Critical Evaluation of Hand Hygiene Practices at WW Aged Care Facility

This report provides a critical evaluation of hand hygiene practices within the WW Aged Care Facility, an 88-bed residential home. The assessment focuses on the observed non-compliance with the recommended 20-second hand washing protocol among staff, as revealed by a recent audit. The report delves into the background and context of the issue, highlighting the importance of hand hygiene in preventing the spread of infections, especially among vulnerable residents. It examines the facility's current practices, including the implementation of the 5 Moments of Hand Hygiene, while also pointing out the limited availability of alcohol-based hand rub (ABHR). The report proposes several strategies to improve hand hygiene compliance, including the placement of ABHR at points of care, the use of visual reminders, and the potential implementation of high-tech hand washing scanners, along with staff training and education. The aim is to improve patient safety and reduce the risk of healthcare-associated infections, aligning with national guidelines and initiatives.

Critical evaluation of Hand Hygiene
Practice in aged care facility

Table of Contents
INTRODUCTION...........................................................................................................................3
Background and Context.............................................................................................................3
Strategy........................................................................................................................................6
Evaluation....................................................................................................................................9
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................12

INTRODUCTION
This essay will critically evaluate hand hygiene practices and compliance of practice in
an aged care facility. Hand hygiene is concerned with a practice in which hands of one are
cleaned and this is done to substantially reduce potential pathogens or harmful microorganism on
the hands. This is very important practice that is undertaken to reduce risk of transmitting
infections among patients and healthcare staff (Australia, (2017). Hand hygiene is very important
part of infection prevention and control of infection in organisation. This is more important for
people who are working in care facilities because they come in contact with people who are
susceptible to infectious diseases. Concerned with hand hygiene time spent on hand washing is
very important and it is very important that to achieve best hand hygiene adequate time is spent
while washing hands. This essay will include a background and context about the case
organisation and hand hygiene practices in case organisation. Case organisation for this essay is
WW Aged Care Facility, this is a 88 bed residential home for aged care. Aged care facility has
strong emphasis on providing a welcoming environment to all the people living in aged care.
Along with this they also focus on comfort, safety and feeling respected and valued. Hand
hygiene is a part of safety consideration at WW Aged Care Facility. However, recent audit in
aged care showed that staff in facility are not washing their hands properly for recommended 20
seconds and most of the staff, most of the time finished quickly. Followed by background, essay
will include strategy and evaluation of the strategy that has been implemented in WW Aged Care
Facility for improving existing practices of hand hygiene.
Background and Context
Problem in this project is that 'in a recent audit it was identified that staff at WW Aged
Care are not washing their hands for recommended 20 seconds'. This means that a time of 20
seconds as standard time for washing hands have been allotted to be considered by healthcare
workers (Australian Guidelines for the Prevention and Control of Infection in Healthcare
Australian Guidelines for the Prevention and Control of Infection in Healthcare, (2019). This is
very important that to ensure effective cleaning of hands and for achieving best standards of
hand hygiene health-care workers wash their hand for 20 seconds. This problem has several
negative impacts on health of patients and also on health of staff if necessary precaution is not
taken (McLaws and Kwok, 2018). Not washing hands properly and neglecting hand hygiene can
lead to spread of several diseases and especially those that develop from germs and

microorganism. Along with this hand hygiene is also important for breaking chain of infection
and to avoid increasing chain of infection. Along with this hand hygiene also is required for
maintain standard precautions in healthcare and to follow national guidelines and information of
Hand Hygiene Australia. To report auditing is important to ensure that all standards of hand
hygiene are being complied and report is done to Hand Hygiene Australia.
WW Gardens Aged Care Facility is places strong emphasis on safety and hygiene and
this is why effective procedure has been implemented in organisation for hand hygiene in order
to avoid infection to residents in facility. In this context staff in WW Aged Care Facility is
requires cleaning and wash their hands every-time before they start working with residents and
undertake any activity that might contribute in spreading of infections to patients. Along with
this, staff working with patients who have issues of mobility and those who are not able to
complete basic activities like eating, they are required to take extra care of hand hygiene. Staff in
WW Aged Care Facility are also required to and have been asked to comply with 5 Moments of
Hand Hygiene (SAVE LIVES - clean your hands (2021). 5 Moments of Hand Hygiene that came
from WHO and were adopted by National Hand Hygiene Australia, includes-
 Before touching a patient- This involves that staff should wash and clean their hand
before entering into the zone of patients (Grayson and et.al., 2018). Through this staff can
protect patients against acquiring harmful germs on hands and transfer them to patients.
 Before clean/aseptic procedure- This involves cleaning hands immediately before
starting procedures for patient. This means that after cleaning hands nothing else
surrounding environment of patient should be touched before procedures starts.
 After body fluid exposure/risk- This involves cleaning hands immediately after
exposure to body fluids and even if staff is having gloves washing hands is very
important. This is because exposure to body fluid can contaminate gloves and hands
might get infected while removing gloves.
 After touching a patient- This is also required that immediately after touching a patient
staff should clean their hand before leaving zone of patient. This is done to avoid any risk
to staff and to avoid contamination of surrounding of care facility.
 After touching surroundings of patient- This involves washing and cleaning hands
after touching surrounding of patient because it might be contaminated because of patient
touching it (SAVE LIVES - clean your hands (2021).

Recent audit at WW Aged Care Facility showed that staff are not washing their hands for
20 seconds recommended for effective hand hygiene and they are finishing washing their hands
quickly. Hygiene audit was done by a team in aged care and staff was trained abut hand hygiene
audit. Along with this, staffs were also informed about Hand Hygiene compliance developed by
Hand Hygiene Australia. For hand hygiene audit minimum standards have also been outlines in
National Hand Hygiene Initiative (Teesing and et.al., (2020). This is an important concern
because washing time for 20 seconds ensure that hands are clean and free of any potential
microorganism that can contribute in developing some disease for patient or residents in aged
care facility.
Not washing hands and cleaning them properly can lead to developing diseases because
of germs and microorganism. In case staff do not wash their hand after production with patient
properly they are at risk of getting or developing diseases through pathogens or microorganism
of patients. National health hygiene initiative have started initiative to improve health hygiene
compliance among Australian health-care workers to reduce risk of health-care related infections
(Australian Guidelines for the Prevention and Control of Infection in Healthcare Australian
Guidelines for the Prevention and Control of Infection in Healthcare, (2019). There are several
risks because of unhygienic hands in which germs can get into body of individual through eyes,
nose and mouth and make them sick. Unwashed hands of staff can also contaminate food and
drinks and can develop food-borne diseases and illness.
WW Aged Care Facility is a facility with 88 beds that comprises three wings. WW Aged
Care Facility provides modern and premium rooms to all residents and adequate facilities have
been provided to staff to wash their hands and clean their hands. In this facility washing basins
are there and along with this, bathrooms are also there where staff can wash their hands. In
addition to this, in WW Aged Care alcohol-based handrub have also been placed on different
places so that staff can ensure their hands are clean and they are maintaining all standards of
hygiene while they are at work (Kwok, Harris and McLaws, (2017). Hand washing basins are
also placed on different places and there are common areas where staff can clean their hand
before entering into zone of patient. This means that in WW Aged Care there are facilities where
staff can ensure compliance to 5 moments of hand hygiene. In other words, they can wash and
clean hands before entering into zone of patient, before starting procedure, after exposure to
body fluid, after touching patients and after touching surroundings of patient. However, ABHR

have not been placed at all places and this is a gap in WW Aged Care because ABHR requires
less time and staff can quickly finish cleaning their hands. However, after all these facilities of
wash basins, staff at WW Aged Care is not cautious about time that they need to spend while
washing or cleaning their hands.
It is very important that they keep their hands clean because they come in contact with
many patients and their surroundings. Along with this, several types of healthcare services are
also provided to all kinds of patients and this is why it is very important that to avoid any
potential risk adequate hand hygiene is maintained by staff working in WW Aged Care.
Not washing hands properly can also cause threat to several people living in aged care
(Sasko, Dixon and Smith, (2017). This means that there are several infectious diseases that can
spread because of not washing hands properly and this is why to avoid impact on all patients in
aged care facility, it is important that staff wash their hands properly. Audit was completed by
comparing hand hygiene practices in aged care with standards outlined by National Hand
Hygiene Initiative and Hand Hygiene Australia’s requirements. Other than this, state infection
prevention and control guidelines are used for comparing audit results. Issues identified were
both time barrier as well as knowledge and awareness of staff at WW Aged care.
Strategy
Under this heading strategy to improve existing situation is to be discussed. Certain
interventions to improve existing condition and make changes in WW Aged Care are-
Having ABHR available at the point of care
This is a very important intervention to deal with the problem facing WW Aged Care and
to reduce possible impact of not washing hands properly. ABHR is concerned with Alcohol-
based hand rub and placing this on different points where care is provided (Hand hygiene in
outpatient care, home-based care and long-term care facilities, (2021). This involves placing
alcohol-based hand rubs in rooms where patients reside, so that before starting procedure with
patient and after touching patient and while coming out of zone of patient staff can use alcohol-
based hand rubs. This will reduce potential of spreading infections drastically. Benefit of using
ABHR is that it is less time consuming compared to washing hands, because of this staff using
less time will be able to maintain effective hand hygiene. As presently there are not enough
places and points for ABHR where staff can easily access ABHR and this is why the strategy has
been suggested.

Increasing compliance rate through visual reminders
This is one of the important intervention to increase compliance rate of hand hygiene
policy in WW Aged Care. As per this WW Aged Care require using visual reminders such as
posters and place it on different areas in facility (SAVE LIVES - clean your hands. (2021).
Along with this, placing such posters on areas around hand washing facility can also increase
compliance rate by staff. This means that while washing hands they will see posters and this will
increase their consciousness for washing hands for 20 seconds (Prasad, Chok and Wilkes,
(2017). Visual reminders can be of several types such as educational posters, informational
brochures, fact sheets and infographics, visual in-house notices and showing images of bacterial
culture.
Use High-Tech Hand Washing Scanners
This is another intervention to improve existing condition in WW Aged Care. Using
high-tech washing scanners will allow staff of WW Aged Care to scan their hands and will
inform them if they have not washed their hands properly. This will increase consciousness of
staff when they are washing their hands and they will consider washing hands for 20 seconds.
However, this strategy is something that can be difficult for WW Aged care to adopt and
implement but adequate planning and organising finance can facilitate its implementation.
Training staff and educating them
This is an intervention in which staff are required to be trained and to be educated, doing
so for enabling them to understand what are positive and negative impact of washing hands
properly (Australian Guidelines for the Prevention and Control of Infection in Healthcare
Australian Guidelines for the Prevention and Control of Infection in Healthcare. (2019). This
involve properly educating them about how they can avoid negative repercussions when they
wash their hands for 20 seconds. In another they should be informed about drawbacks of not
washing hands for 20 seconds. While doing this, using facts and figures is very important, this
helps in realising them reality of a practice and its impacts.
In implementation of these strategies discussed above WW Aged Care will require
support of several parties in organisation (Boyce, (2019). Their support is required for several
purposes such as for their approval and for their engagement in implementation of strategy in
organisation. In order to implement these strategies, process and people involved are-
Developing infection control committee

This involves developing committee for controlling infection in WW Aged Care and this
committee is one that becomes responsible for formulation and implementation of interventions
through which infection can be controlled in organisation (Australian Guidelines for the
Prevention and Control of Infection in Healthcare Australian Guidelines for the Prevention and
Control of Infection in Healthcare. (2019). Along with this, for strategies and measures
suggested by others to improving hand hygiene practice in infection control committee is
required to be established.
Communicating with stakeholders
Stakeholders are all those people and parties who are likely to get affected by
implementation of strategy or intervention in organisation. Implementation of strategy requires
communicating with all stakeholders. Important stakeholders to be communicated includes staff
of WW Aged Care, top management, infection control committee and service users.
Strategies that can be adopted for communication includes meetings with staff and top
management, communicating through notice and informative brochures with service users
(Sendall, McCosker and Halton, (2019). Communicating through report to infection control
committee to give them all important information about interventions in organisation.
Implementation of Intervention
This is a phase in which interventions are implemented in organisation. This requires that
staffs in WW Aged Care are working on new practices. For example, staffs in WW Aged Care
have started using ABHR before starting procedures with patients. Similarly, other interventions
have also become part of hand hygiene practices of staff at WW Aged Care. In this time it is very
important that staff is properly trained and regularly supported so that new practices in hand
hygiene can become part of their life.
Barriers/obstacles in implementation
Barriers and obstacles for implementation of interventions for hand hygiene includes-
Financial barriers- This is one of the barrier in implementation of new interventions in WW
Aged Care. Inadequate finance available can create barriers in implementation of strategy in
organisation. This requires that there is proper planning in place for implementation of planned
interventions and strategy. Along with this, another important strategy is that interventions are
implemented in a fixed time pattern, so that it does not create any kind of financial burden on
WW Aged Care.

Unsupportive leadership- This is also a important barrier that can affect success of
implementation of intervention in organisation (Mckay, Shaban and Ferguson, (2020).
Leadership in organisation should be prepared for changes that are likely to take place in
organisation and how they should support others in implementation and adoption of change.
Workload- This is also important barrier that can affect how conscious staff is about
implementation of strategy and interventions in WW Aged Care. Staff when face high workload
and work-pressure, their focus remains on completion of work and other important things might
be neglected by them. It is important that work pressure in WW Aged Care is balanced so that
staff can focus on maintaining hygiene and take other necessary precautions to prevent infection.
Evaluation
This involves measuring effectiveness of implementation of intervention in organisation.
This helps in identifying whether evaluation was successful or not and if successful then, how
effectively it achieved desired results. There are several ways in which intervention implemented
at WW Aged Care can be evaluated and these are-
Post implementation hand hygiene compliance audit- This is an evaluation method in which
audit is done after intervention has been implemented. This is an important way to ensure that
compliance to hand hygiene was improved. Aim of this project was to improve compliance to
hand hygiene practice and making staff understand importance of washing or cleaning hands for
20 seconds (Australian Guidelines for the Prevention and Control of Infection in Healthcare
Australian Guidelines for the Prevention and Control of Infection in Healthcare. (2019). Post
implementation compliance audit will help in identifying difference in compliance before
implementation of intervention and after implementation of intervention (Slater and et.al.,
(2017). Doing this helped in identifying that compliance to hand hygiene practices and policy
have significantly increased. Staff are more cautious about practices of hand hygiene and they
are washing their hands for 20 seconds rather than quickly finishing washing hands.
Observation- This is also a way through which intervention can be evaluated, in this supervisors
simply observed about hand washing practices of staff at WW Aged Care (Australian Guidelines
for the Prevention and Control of Infection in Healthcare Australian Guidelines for the
Prevention and Control of Infection in Healthcare. (2019). Observation helped in realising that
sometimes when staffs were aware that they are being observed, they cleaned their hands
properly and washed them for 20 seconds.

Feedback from staff- This was also used for evaluation of hand hygiene practices of staff, in
this evaluation practice feedback from staff was collected. Feedback about improvement in hand
hygiene practices were collected through interviewing staff members. This also enabled to
communicate with staff members about what they feel and see as improvement in hand hygiene
practices in aged care facility (World Health Organization, (2017). Outcome of this evaluation
was such that most of the staff members were positive towards change implemented in WW
Aged Care. Staff feedback suggests that they have become more conscious towards washing
hands for 20 seconds recommended time and about hand hygiene while working in WW Aged
Care.
This means that implementation of interventions in WW Aged Care was evaluated in
several ways to ensure exact difference in compliance with hand hygiene practices before and
after implementation of intervention. On the basis of evaluation it was identified that
implementation of interventions in WW Aged Care improved consciousness of staff about hand
washing practices. They were more aware while washing and cleaning their hands after
interventions were implemented in WW Aged Care (SAVE LIVES - clean your hands, (2021)).
Evaluation suggests that there have been improvements in practices of hand hygiene, however
100 percent results have not been achieved. This means that there are still many staff members
who finish quickly washing their hands and do not wash for 20 seconds recommended time. This
means that aim of the project that was to increase compliance was achieved to a great extent and
continuing existing practices will lead to achievement of aim completely. In this ongoing
education to staff, visual reminders in facility and mandatory training would improve practices.
Auditing and reporting of compliance of relevant government will also create awareness and
staff will ensure complete hand hygiene.
CONCLUSION
On the basis of above discussion, it can be concluded that it is very important for health-
care workers and staff to comply with all policy and procedures for hand hygiene. Along with
this, compliance with 5 Moments of Hand Hygiene are vital for success in reducing and avoiding
infection and its spread in aged care facility. Background and context of essay was discussed in
report and this outlined that compliance is very important and WW Aged Care whilst having all
necessary facilities for hand hygiene in place is facing difficulty in maintaining compliance of
staff regarding hand hygiene. This means that staff are not washing their hands for 20 seconds. In

this project for strategy and implementation of intervention was developed with aim to improve
compliance with hand hygiene practice and to wash hands for recommended time. In order to
increase compliance of staff with hand hygiene practice and policy certain strategy and
interventions were planned. These interventions were aimed at educating and encouraging staff
to spend recommended time for washing and cleaning hands. Interventions included using
ABHR, using visual reminders and training and educating staff for improving hand hygiene
practices and spend recommended time for washing and cleaning hands. Evaluation of
intervention was also done and this was done to identify success of interventions and is they have
been successful, then to what extent interventions have been successful in achieving aim of the
project that is to increase compliance with hand hygiene practice and increasing time spent on
hand washing and cleaning to recommended time.

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