Hand Hygiene Practices in Healthcare

This assignment delves into the crucial topic of hand hygiene practices within healthcare environments. It requires a close examination of various research studies focusing on the knowledge, attitudes, and adherence to hand hygiene protocols among healthcare professionals. Students are expected to critically analyze these studies and synthesize their findings to understand the current state of hand hygiene practices in hospitals and other healthcare facilities.

Running head: REFLECTIVE ESSAY
Reflective essay
Name of the Student
Name of the University
Author note

1REFLECTIVE ESSAY
Brief description
The critical analysis of any issue or event through reflection cycle is helpful in increasing
knowledge and understanding of the professional practice in aspects of behaviour and values in
the healthcare and determines how behaviour will change in the future. It provide an insight into
a particular incident that contribute to personality development and aids in ensuring continuous
learning and role improvement. In the similar way, the analysis of the healthcare issue through
reflective cycle helped to gain an insight into the importance of issue and uncertainties around
healthcare practice and policy considerations.
The incident took place during the second year of the placement while working at the
surgical ward. During the wound examination, the doctor examined the wound without washing
the hands with soap or alcohol. It was astonishing and surprising for healthcare professionals to
exhibit such a malpractice in this profession, as hand hygiene is the simplest activity for cross-
infection reduction. The five moments of hand hygiene also reduces the infection rates by
cleaning hands in the right way and time. Therefore, in the next section, analysis of this incident
through Gibb’s reflection cycle will be done followed by uncertainty of health practice or policy
and actions required to enhance hand hygiene in professional health practice.
Gibb’s reflection cycle
Incident
The incident occurred during the second year of my nursing placement. I was assigned to
work in the surgical ward and under the supervision of my senior. My mentor instructed me to
take care of a seventy-year old man. The patient had undergone abdominal surgery and was
instructed for wound dressing removal for the doctor to examine during the round off. I removed

2REFLECTIVE ESSAY
the wound dressing under his guidance through a non-touch procedure. I cleaned the wound as
instructed. At that moment, my mentor was called for visiting another patient and was advised to
stay with the patient until the doctor come for the visit.
The doctor was busy examining another patient and to my surprise, I noticed that doctor
came straight to my patient and started examining his wound. Before examining my patient’s
wound, the doctor without using alcohol or soap wash. I also noticed that doctor’s sleeves were
long and concerned cuff contamination with the wound. At that time, I thought of what to do or
say to the doctor by summoning courage, I realized that it was too late as the doctor was already
examining my patient.
Feelings
This incident alarmed me. It is expected that being a healthcare professional, he would
wash his hands with soap or alcohol before examining the patient. However, it did not happen
and was astonished by the incident. I felt intimidated that as he is a doctor, he would be more
experienced as compared to a nursing student. I did not want to embarrass him and kept quiet. I
did not confront the doctor in front of the patient, as it would concern the patient.
However, I gathered some courage and later spoke to my senior about this incident. He
suggested that he would talk to the doctor about the whole incident. My mentor took and spoke
to the doctor aside. My mentor asked the doctor that whether he had washed his hands before
examining the patient. He looked shocked and was alarmed. He said that he had a busy schedule
and missed it. Finally, my mentor discussed the five moments of hand hygiene and he assured
my mentor that he will wash his hands before touching any patient in the future.

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Evaluation
This incident was shocking for me. It was also surprising for me. I regret that I would
have acted before the doctor examined the patient. However, by the time, I had summoned
courage; the doctor already examined the patient. However, I was pleased that the doctor
responded in a positive manner when my mentor confronted him. He was empathetic when my
mentor provided feedback and I have observed that he had changed his practice after the incident
happened. I have also learned the importance of assertiveness with my colleagues and most
importantly the five moments of hand hygiene for best health practice.
Analysis
Hand hygiene is the most important factor to prevent hospital related infection rates and
cross-contamination. According to World Health Organization (WHO), one in 25 patients who
are admitted in hospital suffer from hospital borne infections. Even the healthcare professionals
are at risk for infection as they are in continuous contact with the patients. This prevention of
infections is important in medical setting. It safeguards the patients and ensures highest quality
of care in the healthcare. The improvement of hand hygiene is important to prevent and reduce
the spread of hospital-associated infections. Recent guidelines provided by the Department of
Australian Commission on Quality and Safety in Health Care (ACSQHC) states the
maximization of implementation of hand hygiene practices. The Nursing and Midwifery Council
Code of Professional Conduct, (Section 8), states that nurses have the responsibility to identify
the risk and try to minimize to safeguard patient safety and deliver highest quality of care. This
statement greatly implies in this incident as the patient was under the supervision of my mentor.

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Moreover, for a student nurse, it is important to apply this hand hygiene practice in daily practice
and has the responsibility to make others aware of it (Sickbert-Bennett et al. 2016).
Apart from hand hygiene, assertiveness is also important for the nursing profession.
Nurses should work schematically for problem solving by unveiling constraints for effective
nursing and in improving quality of care. For effective communication, one has to behave
assertively and prevent barriers to assertiveness among the nurses. As the doctor was
experienced than me, I was unable to challenge his practice and as a result, endangered the
patient safety. This is the reason, assertive skills are important in nursing for effective
communication and risk in healthcare settings.
Conclusion
This incident made me realize that I should have acted at the right time. After looking
back, I realized that I should have acted sooner and warned the doctor to wash his hands before
examining the patient. I realize that I have put the patient safety at risk by not acting at the tight
time. After a brief conversation with my mentor, I realize that I have to develop assertive skills
and confidence to stand for the rightful thing. I have to challenge the wrong practice even if they
are my seniors keeping in mind the safety and well-being of the patients at the forefront. I realize
that I need to be understanding and supportive towards my colleagues keeping in mind the
pressure and demand of the nursing profession. At the same time, it is my responsibility to
ensure patient safety and in minimizing the client risk.
Action Plan
In the future, I will try to develop my assertiveness working with my colleagues that
would ensure the patient safety and highest quality of care. It is my goal to make my colleagues

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aware of the importance of five moments of hand hygiene to provide the best quality of care and
in ensuring patient safety. In my next nursing placement, I will make a goal to enhance my
learning to achieve assertive skills and work in collaboration in ensuring patient safety
(Howatson-Jones 2016).
Hand Hygiene Policy and health practice
After the incident, I wanted to gain an insight into the evidence-based practices and
policy considerations regarding five moments of hand hygiene. For this, I have gone through
various peer-reviewed journals for literature review to understand the uncertainties in hand
hygiene practices and policies related to hand hygiene.
According to Centres for Disease Control and Prevention (CDC), practicing of hand
hygiene is the simplest and effective way to prevent germs and infections by eradicating resistant
antibiotics that are difficult to mitigate (Shinde and Mohite 2014). According to Salmon et al.
(2015) the healthcare professionals should perform five moments of hand hygiene to prevent
hospital associated infections spread and chances of cross-contamination. According to World
Health Organization (WHO), patient-care activities transmit bacteria to the healthcare
professionals during wound-care, respiratory tract, intravascular catheter care (White et al.
2015). During these activities, there are possibilities of healthcare professionals to get infected
with patient body fluids and secretions or during clean contact like patient’s temperature, pulse
or blood pressure. Various microorganisms come in contact after patient visit are Clostridium
difficile, MRSA, Klebsiella spp., Staphylococcus aureus, or gram-negative bacteria. Contact
with contaminated surfaces can also cause spread of infection. Hospitals also have hand hygiene
policies that are important to guide the employees for hand hygiene (Mumford et al. 2014).

6REFLECTIVE ESSAY
However, I personally feel that it is not possible to imply these policies in a healthcare
organization. At the professional level, this issue of hand hygiene requires high degree of
compliance to make changes in the organization to reduce infection rates. According to a recent
report by CDC, one in 25 patients get infected with healthcare-associated infection during the
hospital stay that add up to 722,000 total infection cases in a year. Out of this number, around
75,000 patients die due to infections as clinicians neglect the basic practice of hand hygiene to
prevent infection spread (White et al. 2015).
The five moments of hand hygiene is an effective hand hygiene way as outlined by
WHO. These are performing hand hygiene before contacting a patient, before any aseptic task,
after exposure to bodily fluids and after patient contact and after being in contact with the patient
and contaminated surroundings. At the personal level, I think that these hand hygiene policies
can only work when people show adherence to hand hygiene practices on a daily basis.
According to WHO guidelines, an estimated 50% to 60% of people show adherence to these five
moments of hand hygiene. However, this non-compliance to hand hygiene is unintentional
(Kwok, Callard and McLaws 2015).
In a study conducted by New South Wales (NSW) and Australian Institute of Health and
Welfare (AIHW) the clinicians and nursing staffs work under extreme demanding and stressful
conditions and as a result, miss it (Kwok, Harris and McLaws 2017). In another study conducted
by White et al. (2015) it highlighted the fact that one potential reason for hand hygiene non-
compliance is that the target (pathogen) is visible. At the professional level, I feel that healthcare
professionals do not realize the spread of infections by the carrying pathogens in their hands and
pass to others. They are unable to understand how the pathogens are transmitted from
contaminated hands to other patients when it may result in few days or months. Cost of time is

7REFLECTIVE ESSAY
another reason for their non-compliance to hand hygiene. A practice that is altruistic in nature
makes them feel burdened to perform the task and nothing is there to reap the benefit (Srigley et
al. 2015).
In NSW Health, the Hand Hygiene Policy outlines the policies that minimize the risk of
infection and prevent healthcare associated infections (Allegranzi et al. 2013). The policy sets
out that medical staffs should perform hand hygiene by using soap and use of alcohol-based
wash. In healthcare organizations, hand-washing facilities and Alcohol-based hand rubs (ABHR)
should be available for all clinicians, medical staffs and visitors. There should be strict
surveillance over the practice of good hand hygiene (Ellingson 2017). At the personal and
professional level, I think this is possible through clinical audit in healthcare organizations on a
monthly basis to reduce the rates of HAIs.
Action plan to enhance the professional health practice
Clinical auditing is the most effective action plan that can help to increase compliance to
hand hygiene and in improving the quality of healthcare (Sickbert-Bennett et al. 2016). It is a
clinical process that is well established and set out principles for the evidence-based practices.
This clinical auditing will measure the compliance of hand hygiene by the clinicians and medical
staffs. Clinical auditing is a measure of clinical governance where it provides opportunities for
organizational change and hand hygiene adherence. It is an improvement process in the safety
and quality of healthcare that outlines recommendations for compliance and behaviour change in
reducing HAIs (Macinga et al. 2013).
This can be performed through processing of outcome data after clinical audit measuring
the hand hygiene compliance. The focused interviews and questionnaire obtained from the

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medical staffs and clinicians would help to evaluate the awareness among them regarding the
infection control and adherence to hand hygiene. The evaluation of the interviews and
questionnaires would help to determine the targeted group for behaviour change, its management
and the potential barriers that hinder compliances.
At the personal level, medical staffs and clinicians should understand the issue of hand
hygiene that ensure patient safety and quality of healthcare. While working with patients, they
should perform the five moments of hand hygiene at specific moments wither by alcohol wash or
hand washing with soap. According to WHO, alcohol hand rub is the most easiest and effective
method to perform hand hygiene on a daily basis in the healthcare delivery (Rawles 2014).
However, it is also stated that hand rubs are not affordable and not available in many
countries as said by WHO. Therefore, it is important to improve the affordability and
accessibility of the hand rubs in saving lives while working in public and private collaboration.
These issues are important to address to inculcate the practice of hand hygiene among the
healthcare staffs. At the personal level, I think, creating awareness is the best way to help to
increase compliance to hand hygiene. Hand hygiene programs can help to create awareness and
act as a common platform to share the knowledge in promoting compliance and enhancing
healthcare staffs to use hand hygiene products in their daily routine (McInnes et al. 2014). There
is also need to assess the availability and accessibility of hand hygiene products in all parts of
healthcare organization. Direct observation can also be done as it is regarded as a gold standard
process that provide information about staff compliance to thoroughness of cleaning and their
behaviour towards the hand hygiene issue.

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References
Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M.L., Moro, M.L.,
Memish, Z., Urroz, O., Richet, H., Storr, J. and Donaldson, L., 2013. Global implementation of
WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. The
Lancet infectious diseases, 13(10), pp.843-851.
Ellingson, K., 2017. Hand Hygiene Promotion from the US Perspective: Putting WHO and
CDC. Hand Hygiene: A Handbook for Medical Professionals, 9, p.221.
Howatson-Jones, L., 2016. Reflective practice in nursing. Learning Matters.
Kwok, Y.L.A., Callard, M. and McLaws, M.L., 2015. An automated hand hygiene training
system improves hand hygiene technique but not compliance. American journal of infection
control, 43(8), pp.821-825.
Kwok, Y.L.A., Harris, P. and McLaws, M.L., 2017. Social cohesion: the missing factor required
for a successful hand hygiene program. American journal of infection control, 45(3), pp.222-227.
Macinga, D.R., Edmonds, S.L., Campbell, E., Shumaker, D.J. and Arbogast, J.W., 2013.
Efficacy of novel alcohol-based hand rub products at typical in-use volumes. Infection Control &
Hospital Epidemiology, 34(3), pp.299-301.
McInnes, E., Phillips, R., Middleton, S. and Gould, D., 2014. A qualitative study of senior
hospital managers’ views on current and innovative strategies to improve hand hygiene. BMC
infectious diseases, 14(1), p.611.
Mumford, V., Greenfield, D., Hogden, A., Debono, D., Gospodarevskaya, E., Forde, K.,
Westbrook, J. and Braithwaite, J., 2014. Disentangling quality and safety indicator data: a

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longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96
Australian hospitals. BMJ open, 4(9), p.e005284.
Rawles, Z., 2014. Essential Knowledge and Skills for Healthcare Assistants. CRC Press.
Salmon, S., Pittet, D., Sax, H. and McLaws, M.L., 2015. The ‘My five moments for hand
hygiene’concept for the overcrowded setting in resource-limited healthcare systems. Journal of
Hospital Infection, 91(2), pp.95-99.
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.
Sickbert-Bennett, E.E., DiBiase, L.M., Willis, T.M.S., Wolak, E.S., Weber, D.J. and Rutala,
W.A., 2016. Reduction of healthcare-associated infections by exceeding high compliance with
hand hygiene practices. Emerging infectious diseases, 22(9), p.1628.
Srigley, J.A., Corace, K., Hargadon, D.P., Yu, D., MacDonald, T., Fabrigar, L. and Garber, G.,
2015. Applying psychological frameworks of behaviour change to improve healthcare worker
hand hygiene: a systematic review. Journal of Hospital Infection, 91(3), pp.202-210.
White, K.M., Jimmieson, N.L., Graves, N., Barnett, A., Cockshaw, W., Gee, P., Page, K.,
Campbell, M., Martin, E., Brain, D. and Paterson, D., 2015. Key beliefs of hospital nurses’ hand-
hygiene behaviour: protecting your peers and needing effective reminders. Health Promotion
Journal of Australia, 26(1), pp.74-78.
White, K.M., Jimmieson, N.L., Obst, P.L., Graves, N., Barnett, A., Cockshaw, W., Gee, P.,
Haneman, L., Page, K., Campbell, M. and Martin, E., 2015. Using a theory of planned behaviour

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framework to explore hand hygiene beliefs at the ‘5 critical moments’ among Australian
hospital-based nurses. BMC health services research, 15(1), p.59.
White, K.M., Starfelt, L.C., Jimmieson, N.L., Campbell, M., Graves, N., Barnett, A.G.,
Cockshaw, W., Gee, P., Page, K., Martin, E. and Brain, D., 2015. Understanding the
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