Hand hygiene is recognized between healthcare professionals as a precautionary standard against the spread of infection and hospital acquired illnesses. In a healthcare setting, such as a hospital, immunocompromised patients are already subjected to a high-risk environment, where the objects around them are already potential sources of infection. Appropriate hand hygiene prior to, during, and after patient contact can prevent many hospital acquired illnesses. Keeping hands clean after contact with patients, potentially infectious material, or polluted environment is a key element in interrupting the transmission of microorganisms (Garus-Pakowska, Sobala, & Szatko, 2013). Despite knowing all of its benefits, noncompliance still remains a concern in healthcare today. Doctors, nurses, and nursing assistants are often under great time constraints. With today’s society being strongly focused on patient-centered care, adequate and thorough hand hygiene is oftentimes overlooked. Healthcare providers need to be reminded that patient-centered care also includes adhering to standard protocols. The purpose of this paper is to determine current recommended practice and to compare recommended practice with the policy and practice at a clinical agency. This is a Student Sample ORDER YOUR PAPER NOW
Patients are stakeholders since they are at risk for poor outcomes as a result of poor hand hygiene performed by health care workers. All health care workers, any who will have contact with patients, are stakeholders as well. They need to be able to understand and perform proper hand hygiene. Health care institutions have a stake in this issue as well, since the costs due to healthcare acquired infections fill fall on them. They are also responsible for training their workers and tracking compliance in order to make sure proper hand hygiene practices are being followed.
The Agency’s system-wide policy, Hand Hygiene applies to the Agency Health Care Associates, Physicians, and Volunteers. The policy is very explicit regarding specific guidelines for proper hand hygiene. All associates, physicians, and volunteers will follow standard precautions. Gloves will be worn as a part of STANDARD precautions, CONTACT isolation precautions or if there is a unit based procedure for universal gloving
(wearing gloves for contact with all patients and their immediate environment). Nails must be clean and neatly trimmed. Keep natural nail tips less than ¼-inch long. Keep finger nail polish in good repair. Only clear, fingernail polish may be worn in peri-natal areas. Keep jewelry to a minimum while providing patient care because of the difficulty in cleaning under rings and watches. Hand hygiene technique-Turn on faucet, wet hands with warm water and apply soap. This is a Student Sample ORDER YOUR PAPER NOW
While covering all surfaces, rub hands together using a friction rub for at least 15 seconds while focusing on fingers, fingernails, and under and around jewelry. Rinse hands thoroughly with warm water and pat dry thoroughly with disposable towel. Turn off the faucet with the disposable towel. Hand hygiene using hand rubs-Apply product to palm of one hand according to manufacturer’s recommendation. Rub hands together, while covering all surfaces of hands and fingers, for 15 seconds or until hands are dry. Hand lotions-Apply hand lotions frequently to help prevent infections. Rough or cracked skin tends to harbor more bacteria than smooth skin. Use only hospital issued hand lotion. Indications for Hand Hygiene-Hands shall be washed with soap and water when hands are visibly soiled and during outbreaks of C. difficile infections. Indications for using soap and water OR alcohol-based hand rub-Upon entering a patient room, before direct contact with patients or their environment, after every contact with a patient or the patient’s environment, upon exiting a patient room (Agency Policy, 2014).
Review of Literature
The World Health Organization points out that in any patient interaction, simple hand washing with soap and water is required when disinfectants are not available. All of the recommendations emphasize the necessity to decontaminate the skin of hands after contact with the patient, but also after each use of protective gloves. Hand washing with water and soap
should take minimum of 15 seconds, while hand cleaning with disinfectants should take 20 to 30 seconds (Garus-Pakowska, Sobala & Szatko, 2013).
A study was performed by Kurdistan University of Medical Sciences and Student Research Committee (2011). The objective of this study was to determine the contamination rate (bacterial and fungal) of the health care workers’ (HCWs’) hands and rings in the ICU. A total of 40 subjects were selected in this study (28 females, 12 males). The rate of contamination of hands and rings was observed in 73.1%. Most of isolates are known to cause nosocomial infections which included: 23% staphylococci, 7.9% Klebsiella spp., 4.7% Enterobacter spp., 3.9% Escherichia coli, 3.1% Acinetobacter spp., 2.3% Pseudomonas spp., and 27.7% were colonized with fungi. The fungal isolates were 16.6% Candida spp., 3.9% Rhodotorula spp., 3.1% Aspergillus niger, and 3.9% Aspergillus flavus. According to these results HCWs’ hands and their rings were contaminated with various types of microorganisms. Medical and hospital personals must follow careful hand-washing techniques to minimize transmission of disease and should remove rings, watches, and bracelets before washing their hands and entering the ICU (Sanandaj, 2011).
A report published by the New England Journal of Medicine revealed a 2011 survey of 183 hospitals in 10 states. In that year alone, there were approximately 721,800 infections in 648,000 patients. An astounding 75,000 of these patients died that year as a result of a health care-associated infection (Magill & Edwards, 2014). These shocking statistics reveal that proper hand hygiene is either being severely neglected or not being adequately performed altogether. Sadly, healthcare workers are inadvertently making their patients a victim, by exposing their already immunocompromised body system to harmful bacteria. These infections and deaths can be drastically reduced and ultimately eliminated by simple compliance. According to Aziz (2014), reducing the incidence of infection will provide significant benefits to patients. The aim is that action on hospital acquired-illnesses (HCAIs) will also help to reduce the incidence of other similar infection, through the implementation of improved infection prevention and control (IPC) measures. Treating and caring for people in a safe environment and protecting them from harm is crucial if HCAIs are to be prevented and decreased. Most notably, compliance with hand hygiene is seen as the most credible practice that will help to reduce infections and ensure patient safety (Aziz, 2014). Comprehension of proper hand hygiene and diligence would further annunciate the healthcare worker’s true role: nonmaleficence.
Comparison of Agency Policy to External Data
The Agency’s system wide policy is very particular on what needs adherence and lists the guidelines in good fashion. However, it still allows their healthcare associates, physicians, and volunteers wear jewelry-specifically rings, watches, and bracelets. Jewelry clearly harbors many harmful bacteria. By not wearing and simply avoiding to wear jewelry altogether, it can prevent many hospital acquired illnesses. The policy lightly focuses on cleansing under and around jewelry. The simple act of just removing one’s jewelry could have such significant impact on not passing microorganisms onto patients. The Agency’s policy on disinfectants reveals that rubbing ones hands for 15 seconds is sufficient, but the World Health Organization recommends that rubbing hands with disinfectants should take at least 20 to 30 seconds using disinfectants (Pittet, 2009). This is a Student Sample ORDER YOUR PAPER NOW
The Agency’s hand hygiene protocol is very detailed and addresses the need to perform the much needed task. It really needs to be revisited and fine-tuned. According to many resources patients still pose a great risk for hospital-acquired illnesses. They need to revisit this policy and make changes by having employees not wear jewelry of any type and ensure that hand disinfectant is utilized for a minimum of 20-30 seconds.
Hand hygiene-such a simple and mundane task. Yet it places such a crucial role in the healthcare setting. It is often not done appropriately, or done at all. It can make the difference of an immunocompromised patient’s survival and save the lives of many, many patients. Perhaps hand hygiene is not so mundane after all.
Agency Policy (2014). Hand Hygiene. Unpublished internal document.
Aziz, A. (2014). Hand hygiene compliance for patient safety. British Journal of Healthcare Management, 20(9), 428-434 7p.
Garus-Pakowska, A., Sobala, W., & Szatko, F. (2013). Observance of hand washing procedures performed by the medical personnel after the patient contact. Part II. International Journal of Occupational Medicine & Environmental Health, 26(2), 257-264. doi:10.2478/s13382-013-0094-2
Magill, M.D, Ph.D., S., & Edwards, J. (2014). Multistate point-prevalence survey of health care–associated infections. The New England Journal of Medicine, 1198-1208.
Pittet, D. (2009). WHO guidelines on hand hygiene in health care: A summary. Retrieved November 4, 2015, from http://apps.who.int/iris/bitstream/10665/70126/1/WHO_IER_PSP_2009.07_eng.pdf
Sanandaj, I. (2011, December 1). Evaluation of bacterial and fungal contamination in the health care workers’ hands and rings in the intensive care unit. Retrieved November 9, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/22442928