Factors or Barriers that Influences Adherence to Hand Hygiene among Nurses in Saudi Arabia - Term Paper Example

Factors or Barriers that Influences Adherence to Hand Hygiene among Nurses in Saudi Arabia 1. Introduction Hand hygiene (HH) is the best infection control strategy employed to prevent introduction of harmful microbes into the human body system. This act involves cleaning of hands in order to prevent the transfer of pathogens from the environment into the body, to other people and from one place to another (Pittet et al., 2006, p. 641). The most important people who should ensure their hands are cleaned well are the health care workers (HCW) (Mathur, 2011, p. 615). This is because they can infect their patients; contaminate health care working environment as well as cause their own infections. Hand hygiene utilises several techniques including water and soap, water only, water and antiseptic or even the use of alcohol-based hand rub (ABHR). The most effective method is the alcohol-based hands rub because it reduces skin flora rapidly and requires less time than washing (Diwan et al., 2016, p. 2). Rational of this Research Several studies have reported poor global hand hygiene practices among the HCWs despite the reported importance (Pittet, Mourouga & Pemeger, 1999, p. 127). According to Salmon et al., (2014, p. 73), the observed global compliance rate is less than or at 50 percent. Individual, group and institutional compliance are differently affected by the known barriers since they operate differently. Some of the factors contributing to low HH compliance include leadership, the level of knowledge and education, awareness working conditions, commitment and allocated resources (Pittet, 2000, p. 382). In addition, I have practised nursing for the last thirteen (13) years where I have observed some nurses in hospitals of Saudi Arabia do not comply to hand hygiene policy, and some of them do not implement the correct technique of hand washing. Also, nosocomial spread in some Saudi hospitals is very high due to poor hand hygiene. A current study reported a prevalence of 7.46 percent for pooled point infections and 9.84 percent for healthcare-associated infections (Zigg, Huttner, Sax &Pittet, 2014, p. 678). Therefore, this study will seek to establish barriers to hand hygiene compliance in Saud Arabia leading to high infections via hands. 2-Background information Microbes are freely found in the environment we live. The hospital environment is contaminated by various disease causing pathogens from different patients and samples. Health care workers can easily pass these microbes from one patient to the other leading to hospital-associated infections. It is critical that healthcare workers practice and adhere to good HH in order to reduce disease transmission, prevent hospital-associated infections, tackle anti-microbial resistance and ultimately improve patients’ health outcomes (Erasmus et al., 2010, p. 285). It is based on these facts that the World Health Organization has developed HH guideline to help people in maintaining proper hand hygiene (WHO, 2009, p. 12-18). However, compliance to HH by health care workers has been wanting in both developed and developing countries. Studies report that the compliance in developed countries estimated at 40% while in developing countries is significantly low estimated at 2.1% (Schmitz et al., 2014., p. 8). Hand hygiene was initially considered a good way of fighting hospital-associated infections in 1847. The initial observations were made by Semmelweis, an obstetrician from Hungary, in the year 1847. He observed that women who were assisted by physicians and medical students during labour suffered puerperal fever more than those assisted by midwives. This observation made him curious and sought to investigate the main reason for this occurrence. He realised that physicians and medical students performed autopsies and later attended to pregnant women without hand washing. He concluded that these physicians and medical students contaminated hands during autopsies which transferred the pathogens during deliveries to these mothers (Akyol, 2007, p. 433). A similar investigation was done by Florence Nightingale during the Crimean War in 1854 when she called for the provision of basic public health in a military hospital. She observed that military hospitals experienced many deaths, the majority of which were not related to the war. This observation led her to introduce interventions that were directed at improving personal hygiene, living conditions and food and cleanliness in the hospital environment. After a short period, the deaths in the military hospital decreased indicating that poor hygiene including hand hygiene were the major causes of these deaths. Henceforth, good hygiene was applied in the military hospitals to control infections within and outside the hospital. Her serious work led to the establishment of the relationship between infection control and nursing (Smith, 2009, p. 781). Despite the knowledge of HH as an infection control measure and the magnitude of hospital associated problems, its adherence is significantly low (Takahashi & Turale, 2010, p. 130). It is a surprise that HH compliance in developed economies rarely passes 50 percent. A study by Takahashi & Turale (2010) showed that rate of compliance in the USA stands at 50%, 32% in the UK, and 42% in Switzerland. This has contributed to high morbidity and mortality in these countries. For instance, in the USA, it is estimated that about 2 million people had contracted HAI by 2010 and these infections cause more than 90,000 deaths every year. Additionally, HAI presents major challenges in healthcare facilities since nearly 10% of hospitalised patients get infected. The situation is worse in developing countries even though there is scarce data from these countries. For instance, a study by Devnani, Kumar, Sharma and Gupta (2011, p. 116) reported anHAI rate of between 6 to 27%. The bad news is that more than 1.4 million people globally get infections at any time during their admission to hospital (Momen & Fernie, 2010, p. 395). Patients still remain vulnerable to unintentional infections from hospitals even though greater strides have made to minimise these risks through continuous improvement of healthcare systems (Al-Busaidi, 2013, p. 1). 3-Literature Search and Literature Review Comprehensive literature search includes multistage and iterative processes whereby at first a list of citations from relevant sources is generated such as electronic bibliographic databases, a reference list of known primary and relevant journals (Khan, Kunz, Klijnen & Antes, 2011, p. 23). Since this review was on health care intervention, a search was done on databases which were relevant to my topic area MEDLINE and EMBASE (Higgins, & Green, 2008, p. 12). A further search was done using google scholar, EBSCO, university library, CINHAL, and PubMed. The search words used included compliance of hand hygiene, barriers of adherence to hand wash among nurses, nurse staffs and noncompliance to hand hygiene, factors influence nurses to do hand wash. The next step is quality evaluation where I used Critical Appraisal Skill Program (CASP) tool to assess the external validity (population, intervention and intervention) as well as internal validity (design, conduct and analysis of the study) (CRD, 2008, p. 6). 4. Literature review 4.1. Professional and Organisational Barriers Several factors have been identified that affect hand hygiene adherence among health care workers. These factors are either classified as professional or organisational depending on the source (Trampuz & Widmer, 2004, p. 110). Professional are those which are related to the nature of the job and the person himself or herself while organisational are those related to the health care facility. 4.2. Lack of Awareness and Scientific Knowledge Lack of awareness and scientific knowledge is a professional barrier which has proved to be adversely affecting hand hygiene among HCWs. This results from lack of proper training among students who pursue professions in health sciences. It is attributed to the fact that in most medical schools, training on standard infection control precautions is taught during the first seven weeks after registration (Ott & French, 2009, p. 703). This is observed when students on their attachment or placement training fail to adhere to the taught infection control strategies (Karabay et al., 2005, p. 316). Additionally, nurses’ attitudes and cultures at work tend to follow imitation rather than actual reason, and hence the new staff and student nurse follow their mentors and other HCWs in order to be accepted within that culture (Al-Busaidi, 2013, p. 8). This has led to many students not performing hand hygiene adequately because they want to appear as busy as their mentors hence have less time for hand hygiene. Furthermore, no further training on this important issue is emphasised during the latter years of training, and hence the benefit or importance of this issue declines or is forgotten before the students enter the real practice. Studies show that broad infection control education programme is missing in most pre-registration nursing students (Nazarko, 2009, p. 66). Therefore, it is important to provide further training on infection control measures during induction and provide regular updates through seminars, conferences and also offer short courses as HCWs advance in their career (Takahanshi & Turale, 2010, p). 4.3. Shortage and Work Load of Nurse Nearly every country in the world faces shortage of nursing practitioners for different reasons. In most developed countries, the number of trained nurse is less than the demand, and some have resulted to employing foreigners in order to address the shortage. In some developing countries, there are more trained nurses of health care workers, but the employment opportunities are few due to lack of finances. Most facilities are forced to work with less number of nurses than recommended by the WHO guidelines. For instance, in Saudi Arabia, the ratio of physicians to patients is 16 per 10,000 population while that of nurses stands at 36 per 10,000 population. In Uganda, the healthcare workforce available includes 7270 nurses and midwives, 495 physicians/generalists and 32 obstetricians and gynaecologists (UNFPA, 2014, p. 2). The physician density was 120 per 100,000 populations, and nurse density is 131 per 100,000 populations (WHO, 2011, p. 1). This is not near the WHO recommendations, and there is need to recruit more HCWs in order to reduce the burden. Few HCWs lead to workload which does not allow the nurse on duty to adequately practice proper HH. This is worse in emergency wards when nurses have to save lives of the most critical conditions immediately as they come. Nurses end up omitting this important step in their attempt to serve many patients as possible resulting in many hospital-associated infections. 4.4. Lack of Hand Hygiene Products and Facilities Well trained staff and willing to implement whatever taught in class may be discouraged or adherence reduced as a result of the lack or inadequate hand hygiene products and facilities. These include things like sinks, hand paper towels, running water, antiseptics, alcohol hand-rubs and non-antiseptic soaps (Kampf & Loffler, 2010, p. 980). Some of these products are used on a daily basis and hence get exhausted very quickly. They need daily or frequent replacement in order to maintain their use and compliance. The worse situation is witnessed in most developing countries where they experience financial shortages. In most hospitals in low and middle-income countries, maintaining running water and providing these consumables is a problem. In some hospitals, the cleaners and other non-medical staff steal these consumables and take them to their homed due to poor wages and salaries causing shortages in the hospitals. This leads to willing HCWs not practice adequate hand hygiene as recommended resulting in hospital-associated infections. For instance, a study done in Nigeria found out that, most wards lack adequate facilities for effective HH and use bowl or bucket method as an alternative to running water (Ogunsola & Adesiji, 2008, p. 26). In India, a similar study reported unavailability of hand paper towels, inconveniently positioned sinks, lack of electrical dryers, inadequate access to soap and water as the main obstacles to proper HH practice. 4.5 Healthcare workers and Lifestyle The kind of lifestyle a healthcare worker embraces significantly affects hand washing hygiene. For instance, female healthcare workers have resulted to fingernails enhancements or do not cut short their natural nail for they purport to be classy (. The male counterparts and some female health staff have resulted to extreme use of jewellery and rings (Jacobsen et al., 1985, p. 187) some of which are put in each finger. Several microorganisms harbour in these nails particularly gram-negative rods including Pseudomonas sp., yeasts and Corynebacteria (Hedderwick et al., 2000, p. 508). This lowers appropriate hand hygiene since of these jewellery and rings are not supposed to come to contact with water for fear to rusting. Some have to remove them beforehand cleansing which makes it difficult to do so every time they have to serve a patient thus end up serving the patient without even trying simple hand wash. They are influenced by their peer within their profession or in other professions which are influenced by their status in the community where they are highly respected and regarded as the cream of the society. Therefore, the complex lifestyle adopted by some healthcare workers lowers the HH adherence causing hospital-associated infections to most hospitalized patients. Barriers to hand hygiene compliance among health care workers are so diverse and depend on the professional part as well as organisation’s setting. The complexity of this medical field calls for more research in order to address any hidden and emerging barriers that are contributing to unacceptable lower levels of hand hygiene compliance. Additionally, very little data is available about the HCWs hand hygiene in low and middle-income countries and hence the need to carry out this study to contribute the already available information. Research Question What are the barriers of hand hygiene among healthcare workers in Saudi Arabia? References Akyol, A.D., 2007. ‘Hand hygiene among nurses in Turkey: opinions and practices’, Journal of Clinical Nursing, 16, p. 431-437. Al-Busaidi, S., 2013. Healthcare workers and hand hygiene practice: A literature review. Diffusion: the UClan Journal of Undergraduate Research, 6(1), p. 1-13. CRD., 2008. Systematic Reviews: CRD’s guidance for undertaking reviews in health care. Centre for Reviews and Dissemination. York: University of York. Available free at http://www.york.ac.uk/inst/crd/systematic_ reviews_book.htm. 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Assessing the Burden of Healthcare-Associated Infections through Prevalence Studies: What Is the Best Method? Infection Control and Hospital Epidemiology, 35(6), p. 674-684. Read More