Infection Control Measure Design and Analysis - Essay Example

? Infection Control and Contents Introduction 2 Literature Searching Process 4 Main Body 5 Infection Control 5 Focused discussion on identified themes 11 Hand hygiene as a primary infection control 11 Effectiveness of hand hygiene as an infection control 12 The challenge of reduced hand hygiene compliance 12 Approaches to hand hygiene compliance 13 Conclusion 15 References 17 Primary journal articles 17 Secondary journal articles 18 Books 20 Introduction The issue of health has attracted increased attention in recent times. As health practitioners focus on modern infection-control practices, nurses continue putting more emphasis on traditional control measures that are safe and ethical. Kilpatrick, Allegranzi and Pittet (2009), observes that infectious diseases are currently a great threat to human health as well as their well-being. In the 21st century, various infections have turned a major threat to prosperity and social stability of human kind. This is as a result of emergence of multi-drug-resistant strains of bacteria such as Clostridium difficile (CDT) and methicillin-resistant Staphylococcus aureus (MRSA) among others. These infections cause many deaths with thousand others suffering from poor health. Schneider, et al. (2009) observes that having sound measures for controlling infections help to significantly reduce the spread of both minor and major infections hence reducing suffering, mortality and morbidity rates. Maintaining proper hand hygiene is the simplest and single least-expensive way of reducing prevalence of many infections. According to WTO (2012), every individual must embrace behavioural change. The health fraternity should also join the board by encouraging the public to actively comply with the stipulated infection-control practices. Further, the government is also contributing through the provision of high quality, safe and reliable care. Hand hygiene according to Erasmus, et al. (2009), is a simple, but high-impact intervention that helps in prevention and control of some of the fore mentioned infections. Infection control, therefore, remains one of the world governments’ agenda for reducing morbidity and mortality rates. Various infections control management systems have been put in place to assess and control infections, maintain appropriate clean environment and educate individuals on how to avoid preventable diseases. Numerous studies have demonstrated that the practice of hand washing virtually eliminates the majority of infections through contact. Increased compliance in hand hygiene practice was found to considerably reduce infection rates. Basically, on assessment of numerous data on transmission cycles, it was established that hands form a critical component in controlling such infections. Further, numerous intervention measures have confirmed presence of link between infectious disease transmission and hand hygiene. This research essay applies both qualitative and quantitative methods to justify the effectiveness of hand hygiene in controlling infections. Qualitative methods refer to explanations that help in understanding why and how certain outcomes are arrived at with quantitative method involving numbers to interpret information. The research sampled relevant materials written between 2004 and 2012. Meta-analysis data collection method was used to collect data. Basically, Meta-analysis involves a combination of results from various studies with a view of identifying the pattern of variables under study. Meta-analysis method is used to review literature narrative. It involves combination and systematic identification of quantitative studies to examine the issue at hand. This method was found appropriate for this paper as it contrasts and more importantly reconcile a number of literatures based on qualitative review of the topic under study. According to RCN (2009), the research essay also takes into account the issue of ethical consideration by using materials consented of the respective authors. Literature Searching Process The volume of online sources and bibliographical databases continues to expand. This has increasingly made the work of a researcher quite challenging making the practice of systematic and effective material search an area to focus. This study mainly dealt on online literature search guided by the four main sections of the entire paper. For instance, in the introduction section, the researcher searched material that covered infection control and hand hygiene. It is at this point that the researcher could establish the link between the two while at the same time developing themes to be focused. Considering that this research essay concerns medicine, a number of medical related databases such as CINAHL and British Nursing Index were accessed in search of relevant materials. CINAHL database has a high number of journals and other nursing materials that were very helpful. On the other hand British Nursing Index was found to comprise cross-sectoral libraries of nursing educational materials. Electronic search strategies were used to access research materials from the two databases guided by the research topic ‘infection control’ and sub-topic ‘hand hygiene’ which were the key words. Although the research focused on research materials five years back, material that were ten years old and found useful were also considered. Additional methods such as wider internet searches were also used to ensure a thorough search. Many of the research materials were accessed electronically using short key phrases leading to retrieval of a variety of irrelevant matching studies from the databases. Generation of such high numbers of irrelevant materials made the search seemingly impossible and tiresome. However, simple search filters that comprised short phrases on both the main topic, and the sub-topic were developed to overcome this problem. In addition, date ranges were included to ensure accessed materials fell within one to ten years. Non-journal sources used in this research were also accessed electronically through Google books and Amazon. Main Body Infection Control Infection control starts with sensitizing the entire community on the need to practice responsible ways of living. Numerous people, including support staff, healthcare workers and patients are involved in healthcare activities, and every person is relied upon in controlling the spread of pathogens (Rykkje, Heggelund & Harthug, 2007). Notably, prevention of infections is an integral activity of every staff within the healthcare facility. Infections can be caused by various groups of micro-organisms, including fungi, viruses and bacteria all with a potential of resulting to different classes of infections such as urinary tract infection, blood, respiratory, bone, skin and other kinds of infections. Certainly, not all infections are communicable, but others have the potential of spreading from one patient to the other leading to diseases. Barrett and Randle (2008) point out that healthcare setting provides an environment to counter risks transfer of microorganisms from one individual to the other. In this regard, vulnerability of individuals, presence of opportunistic pathogens and complexity of health care intervention means requires increased vigilance at all times. Moreover, clear understanding of how various microorganisms spread and the resultant infections become critical in preventing the occurrence of such infections. The primary aim of nurses should therefore be the enactment of the appropriate prevention measures. The principles of nursing practice require all nurses to remain vigilant concerning risks by helping everyone to remain safe within the hospital setting. Undeniably, there are increased risk of getting infected within the hospital setting considering the presence of many ill patients and other susceptible people (McDonnell, et al., 2013). In this light, more emphasis should be put on the need to increase training in order to maintain hygiene as one way of preventing avoidable ailments. Even though there are numerous measures adopted by hospitals to control pathogen's transmission, including appropriate building designs to enhance proper aeration, the simple and basic practice of hand hygiene has not been heavily emphasized and therefore, remains an important measure for preventing infections. As echoed by Sax et al. (2007), these infections affect patients in different ways from intense pain, discomfort, disability and in some cases death. The other notable burden is that such infections can cause lengthy stay in bed as patients get admitted to hospitals. Approximately, 9% of hospital admissions are caused by these infections with 30% of them being preventable by application of the existing infection-control practices. Campaigns have been initiated for the public to challenge health care providers to play their role in maintaining hygiene as a way of controlling spread of infections. Hand Hygiene Many people do not take hand washing seriously due to lack of understanding of how essential it is in prevention of infections and ailments. In this vein, they fail to wash their hand thoroughly when they undertake activities that require hand washing. Previous researchers have indicated that many individuals overrate the extent to which they wash their hands; with women washing their hands more often than their male counterparts. According to Sax et al (2007), failure to maintain proper hand hygiene accounts more than 50% of food-borne disease. Sax et al (2007) performed a meta-analysis and found that washing hands with soap can significantly reduce the risk of suffering from diarrhoea by about 40% and more importantly, the practice of hand washing can save about one million lives annually. Ideally, washing hand with soap interrupts transfer of pathogens that causes pneumonia and diarrhoea. According to statistics, 0.751 million children aged 1-59 months die from diarrhoea while1.071 million from pneumonia. However, epidemiological studies explain that the practice of maintaining hand hygiene plays a critical role in reducing the risk of infection (Dougherty and Lister, 2008). Further studies have indicated that proper hand washing can also lower respiratory tract infections by approximately 23%. Further, reduce compliance to hand hygiene protocols places health-care workers in a position to acquire patient infections. According to Gould et al. (2010), a number of infections have been transmitted from patients to their care givers due to contact exposure. For instance, conjunctivitis is a form of disease that is relatively not familiar with adults, but is common with healthcare givers. This disease is caused by adenovirus contracted through contact and can therefore be prevented by thorough hand washing. Jumaa (2005) found that the modern infection-control methods to a large extent draw from the early works done by Ignaz Semelweis, a medical professor who demonstrated the need to ensure hand hygiene in 1840s. The scholar showed how clean hands would reduce infection rates within the hospital setting and also in the entire community. Since then, a number of researchers have continued showing connection between lower rates of infection and proper hand hygiene. Unbelievably, despite the increased advocacy to maintain proper hand hygiene, people continue dying of avoidable ailments. It is estimated that more than 8,000 people die every year from hand-related infections (Suchitra and Lakshmi, 2007). Numerous studies have established that proper hand hygiene is critical in reducing infections. Hand hygiene by definition are those actions that involve proper hand washing by using anti-septic hand wash; hand rub or undergoing surgical hand antisepsis. Primarily, hand hygiene comprises washing hand with soap and water or use of alcohol-based hand rub mainly in routine patient care. Joan and Hebden (2013) argue that emergence of health concerns such as avian flu and SARS have led to increased advocacy for hand hygiene in the public sphere. Hand hygiene remains an issue of public health concern due to the following reasons: First, most of the infections are communicable, and they can easily spread to a large number of people. Further, such infections are a public health concern considering that many of them are caused by drug-resistance micro organisms (Erasmus, et al. 2010). Most of these infections were found to significantly affect the community due to their ability of spreading to a large population within a short period of time. Therefore, taking a public health perspective in containing such infections is essential. Despite the increased efforts to educate individuals on the need to maintain hand hygiene, the compliance rates remain quite low. According to Raka and Lowbury (2009), novel intervention measures need to be put in place to improve adherence. It, therefore, becomes habitual for care providers to make it a priority to enlighten the community on the need to practice hand hygiene. Achieving this goal will require individual behaviour change as well as complete change of discourses influencing hand hygiene compliance (Allegranzi, et al. 2010). Both the public and health care providers will therefore need to work together in the provision of primary healthcare and not merely act as an asset to the practice. Link between infection control and hand hygiene The spread of infectious diseases at home, within the hospital setting and community at large still remains an issue of great concern. Assessment of strategies for reducing transmission of infectious diseases through hygiene, contaminated hands and failure to practice hand hygiene were found to be the major contributors to transmission of infectious diseases (Sjoberg & Eriksson, 2010). In the recent past, intensive research has been carried out to come up with workable strategies for changing hand hygiene behaviour. Traditionally, the society was encouraged to improve their hand hygiene behaviour through education and linking hygiene to infection control. Such awareness strategies were found to raise awareness, even though they did not fully achieve the desired effects. Therefore, for hand hygiene to become a universal norm, multimodal approaches must be applied to persuade people to change their behaviours. The criteria for assessing the link between proper hand hygiene and infectious diseases control have been extensively studied (Pittet & Donaldson, 2006). To establish the health impact of hand hygiene intervention requires interrogation of previous literatures to gather sufficient evidence. Gralton and McLaws (2011) recognize that a single factor such as dirty hands can significantly contribute to infection transmission. In this vein, spread of infections involves a number of components which together or solely contributes to the overall risk. Certainly, the primary means through which infections are transmitted at homes are hands. This is because hands are the single most transmission routes as they come into contact with many ports of pathogen's entry, including nose, mouth and eyes. In other instances, pathogen's transmission involves several components such as contaminated food, which gets into contact with the surface and then the hand touches the surface and eventually such hand touches one of the ports of pathogen's entry. According to Eagerness and Lingaas (2011), the right intervention is fundamental in risk-based approach to hygiene. Practically, pathogens may be transmitted in different ways and therefore, quite difficult to achieve over-all hand hygiene compliance. This means that interventions to mitigate infectious diseases within home must be multifaceted. Primarily, effective hand hygiene remains one of the key ways of preventing infections transmission. Bahal, et al. (2007) argues that as a principle, hand washing with soap and water removes microorganisms, but to enhance effectiveness, this must be done in conjunction with the rubbing process in order to enhance the release of microbes from the skin surface and rinsing process that totally clears all the microbes. Even though, elimination of pathogen through exercising hand hygiene is plausible, the efficacy of such exercise varies considerably depending on the method applied. Gould, et al. (2010) study indicated the following factors to affect the levels of efficacy: type of hand hygiene agent used, concentration of micro-organisms and the method of application of the hygiene agent. Different studies have been carried out to determine efficacy of hand hygiene as the primary means of infection control. Wongworawat and Jones (2007) argue that extending the wash time by one-minute results into a reduction in the number of micro- organisms. Although the majority of panel data analyzed suggests hand washing efficacy to be similar across the divide, Gould, et al. (2010) observes that hand hygiene is more effective in eliminating bacteria relative to viruses. In addition, some microorganisms are firmly attached to the hand surface and therefore, not easily removed. In this regard, the essay focuses on-hand hygiene as a primary method of infection control, its effectiveness and challenges of reduced hand hygiene compliance. Moreover, with the increased deaths as a result of infections, the paper will also discuss approaches used to increase compliance. Focused discussion on identified themes Hand hygiene as a primary infection control Clinical benefits from hand hygiene were first evidenced in 1840 at Great Hospital in Vienna. This hospital had two obstetric departments, and women were admitted concurrently depending on their clinical conditions. Regrettably, maternal mortality was as high as 18% in the first department due to puerperal fever and only 2% in the second department. Semmelweis observed that one of the patients succumbed to illness close to puerperal fever after suffering a cut during necropsy. Muller and Detsky (2010) established that the infection was caused by particles from cadavers that were transmitted through infected hands. In response to this incidence, the scholar ordered disinfection of caregivers’ hands using chlorinated lime leading to a significant decline in maternal morbidity. Unluckily, the scholar failed in convincing fellow medical practitioners on the need to maintain hand hygiene as they continued ignoring such important findings. In this vein, hand hygiene should be a top priority in health training. It should be clear in the minds of nurses together with other medical practitioners, that hands get contaminated by micro-organisms following contact with patients and as such. It becomes easy to transfer these pathogens from one patient to the other. According to Boyce (2008), washing hands using soap and flowing water or by using alcohol hand swabs are some of the easiest and effective means of decontaminating hands to significantly reduce cases of infections. Thus, effective hand hygiene plays a key role in preventing the spread of a wide range of infections thus improving both patient and staff safety. Effectiveness of hand hygiene as an infection control Basically, improved hand hygiene has proven to be an effective infection control. Lack of appropriate hand hygiene was found to be a leading cause of health-related problems. Following review of numerous materials on infections control, the majority of them indicate that improved hand hygiene significantly contributes in reducing infection rates. This was echoed by Haas and Larson (2007) who support the use of multi modal hygiene practices to control infections. Multimodal program includes training healthcare workers and patients on practicing effective measures in infection prevention. Hand hygiene as a primary method of controlling infections has overtime attracted limited success across the world. In this vein, raising awareness among the health-care workers and members of the public becomes paramount. Indeed, private companies, non-governmental organizations and government agencies continue to emphasize offering training to health-care workers on the importance of hand hygiene as a primary infection-control measure. Nevertheless, the efficacy of maintaining hand hygiene has been quantitatively measured by the reduced infection incidence reported by people who have complied with the practice. The challenge of reduced hand hygiene compliance Even though maintaining hand hygiene is a relatively simple procedure, the behaviour of healthcare providers is quite complex, and therefore, it remains difficult to explain, understand or even change their behaviour. In response to the inability to get healthcare providers routinely wash their hands; many scholars have come forward to explore the barriers that negate the success of this practice. For instance, one study found that being too busy was one of the major reasons why health care providers did not perform hand hygiene practices. Other aspects that were found to contribute to low compliance levels included lack of hand basins, individual’s health conditions, myths that hand hygiene products cause dry skin and irritations, and most importantly lack of adequate guidelines on hand hygiene (Shea and Shaw, 2012). Approaches to hand hygiene compliance Following the World Health Organization (WHO) campaign known as ‘clean care is safer care’, many countries around the world are devising their own means to comply with hand hygiene in order to improve patient’s health. A report produced by WHO suggest that use of a theory to influence individual’s behaviour can significantly enhance compliance. Other notable elements that can enhance compliance include advertising using electronic and print media in order to raise awareness about the benefits of maintaining hand hygiene as a primary way of controlling infections (WHO, 2010). Evaluation of the effectiveness of the campaign has found the majority of people to have learned about the campaign, and reportedly; they would most likely wash their hand regularly following the advertisement. Almost all of those who watched the advertisement supported the practice of hand washing in contrast to a few who did not experience the advertisement campaigns. Other campaigns towards improved hand hygiene include use of campaign posters, preparing educational material for patients, staff champion posters and press releases. One of the highly successive hand hygiene campaigns is Hopi Safe launched in the Geneva University Hospital in Switzerland. The campaign involved administering educational and communication tools, repeated monitoring of compliance levels, active participation of staff and patients and more importantly garnering support of senior management who were expected to provide the required financial support. Hopi Safe campaign was a complete success in improving hand hygiene compliance as well as significantly reducing different preventable infections. According to Muller and Detsky (2010), Hopi Safe campaign achieved 18.6% increase in hand hygiene compliance between 1994 and 1997. At the same time, the substantial decline in infection rates was observed within the same period with infection rates falling from 18 cases in every 100 admissions to 10 cases. Therefore, through this multifaceted approach, Hopi Safe campaign has so far succeeded in improving hand hygiene compliance while at the same time controlling infection rates. To successfully overcome the challenge of reduced compliance; experts suggest that there is increased need to employ behavioural change approaches. Use of behavioural change theories will encourage change of guidelines leading to more organized methods for identifying and conceptualizing barriers to change (Wright, et al., 2008). Basically, behaviour change should not only be used when planning a new initiative, but throughout the entire process, including development of campaigns, implementation and finally evaluation. One of the theories suggested for use in healthcare setting is the theory of Planned Behaviour (TPB) that postulates the cause of a given planned behaviour is the will to perform the behaviour (Yahui, 2012). It goes further to say that; individual’s intention to pursue the behaviour can be predicted by three variables, including subjective norms, perceived behavioural control and attitudes. The other theory is the Health Belief Model (HBM) that also includes all the three elements of TPB theory. HBM model mainly concerns individual attitudes and perceptions that affect a given behaviour; therefore, failing to address the social impacts of such behavioural change Social Cognitive Theory (SCT) is the third theory and posits that individual behaviour is influenced by observing others. Following SCT theory, health-care workers working with senior staff members who fail to comply with hand hygiene practices will most likely also be non-compliant. Conclusion The spread of infectious disease remains an issue of great concern. According to statistics, the problem of infectious diseases accounts for more than 13 million deaths annually with the majority of these deaths occurring in the developing nations. Several environmental, demographic as well as health care reports indicate that the threat of infectious diseases will most likely increase in the coming years. This is attributed to ever rising populations together with the increasing proportion of population that is more vulnerable to such infections. In this light, it is important to ensure increased health provisions to mitigate the opportunities of the increase in infectious diseases (Gralton & McLaws, 2011). Surprisingly, infections can lead to health complications with others leading to development of chronic conditions. Those responsible for controlling infections should therefore devise effective ways of addressing this problem, including encouraging people to adopt rigorous standards of hand hygiene. Hand washing is the single most known intervention for prevention of many communicable diseases. However, the level of compliance with standard protocols for hand hygiene has been quite low. This is not only common within the health care facilities, but also in the entire community. Luckily, the availability and existence of vast knowledge base coupled with the current drive of hand hygiene indicates there is will to pursue improved hand hygiene practices. Therefore, it is widely believed that such continued efforts will lead to initiation of intervention measures that are evidence based. This paper has acknowledged the unyielding efforts of infection control measures commonly applied and thus challenging health systems and community at large to adopt hand hygiene as the primary and least expensive approach to infection prevention and control. According to Erasmus, et al. (2009), development of highly resourceful and evidence based approaches for controlling infections continues to be a complex and a big challenge to modernized health systems with no significant breakthrough expected anytime soon. There are ongoing discussions amongst various health experts to integrate various evidences into strategies that could help in mitigating preventable harms. Nevertheless, those responsible for controlling infections should therefore devise effective ways of addressing this problem including encouraging people to adopt rigorous standards of hand hygiene. In the meantime, rather than waiting for analytical scientific evidence to come up with more evidence based measures, the community and the health care providers should continue practicing thorough hand hygiene as the primary measure of controlling infections (Jumaa, 2005). Evidently, most of the infections circulating within the community are hygiene-related and promoting hand hygiene could significantly lead to improved public health and individuals’ well being. References Primary journal articles Cox, C., 2002. What health care assistants know about clean hands? Nursing today, Spring Issue, pp.647-85. Erasmus, et al., 2010. Systematic review of studies on compliance with hand hygiene guideline in hospital care. Infection Control Hosp Epidemiology, 31(6), pp. 283– 294. Fagernes, M. and Lingaas, E., 2011.Factors interfering with the micro flora on hands: a regression analysis of samples from 465 healthcare workers. Journal Adv Nurs, 67(2), pp. 297–307. Haas, J.P. and Larson, E.L., 2007. Measurement of compliance with hand hygiene. Journal of Hospital Infections, 66(1), pp. 6–14. Jumaa, P.A., 2005. Hand hygiene: simple and complex. International Journal of Infectious Diseases, 9 (2): pp. 3–14. Raka, L., 2009. Infection control and limited resources searching for the best solutions. Journal of Hospital Infections, 72 (12), pp. 292–298. Randle, J., Clarke, M. and Storr, J., 2006. Hand hygiene compliance in healthcare workers. Journal of Hospital Infection, 64 (3), pp. 205–209. Rykkje, L., Heggelund, A. and Harthug, S., 2007. Improved hand hygiene through simple interventions. Tidsskr Nor Laegeforen, 127(5), pp. 861–863. Sax, H. et al., 2007. Determinants of good adherence to Hand Hygiene among healthcare workers who have extensive exposure to Hand Hygiene campaigns. Infection Control Hospital Epidemiology, 28 (15), pp. 1267–1274. Schneider, J. et al., 2009. Hand hygiene adherence is influenced by the behaviour of role models. 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