Background

Discuss about the Hand Hygiene Moments by Heath Care Workers.

Maintenance of hand hygiene in the healthcare sectors have been a leading concern in all the nations over the world. Different researches over the years have shown how patients have become the prey of infectious diseases accounting for about 5 to 10% globally. From this fraction of infection harming the patients, 20 to 30 % of cases show instances where hospital acquired or nosocomial infections arising from non compliance with hand hygiene have been found to be the main cause. As a result mortality rate of the patients has increased thereby creating a burden on the quality control measurement of each and every healthcare sector. World Health Organization’s World Alliance for Patient Safety has taken a large number of initiatives over the past two decades for decreasing the rate of infection and death due to hospital acquired infections ( Erasmus et al., 2010).

One has to look over the causes that act as the main background of this serious issue. Often excessive load of work due to nursing shortages has become an excuse among the healthcare professional to sacrifice their morality of treatment of patients which in simple words can be compared to forget washing their hands properly with soaps and alcohols (de Wandal et al., 2010). Even physicians are also noticed to be careless enough not to follow the guidelines. The report will contain a detailed analysis of the condition of healthcare sectors that fail to meet the standards of practise in maintenance of proper hygiene especially hand hygiene in intensive care units. It would also provide recommendations that would lead the situations not worsen further along with the implementation of initiatives which would not provide scope to any healthcare professionals to be careless enough to play with lives.

PICOT approach has often been used by researchers to form questions that would help them to summarise their entire concern for the researches in the form of interrogative statement. This helps to derive the main aim of the researches through a number of evidence based practices that helps to clear our concepts in a stepwise manner by availing details in the form of answer to the research question (Riva et al., 2012). By deriving the answer to the questions one can find that the research inferences have been easily achieved and thereby the PICOT format is well acclaimed method acting as search statements.

PICOT approach

Therefore from the above table one can form a research question as in:

“Do patients admitted in intensive care units have lower rates of infection when the healthcare staffs maintain compliance with proper hand hygiene in comparison to those staffs who do not comply with hand hygiene guidelines?”

A number of databases that can help one to get evidence based literature to answer the research question are GOOGLE SCHOLAR, PUBMED, PLOS ONE and many others. Wiley online library, Cochrane library and CINHAL library were also consulted for searching good number of articles and journals that would be suitable with the topic provided. Search terms that can be included are ‘Compliance of hand hygiene’, ‘intensive care unit patients’, ‘infection from hand hygiene’, ‘hand hygiene guidelines’, ‘ factors governing compliance in hand hygiene, ‘recommendations in hand hygiene compliance’, ‘Hand hygiene in New Zealand’  many others. Forming a picot questions and taking the help of search terms help in narrowing our search in the search engines so that proper information can be obtained along with journal articles that would help in forming the status of the hand hygiene status in the hospital in the time framework of 2010 to 2015. Therefore, using correct search times is an important approach towards proper analysis of the given issue in the nations.

Time related barriers were found to be the main factor that has been reported to be the main reason behind noncompliance with the hand hygiene guidelines. This paper also stated that neither theoretical knowledge, nor moral values and any kind of social influence could not predict the value of the practise of complying health hygiene (De Wandel et al., 2010). This is a level IV of evidence based on an observational study of nurses through questionnaires. It was also noted in an article where systematic reviews confirmed that hand hygiene guidelines are not complied because of high activity level that is overload of work and time management. So proper time management and proper planning of the jobs should be done to solve the issue (Gould et al., 2010). It is a level I evidence as systematic reviews were based on several randomised and nonrandomised trials, which showed more compliance among nurses than physicians, more compliance after patient handling than before patient handling, more in other units than in intensive care units that are the ICU nurses are more prone to noncompliance.

Similar such conclusions were also provided by Scheithauer et al. (2010) who provided a randomised trial showing high compliance rate be noticed more in neonatal and paediatric nurses than physicians. However, they argued that compliance rate was higher before patient handling and said that nurses were found to following non compliance in 3 fold manner in disinfectant usage. It also showed proper time management to be included in the practical courses during their degree courses. This was level III evidence because several observational studies have been conducted in this arena.

Findings of the Recommendations

Another article revealed that hand hygiene was found to be less followed in the night shifts than in the other shifts. The main activities that were found to be the reason of low compliance were no hand washing after procedure, improper duration of hand washing or no hand washing at all in most of the events and all their rates were found to be less in the night shifts. So education workshops are  to be conducted to make the nurses learn the correct ways of hand hygiene compliance and thereby avoid such issues (Casey et al., 2012). It is a level IV of evidence because this article was based on the observational studies conducted over a period of 6 months in multidisciplinary intensive care units. This has been argued by Randle, Arthur & Vaughan (2010), where they stated that health care workers show less compliance when working in early shifts and proper monitoring bodies should be fixed for this purpose. This is a level IV of evidence since an observational study was conducted by the researchers within a time span of 24 hours in two hospitals.

Moreover a peculiar observation was also made by researchers which stated that hand hygiene compliance was found to be higher in case of high risk procedures  than in procedures which involved lower risk showing negligence in their moral ethics and values regarding the maintenance of hygiene for the patients and also to maintain their own health. So proper ethics and moral values are important criteria that should be followed by nurses. (Korniewicz & El-Masri, 2010). This is also level IV evidence as the study was based on the observational study conducted in intensive care unit in oncology hospitals.

Excessive load of work due to shortage in nursing, time constraints and apathy are other factors that affect the health of the patients leading increase in mortality rate among the intensive care unit (Alsubaie et al., 2013). This is a level  3 evidence found from reviews. The main factors that resulted in the low compliance of hand hygiene are improper knowledge and understanding and proper lack of communication during the academic years. Low levels of knowledge and practical skills were found to be prevalent in newly joined nurses and also among others. This attitude mainly developed from the lack of proper curriculum management and proper theoretical approach in the nursing schools that resulted in lack of proper development of habit in maintenance of hand hygiene (Kelcíkova, Skodova & Straka, 2012). This is level IV evidence based on an observational study.

A number of recommendations can be provided in order to create systems that would help in promoting the habits of proper health hygiene among the health care nurses especially the nurses appointed in intensive care unit of New Zealand. Proper education program and similar workshops can be conducted which would help in making the nurses aware of the importance of hand hygiene. It was seen that there was a decreased rate of patient mortality due to infection after an education program was conducted in the hospital for the nurses on hand hygiene in comparison to that when before the implementation of the education program ( Helder et al., 2010). This proved to be an important initiative that might be taken by the authorities or local communities to reduce the incidences of patient mortality. As this is a level II evidence because randomised trials have been conducted for finding ways to reduce such consequences one can easily implement in the settings of New Zealand. Researchers have stated that increasing uses of alcohol based hand rub along with a number of educational workshops are not resulting in as much output as required to erase the non-compliance attitude of the nurses in hand hygiene. They suggested that works done over the years have shown utilising multiple strategies including huge number of staffs in planning activities and applying marketing strategies such as social marketing were proved much more helpful. Inclusion od proper mral values and ethics would prevent apathy from nursing individuals but this is a level 4 evidence and therefore it should not be placed on high priority as a recommendation.

Another study conducted by Erasmus et al. showed that proper action planning by the healthcare nurses in the hospitals were found to be an effective solution to overcome the habits of noncompliance with the hand hygiene systems. An example of formatted plan can be given as :

This is Level II of evidence because  a randomised trial was conducted where readings were taken before and after implementation of the program. All the programs mentioned above are relevant to the practises and should be conducted all together in a multistage backdrop so that the positive outcomes of all the possible initiative can have a combined effect on the practice and can be set up in New Zealand.

In the month of January in 2009, Auckland District Health Board conducted programs for the implementation of the hand hygiene habits in New Zealand called the Hand Hygiene New Zealand (HHNZ) that resulted in bringing out the best effects in the study conducted. This programme focused on a cultural change based on five important aspects such as roll out and preparations of facility, evaluation of baseline, follow- up evaluation and sustainability. This had a positive impact and showed a considerable decrease in the infection by Streptococcus aureus (Robert et al., 2012). This is a level II evidence Therefore, a culture change programme can be of immense help to the nurses of health care sectors.

Moreover health care policies in hand hygiene and dress code policies of New Zealand also suggest the removal of wristwatches, bracelets and other jewellery. This practise is supported by evidence-based literature, which states that use of personal protective environment is a good method (Barratt, 2012). It has been also stated that important organisations should join hands and bring out a collaborative approach against the hand hygiene non-compliance criteria.  Therefore, a nurse can be well trained in not only theoretical and practical works but also should develop moral and ethical values that would prevent her from showing excuses like shift timings or workload to be a factors inhibiting them from complying with hand hygiene.

It has been reported by researcher Jowitt that The Health Quality & Safety Commission (HQSC) had come into a collaborative project with different healthcare professionals , service users and patients to ensure that the people from New Zealand receives the best protection from infection caused due to non compliance with hand hygiene. Five moments for hand hygiene opted by WHO 2009 had been accepted by Australians and New Zealanders. They have even established quarterly newsletter and the website of HHNZ where hand hygiene guidelines are provided along with manuals. This is level VII evidence as it contains the steps taken by the authorities of New Zealand.

Conclusions:

From the entire report, one can easily understand that the importance of compliance of hand hygiene in the treatment of patients because lives of patients may be at risk because of non-compliance of hand hygiene. An increased risk of infection is a concern due to such habits and therefore it should be an integral part of a nurses’ daily routine of works while handling of patients (Casey, 2012). Although a large number of factors may be the reasons of the habit of not following the main moments of hand hygiene but the nurses should be careful enough to overcome such barriers and incorporate them into their practises for their own safety as well as for the lives of the people under their treatment. Proper hygiene leads to a health life.

References:

Alsubaie, S., bin Maither, A., Alalmaei, W., Al-Shammari, A. D., Tashkandi, M., Somily, A. M., … & BinSaeed, A. A. (2013). Determinants of hand hygiene noncompliance in intensive care units. American journal of infection control, 41(2), 131-135.

Barratt, R. (2012). Hand hygiene correction. Nursing New Zealand (Wellington, N.Z. : 1995),18(9), 3.

Casey, M. (2012). Hand hygiene safe practice in the clinical setting. The Dissector: Journal of the Perioperative Nurses College of the New Zealand Nurses Organisation, 40(2), 26.

De Wandel, D., Maes, L., Labeau, S., Vereecken, C., & Blot, S. (2010). Behavioral determinants of hand hygiene compliance in intensive care units. American Journal of Critical Care, 19(3), 230-239.

Efstathiou, G., Papastavrou, E., Raftopoulos, V., & Merkouris, A. (2011). Factors influencing nurses’ compliance with Standard Precautions in order to avoid occupational exposure to microorganisms: A focus group study. BMC nursing, 10(1), 1.

Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., & van Beeck, E. F. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control & Hospital Epidemiology, 31(03), 283-294.

Erasmus, V., Kuperus, M. N., Richardus, J. H., Vos, M. C., Oenema, A., & Van Beeck, E. F. (2010). Improving hand hygiene behaviour of nurses using action planning: a pilot study in the intensive care unit and surgical ward. Journal of Hospital Infection, 76(2), 161-164.

Gould, D. J., Moralejo, D., Drey, N., & Chudleigh, J. H. (2010). Interventions to improve hand hygiene compliance in patient care. The Cochrane Library.

Hand hygiene cuts blood-borne infections in auckland hospitals. (2012). The Dissector: Journal of the Perioperative Nurses College of the New Zealand Nurses Organisation, 40(1), 10.

Helder, O. K., Brug, J., Looman, C. W., van Goudoever, J. B., & Kornelisse, R. F. (2010). The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: an intervention study with before and after comparison. International journal of nursing studies, 47(10), 1245-1252.

Jowitt, D. (2012). Improving safety in health care: Of the three infection prevention and control programmes being led by the health quality & safety commission, hand hygiene remains fundamental. Kai Tiaki: Nursing New Zealand, 18(10), 31.

Kelcíkova, S., Skodova, Z., & Straka, S. (2012). Effectiveness of hand hygiene education in a basic nursing school curricula. Public Health Nursing, 29(2), 152-159.

Koff, M. D., Corwin, H. L., Beach, M. L., Surgenor, S. D., & Loftus, R. W. (2011). Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program. Journal of critical care, 26(5), 489-495.

Korniewicz, D. M., & El-Masri, M. (2010). Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice. Applied Nursing Research, 23(2), 86-90.

Marra, A. R., Moura, D. F., Paes, A. T., Dos Santos, O. F. P., & Edmond, M. B. (2010). Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices. Infection Control & Hospital Epidemiology, 31(08), 796-801.

Randle, J., Arthur, A., & Vaughan, N. (2010). Twenty-four-hour observational study of hospital hand hygiene compliance. Journal of Hospital Infection, 76(3), 252-255.

Riva, J. J., Malik, K. M., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your research question? An introduction to the PICOT format for clinicians. The Journal of the Canadian Chiropractic Association, 56(3), 167.

Roberts, S. A., Sieczkowski, C., Campbell, T., Balla, G., & Keenan, A. (2012). Implementing and sustaining a hand hygiene culture change programme at Auckland District Health Board. The New Zealand Medical Journal (Online), 125(1354), 75.

Sahay, S., Panja, S., Ray, S., & Rao, B. K. (2010). Diurnal variation in hand hygiene compliance in a tertiary level multidisciplinary intensive care unit. American journal of infection control, 38(7), 535-539.

Scheithauer, S., Oude-Aost, J., Heimann, K., Haefner, H., Schwanz, T., Waitschies, B., … & Lemmen, S. W. (2011). Hand hygiene in pediatric and neonatal intensive care unit patients: daily opportunities and indication-and profession-specific analyses of compliance. American journal of infection control, 39(9), 732-737.