Evidence-Based Nursing: Hand Hygiene Practices and Infection Control

This report, prepared for an Evidence-Based Nursing assignment, investigates the critical role of hand hygiene in preventing healthcare-associated infections. The study identifies hand hygiene as a key instrument in healthcare settings, addressing the spread of infectious diseases among patients and healthcare professionals. It begins by identifying hand hygiene as an area of specialty, then formulates a PICO question to guide the research and provides discussion based on evidence, analyzing the impact of hand hygiene on reducing healthcare-associated infections. The report compares and contrasts levels of evidence, highlighting the effectiveness of alcohol-based hand rubs, and discusses potential barriers to implementation. It also provides recommendations for improving hand hygiene practices through multimodal approaches, organizational structures, and educational initiatives. The conclusion emphasizes the need for continued emphasis on infection control to improve patient safety.

Running head: EVIDENCE BASED NURSING
EVIDENCE BASED NURSING
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Control of infection spread and reduction of the amount of diseases associated with health
care is of major concern to every health care unit. There are aspects of a health plant in the
setting that can effectively promote infectious illness growth and propagation (Zingg et al.
2015). Everything from water in the facility to individuals working in the facility could be
prospective contamination carriers The invasive type of many contemporary medical
processes means that there is a strong chance of unrelated diseases in clinics or in other health
establishments. In latest centuries the amount of operations has risen, and patients have been
opened to infection at incision locations (Zmora et al. 2016). A variety of diagnostic tools
and other medical equipment are also used for infection treatment. Aseptic process for all
invasive medical processes is a main component. Likewise, the most efficient interventions
for infection controls are standard (safety) precautions as the disease that is untreated is the
most common. Hospitals need to make sure that infectious diseases do not really spread more
critically than ever. The spread of diseases in clinics leads to deaths every year. Health
employees can take measures to stop infectious illnesses from spreading. These measures are
component of the prevention of infections (World Health Organization 2016). The infection
control covers variables linked to the disease spreading within the context of health care
whether it is patient to patient, patient to employees, employees to patient, and staff to staff.
On that principle, infection avoidance and control is the popular theme taken in the field of
health care.
Task 1: Identification and description of area of speciality:
Many health professionals describe 'Hand Hygiene' as a key instrument for stopping the
propagation of health-related diseases among clients (Ellingson et al. 204). As per the WHO,
that there is little definitive information on the activity of the patient care system, which will

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most probably pass organisms on to the health care provider's hands (Who.int 2019).
Organisms have been discovered in palms of the health care worker after actions like wound
care, catheter treatment, pulmonary tract treatment and the treated secretions of clients as
anticipated; however, after so called clean contact, bacteria have also been discovered on
health care worker palms after activities like taking pulse, blood pressure and
temperatures etc (Who.int 2019).
Task 2a: PICO Questions:
PICO is a valuable tool to ask to the point clinical questions. Small variants of this concept
are used for quantitative and qualitative assessments (Libguides.murdoch.edu.au 2019).
Hence, a PICO question has been generated in this regard and the PICO question is:
“Implementation of Hand Hygiene technique for the prevention of spread of the health care
associated infection among Nurses and health care professionals.”
Task 2b: Discussion based on evidence:
Washing hands pre and post contact with the patient may seem like a simple way to prevent
infections from spreading between clients. Most clinics have strategies for hand hygiene that
support their staff. However, it is not as easy as it might seem. According to Centre of
Disease Control information, during patient care, roughly one out of 25 patients acquires a
health-associated infection or HAI. Out of those patients, around 75,000 individuals die of
infection (Haque et al. 2018). With the increasing burden of health care associated infection,
the effects of hand hygiene in reducing health care associated infection are supported by
restricted alternatives for efficient antimicrobial proof. The only way to reduce health care
associated infection incidences and the spread of antimicrobial resistance is to ensure proper
hand hygiene and it is the most significant, simple and less costly way (Sickbert-Bennett et
al. 2016). Several surveys have shown that washing hands before an operation in Intensive

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Care Unit is virtually eradicated the carriage of Methicillin resistant Staphylococcus aureus.
A decline in Methicillin resistant Staphylococcus aureus levels was observed in the
adherence of hand washing (Barnes et al. 2014). The adherence to the suggested hand
washing methods in most health organizations continues unacceptable, usually surpassing 40
per cent of those stated in the case of hand hygiene. Hygiene of hands represents attitudes,
behaviours and convictions. Certain variables discovered to affect hand hygiene behaviours
that have been observed or self reported are included. The use of alcohol based hand rub
rather than the cleaning with soap and water is one of the main components in enhancing
hand hygienic practices. A hand massage with alcohol takes less time is microbiologically
more efficient and is less skin annoying than traditional hand water and soap cleaning. In
Intensive Care Units, the period needed for hand hygiene would reduce the time from 1.3 h
(or 17 per cent of complete working time) to 0.3 h (or 4 per cent of complete working time)
to switch to alcohol based hand disinfection from soap and water (Huang, Stewardson and
Grayson 2014). In addition, health services that are easily supported by hand hygiene
policies are also more accessible to deeper examination of their infection control methods in
particular. The effect of concentrating on health in the hands can therefore contribute to a
general enhancement in the security of patients throughout a whole company. Much has been
improved in sanitation of hands in many areas of the globe in latest years. However,
insufficient access to clean water, not enough toilets or toilets, insufficient knowledge of the
key position performed by hygienic handles and insufficient capital to address the abysmally
small adherence rates are still available. While hand hygiene is not the only indicator of
health care associated infection control, it alone can improve patient security dramatically, as
many sciences proof show that bacteria causing health care associated infection are most
often propagated by health care professionals (El-Soussi et al. 2017).
Task 3: Comparing and contrasting level of evidence:

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Following the extensive use of alcoholic rubs as the gold level for hand sanitation in
medicine, their ineffectiveness against sporoidal pathogens has been highlighted. Other than
iodophors, no Hand hygiene (including chlorhexidine, alcohols, hexachlorofen, chloroxylenol
and triclosane) is reliably sporicidal to Clostridium or Bacillus spp, although the
concentrations are extremely greater than those used in antiseptic drugs. When cleaning
hands thoroughly with soap and water, mechanical friction may assist physical removal of
bacteria from the surface of contaminated hands. Contact precautions during C. difficile
associated disease are therefore strongly advised (Rubin, Martin and Allyn 2018). C. difficile
associated disease outbreaks, in specific, glove use and hand cleaning after the hand
washing with non- antimicrobial or antimicrobial oil and water should be practiced specially
after care of clients with diarrhoea (Rubin, Martin and Allyn 2018). C. difficile associated
disease rates are constantly accused of increased use of alcohol-based hand strokes in medical
facilities. In addition, the introduction of alcohólic rubbing in the side of a big outbreak with
the REA-group B1 epidemic strain (equal to the ribotype 027) was effectively controlled.
Furthermore, several trials have lately shown a absence of a link between alcohol-based man
rubber intake and the occurrence of C. difficile clinical isolates. In summary, the deprivation
of the extensive use of alcohol hand rub for the treatment of non- C. difficile will only
endanger the general security of nurses in the lengthy term.
Another contentious problem is how important the rise in hand hygiene adherence should be
in order to be deemed acceptable following the interference. On the other side, because of the
complicated spectrum of variables affecting health care workers' behaviour with regard to
manual health results, the objective of sustainable 100 per cent adherence is not likely to be
accomplished. Therefore, attention needs to be paid to prevent failure and frustration before
establishing an objective of zero tolerance for hand-hygiene non-compliance (Al Salman et
al. 2015).

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Identification of possible barriers:
Despite increasing implementation of evidentiary rules in developing nations, there are still
absence of fundamental health equipment, monitoring networks and funds for the curtailment
of HRIs for developing nations. Hand washing services are a significant deterrent in the
application of hand hygiene (e.g. sinks, running water and wastewater systems). A practical
alternative for removing these restrictions is the use of WHO championed alcoholic rubber
hands, as they can be given separately to pocket-carrying employees and cared for. The great
benefit of this is that it is well suited to circumstances typical for emerging nations, such as
two patients with the same bed or families who are asked to assist with the delivery of care
(Dyson et al. 2013). After the application of CCiSC, several clinics have now reported
enhanced adherence. Several nations have also launched nationally organized hand hygiene
activities. Moreover, it is only possible for these populous emerging countries to successfully
monitor the threat by drawing up domestic or local strategies and strictly following the
Guidelines that worldwide healthcare infection prevention programmes. Provided the
complicated behaviour of hand hygiene, the advancement of excellent habits, and the
sensitive equilibrium between benefit assessment and the existing hurdles, is complicated and
depends on how well to achieve it (Who.int 2019).
Strength of recommendations:
Multimodal approaches have proved to be more effective than single measures in enhancing
compliance levels with hand hygiene in health care workers. The enhancement of hand sanity
has been suggested for targeted, multi-faceted methods concentrating on system shifting,
administration help, drive for motive, alcohol-based hand rubber accessibility, coaching and
extensive instruction in health care workers, and recalls at work. New surveys promote the
reality that hand hygiene observance is greatly improved through interactive instructional

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programs coupled with free accessibility of hand disinfectants (Allegranzi et al. 2014).
Studies recommended that the health care workers be given easy work-in-class teaching
courses to bring the benefit of hand rubbing over hand drying. Further variables such as
favourable role modelling and the use of efficiency indices (hand hygiene practices of senior
professionals) are significantly increasing adhesion to hand hygiene. Where needed,
appropriate supplies of hygienic hand goods, creams and lotions, linen and hand washing
equipment should be available. At the stage of care adequate amounts of alcohol hand pads
should be accessible. Wear gloves must be stressed, as the need for hand hygiene does not
substitute and contamination can happen during extraction of the glove. Studies have
demonstrated notable and permanent improvements in the conformity of hand hygiene with a
multimodal approach taken by the first WHO Global Challenge for Patient Safety to create
policies for hand hygiene. Individual pocket-borne bottles are also available to enhance
adherence. In addition, all clinics should have a vibrant infection control squad, a solid
monitoring scheme and sufficient employees to disseminate proof-based understanding to all
personnel managers (Jun, Kovner and Stimpfel 2016). There is a need for organizational
structures or programs to cope with the health care associated infection at a more local or
national stage. The Healthcare Improvement Institute provides comprehensive coaching
modules on multiple elements of patient care. The WHO CCiSC manual and a variety of
instruments for hand hygiene are provided for execution (Squires et al. 2013).
Conclusion:
Educational priority should be given to hand washing. Medical education initiative should
clearly show that health care workers hands become seriously contaminated by bacteria upon
interaction and that alcohol hand rubbing is the simplest and most efficient way of
disinfecting hands and thus decreasing levels of health care associated infections. Health care
workers hands are not disinfected with pathogens. Key steps are to be taken in Australian

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health care facilities by enhancing emphasis on infection control, entrusting the responsibility
of the senior management of infection, altering the surveillance paradigm into ongoing
surveillance and efficient information feedback. The health care professionals must pursue
fundamental and easy infection avoidance procedures to address these microbial problems.
The professionals of the health service industry in our nation must prepare for their regular
work as a role template of the coming generations of physicians, nurses and paramedical
personnel to install an easy, fundamental and efficient practice of hand hygiene. The proof
accessible shows that multimodal procedures are the best approach for determining
behavioural shift leading to enhanced accordance with hand hygiene and a decrease in the
level of health care associated infections. Hand health as a study subject should also be
provided a higher priority through high-quality, randomized monitored studies to finally
determine the effect on health care associated infections and the comparative efficacy of
multimodal strategy elements.

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References:
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Barnes, S.L., Morgan, D.J., Harris, A.D., Carling, P.C. and Thom, K.A., 2014. Preventing the
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