Systematically Changing Hand Hygiene at the Point of Care - Dissertation Example

?Literature Review Systematically Changing Hand Hygiene at The Point of Care Introduction The purpose of this literature review is to present information about hand hygiene at the point of care. The review will present information on the guidelines for hand hygiene in healthcare facilities as well as information on the type of training that is needed for staff members. The question that motivates this literature review is, Will training and education utilizing the World Health Organization’s (WHO) recommendations for improvement of hand hygiene (2005) and VHA’s Hand Hygiene Directive 2011-007 improve hand hygiene practices of healthcare workers, thereby preventing the spread of healthcare infections (HAI)? The major hypothesis for this question is that a hand hygiene training program will enhance the healthcare workers understanding and this will increase their practice of healthcare hygiene. Methodology The author reviewed the literature to examine other hand hygiene programs that used the VHA Directive and/or the WHO model. The literature that was reviewed was online databases, pertinent professional websites, and specific training programs that were similar to the one this research will create. The databases used were CINAHL with full text, MEDLINE and ProQuest. Key search terms were: hand hygiene training programs, hand hygiene programs, hand hygiene guidelines, hand hygiene presentations and hand hygiene and infections. There were a few relevant articles between the years 2000 and 2005 that were used for background information. The majority of articles were found between 2005 and 2011, to insure that the most current and relevant information would be found. The database searches yielded only a handful of articles, which was somewhat frustrating for the author. A search for peer reviewed articles in ProQuest database found only one article that did not relate exactly to the topic. Another way to search was through Google and Google Scholar which yielded more articles. The same search terms were used. Most of the references that were found through Google used the CDC guidelines for hand hygiene as a base to develop their own guidelines. In looking for health hygiene articles, a total of 11 articles were found. Each article was reviewed fro relevance to the topic and it was important to make sure that the training programs had used the same or similar guidelines in either the VHA or the WHO guidelines. All articles were written by doctors and nurses. Findings Training programs do not have to be developed without guidelines. When these guidelines are used, the trainer can be certain that all important topics are covered. During the research it was found that many healthcare workers do not know the value of practicing hand hygiene for themselves or for their patients. They understood that without it they could cause disease to spread but they did not understand how it could happen. After training, a majority of healthcare workers practiced better hand hygiene. Guidelines for Hand Hygiene There are several guidelines for hand hygiene that have the same themes. They all give practical ideas for helping healthcare workers practice this more regularly. The major guidelines are those from the Centers of Disease Control and Prevention (CDC), the WHO Recommendations for Improvement of Hand Hygiene and the VHA’s Hand Hygiene Directive 2011-007. Each guideline gives the same basic information. The WHO guidelines were the most comprehensive because they not only gave information on hand hygiene, they also gave information about what normal skin should look like and the various infections that can happen when hands are not washed. Every aspect of hand hygiene is covered in their guidelines. The VHA guidelines follow the CDC guidelines as a foundation for their information. The reason the CDC guidelines are important is because they read through over 400 publications before they provided 40 recommendations for hand hygiene. The VHA directive took the information form CDC along with information from the Joint Commission and the Under Secretary of Health to create their guidelines. The VHA guidelines give basic hand hygiene practices and when to use each of the hand washing techniques. Boyce and Pittet (2002) also presented guidelines for basic hand hygiene based on the CDC recommendations, along with information from the WHO guidelines. These guidelines did not really supply information on what should be done for hand hygiene but it was more geared towards training and why proper hand hygiene was important. This article also gave a definition of terms that would be very important to training materials. Basic Requirements for Hand Hygiene The basic hand hygiene requirements showed that there must first be a written policy about hand hygiene placed in each healthcare facility. Staff should use either an antimicrobial soap or water to wash their hands or an alcohol-based hand rub to decontaminate their hands, whether the hands look soiled or not. The guidelines state when the alcohol rub versus the antimicrobial soap and water should be used. Basically, when something has soiled the hands such as blood, excrement, mucous from the mucous membranes and so forth, the antimicrobial soap and water should be used. The alcohol rub was recommended when the hands were not visibly soiled. These guidelines are from the CDC guidelines. Also, the guidelines are very clear about what types of hand washing should be done and in what situations they should be done. They suggest that gloves are necessary in most situations. The guidelines also point out where in hallways the alcohol dispensers should be placed and under what circumstances (e.g. they should not be put in carpeted hallways). Challenges to Compliance There were four articles that presented information about the challenges faced when attempting to enforce hand hygiene. The Joint Commission (2009) provided an understanding of how to measure hand hygiene compliance and how to overcome the challenges to getting healthcare workers to comply with the guidelines. They outlined several ideas for changing employee behavior in order for them to accept that they must use proper hand hygiene. The Joint Commission states that behavior change is not easy and that without “a multi-disciplinary effort that includes explicit support from [the] administration … “ (p. 107) the guidelines do not work well. Haas and Larson (2008) provided startling statistics on hand hygiene. They state that there are approximately 1.7 million health care associated infections that occur every year in hospitals that cause approximately 100,000 deaths. Although this information is available, many healthcare workers ignore this issue thinking that it will not happen to them. Longtin et al. (2010) reported on the value of brining patients into the participation of hand hygiene as a key component to any training. With patients and healthcare staff working together, many hospitals have found that they have more success with their hand hygiene training. Pittet et al. (2000) provided information on hospital wide hygiene training. Their study monitored the compliance issues in a variety of hospitals. They found that doctors had the least amount of compliance. The study also found that when there was a high demand to use hand hygiene, most professionals did not use it. This was especially so when there was a low staff ratio to a high patient ratio. Training Programs and the Use of Guidelines Four articles presented information about specific training programs using various guidelines. The ICR Institute (2008) created guidelines for training programs. They suggest that organizations must first assess what their organizations are doing with hand hygiene currently before they prepare training. They can then create an opportunity for training that encompasses the issues that they need to address. Widmer et al. (2007) presented information about why it was important to make sure that health care workers understood how to use alcohol based Hand rubs. They used a dye on the hands to show people what their hands looked like before and after they were cleaned. Before they training only 31% of workers were using the hand rubs and after the training, there were 50% of people using the hand rubs. The researchers concluded that with proper training staff would use proper hand hygiene. Limitations Hand hygiene does not seem to be a topic that has resulted in many peer reviewed studies so this area is very small. Generally, there are more guideline articles throughout the Internet that use the CDC guidelines for developing ones specific to organizations. A few articles emphasized the WHO guidelines, but these may be too overwhelming for some because they are so comprehensive and cover every element of hand health that can be imagined. Most articles that covered training courses stated that the use of hand hygiene improved after structured training programs. Conclusion The practice of hand hygiene is important to the health and safety of both patient and healthcare workers. The guidelines for hand hygiene from WHO or from the CDC are generally used and modified to fit the needs of the healthcare organization. This may be because by using these guidelines, the organization can be sure that there every topic that must be covered is covered and the guidelines present a structure that can be used. This would allow health care professionals who may move from one facility to another to have the information they need without going through a second training. There is a need for more formalized studies to show why hand hygiene should be practiced. Although this seems like it would be common sense, people are busy and they may not want to take the time to wash their hands if they do not have a solid reason to do so. Most people understand that hand hygiene is important when their hands are soiled, but some do not understand why they should continually wash their hands if they do not look soiled. The information from the literature review supports the fact that training programs are needed to enhance hand hygiene. These research findings can also be used to develop an effective training program. References Boyce, J.M. and Pitter, D. (2002). Guideline for hand hygiene in health-care settings: Recommendations of the healthcare committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Recommendations and Reports, 51 (RR-16), 1-5. Creedon, S.A. (2006). Infection control: Behavioral issues for healthcare workers. Clinical Governance: An International Journal, 11 (4). 316-325. Retrieved from http://www.nurse2nurse.ie/Upload/NA4987published%20paper%20creedon.pdf Cummings, K.L., Anderson, D.J., and Kaye, K.S. (2010). Hand hygiene noncompliance and the cost of hospital-acquired methicillin-resistant staphloccus areus infection. Infection Control and Hospital Epidemiology, 31 (4), 357-364. Retrieved from https://dicon.mc.duke.edu/wysiwyg/downloads/M54-Cummings_et_al_ICHE_2010.pdf Martin-Madrazo, C., Canada-Dorado, A., Angel Salinero-Fort, M., Carlos Abanades-Herranz, J., Arnal-Selfa, R. … Soto-Diaz, S. (2009). Effectiveness of a training programme to improve hand hygiene compliance in primary healthcare. BMC Public Health, 9, 469-476. doi: 10.1186/1471-2458-9-469 Department of Veterans Affairs. (2011). Required hand hygiene practices. VHA Directive 2011-007. Retrieved from http://www.va.gov/vhapublications/ ViewPublictions.asp?pub_ID=2367 ECR Institute. (2008). Healthcare risk control. Hand hygiene training program. Retrieved from http://www.ecri.org/Documents/PSA/May%202008/Hand_Hygiene.pdf Haas, J.P. and Larson, E.L. (2008). Compliance with hand hygiene. Retrieved from http://www.nursingcenter.com/pdf.asp?AID=807012 Longtin, Y., Sax, H., Leape, L.L., Sheridan, S.E., Donaldson, L. and Pettet, D. (2010). Patient participation: Current knowledge and applicability to patient safety. Mayo Clinic Proceedings, 85 (1), 53-62. doi: 10.4065/mcp.2009.0248 The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Monograph. Retrieved from http://www.jointcomission.org/ assets/1/18/hh_monograph.pdf Widmer, A.F., Conzelmann, M., Tomic, M., Frei, R., and Stranden, A.M. (2007). Introducing alcohol-based hand rub for hand hygiene: The critical need for training. Infection Control and Hospital Epidemiology, 28 (1). 50-54. Retrieved from http://www.felixplatterspital.ch/fileadmin/pdf/news/fps_2_3_0701311208.pdf World Health Organization (WHO). (2009). WHO guidelines on health hygiene in healthcare: First global patient safety challenge clean care is safe care. World Health Organization. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf Read More