Hand Hygiene Report: U1112475, NUR2300, Semester 3

This report, authored by Balwinder Singh, U1112475, for NUR2300, delves into the critical importance of hand hygiene in preventing healthcare-associated infections (HAI). It begins by defining HAI and highlighting their prevalence and associated risks, including increased morbidity, mortality, and healthcare costs. The report then poses a research question, using the PICO framework, to investigate whether hand hygiene can reduce HAI incidence. A systematic review of literature, utilizing databases such as NCBI, Google Scholar, and PubMed, is conducted to gather evidence. The report critically appraises a selected research article using the CASP tool, evaluating its methodology and findings. The report also summarizes recommendations from the World Health Organization (WHO) for effective hand hygiene practices, including proper handwashing techniques, the use of alcohol-based hand rubs, and the importance of education and training for healthcare workers. The report concludes by emphasizing the need for consistent hand hygiene protocols to minimize the spread of infections and improve patient outcomes. The report uses several research articles to support the findings and analysis.

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Hand Hygiene
Name of the student
Name of the university
Author’s name
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Introduction
There are various kinds of diseases which are obtained during the period when a person is
getting a treatment in the hospital. Such kind of disease is called as Health care-associated
infections (HAI). Around hundreds of millions of patients get affected to the HAI each year.
Acquiring HAI, lead to rise of several critical diseases, rise in the duration of stay, rise in various
health disabilities which ultimately increases the costs of family and lead to a tremendous
financial burden on the healthcare system and sometimes it may result in death of the individual
(Ellingson et al., 2014). As a result of the nature of the diseases, HAI are caused by many factors
linked to systems and processes of delivery of care and also the human behavior which is tagged
by the literacy, political and economic restraints on systems and nations, and often on societal
culture and ideas. Though, there are several infections which can be prevented. The spread of the
HAI occurs as a result of the spread of health care-associated microorganisms which takes place
through a direct or indirect touch with the infected fluids, air and through a common vehicle
(Chen et al., 2013). There are several research papers which show that the healthcare workers
often spoil their hands or gloves by coming in contact with the Gram-negative bacilli, S. aureus,
enterococci or C. difficile (Marchaim & Kaye, 2017).
Hand hygiene is a very essential strategy to reduce the incidence of the Health care-
associated infections. It is a simple and very effective approach, though its lack of compliance
among the healthcare professionals is the main reason behind the incidence of HAI worldwide. It
has already been proved that hand hygiene is a significant asset in preventing the spread of the
HAI among patients. Therefore, this study will describe what a HAI is and how hygiene hands
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can prevent the spread of the HAI. It will develop a research question which will be answered
through critical analysis using the CASP tool.
Search Strategy
To initiate gathering of information on hand hygiene, it is necessary to develop a research
question. The PICO strategy will be used to develop the question.
PICO
 P - Health care-associated infections (HAI)
 I – Hand Washing
 C - No hand washing, or other solutions, alcohol based hand rub
 O – Decrease in the rate of HAI
Can hand hygiene approach reduce the incidence of the HAI by increasing the compliance rate
among the healthcare?
A systematic review has been conducted on understanding the effectiveness of hand hygiene in
the reduction of HAI and to answer the research question. Different online databases and
websites have been used to search for the literature studies such as NCBI, Google Scholar,
Cinahl, PubMed, and Medline. Few keywords were used in order to search for the articles in an
easy way, which are Hand Washing, Hand hygiene, Healthcare-associated infections (HAI) and
compliance of Hand hygiene guidelines by the healthcare staffs. The chosen articles are –
1. Allegranzi, B., Conway, L., Larson, E., & Pittet, D. (2014). Status of the implementation of
the World Health Organization multimodal hand hygiene strategy in United States of
America health care facilities. American journal of infection control, 42(3), 224-230.
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2. Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change
within multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
3. Chen, L. F., Carriker, C., Staheli, R., Isaacs, P., Elliott, B., Miller, B. A., ... & Rhodes, L.
(2013). Observing and improving hand hygiene compliance implementation and refinement
of an electronic-assisted direct-observer hand hygiene audit program. Infection Control &
Hospital Epidemiology, 34(2), 207-210.
4. Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., ... &
VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand
hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960.
5. Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to improve hand hygiene compliance:
brief update review. Making health care safer II: An updated critical analysis of the evidence
for patient safety practices.
Reviewing and synthesizing the evidence
Rationale for selecting this articles
Healthcare-associated infection (HCAI) has become a very terrible and dangerous disease
that is threatening the lives of millions of individuals worldwide. Every year, hundred million
individuals die just due to the infections acquired from the healthcare settings. Acquiring HAI,
lead to rise of several critical diseases, rise in the duration of stay, rise in various health
disabilities which ultimately increases the costs of family and lead to a tremendous financial
burden on the healthcare system and sometimes it may result in death of the individual. Even
after different researchers conducted research to understand the importance of the hand hygiene,
researchers and healthcare systems have consistently failed in implementing this policy widely
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and it has caused a hug gap causing lack of hand hygiene compliance. Hand hygiene compliance
is still lacking in several developing and developed countries.
Thus, these articles were chosen because these articles give different interventions to
improve hand hygiene compliance (Pfoh, Dy & Engineer, 2013), recommend different strategies
to prevent healthcare-associated infections through hand hygiene (Ellingson et al., 2014), uses an
electronic-assisted direct-observer hand hygiene audit program to observe the improvement of
hand hygiene compliance (Chen et al., 2013) and provides various other information regarding
hand hygiene and HAI. The selected research papers will help in answering the research question
and will prove that hand hygiene is a successful way for reducing the frequency of hospital-
related infections by healthcare professionals. A critical appraisal will be done of a research
paper through the CASP tool in order to answer the research question.
CASP
For the critical appraisal the following article has been chosen –
Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change within
multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
 Did the review address a clearly focused question?
This research article has clearly addressed the PICO research question as this review précises
different available research papers signifying a system change are highly required which can
be initiated through the help of a multi-modal hand hygiene improvement strategy.
 Did the authors look for the right type of papers?
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Yes, the authors have used those papers which provide information regarding the hand
hygiene practices of the healthcare professionals and describe the factors that suggest a need
in system change.
 Do you think all the important, relevant studies were included?
Yes, the authors have included those papers which provide information regarding the hand
hygiene practices of the healthcare professionals and describe the factors that suggest a need
in system change. The paper has included those papers also which demonstrate the factors
responsible for lack of hand hygiene compliance.
 Did the review’s authors do enough to assess quality of the included studies?
Yes, authors conducted the study very thoroughly and did enough to assess the quality of the
included studies.
 If the results of the review have been combined, was it reasonable to do so?
Yes, combination of the different results of diverse review was reasonable to do as by
combining the results, it efficiently answered the PICO research question and was able to
decide that a system change is required to improve hand hygiene in healthcare.
 What are the overall results of the review?
The following article chose 121articels to conduct a literature review. The review concluded
that a system change is required starting from the alcohol hand rub. The paper suggested that
to attain continued development, critical aspects have to be considered.
 How precise are the results?
Since this paper was a literature review and the data which have been provided or the
research articles selected for this review are outdated. So the precision of the results cannot
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be related with current day. Though, at the end of the paper it has been stated that the
researchers did not find any conflict of interest.
 Can the results be applied to the local population?
Yes, even though the data used in the paper corresponds to the time-frame of 1989 – 2012,
the data provided gives the idea about which factors cause a lack of hand hygiene
compliance, and also provides few strategies to improve the hand hygiene compliance.
 Were all important outcomes considered?
Yes, all the important outcomes have been considered.
 Are the benefits worth the harms and costs?
Yes, the benefits or the interventions are worth the harms and costs.
Recommendation
World Health Organization has recommended certain strategies to improve the hand hygiene
compliance and reduce the rate of hospital associated infections (WHO, 2016). The
recommendations include -
 Hands should be washed by soap and water when there are visible dirty stains of blood or
other body fluids present; also after using the toilet hands should be washed. When there is a
significant possibility or confirmed exposure to possible spore-forming pathogens, including
C. difficile outbreaks then hands should be washed with soap and water as it is a preferred
means of hand washing.
 Before giving medicines to a patient or preparing food for them, it is necessary to clean the
hand using the alcohol-based hand rub approach or hands can be washed using plain or
antimicrobial soap and water.
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 During the surgical procedures, the healthcare professionals should remove their rings,
bracelets, watches and other accessories to prevent the spread of the germs.
 Sinks should be used to wash hands and prevent the splashes of blood or other microbial
stains via water.
 Surgical hand antiseptic care should be done either with an appropriate antimicrobial soap or
with an appropriate hand rub with alcohol, especially with a substance that ensures
continuous operation, before wearing sterile gloves.
 Provide HCWs with appropriate hand hygiene products which have low potential for
irritation.
 To increase HCW's approval of hand hygiene products, seek their suggestions regarding the
skin tolerance, smell, and scent of any of the items being considered. Comparative tests can
be of great help throughout this step.
 Certain learning programs such as the information regarding the hand care practices to
decrease the danger of irritant contact dermatitis and other skin damage should be
incorporated in the education programmes for HCWs.
 It is necessary for the healthcare management system to keep data on the allergic reactions of
their HCWs and according to that they should alternative and suitable hand hygiene products
in the health-care setting.
 Supply HCWs with hand lotions or creams to reduce the incidence of hand antiseptic or
handwashing irritant causing dermatitis.
 Wear gloves, if blood or other possibly contagious products, mucous membranes or intact
skin are fairly likely to come into contact with it.
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 When wearing gloves, change or remove gloves during the patient care from an infected
body site to some other body position in one patient or in the surroundings (along with the
nonintact skin, mucous membrane or medical device).
 Throughout hand hygiene initiatives for HCWs, a particular focus should be put on
the causes that actually impact behaviour, and not only the form of hand hygiene products.
The approach should be multi-faceted and multimodal and should involve preparation and
organizational assistance.
 Enlighten HCWs about the kinds of hand-contamination during the patient care procedure
and the pros and cons of different methods of washing their hands Observe and provide
qualitative reviews in accordance with approved standards in hand hygiene through HCWs.
Encourage patient-family and HCW partnerships to improve health care hand hygiene.
Conclusion
The inconsistent structures and approaches which mitigate optimum adherence to hand
hygiene end up causing avoidable damage for patients undergoing healthcare. In order to ensure
that no individual is ultimately affected with non-compliance by hand hygiene, globally
organized efforts (in some instances campaigns) must be taken into account to encourage and
preserve change in hand hygiene, manage the problem at the national level and guarantee
the successful application of legislation that has an impact on hand hygiene. The presence of
recommendations in itself does not enhance consistency with hand hygiene. Therefore, a strong
local supplement has been shown to be the additional catalyst of a centrally coordinated
campaign or plan, which involves reporting and reviews, goals and regulations. In general,
increase awareness of the problem and make it a priority, which could not be understood in the
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absence of a concerted national effort. A strategic plan should be addressed for changes in hand
hygiene to flourish in an overall health & infection control policy. Eventually, the best way to
prevent transfers of pathogenes is to have sanitation by hand If available, the best way to protect
oneself and patients would be to wash hands thoroughly with soap and water. When soap and
water are not accessible then an acceptable form of hand hygiene is the correct use of a hand
sanitizer. The ultimate goal of fostering a strong culture of medical care is to strengthen hand
hygiene habits.
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References
Al Salman, J. M., Hani, S., de Marcellis-Warin, N., & Isa, S. F. (2015). Effectiveness of an
electronic hand hygiene monitoring system on healthcare workers’ compliance to
guidelines. Journal of infection and public health, 8(2), 117-126.
Allegranzi, B., Conway, L., Larson, E., & Pittet, D. (2014). Status of the implementation of the
World Health Organization multimodal hand hygiene strategy in United States of
America health care facilities. American journal of infection control, 42(3), 224-230.
Allegranzi, B., Sax, H., & Pittet, D. (2013). Hand hygiene and healthcare system change within
multi-modal promotion: a narrative review. Journal of Hospital Infection, 83, S3-S10.
Chen, L. F., Carriker, C., Staheli, R., Isaacs, P., Elliott, B., Miller, B. A., ... & Rhodes, L. (2013).
Observing and improving hand hygiene compliance implementation and refinement of an
electronic-assisted direct-observer hand hygiene audit program. Infection Control &
Hospital Epidemiology, 34(2), 207-210.
Davis, R., Parand, A., Pinto, A., & Buetow, S. (2015). Systematic review of the effectiveness of
strategies to encourage patients to remind healthcare professionals about their hand
hygiene. Journal of Hospital Infection, 89(3), 141-162.
Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., ... &
VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through
hand hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960.
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Hübner, N. O., Hübner, C., Wodny, M., Kampf, G., & Kramer, A. (2010). Effectiveness of
alcohol-based hand disinfectants in a public administration: impact on health and work
performance related to acute respiratory symptoms and diarrhoea. BMC infectious
diseases, 10(1), 250.
Kapil, R., Bhavsar, H. K., & Madan, M. (2015). Hand hygiene in reducing transient flora on the
hands of healthcare workers: an educational intervention. Indian journal of medical
microbiology, 33(1), 125.
Marchaim, D., & Kaye, K. (2017). Infections and antimicrobial resistance in the intensive care
unit: Epidemiology and prevention. Prieiga per internetą https://www. uptodate.
com/contents/infectionsand-antimicrobial-resistance-in-the-intensive-care-unit-
epidemiology-and-prevention.
Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., ... & Mura, P. (2017).
Assessing hand hygiene compliance among healthcare workers in six Intensive Care
Units. Journal of preventive medicine and hygiene, 58(3), E231.
Nair, S. S., Hanumantappa, R., Hiremath, S. G., Siraj, M. A., & Raghunath, P. (2014).
Knowledge, attitude, and practice of hand hygiene among medical and nursing students at
a tertiary health care centre in Raichur, India. ISRN preventive medicine, 2014.
Pfoh, E., Dy, S., & Engineer, C. (2013). Interventions to improve hand hygiene compliance:
brief update review. Making health care safer II: An updated critical analysis of the
evidence for patient safety practices.
Balwinder Singh, U1112475, NUR2300