Infection Prevention and Control for Clinical Practice

This document discusses the importance of hand hygiene in healthcare settings and its impact on preventing infections. It presents findings from an observational investigation conducted in a medicine department, highlighting the practices of caregivers in washing their hands. The document also provides recommendations for effective hand hygiene practices.

Infection Prevention and
Control for Clinical Practice

Table of Contents
INTRODUCTION...........................................................................................................................1
Facts and Statistics...........................................................................................................................1
Methods of research.........................................................................................................................3
Findings...........................................................................................................................................5
Caregivers wash their hands........................................................................................................5
Number of times people actually wash their hands in a health care set up.................................5
Number of infected patients arrived at the duration of 12 hours of observation.........................6
Effectiveness in the method of washing hands............................................................................6
Caregivers washing their hands after handling infected patient..................................................6
Analysis...........................................................................................................................................6
Recommendations............................................................................................................................8
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................11
APPENDIX....................................................................................................................................13

INTRODUCTION
Hand hygiene practice is a vital activity that must be performed by all, especially by the care
givers who directly deals with handling patients in a health care set up. The report discusses
regarding impact on health of an individual if he / she is not involved in washing hands after
coming in contact with some infected set up. It also focuses upon various scenarios in which
hand hygiene is mandatorily be adopted. An observational investigation will be discussed which
has been performed in department of medicine discussing various practices that are generally
adopted by care giving staff members. The report is then responsible for finding out various
practices that can he recommended to the health care set up for effective hand hygiene practices.
Facts and Statistics
Infection control practices help in maintaining clean and safe environment for people. It
plays an important role in reducing the risk of potential spread of a particular disease from one
individual to other. There are various infection control practices that are generally adopted by
individuals. These are cleaning and disinfection, respiratory hygiene, safe injection practices,
proper arrangement of waste disposal, etc. One of the most important practices that can be
adopted by the individual at their home is hand hygiene practices (Davey and et.al., 2013).
Observers have stated that a solid hand hygiene programme backed with documented
evidences can help in reducing the transmission of microorganism from one individual to other.
It also reduces the risk of healthcare worker colonisation. It also assists in preventing food
poisoning, flu and other health care related infections that can be easily transferred from one
individual to other.
The research conducted by government of UK stated that the main purpose of initiated
hand washing is to remove dirt, bacteria and virus from hands so that it can be stopped from
transferring to environment which can lead the individual to illness. Hence, an individual must
be indulged in washing hands particularly in following scenarios:
 After using toilet
 After handling raw food like meat, chicken and vegetables
 Before eating or handling ready to eat food
 After handling any type of animal or pets (Shinde and Mohite, 2014)
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Despite of knowing the importance of hand hygiene, there are a large percentage of British
individuals, who do not follow this practice. 95 out of every 100 individuals surveyed stated that
they wash their hands after using toilet. But the reality is, only 65 of them perform this action.
The statistics revealed that 8 out of 10 infections are commonly spread by touch. Passing bacteria
and other infectious disease is entirely avoidable if an individual is involved in washing hands
after every specific interval. Infection Prevention Society (IPS) have suggested that if proper
infection control techniques can be taught to children, then their absenteeism due to infection
will be reduced by 20% (Yawson and Hesse, 2013). Further, respiratory infections can also be
reduced by approximately 17% with adoption of good hand hygiene practices.
Research has been able to state that a hospital tends to contain 20,000 germs every square
inch. These germs can be passed in the form of phones, coffee machines or any other thing that
can come in contact with the washroom. By not washing hands, one is promoting its spread and
divides it multiple times (Mahfouz, El Gamal and Al-Azraqi, 2013). Despite of knowing the
importance of washing hands, there are 62% and 40% of women who actually don’t wash hands
after using the toilet.
80% of the communicable diseases are actually spread by touch which means that it can
easily be prevented by application of proper hand washing techniques. Touching food with
contaminated hands can lead to various food borne infections, such as, E. coli, Salmonella and
diarrheal infection. Diarrhoea is the second prominent cause of childhood death, which can be
reduced by 40%, simply by practices effective hand washing techniques (Al-Tawfiq and et.al.,
2013).
Adequate significance is present for washing hands in patient care. Decontamination of
hands can help in reducing the incidence of perpetual fever and maternal mortality as well.
Since, it is the least expensive practice adopted by the health care workers, its adoption can
reduce the degree of infections that may be prevailing in the hospital environment. The study
revealed that health care workers actually clean their hands only half of times they actually
should. Hence, it has become major contribution to health care associated infections which affect
1 out of 25 patients visited or admitted to the hospital every day.
Already sick people tend to face weak immune system which can easily get attracted to the
infections, revolving in the air of hospital. It becomes important to control prevalence of infected
microorganisms to reduce infection. Hand hygiene is not the only method to control health care
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associated infections and only adoption of this action cannot promote patient’s safety. But
significantly, the spread is through hands of patients and health care workers only (Al Kadi and
Salati, 2012). Adoption of health care facilities that can help in promoting effective hand hygiene
techniques can reduce the illness of patients through health care set up associated infections to
the minimum. Embracing the strategies for improvement of health hygiene in hospital and
closely scrutinizing the infection control practices can help in better set up of activities.
World have been noticing a significant amount of improvements in hand hygiene practices.
However, the issue is related to inadequate availability of clean water, inadequate availability of
sinks, dry towels and blowers, inadequate awareness of effective hand washing techniques,
inadequate investment in multifaceted approach low stimulation of adoption of effective
practices. Moreover, another research has suggested that infection generally acquired in ICU
may vary from 9% to 37%, if prevalence of ineffective hand hygiene is high. The mortality rate
also lies between 12% and 80% in the patients (Shea and Shaw, 2012). Basic infection control
measures are quite non-existent in majority of the health care settings. Infection is the
combination of numerous unfavourable conditions. These are, understaffing, lack or shortage of
certain basic equipment, poor hygiene and sanitation conditions, inadequate infrastructures and
overcrowding of the patients in wards (Ariyaratne and et.al., 2015). The issues are generally
generated due to ineffective availability of financial resources with the health care set up.
Health care associated pathogens are transmitted through direct or indirect contact between
infected individuals, droplets and air is the common vehicle of it. Transmission generally takes
place based upon five step processes:
Step 1: Organisms are present on patient’s skin or are dropped to a particular object.
Step 2: Organisms are then transferred to health care worker at the time of contact or
examination.
Step 3: Organisms are generally capable of surviving on the hands of health care workers.
Step 4: Inadequate or omitted hand washing or inappropriate use of hand washing agent must be
initiated by health care worker.
Step 5: Contaminated hands of care giver may come in contact with the other patient, leaving
him / her ill (Joshi and et.al., 2012).
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Methods of Observational Auditing related to hand hygiene
It is important to assess that effective methods have been used by the observer to initiate
investigation on the stated topic related hand hygiene as an effective technique of preventing
infection control. In order to carry out observation, appropriate choice of sample and data
analysis technique can help in drawing out the results. The section will help in discussing various
investigation tools used to conduct the research on hand hygiene.
What did observer do?
Observer conducted the research where he took permission from ward manager and ward
staff to carry out a research disclosing that he wants to perform an investigation on hand hygiene.
The above section stated the importance of hand hygiene. Hence, the best method analyses its
practice is by coming direct contact to the practitioners at a health care set up. It will help in
assessing each and every aspect that is directly related to this practice (Kirkland and et.al., 2012).
How did observer do?
Observer tried to carry out the research in a health care set up where he communicated
with the ward manager and staff. He tries to observe their practices when they were indulged in
handling the patients and their switch from one patient to the other. The process of examination,
injection and other common practices adopted by them was analysed so that their practice of
washing hands can be observed. It tried to investigate them for continuously 12 hours. The shift
was fixed and have to be performed by health care professionals and other staff members for
continuously 12 hours.
What occasions were reported by me?
Observer tried to observe various occasions in which health care professionals and team
members were directly involved in it. It helped me in understanding their hand hygiene practices
while examining and dealing with the patients. Observer also observed the practices that are
adopted by them so as to control infection in the ward so that it can be prevented from any type
of spread. It also helped me in observing various practices that are adopted by the team and is
also at high risk of spreading infection. WHO states that hand hygiene is the most important
aspect for the people directly involved with the patient carrying one or the other type of infection
that is communicable in nature. Observer also analysed the patients that visited to the doctor. The
investigation was conducted in the medicine department of a renowned hospital.
How did he manage it?
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Observer tried to note each and every activity that he observed in the health care ward. It
is an important activity so that no important information is missed while performing analysis of
the research. Also, observer tried to take some snaps and prepare videos so as to have evidences
of what he actually presents in the overall research. There were around 4 doctors and 15 nurses
on duty, whose practices have been noticed for the observational purposes in the ward. Hence,
outcomes are generates based upon the observation made on these 19 candidates.
What tools of investigation did he use?
In order to analyse the investigate made, it is important to analyse each and every aspect
of data that ahs been collected for analysis through a health care set up. In order to perform this
function, comparative analysis of the practices is performed where the collected data is directly
compared to the guidelines issued by the government and WHO related to hand hygiene (Van De
Mortel and et.al., 2012). Moreover, it also helped in analysing whether proper guidelines are
actually followed by the caregivers or not.
Findings
Caregivers wash their hands
The analysis made for 12 hours stated that caregivers do wash their hands as soon as they
come in touch with the patients. However, the practices are not generally adopted by all. Hence,
it has become the leading cause of prevailing infection in the set up. Out of the 19 caregivers,
comprising of 4 health care professionals and 15 nurses in the ward of medicine. Only 8 nurses
were involved in constant wash of hands or using sanitizer so as to control the level of infection.
However, there were other 7 nurses who were washing their hands after receiving 2 to 3 patients.
It shows that the infection in the department can be transferred by these 7 nurses who were not
involved in hand hygiene practices. The investigation has been made based on falling basis of
information observed:
 Do the caregivers wash their hands?
 How many times people actually wash their hands in a health care set up?
 How many infected patients arrived at the duration of 12 hours of observation?
 Is the method of washing hands is effective enough?
 Did they wash their hands after handling infected patient?
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Number of times people actually wash their hands in a health care set up
Based upon the observation made on number of times caregivers actually wash their hand
during the care giving activity. The total number of patients that arrived in the department for
check up and were admitted in the ward were 54. If the patients were averagely checked for 2
times in those 12 hours, then in that case, the number of times, nurses and health care
professionals should have washed their hand must be 108. However, the actual total number of
times, caregivers washed their hands is 75 times. It shows that there are 30.56% of chances that
infection may prevail in the department.
Number of infected patients arrived at the duration of 12 hours of observation
A total of 54 patients were there, whom caregivers came in direct contact with. Out of
those 54 patients, there were around 20 patients who arrived for treatment in the hospital. These
patients were suffering from the disease which was communicable and infected enough that ca
infect the other patients in the ward. In such scenarios, gloves were used by the caregivers while
analysing him. Moreover, he was kept in the separate section of the department so that infection
and can be controlled from being spread.
Effectiveness in the method of washing hands
The guidelines states that an individual must wash his / her hands for at least 20 seconds.
However, as per the observation in the department od medicine, out of 19 care givers, there were
only 5 caregivers who were involved in washing their hands for 20 seconds. It affected the
overall process of washing hands and output generated through it. It shows that approximately
74% of the caregivers were not involved in washing their hands properly at the time of their
duty. The reason can be shortage of time or they may not be aware of effectiveness of the
practice.
Caregivers washing their hands after handling infected patient
It is a common practice that was seen the department of medicine, where there were 15
caregivers out of 19, who were involved in washing their hands after examining an infected
patient. It was out of the concern that, if they will not wash their hands, it can affect them and
other patients increasing their in-bed time in the hospital.
Analysis
Adoption of hand hygiene practice in hospital
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It has been assessed that washing hand is suitable and effective method of reducing the
prevalence of infection in the health care set up to the minimum. Hence, it is an effective practice
to be adopted by all the care giver, whether they are nurses or doctors. The observational data
collected from department of medicine in a renowned hospital set up, it has been analysed that
ineffective hand hygiene practices have been adopted by the team (Uneke and et.al., 2014).
There are various nurses and caregivers who do not opt for washing their hands while coming in
direct contact with the patient. Asper the guidelines issued by WHO and other research experts
of hand hygiene, it is important for the caregivers to opt for washing their hands for 20 seconds
so that any possibility of presence of germs and microorganism can be reduced to the minimum.
It also helps in ensuring that all the infectious microorganism is prevented, that have the
capability to be transferred to the other individual and create infection in his body. Moreover, it
is important to be noticed that hand hygiene practice takes place so that infection can be
controlled. The observation states that it is not effectively being practices in the hospital.
Actual adoption of hand washing practice in department of medicine in health care set up
As per the guidelines of WHO, it is important for the ant hospital set up to opt for proper
hand hygiene guidelines. In such cases, it helps in reduction of the transmission of various
pathogenic microorganism. It is the duty of hospital administrators to ensure and review the
practices of health hygiene actually followed in health care department. The primary research
conducted on similar topic conducted that there are only 5 caregivers out of 19 who are involved
in washing their hands for 20 seconds. Moreover, only few of them are involved where they
wash their hands after coming in contact with any patient.
Use of hand sanitiser is another important activity that can be performed by the individual
only if the hands are not soiled and looks clean in the appearance. However, if the hands are
soiled and looks dirty that it is recommended to opt for washing hands with the help of effective
agents. There is certain national programme run by WHO so as to campaign regarding important
of adoption of hand hygiene practices. National health improvement programme is particularly
designed to mobilize actions of hand hygiene from local level and bring changes in behaviour of
caregivers (Aboumatar and et.al., 2012). However, campaigning is only successful if adequate
changes are brought to it on continuous basis. There are various social movements as well which
are completely focussed on improvement of hand hygiene which can bring adequate amount of
improvement in its functions. Adoption of the same in health care department can reduce the
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prevalence of infection among people. The method can also ensure that infection is not
transferred from one individual to the other.
Practice of hand hygiene working as an infection control mechanism
Hand Hygiene is considered as the most important factor for an infection control
mechanism. As the burden of Health care associated infections are growing, the serious illness
and complexity in the treatment are now adopting the basic of prevention of infection by taking
simple measures such as hand hygiene. Reason behind this is the adoption of it can help to
reduce the transmission of infections in health care facilities within a hospital.
Washing hands with soap and water when dirt is visible or contaminated from
proteinaceous material , blood or other body fluids is proven to be very effective for controlling
infection. Also in a clinical state , an alcohol based hand rub should be used more frequently for
decontaminating the hands from infections. Also it should be taken care while having direct
contact with patients,before wearing sterile gloves or using other invasive devices which does
not require any surgical procedure. It should be implemented after the contact with a patient's
operated skin or fluids or excretion, mucous membranes and wounds while dressing and after
removing gloves. Touching the surface while close proximity to the patient should be avoided
(Anargh and et.al., 2013).
For hand washing there is a certain technique which everyone should imply in a hospital
which states that before washing hands jewellery should be removed and hands should be
washed under running water. Cover all your hands with lather created by soap and with the use
of friction make sure hands are completely under lather. Thoroughly washing should be done.
Dry hands with the use of air drying or a towel which can be used for a single time. If a person
uses antiseptic rub than after rubbing let it dry of their own.
The major factors for the determination of product selection for hand hygiene in a
hospital can be antimicrobial profile, acceptance of user and cost effectiveness. Liquids that are
used after contaminating hands must have least fungicidal, bactericidal and viricidal activity
(Abdul-Mutalib and et.al., 2012).
One of the best element in the improvement of health hygiene in a hospital is an alcohol-
based hand rub instead of soaps. As it requires less time and is microbiologically effective and
causes less irritation to skin as compared to traditional hand washes. It is used specially in ICUs
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as it can decrease the time which is necessary for the hand hygiene from 1.3 hrs to 0.3 hrs which
is 4 percent of the nursing time (Cherry and et.al., 2012).
Recommendations
From this report, it is analysed that there are various problems have been faced patients due
to ineffective hand hygiene of health care professional in hospitals settings. When asked how
they will improve their hand hygiene compliance, there are various important methods have been
identified through which they will be able to improve their hand hygiene. Establishment of
continuous monitoring and feedback on the infection rates to health care professionals such as
tracking endemic and emerging drug will help in improvement of hand Hygiene (Srigley, and
et.al., 2014). Management of Hospital also needs to create multidisciplinary design and response
team which is led by the senior administrator or professionals to emphasize that organisation is
committed to hand hygiene compliance. It is also essential for the health care professional to use
proper sanitized equipments for providing treatments to patients and must take care of Washing
hands with antiseptic liquid while using any equipment. Moreover, Hospital must ensure that
resources of hand hygiene needs to be easily assessable throughout the organisation, including
the patient care corridors and at the entrance and exit of the patient rooms. Traditionally the hand
hygiene was considered as the single most important way of reducing the health care associated
infections many of which are spread by the direct contact, specially by hands of health care
workers (de Macedo and et.al., 2012).
Management also needs to be aware about the problems which are caused by this
ineffective health hygiene to patients. They should spread awareness among the patients to
monitor that professional will provide them service with proper care and maintain hygiene to
reduce infections. They can also provide continuous education and training for employees,
patients and families and visitors. The reports suggest that they must use instructive posters,
pocket cards and brochures for training. Commitment of management of Hospital towards the
hand hygiene needs to be visible and engaging to the organisation and public through the formal
communication. Moreover, it is also suggested that professional should take care that any
harmful chemical must not be they’re near the patient which created infection. They also need to
reinforce the hand hygiene behaviour and accountability of staff at workplace. Management can
also achieve success by conducting contests and recognizing the health care professionals who
comply with this guideline. In order to communicate the information related to health and
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hygiene, management should organise workshops and seminars which helps in providing
complete understanding and experience to professionals. For improvement of hand Hygiene,
management needs to develop an ongoing monitoring program at premises that includes
feedback. Post monthly compliance data on the units of hospital, websites and discuss the
information with staff at the time of meeting. All the equipment which are required to improve
the strategies that needs to be completed (WHO Guidelines on Hand Hygiene in Health Care: a
Summary, 2018).
Thus, it can be said that the variety of single intervention strategies and the combination
of strategies, many based on the current recommendations from the world health organisation
will lead to increase in compliance of hand hygiene in the most of the health care settings.
CONCLUSION
It can be concluded from the above report that hand hygiene is the most important and
inexpensive method that can be adopted by a health care set up to control the prevailing infection
from one individual to other (We are counting on you to wash your hands, 2017). In order to
implement the same, nurses and health care professionals plays an important role in it where they
are required to clean their hands every time after they come in contact with some infectious
patient. Wearing gloves can also act as a protective measure. An observational study has been
conducted by the observer analysing various hand hygiene practices adopted by 15 nurses and 4
doctors at the time of duty in department of medicine for a stretch of 12 hours. The survey
helped in ascertaining that only few of them are involved intaking care these practices and take a
step to prevent infection from spreading in the department. It also helped in understating that out
of 19 care givers, there are only 5 care giving staff, who opt for washing their hands for
continuously 20 seconds. In the end, it has been recommended that commitment of management
of Hospital towards the hand hygiene needs to be visible and engaging to the organisation and
public through the formal communication.
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REFERENCES
Books and Journals
Abdul-Mutalib, N. A. and et.al., 2012. Knowledge, attitude and practices regarding food hygiene
and sanitation of food handlers in Kuala Pilah, Malaysia. Food Control. 27(2). pp.289-
293.
Aboumatar, H. and et.al., 2012. Infection prevention promotion program based on the PRECEDE
model: improving hand hygiene behaviors among healthcare personnel. Infection Control
& Hospital Epidemiology. 33(2). pp.144-151.
Al Kadi, A. and Salati, S. A., 2012. Hand hygiene practices among medical
students. Interdisciplinary perspectives on infectious diseases, 2012.
Al-Tawfiq, J. A. and et.al., 2013. Promoting and sustaining a hospital-wide, multifaceted hand
hygiene program resulted in significant reduction in health care-associated
infections. American journal of infection control. 41(6). pp.482-486.
Anargh, V. and et.al., 2013. Hand hygiene practices among health care workers (HCWs) in a
tertiary care facility in Pune. Medical journal armed forces India. 69(1). pp.54-56.
Ariyaratne, M. H. J. D. and et.al., 2015. Knowledge, attitudes and practices of hand hygiene
among final year medical and nursing students at the University of Sri Jayewardenepura.
Cherry, M. G. and et.al., 2012. Features of educational interventions that lead to compliance with
hand hygiene in healthcare professionals within a hospital care setting. A BEME
systematic review: BEME Guide No. 22. Medical teacher. 34(6). pp.e406-e420.
Davey, P. and et.al., 2013. Interventions to improve antibiotic prescribing practices for hospital
inpatients. Cochrane Database Syst Rev. 4(4).
de Macedo, R. D. C. R. and et.al., 2012. Positive deviance: Using a nurse call system to evaluate
hand hygiene practices. American journal of infection control. 40(10). pp.946-950.
Joshi, S. C. and et.al., 2012. Qualitative study on perceptions of hand hygiene among hospital
staff in a rural teaching hospital in India. Journal of Hospital Infection. 80(4). pp.340-
344.
Kirkland, K. B. and et.al., 2012. Impact of a hospital-wide hand hygiene initiative on healthcare-
associated infections: results of an interrupted time series. BMJ Qual Saf, pp.qhc-2012.
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Mahfouz, A. A., El Gamal, M. N. and Al-Azraqi, T. A., 2013. Hand hygiene non-compliance
among intensive care unit health care workers in Aseer Central Hospital, south-western
Saudi Arabia. International Journal of Infectious Diseases. 17(9). pp.e729-e732.
Shea, A. and Shaw, S., 2012. Evaluation of an educational campaign to increase hand hygiene at
a small animal veterinary teaching hospital. Journal of the American Veterinary Medical
Association. 240(1). pp.61-64.
Shinde, M. B. and Mohite, V. R., 2014. A study to assess knowledge, attitude and practices of
five moments of hand hygiene among nursing staff and students at a tertiary care hospital
at Karad. International Journal of Science and Research. 3(2). pp.311-321.
Srigley, J. A. and et.al., 2014. Quantification of the Hawthorne effect in hand hygiene
compliance monitoring using an electronic monitoring system: a retrospective cohort
study. BMJ Qual Saf. 23(12). pp.974-980.
Uneke, C. J. and et.al., 2014. Promotion of hand hygiene strengthening initiative in a Nigerian
teaching hospital: implication for improved patient safety in low-income health
facilities. The Brazilian Journal of Infectious Diseases. 18(1). pp.21-27.
Van De Mortel, T. F. and et.al., 2012. A comparison of the hand hygiene knowledge, beliefs and
practices of Italian nursing and medical students. Journal of advanced nursing. 68(3).
pp.569-579.
Yawson, A. E. and Hesse, A. A., 2013. Hand hygiene practices and resources in a teaching
hospital in Ghana. The Journal of Infection in Developing Countries. 7(04). pp.338-347.
Online
WHO Guidelines on Hand Hygiene in Health Care: a Summary. 2018. [Pdf]. Available through
< http://www.who.int/gpsc/5may/tools/who_guidelines-handhygiene_summary.pdf>
We are counting on you to wash your hands. 2017. [Online]. Available through <
https://www.gov.uk/government/news/we-are-counting-on-you-to-wash-your-hands>
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APPENDIX
Basis of Observation
 Do the caregivers wash their hands?
 How many times people actually wash their hands in a health care set up?
 How many infected patients arrived at the duration of 12 hours of observation?
 Is the method of washing hands is effective enough?
 Did they wash their hands after handling infected patient?
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