NURS1125 Foundations For Nursing Practice

Hand Hygiene

Infection control can be defined as one of the most important concepts associated with the health care delivery in the present day scenario. The frequency of hospital associated infection has risen in an alarming rate and in case of the Australian demographics, it has to be mentioned that around 165000 Australians have been reported to be contracting infections in the health care facility on a yearly basis. Researchers are of the opinion that hospital acquired infections, especially the urinary tract infections, MRSA, surgical site infections and respiratory infections in the cardiac arrest or stroke patients are contributing factors to enhanced mortality in the patients due to their frail and immune-compromised state due to the burden of the burden of the disease (Huttner et al., 2013). This essay will attempt to explore hand hygiene which is one among the most effective infection control measure for preventing the health care acquired infections in the health care setting. The essay will sequentially cover how infections can spread in the health care facilities, specific actions to be taken in order to avoid HCAI, and different strategies to ensure hand hygiene compliance.

As mentioned by the Slimings et al. (2014), the modern health care system has a variety of different invasive devices and procedures that are regularly used to treat the patients such as feeding tubes, catheters, ventilators, masks and many more. All these devices and the hands of the health care providers are reservoir for various pathogens that can cause a variety of different infections. It has to be mentioned that the impact of the health care associated infections is extreme on the patient safety and leads directly to enhanced mortality and morbidity in the patients and is also facilitated on the increased hospice stay and healthcare costs. According to the Gardner et al. (2014), health care associated infections or the HCAIs comprises of central line associated bloodstream infections, catheter catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections. The term of HCAI is known to cover a wide array of infections, however the most known of the infections are the MRSA and the Clostridium difficile.

Exploring how the health care associated infections occur, it has to be mentioned that health care associated infections can occur across a variety of different health care scenarios such as the acute care, ambulatory surgical centres, dialysis ward, outpatient care services and even the long term care facilities. There are different types of HCAI and each type has a different infection method. For instance, the central line associated blood stream infection or CLABSI can be classified where the pathogen, mainly bacteria, invades the blood stream through any of the central line devices. These are considered as a very impactful infection type leading of severe exacerbations and causing a large number of deaths and added costs to the Australian health care system. The most common type of HCAI is the MRSA infection or the Methicillin resistant Staphylococcus aureus, an infection which is very difficult to control due to the pathogen being resistant to a wide variety of broad spectrum antibiotics. This generally transmitted via contact with the care providers’ hands mostly and leads to life-threatening bloodstream infections, pneumonia, and surgical site infections. Hence, these are a few common types of health care associated infections that fall under the HCAI and cause a high number of exacerbations and even death in the Australian health care system (Uhlemann et al., 2014).

It has to be mentioned that infection control plays a very important role in the preventing the different health care associated infections and ensuring optimal patient safety for the patents residing in the different care facilities. According to WHO, these infections affect hundreds of millions of patients all across the globe and human behavior is the most important contributing factor to the causing of the infections. It has to be mentioned in this context that the most of these infections are easily preventable if adequate infection control measures cam be taken. There are different types of infection control measures, such as standard precautions involving hand hygiene, use of personal protective equipments, prevention of needle-stick or sharps injuries, cleaning and spill management, waste disposal and disinfections, and cleaning of the supplies. However, it has to be mentioned that hand hygiene is one of the most important and impactful infection control measures (Mitchell et al., 2017).

One of the primary causes for the infection transmissions has to be the contaminated hands of the health care workers. Hence WHO has outlined routine hand washing to be one of the most effective measures to prevent or reduce the frequency of all transmission based infections in the health care setting and enhance the safety of the care given to the patients in the health care setting. According to the WHO recommendations, there are various different indications for hand washing. First and foremost, the hands of the health care workers need to be washed diligently with soap and water when the hands appear visibly dirty or soiled (Who.int, 2018). Along with that, when the career is exposed to pathogens that are potentially spore forming such as the C. difficile the health care worker is supposed to wash hands with antibacterial soap and water. There is use of alcohol rub based hand hygiene recommended by the WHO to prevent the occurrences of HCAI, including “before and after touching any patient, before handling an invasive device for patient care, regardless of whether or not gloves are used, after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings, after contacting with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient, and after removing gloves” (Who.int, 2018). Along with that, the WHO recommendations state that the carers will need to perform hand hygiene using a alcohol based hand-rub or with antimicrobial soap and water before handling any medication or preparing food (Marimuthu, Pittet & Harbarth, 2014). As per the guidelines though, soap and alcohol-based hand-rub are not to be used concurrently. In order to each the compliance to the hand hygiene guidelines for the patients, the WHO guidelines also specify a five moments of hand hygiene that the professionals will need to adhere to at all times to ensure  inhibiting the spread of the infections. The heath care professionals are directed to use either a potent antimicrobial wash of alcohol rub technique, before touching the patient in any manner, before any care or treatment procedure, after any procedure with body fluid exposure risk, after any kind of contact with patients and after any kind of contact with their surroundings (Who.int, 2018).

According to the Page et al. (2014), hand hygiene is a potent tool for infection control in the health care setting however only if the guidelines are followed unequivocally by all of the health care providers across the health care setting. According o the WHO report, the compliance rate among the health care workers to hand hygiene practice in day to day practice setting has been reported developed as well as developing countries. The compliance rate of the health care providers are alarmingly low in Australia, especially in the rural and remote regions. As discussed by the authors, the care providers from remote areas have lower hand hygiene compliance due to lack of education and awareness, limited resources, and limited policy protocol mandating the use of hand hygiene. Hence for any strategy to enhance the compliance statistics to hand hygiene guidelines, it is crucial to address education, policy and resource availability (Barnett et al., 2014).

First and foremost, the hand washing strategies must take into account the fact that resource availability is a very important aspect for compliance to the meticulous hand hygiene protocol. According to the Azim and McLaws (2014), in the rural or remote locations often the availability of hand washing supplies lead to very minimal hand washing practice ranging from only 6.6 to 30 seconds. Hence, there is need for a thorough analysis of the resource availability and feasibility to ensure handwashing supplies is available at every section and patient cabins along with written instructions posted on walls over the sink to ensure proper hand hygiene compliance. According to Preston, Larson & Stamm, more convenient sink locations have served to be effective strategies for improving hand hygiene across settings as well. Secondly, the education and awareness is another very important aspect, often the cultural diversity or limited English proficiency restricts health care professionals from adequate professional skill enhancements including proper hand hygiene. Hence, the second strategy is to include different educational and awareness campaigns that are culturally competent and easily understandable by all groups of carers. Written pamphlets with key points of hand hygiene in a culturally inclusive manner can help different groups of health care workers be able to adhere to the hand hygiene protocols effectively. Lastly, the importance of policies mandating hand hygiene adherence cannot be ignored either. it has to be mentioned in this context that reward and punishment based structure implemented in the facility for adherence to hand hygiene cam be a very potent tool in improving the behavior of the care providers towards the need for hand hygiene and can effectively improve the hand hygiene compliance as well across care settings (White et al., 2015).

On a concluding note, it has to be mentioned that hand hygiene is undoubted one of the most potent tools of infection control that can be utilized to not only ward off the chances of different secondary infections but also be able to ensure safety of the health care staff as well which are constantly exposed to different infection risks. It has been mentioned by many authors that hand hygiene is undoubtedly the fasted, easiest technique for infection control that also has a massive impact as well. Hence, WHO has issued various guidelines following which a care facility can ensure minimal health care associated infection and optimal safety for the patients as well. However, compliance yet continues to be the issue that plagues the effectiveness or success of the hand hygiene guidelines. This essay has attempted to outline what are HCAIs, how they spread and hand hygiene guidelines that can ensure infection control along with strategies to ensure better compliance to the guidelines or protocol.

References

Azim, S., & McLaws, M. L. (2014). Doctor, do you have a moment? National Hand Hygiene Initiative compliance in Australian hospitals. The Medical Journal of Australia, 200(9), 534-537.

Barnett, A. G., Page, K., Campbell, M., Brain, D., Martin, E., Rashleigh-Rolls, R., … & Paterson, D. (2014). Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative. Infection Control & Hospital Epidemiology, 35(8), 1029-1036.

Gardner, A., Mitchell, B., Beckingham, W., & Fasugba, O. (2014). A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals. BMJ open, 4(7), e005099.

Huttner, A., Harbarth, S., Carlet, J., Cosgrove, S., Goossens, H., Holmes, A., … & Pittet, D. (2013). Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrobial resistance and infection control, 2(1), 31.

Marimuthu, K., Pittet, D., & Harbarth, S. (2014). The effect of improved hand hygiene on nosocomial MRSA control. Antimicrobial resistance and infection control, 3(1), 34.

Mitchell, B. G., Shaban, R. Z., MacBeth, D., Wood, C. J., & Russo, P. L. (2017). The burden of healthcare-associated infection in Australian hospitals: A systematic review of the literature. Infection, Disease & Health, 22(3), 117-128.

Page, K., Barnett, A. G., Campbell, M., Brain, D., Martin, E., Fulop, N., & Graves, N. (2014). Costing the Australian National hand hygiene initiative. Journal of Hospital Infection, 88(3), 141-148.

Slimings, C., Armstrong, P., Beckingham, W. D., Bull, A. L., Hall, L., Kennedy, K. J., … & Richards, M. J. (2014). Increasing incidence of Clostridium difficile infection, Australia, 2011–2012. The Medical Journal of Australia, 200(5), 272-276.

Uhlemann, A. C., Otto, M., Lowy, F. D., & DeLeo, F. R. (2014). Evolution of community-and healthcare-associated methicillin-resistant Staphylococcus aureus. Infection, Genetics and Evolution, 21, 563-574.

White, K. M., Jimmieson, N. L., Obst, P. L., Graves, N., Barnett, A., Cockshaw, W., … & Martin, E. (2015). Using a theory of planned behaviour framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian hospital-based nurses. BMC health services research, 15(1), 59.

Who.int. (2018). WHO | Five moments for hand hygiene. [online] Available at: https://www.who.int/gpsc/tools/Five_moments/en/ [Accessed 20 May 2018].

Who.int. (2018). WHO Guidelines on Hand Hygiene in Health Care: a Summary. (2018). Retrieved from https://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf?ua=1