and events that will not only help them to adopt change within the organization, but would also encourage the public (visitors, patients, friends, and families) to practice hand-washing in their residences.

According to the Australian Commission for Quality and Safety guidelines, health and safety of the staff and patients should be the number one goal of every healthcare provider or organization. As a result, the resources and facilities that are vital for achieving this standard should always be safe and accessible to all within the healthcare facility as per Kotay et al. (2017). Adapting the use of sinks within the organization is necessary while the management should always ensure that the sinks have safe and clean water constantly running for hand-washing at all times. As the sinks are placed or fixed in accessible locations with alcohol-based detergent or soap, the service is made available to for use to ensure hand hygiene and hence increases the compliance as per the guidelines.


Implications for Professional Nursing Practice in the Implementation of the Strategies

According to Tsalik et al. (2011), hand hygiene is considered among the most important measures that should be adopted in both clinical and residential settings with the aim of preventing the spread of infections. Research proves that one in five hospitals do not fully comply with the strategies and guidelines recommended for healthcare settings (Duval, 2010). However, Barrow, Mehler, and Price (2012) refute this claim by blaming the management of these organizations for their failure to ensure these strategies are in place.

According to him, the commitment of leadership in hand hygiene should be engaging and visible to the public and the organization through hand hygiene education, formal communication, event sponsorships, and promotions. However, professional nursing practices often view hand hygiene as a common-sense concept refuting the saying ‘common sense is not common for everybody’.

In this case, the Nursing Unit Department should establish continuous and periodical monitoring and report on the rate of infections such as the emerging drug-resistant pathogens and tracking endemics that are related to hand hygiene for nurses and patients. In his study, Kingston, O'Connell, and Dunne (2017) denote that it is an essential aspect of the professional nursing practices to help in creating a multidisciplinary response and design team led by the senior leaders within the organization with the aim of making emphasis on the commitment of the organization towards hand hygiene compliance. Such a multidisciplinary response is essential for providing a base of training and education for the patients, staff, visitors, and families as well as creating awareness on hand hygiene through brochures, instructive posters, and pocket cards as pointed out by Lee and Greig  (2010). With sinks designed at strategic points within the clinical setting, training and awareness strategies, the use of the sinks for hand-washing before and after essential produces will increase.


With the help of leadership, professional nurses should also ensure that relevant resources for hand hygiene can be easily accessed throughout the organizations including corridors for patient care, exits and entrance points of the staff and patient rooms. In a systematic review, Whitcomb (2014) denotes that making the hand hygiene resources available helps in reinforcing the accountability and behavioral adoption for hand-washing not only among the staff but even the public (patients, visitors, and families). The same study denotes that other organizations have often been successful in conducting various contests and later recognizing the healthcare workers and medical staff who comply with the hand hygiene guidelines. Ford et al. (2014) also assert that there is a need of developing a continuous monitoring program that would post weekly or monthly compliance information in the clinic websites and units, and discuss the findings with staff during regular professional meetings. Such strategies will be beneficial in encouraging the use of sinks and the understanding of the importance of detergents used with the aim of reducing hand hygiene related infections.


In summary, although it is accepted that hand hygiene is one of the most critical patient and staff safety practices in reducing infections associated with healthcare settings, there is a low compliance with the practice in many healthcare providers. Many studies have different concepts concerning the hand hygiene compliance with interventions lacking in most organizations. However, healthcare-associated infections are caused by various factors and affect millions of patients and professionals globally every year. These infections can lead to more complicated illnesses, induced long-term health complications, high cost of care forpatients and their families, the massive financial burden on the healthcare systems, prolonged hospital stay, and tragic loss of life in worst cases. Education is hence necessary for both the staff and public, with the aim of creating awareness on the basic knowledge of hand hygiene and the importance of thorough hand washing before or after handling a patient. Installation of sinks is also an effective strategy, as it provides easy access for hand washing, in designated places.



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 Worker's. Journal Of Continuing Education In Nursing, 41(10), 463-471.

Aunger, R., & Schmidt, W. (2012).Experimental Pretesting of Hand-Washing Interventions in a Natural Setting. American Journal Of Public Health, 99S405-S411.

Barrow, B., Mehler, P., & Price, C. (2012). A communications campaign designed to improve hand hygiene compliance and reduce infection rates. Journal Of Communication In Healthcare, 2(1), 61-77.

Chhapola, V., &Brar, R. (2015).Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit. International Journal Of Nursing Practice, 21(5), 486-492. doi:10.1111/ijn.12283

Deyneko, A., Cordeiro, F., Berlin, L., Ben-David, D., Perna, S., &Longtin, Y. (2016).Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study. BMC Infectious Diseases, 161-7.doi:10.1186/s12879-016-1535-x

Duval, L. (2010). CNE: Continuing Nursing Education. Infection Control 101. Nephrology Nursing Journal, 37(5), 485-489.

Ford, E. e., Boyer, B. T., Menachemi, N., & Huerta, T. R. (2014). Increasing Hand Washing Compliance With a Simple Visual Cue. American Journal Of Public Health, 104(10), 1851-1856.

Kingston, L. l., O'Connell, N. H., & Dunne, C. P. (2017). Survey of attitudes and practices of Irish nursing students towards hand hygiene, including handrubbing with alcohol-based hand rub. Nurse Education Today, 5257-62.

Kotay, S., Weidong, C., Guilford, W., Barry, K., &Mathers, A. J. (2017). Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs. Applied & Environmental Microbiology, 83(8), 1-12. doi:10.1128/AEM.03327-16

Lee, M. B., &Greig, J. D. (2010). A Review of Gastrointestinal Outbreaks in Schools: Effective Infection Control Interventions. Journal Of School Health, 80(12), 588-598.

Lorenzi, N. (2017). Hospital plumbing system advances. Health Facilities Management, 30(3), 41-44.

Marques, R., Gregório, J., Pinheiro, F., Póvoa, P., da Silva, M. M., &Lapão, L. V. (2017). How can information systems provide support to nurses' hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections. BMC Medical Informatics & Decision Making, 171-16.doi:10.1186/s12911-017-0410-z

Mortland, S. (2012). Hospitals taking extra care in preventing infections. Crain's Cleveland Business, 28(49), 7.

Pan, S., Sheng, W., Tien, K., Chien, K., Chen, Y., & Chang, S. (2016). Promoting a Hand Hygiene Program Using Social Media: An Observational Study. Journal Of Medical Internet Research, 18(2), 1. doi:10.2196/publichealth.5101

Rahim, R. A., & Barnett, T. (2013).Reducing nosocomial infection in neonatal intensive care: An intervention study. International Journal Of Nursing Practice, 15(6), 580-584. doi:10.1111/j.1440-172X.2009.01800.x

Stock, S. s., Tebest, R. r., Westermann, K. k., Samel, C. c., Strohbücker, B. b., Stosch, C. c., & ... Redaèlli, M. m. (2016). Implementation of an innovative hands-on training to improve adherence to hygiene rules: A feasibility Study. Nurse Education Today, 36407-411.

Tsalik, E. L., Cunningham, C. K., Cunningham, H. M., Lopez-Marti, M. G., Sangvai, D. G., Purdy, W. K., & ... Hendershot, E. F. (2011). An Infection Control Program for a 2011 Influenza A H1N1 Outbreak in a University-Based Summer Camp. Journal Of American College Health, 59(5), 419-426.

Waltman, P. A., Schenk, L. K., Martin, T. M., & Walker, J. (2011). Effects of Student Participation in Hand Hygiene Monitoring on Knowledge and Perception of Infection Control Practices. Journal Of Nursing Education, 50(4), 216-221.

Whitcomb, K. k. (2014). Using a Multidimensional Approach to Improve Quality Related to Students’ Hand Hygiene Practice. Nurse Educator, 39(6), 269-273.


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