Hand hygiene practice in Sub Saharan Africa, patient safety implications Outline • Introduction • Part I: The problem o Magnitude of health care-associated infection burden o Health care-associated infection in developing countries o Health care-associated infection among health-care workers • Part II: The role of hand hygiene to reduce the burden of HCAI o Transmission of health care-associated pathogens through hands Hand hygiene compliance among health-care workers o Strategies to improve hand hygiene compliance o Impact of hand hygiene promotion on health care-associated infection o Cost-effectiveness of hand hygiene promotion o Monitoring & implementations • Summary Introduction Health care-associated infection (HCAI), also referred to as “nosocomial” or “hospital” infection, is defined as: “An infection occurring in a patient during the process of care in a health-care facility which was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff. Healthcare workers’ hands are the most common vehicles for the transmission of microbes, causing health care associated infections, from patient to patient and within the healthcare environment. It is estimated that 50% of health care associated infection occurs due to hand of health care providers (HCPs). Hence, hand hygiene is the leading measure for preventing the spread of antimicrobial
Good hand hygiene is the simplest, yet proven strategy to counteract hospital infection. However, the difficulties of achieving good levels of compliance are well noted in the literature. There are several seeming barriers to carry out adequate hand hygiene:
This study was intended to prove that hand hygiene practiced according to the CDC guidelines will decrease the incidence of hospital acquired infections. This could not really be proved in this study since the hospitals were not able to maintain improvement in hand hygiene. Health care workers were familiar with guidelines but significant practice changes were not maintained. Some of the infection rates did improve during this time but the correlation with hand hygiene is not consistent. There were other practice changes occurring during this same time and those changes may be responsible for the decreased infection rates.
* Hand washing is the most important method of preventing the spread of infection by contact (Ayliffe et al 1999). The Nottingham University Trust Policy on Hand Hygiene (2009) states that there are three types of hand hygiene, the first is ‘routine hand hygiene’ which involves the use of soap and water for 15 – 20 seconds or the application of alcohol hand rub until the hand are dry. The second is ‘hand disinfection’ which should be used prior to an aseptic procedure by washing with soap and water and applying alcohol hand rub afterwards. The third is ‘surgical hand washing’ which is the application of a microbial agent to the hands and wrists for two minutes. In addition to which a sterile, disposable brush may be used for the first surgical hand wash of the day although continued use will encourage colonisation of microbes. The third example is the most appropriate to any O.D.P undertaking the surgical role as it is the best way for the surgical team to eliminate transient flora and reduce resident skin flora (World Health Organization 2010). The first and second are important to any O.D.P undertaking any other role within the Operating Department as this is the best way to reduce the transient microbial flora without necessarily affecting the resident skin flora
Preventing infections in the hospitalized patient always has been a performance measure and is part of The Joint Commission’s national patient safety goals for 2015 (Joint Commission, 2015). Controlling infections in the hospitalized patient is an evidenced-based practice known to improve patient's health, reduce costs, prevent healthcare-associated infections (HAI), and prevent the spread of multi-resistant organisms (CDC, 2013). Hand hygiene is the routine use of hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis (CDC, 2013). In the hospitalized patient the routine use of an alcohol-based antiseptic hand rub or antiseptic hand wash to remove or destroy any transient microorganisms and decrease resident flora
There are numerous evidence-based practice interventions that have become standard nursing practices across the country. Hand hygiene is a nursing practice intervention that is currently evidence (research) based. It is one of, if not the most, important interventions practiced in providing standardized care. The rationale behind that statement refers to the high percentage of hospital acquired infections; hand hygiene practices are measures used for maximum effectiveness in reducing the spread of these infections. Compared to the various health care professionals who come in contact with patients when providing care, nurses are by far the largest faction that implements the highest quantity of direct patient care in health care. That said, of all the asepsis precautions, techniques, and interventions that are currently in place, hand hygiene is the single most effective intervention used by nurse to prevent themselves from infection and the cross-infection to their patients. Although this evidence-based intervention is of utmost importance to implement at all times, research shows the difficulty in influencing nurses and other health care professionals to practice hand hygiene as often as recommended.
Keeping our hands clean is one of the most effcient and important steps we can do as humans to avoid getting sick or spreading germs to other people. Unwashed hands spread many diseases such as the flue, E. coli, and salmonella. Unfortunately, hand hygiene is still one of today’s most leading causes of infection in health care facilities. The risk of clinicians, patients, and visitors not complying with hand hygiene protocols creates a practice problem for nurses and their patient care. The cause of health care infections, also known as, health care-associated infections (HAIs) are increasing along with the rise of the inability to control or treat infections that are multi-drug resistant. Lack of proper hand hygiene is a major problem in clinical settings sourcing from critical care divisions where the most contaminations are prevalent. This paper will discuss how hand hygiene affects the nursing process and solutions of how to better prevent HAIs within the nursing scope of practice.
Hand hygiene (HH), or cleansing of the hands with soap and water or an alcohol-based hand rub (ABHR), is the single most important clinical determinant for marked risk reduction of hospital-acquired infections (HAIs) or more specifically, multidrug-resistant organisms (MDROs), a major contributing factor to patient morbidity and mortality. Despite being one of multiple quality indicators for hospital patient safety ratings and infection prevention interventions, hand hygiene compliance (HHC) amongst healthcare workers (HCW) is subpar across the nation. This paper explores the significance of HHC, a current quality improvement issue in nursing practice. Current data and tools for measuring the nursing sensitive indicator of HHC will be discussed. It concludes with a model for improvement in HHC to meet a minimum recommended sustained rate of 90% compliance.
The main of focus of the quality improvement program is always patient’s safety, needs, quality care and expectations. Even though the healthcare system is very critical as it involves the lives of other, there are some errors that can lead to undesirable consequences. One of the most common error that risks the lives of thousands of people including both patients and healthcare employees is the hand hygiene. Healthcare personnel are the leading source for the spread of Hospital acquired Infections. Every year about one million people die from hospital acquired infections in United States.
First, reducing the risk of healthcare associated infections is implemented a few different ways. One of the ways is proper hand hygiene, by setting goals to improve the compliance of employees it will aid in lowering the percent of healthcare associated infections. This doesn’t just reduce the risk for infections but it mostly reduces the risk of antibiotic-resistant bacteria. (May 5: Hand Hygiene Day, 2014) About 2 million people in the United States obtain infections that are resistant to antibiotics and over 22,000 people die from these infections every year (May 5: Hand Hygiene Day, 2014). Hand hygiene isn’t just about washing your hands there are other aspects to hand hygiene that are just as important. The Joint Commission has issued specific guidelines that follow hand hygiene and require that organizations are to comply with these guidelines to remain accredited. (Joint Commission, n.d.) Many aspects of hand hygiene that are monitored such as when to wash, how long to wash for, which cleaning agents to use, when it is appropriate to use disposable gloves, and whether or not it is acceptable to wear artificial nails or jewelry. (May 5: Hand Hygiene Day, 2014)
One the main roles healthcare workers (HCWs) can do is to provide patients with a safe environment whilst they are in the healthcare setting. In providing clinical safety to patients HCWs are ensuring that the patient will be safe from preventable adverse events occurring to them whilst they are in the hospital setting. Patient safety should be a of high priority to the healthcare setting and HCWs. Nursing staff are the main providers of care to patients whilst in the healthcare setting and have many responsibilities in delivering safe patient care. Whilst in the healthcare setting patients are vulnerable and at the hand of healthcare workers, thus it is extremely important for healthcare workers to maintain hand hygiene. To maintain a
Hospital acquired infections are best described as: “Nosocomial infections are hospital acquired infections (HAI) also known as health care associated
Ethical Considerations within Hand Washing Handwashing is one of the most important preventive measures when it comes to infection control and all healthcare professionals including nurses should have an ethical obligation to abide to proper hand hygiene. A study conducted by CUPE has exhibited that around 8,500-12,000 deaths in Canada per annum are attributed to healthcare associated infections (HCAI). HCAI usually develop as an outcome of the exposure to procedures and facilities of healthcare. If one needs to establish the simplest yet important nursing practice that helps in tremendous control and reduction in the contamination and infection spread, it would certainly be the maintenance of proper hand hygiene (Pratt, 2007). The various preventive practices that focus on interrupting the transmission
Healthcare associated infections have an impact on patients - how? Can be prevented greatly with compliance to hand hygiene protocols (REF).
A hospital is a place where patients go to get medical or surgical treatment and most patients that are admitted into hospitals or get checked up, usually already have an infection or illness of some sort. Therefore, they are seen by a professional to treat or get rid of it. Doctors may treat the patient’s initial illness, however, the patient has a chance of leaving the hospital with a different infection. Healthcare-associated infections are infections that are spread around hospitals. According to ODPHP, the Office of Disease Prevention and Health Promotion, 1 out of every 25 hospitalized patients are affected by a healthcare-associated infection (HAI). The old term for healthcare-associated infections was “nosocomial infections,” simply
As a future medical practitioner, it is of paramount importance that I lead by example, work to influence and encourage fellow health professionals to practice good hand hygiene. The increase in nosocomial infections reflects poorly on the health care system, not only it is costly, strenuous on patients and unethical, but essentially, it reflects poorly on us as doctors, our morals and our practice. It is up to us, the future doctors, to change this to see a transformation in our attitudes and actions towards hand washing.