Running head: HAND HYGIENE IN HEALTHCARE

Hand Hygiene in Healthcare Tori Gwilt Ferris State University

HAND HYGIENE IN HEALTHCARE Abstract Hand hygiene is one of the most valuable and substantial practices in preventing hospital

acquired infections. Unfortunately, compliance is extremely and precariously low in all hospitals in various countries around the world. Although the act of hand washing is a relatively simple concept, it is difficult to put the action into practice as it relies heavily upon individual accountability. The most common reasons for inadequate hand hygiene include no available antiseptic supplies, lack of time, and more pressing responsibilities of the health care worker. Even in the presence of these obstacles, the hand hygiene process can be amended to conform to the predetermined standards and regulations set in place for the safety and welfare of the patient population. The adoption of these new protocols will require modification of behavior, along with cooperation from all health care personnel. However, alteration is vital in order to prevent the rapid spread of infection among people.

HAND HYGIENE IN HEALTHCARE Hand Hygiene in Healthcare Hand hygiene is the act of thoroughly washing and cleaning hands with the intent to eliminate potentially harmful organisms. This process can be accomplished through the use of

soap and water or alcohol hand gel. It is an essential and relevant practice used during every day activities in everyday life. It is especially valuable and substantial in the realm of the health care field. The simple act of hand washing is an integral component in the prevention of hospital acquired infections. It also helps to thwart the transmission of illnesses and diseases passed from person to person. Unfortunately, it is a practice that is often neglected and disregarded. This causes catastrophic consequences in the health and wellness of the patient population by increasing the risk and development of infections. Within the last 200 years, the connection has been made regarding hand hygiene hindering the development of nosocomial infections (Mathai, Allegranzi, Kilpatrick, & Pittet, 2010). Since this time, a moderate amount of research has been conducted on the subject of hand hygiene. Past research on this topic has been pointed towards how and why hand hygiene prevents and reduces the risk of infection. However, recent research has discovered that despite its advantages, hand hygiene compliance is extremely and dangerously low in the hospital setting, frequently and repeatedly falling below 50 percent (Camargo et al., 2009). This paper discusses the many obstacles that prevent proper hand hygiene compliance in the health care field. It also addresses the consequences that may befall a patient from poor hand hygiene practice by caretakers. The final point of this paper is to consider how positive changes can be made to increase the compliance of hand hygiene. Deterrents to Hand Hygiene Compliance

HAND HYGIENE IN HEALTHCARE Investigation and research into hand hygiene has found many obstacles that prevent successful observance of the practice. According to the World Health Organization, it is imperative that all health care workers wash their hands with an approved cleanser after coming in direct contact with any possible contaminant. It is also recommended that an alcohol based gel be used regularly when hands are not noticeably unclean (2009). An article published by Mathai et al. (2010) states that all hand cleanser (soap and alcohol gel) used in the health care

field must adhere to strict guidelines set forth by the American Society for Testing and Materials (ASTM). The ASTM mandates that the cleanser must exceed the efficacy level of ordinary household hand cleansers and have the ability to destroy and inhibit the regrowth of microorganisms (World Health Organization, 2009). According to research published in the Journal of the Royal Society of Medicine Short Reports, 339 health care professionals composed of doctors, nurses, medical assistants, and secretarial staff were surveyed about their personal response to alcohol hand gel. The results of the review found that 88% of the 339 people had an adverse skin reaction or ongoing skin problems due to repeated use of a health care accepted hand cleanser (McKenzie et al., 2011). Common antiseptic hand cleansers, such as chlorhexidine gluconate and povidone-iodine, have also been affiliated with skin issues, such as contact dermatitis (Mathai et al., 2010). Another hindrance to proper hand hygiene is the incommodious location of hand sanitization items such as soap, a sink, or alcohol gel (Erasmus et al., 2009). If antiseptic supplies are not located in a convenient place and readily available for use, the chances of properly following hand hygiene guidelines and protocols drastically decrease. Unfortunately, frequent and tangible reminders of hand asepsis are few and far between in everyday life in the workplace.

HAND HYGIENE IN HEALTHCARE The World Health Organization pinpointed many elements that play a role in decreasing the practice of hand sanitation. One common factor is attributed to overwhelmed staff members responsible for treating a vast and complex patient population. Other concerns include not

believing hands are actually dirty following the removal of gloves and not remembering to clean hands before and after any patient contact as required by preset guidelines (2009). Time constraint due to increased demands and responsibilities also plays an important role in the lack of hand cleanliness (Erasmus et al., 2009). In addition, a decrease in the workers inspiration and enthusiasm is also attributed to the insufficient hand washing process (Sharma, Sharma, Puri, & Whig, 2011). Potential Consequences Directly Related to Poor Hand Hygiene Hand hygiene is crucial action that a health care provider can take to prevent negative consequences in the patient population. The development of a nosocomial infection is a common, yet avoidable complication in the health care field (Sharma et al., 2011). The most successful and recognized action in circumventing this type of infection is appropriate hand hygiene (Huis et al., 2011). In addition, public health officials have identified that hand hygiene is an important factor in decreasing and impeding the rate of sickness and death in the hospital, community and around the globe (Erasmus et al., 2011). Even with these statistics available, hand hygiene conformity continues to decrease (Erasmus et al., 2011; Huis et al., 2011). The development of a nosocomial infection generates many negative and unwanted side effects. It creates harrowing circumstances that often require additional treatment in order to control and resolve the infection (Erasmus et al., 2011). Because of this, it forces the patient to reside for a longer period of time in the hospital (Huis et al., 2011). In order to treat the infection, doctors must change the patients treatment regimen to include additional medication

HAND HYGIENE IN HEALTHCARE and therapies that would otherwise have not been required. Also, due to the complexity of the patients condition, doctors observe closely for subsequent complications. A natural repercussion that comes from the development of a nosocomial infection is high health care expenses (Erasmus et al., 2011; Huis et al., 2011). An examination into health care costs following the development of a hospital acquired infection was published by the World Health Organization. This study compared the four most prevalent types urinary tract infections caused by catheter insertion, bloodstream infections, surgical site infections, and ventilator-associated pneumonia. The study found that the lowest amount of money for treating one of these infections in one patient is $5,500. The report further states that a catheter or bloodstream infection caused by Methicillin-resistant Staphylococcus aureus (MRSA) may cost

as much as $38,000 to treat one case. Unexpected infection treatment increases the cost of health care to the hospital, patient, and insurance company (2009). In some cases, a nosocomial infection may cause ongoing morbidity or even mortality. It is the worst outcome which is inessential and can be prevented (Erasmus et al., 2011). All health care employees have the opportunity to prevent this atrocity by simply taking time out of a busy work day to wash their hands. Ability to Change Hand Hygiene Behavior Although inadequate hand hygiene habits run rampant throughout the health care world, the potential for changing attitudes and behaviors to promote an appropriate and more suitable practice is feasible. One article written in reference to hand hygiene conduct states that even if a person has a thorough understanding of the standards and protocols regarding hand sanitization and its benefits, it does not assure follow through on acceptable practice (De Wandel, Maes,

HAND HYGIENE IN HEALTHCARE

Labeau, Vereecken, & Blot, 2010). The article goes on to say that friends, co-workers, and even ones own belief system and ethics cannot guarantee satisfactory hand hygiene practice. The act of hand washing is uncomplicated. However, understanding the issue of nonadherence to the practice is intricate and involved (Sharma et al., 2011). An examination led by Sharma, Sharma, Puri, & Whig found that the best way to incite change in the hand washing realm is to involve the managerial staff of the hospital who should concentrate their efforts on enforcing the predetermined guidelines as part of the routine practice of health care employees (2011). A study conducted by another group of researchers (Mathai et al.) found that if a change in the current hand hygiene process is to occur, an alteration must be made in the way people act as well as in the way the facility is run. The article further states that there are five necessary actions to help expedite and ease the change into the hand hygiene initiative. These actions include improving accessibility of hand sanitation products, providing accurate instruction and information on hand washing, supervising and evaluating hand washing efforts of staff, frequent visible prompts at work, and decreasing the potentially risky and dangerous practices of both staff workers and administration. The same study discusses several occasions at which hand asepsis should be implemented throughout the average day of a health care worker. The article states that hand sanitation should be performed before and immediately following any contact with a patient and after handling the patients personal belongings. This rule is in place to help prevent the spread of germs from the health care provider to the patient and vice versa. The article continues to state that hand hygiene needs to be practiced before performing activities such as foley catheter or nasogastric tube insertion and intravenous catheter placement. This

HAND HYGIENE IN HEALTHCARE parameter is meant to protect the health care worker in the event of direct contact with the patients blood, mucous, or saliva (2010). According to a study led by Grol and Grimshaw, it is possible to alter the hand hygiene issue, but it will require an extensive multidimensional program and cooperation from all

members of the health care team. The researchers state that the program should strive to involve the individual staff members, groups of people in different job categories, the health care facility, and the patients. The article continues by asserting that a group focused approach is most useful because members of the health care team are frequently required to work together in order to meet the end goal of treating and caring for the patient. The examiners believe that if this mind set is transferred into bettering the hand hygiene initiative, it would have a greater chance of being more successful (Huis et al., 2011). Conclusion Appropriate hand asepsis is the key for health care workers to protect patients from further illness and prevent themselves from contracting an infection or disease. Even though hand hygiene compliance is currently a serious problem, it is an issue that can be resolved with the application of proper techniques. The articles discussed in this paper demonstrate the necessity of discovering a remedy to the inappropriate hand hygiene epidemic. It is clear that the examination into this problem has yielded valuable information as to the cause of the noncompliance issue. However, further research on this topic is required to identify the avenues which have the best chance of promoting the efforts of the hand hygiene reform. As of now, even the most well thought out and accepted restructuring plans have an ephemeral lifespan. Unfortunately, after a short period of time, health care workers revert back to noncompliance. The proper practice of hand hygiene is an ongoing battle that will not be

HAND HYGIENE IN HEALTHCARE effortlessly transformed into a perfect system of hand hygiene compliance. It will be a difficult project that involves a great deal of work and collaboration between many parties. With the participation and determination from all health care team members, it is possible to achieve the end goal and bring about high quality health care that people deserve.

HAND HYGIENE IN HEALTHCARE Reference

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Camargo, L.F.A., Marra, A.R., Silva, C.V., Laselva, C.R., Moura Junior, D.F., Cal, R.G.G., et al. (2009). Low compliance with alcohol gel compared with chlorhexidine for hand hygiene in ICU patients: Results of an alcohol gel implementation program. Braz J Infect Dis, 13(5), 330-334. doi: 10.1590/S141386702009000500003. De Wandel, D., Maes, L., Labeau, S., Vereecken, C., & Blot, S. (2010). Behavioral determinants of hand hygiene compliance in intensive care units. Am J Crit Care, 19(3), 230-239. doi: 10.4037/ajcc2010892. Erasmus, V., Brouwer, W., van Beeck, E.F., Oenema, A., Daha, T.J., Richardus, J.H., et al. (2009). Infection control and hospital epidemiology. A qualitative exploration of reasons for poor hand hygiene among hospital workers: Lack of positive role models and of convincing evidence that hand hygiene prevents cross infection. The Society for Healthcare Epidemiology of America, 30(5). doi: 10.1086/596773. Erasmus, V., Huis, A., Oenema, A., van Empelen, P., Boog, M.C., van Beeck, E.H.E., et al. (2011). The ACCOMPLISH study. A cluster randomized trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections. BMC Public Health, 11, 721. doi: 10.1186/1471-2458-11-721. Huis, A., Schoonhoven, L., Grol, R., Borm, G., Adang, E., Hulscher, M., et al. (2011). Helping hands: A cluster randomized trial to evaluate the effectiveness of two different strategies for promoting hand hygiene in hospital nurses. Implement Sci, 6, 101. doi: 10.1186/1748-5908-6-101. Mathai, E., Allegranzi, B., Kilpatrick, C., & Pittet, D. (2010). Prevention and control of health care associated infections through improved hand hygiene. Indian J Med Microbial, 28(2), 100-106. doi: 10.4103/0255-0857.62483.

HAND HYGIENE IN HEALTHCARE Mckenzie, S.N., Turton, P., Castle, K., Clark, S.M., Lansdown, M.R., Horgan, K. (2011).

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Alcohol hand abuse: A cross-sectional survey of skin complaints and usage of patterns at a large UK teaching hospital. JRSM Short Rep, 2(8), 68. doi: 10.1258/shorts.2011.011034. Sharma, S., Sharma, S., Puri, S., & Whig, J. (2011). Hand hygiene compliance in the intensive care units of a tertiary care hospital. Indian J Community Med, 36(3), 217-221. doi: 10.4103/0970-0218.86524. World Health Organization (2009). WHO guidelines on hand hygiene in health care: First global patient safety challenge clean care is safer care. WHO Library Catalogulng-In Publication Data. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf.