Hand Hygiene Noncompliance in Medical Settings - Literature review Example

Hand Hygiene Noncompliance in Medical Settings Introduction The World Health Organisation (2006, p.9) defines hand hygiene (HH) as “a general term referring to any action of hand cleansing”. Hand hygiene noncompliance is the tendency by an individual to disregard hand hygiene requirements by failing to clean their hands after exposure to some form of contamination (Polk 2008). Erasmus et al (2010) observes that compliance of health care workers (HCWs) to HH guidelines is unacceptably poor. Noncompliance in hand hygiene by medics is the root cause of the spread of hand acquired infections in hospitals. While attending to patients, medics may ignore hand hygiene procedures and as a result hand acquired infections (HAIs) are transmitted to other patients (Erasmus et al 2010; Gould 2010). HAIs are major cause of morbidity and mortality among patients (Gould 2010; Gould, Moralejo &Chudleigh 2011). Similarly, Alsubaie et al (2013) notes that HAIs persist as a major and growing health problem resulting in higher levels of morbidity, prolonged hospital stays and in-hospital deaths. Erasmus et al (2009) also asserts that HH noncompliance is a problem that must be combated in prevention of cross-transmission of HAIs. This paper seeks to critically examine issues revolving around hand hygiene noncompliance. It will look at some of the causes and implications of hand hygiene noncompliance and provide recommendations on how to improve hand hygiene compliance in medical settings. Factors influencing hand hygiene noncompliance A research study conducted by Felembam et al (2012) on HH practices of home visiting community nurses yielded worrying results on hand hygiene non-compliance. The study established that nurses were not consistent with best practice and fell short of the hand hygiene guidelines. Sadly, this situation is no different in hospitals and health care centres. In most circumstances HCWs do not take precaution when attending to patients except in situations where there is a great risk to their personal health. Alsubaie et al (2013) conducted a research to find out the determinants of hand hygiene noncompliance in Intensive Care Units (ICUs). They found that noncompliance to hand hygiene procedures were highest amongst health care workers (HCWs) before and after handling patients. However, the research also established that hand hygiene (HH) noncompliance rates were lowest in the ICU when HCWs were engaged in aseptic technique and also when they were exposed to bodily fluids. This shows that when most HCWs comply with hand hygiene requirements when they feel that there is a great risk to their personal health (Alsubaie et al 2013). Similarly, Erasmus et al (2009) established that the compliance of most HCW’s to hand hygiene guidelines were driven by the need for self-protection. Moreover, Erasmus et al (2009) and Lusardi (2007) attribute the lack of positive role models in medical settings as a cause of hand hygiene non-compliance. Lusardi’s study explored hand hygiene experiences of student nurses on clinical placement. His study showed that, there is a lack of role of models in the clinical settings to provide motivation and good examples for hand hygiene compliance. Erasmus et al (2009) notes that, medical students surprisingly emulate their supervisors who show disregard for hand hygiene practices in the hospital. Lusardi (2007) asserts that, there is need for mentors in medical settings to ensure that hand hygiene standards are met particularly by nurses on clinical placement and new health workers. Furthermore, social norms, personal beliefs or convictions also determine the level of compliance to HH requirements. Erasmus et al (2009) observes that individuals are varied in their conceptualizations of the adequate and or sufficient level of hand hygiene practices and procedures. Therefore, what a person believes or is used to may influence their compliance to HH requirements. In yet another research conducted by Erasmus et al (2010) on a systematic review to investigate compliance with hand hygiene guidelines in hospital care. It was observed that a majority of health care workers were prone to disregard HH procedures after attending to a patient more frequently than before attending to a patient. Human beings are prone to constant reminders to keep up with certain schedules and obligations in their daily routine. HH practices are not exceptions, therefore it serves right for HCWs to be constantly reminded of HH practices in their routine work in order to curb HH noncompliance among them (Venkatesh et al 2008). Based on personal observation, I believe that the hospital environment may also play a pivotal role in the behaviour exhibited by HCWs with regards to HH. Factors such as ease of access and arrangement of the sinks in the wards and clinics have been proven to some extent to influence the practice of HH by HCWs. According to Forrester, Bryce, & Mediaa (2009) some of the barriers to HH practices include; inappropriate placement of sinks, traffic flow issues, inadequately stocked washrooms, work load and time constraints. Implications of hand hygiene non-compliance A considerable number of studies have established that non-compliance with hand hygiene protocols accelerate the rate at which infections spread in the hospital and increase the risk of acquisition of HIAs (Fakhry et al; Helder et al 2012). HAIs are major cause of morbidity and mortality among patients (Gould 2010; Gould, Moralejo &Chudleigh 2011). HH noncompliance is also associated with financial risks. Researchers have proven beyond doubt that unhealthy HH practices have quite adverse cost implications. In a research conducted by Cummings et al (2010) to investigate the correlation between HH noncompliance and the cost of hospital-acquired methicillin-resistant staphylococcus aureus (MRSA) infection, it was established that a hospital with a 200 bed capacity saved a substantial amount of $39,650 for every 1% increase in HH compliance practices annually. Consistent noncompliance with HH can prove very expensive where nosocomial infections spread out through the hospital unabated with financial implications born by patients as well as the hospital. Notwithstanding, in such situations patients and staff are victims respectively. However, cost implications can reduce drastically if willingness to comply with regulations is adhered to and HH practices implemented (Cummings et al, 2010). In another study to investigate the role of patient isolation and compliance with isolation practices in the control of MRSA in acute care, Halcomb et al (2008) found that there is some evidence that cessation of single room isolation and co-hosting of MRSA patients does not increase nosocomial MRSA transmission when hand-washing compliance and standard precautions are maintained. On the other hand, HCWs are in most circumstances the primary spreaders of nosocomial infections. Temime et al (2009) describe Peripatetic health-care workers as potential super spreaders of nosocomial outbreaks. They describe a Peripatetic HCW as one who pays a single possibly short visit to all patients in the ICU daily. Peripatetic HCWs may include among others; physical therapist, radiologist and other heads of staff. Consequently, peripatetic HCWs are the highest in terms of noncompliance to HH measures and as such are considerably great contributors in the spread of nosocomial infections. Recommendations Continued education of HCWs and personnel visiting the hospital or health centres is crucial in eradicating poor HH practices. The review of the appropriateness, accessibility and convenience of hand washing resources coupled by in-service education of the HCWs on the importance and the need for compliance with HH regulations should constantly remind them of their obligation as HCWs by eliciting feelings of moral responsibility (Felembam et al 2012; Helder et al, 2012). Erasmus (2010) recommends that due to the universality of the noncompliance with hand hygiene, standardised measures for research and monitoring should be sought. Furthermore, modules from behavioural sciences should be used internationally to bring the entire health community in unison to eradicate poor HH practices. Similar studies carried out by Erkan, Findik & Tokuc (2011) support the notion that planned training programmes for hand washing practices improve the practice knowledge and quality. Deliberately planned hand washing programmes should be implemented to improve the behaviour and knowledge of HCWs. Likewise, Sylne, Phillips and Parkes (2012) postulate that HCWs experience of tenure enhances infection prevention measures and ultimately HH compliance. Further, knowledge of HIAs is limited among HCWs and thus reflects poor practice of HH. Thus, special focus on training and education of HCWs should be geared towards care of patients with specific infections e.g. MRSA. Such training should also provide precise guidelines on how to handle HH protocols when attending to patients. Conveserly, Forrester, Bryce, & Mediaa (2009) are of the view that hand hygiene campaigns that focus exclusively on increasing awareness among HCWs may not always be as successful as campaigns that target identified barriers to HH. Such barriers may include but not limited to, workload, ease of traffic flow in the wards and clinics and inappropriate placement of sinks. By identifying specific reasons as to why HH practices are being neglected a social marketing approach to eradicating poor HH practices is thus administered and ensures that such barriers are eradicated. Putting in place reminders can also play a significant role in encouraging HH compliance. Fakhry et al (2008) notes that audible reminders on HH may improve hand washing practices in medical settings. In order to establish the effectiveness of audible reminders in combating hand hygiene non-compliance, audible hand hygiene reminders were put at the entry of wards. Subsequently, a study was conducted after eight month to establish whether hand washing practices have improved in the hospital. The findings of this study showed that there was a significant improvement in compliance to hand washing requirements by hospital staff and visitors (Fakhry et al, 2008). Moreover, Venkatesh et al (2008) advocates that electronic devices can effectively monitor HH compliance among HCWs and facilitate improved adherence to guidelines. Such innovative devices should be continually developed to monitor and evaluate HH practices among HCWs in the long run. Monitoring of HH practices should target specific locations within the health care centres notorious for HH noncompliance. To effectively eradicate noncompliance with HH practices electronic reminders should be strategically located in locations with most opportunities for HH practices. Such locations include; patient room entrances, individual patients environments in multi-bed rooms such as wards and shared en-suit bathrooms (Boscart et al 2010). Furthermore, development implementation and monitoring of HH programmes targeting eradication of nosocomial infections should be prioritised to reduce the instance of noncompliance with HH protocols. Aboumatar et al (2012) note that implementation of infection prevention promotion programs may significantly steer sustainable HH practices amongst HCWs. Consequently, such programs if carried out in the long-run instigate a culture of HH practice that eradicates noncompliance. In addition, the presence of positive role models in medical settings may motivate or promote adherence to suitable HH practices. Therefore, there is need for experienced medics in health care systems to take it upon themselves to provide guidance and act as good examples for others to emulate when it comes to suitable HH practices (Fakhry et al 2008). Generally, adherence to HH boils down to personal commitment and discipline. Furthermore, the availability of hand hygiene motivating factors such hand washing resources such alcohol based hand rub, water, soap and assessment and feedback of performance may influence the compliance of HCWs to appropriate hand washing practices (Fakhry et al 2008). Conclusion This paper has examined issues revolving around hand hygiene noncompliance. It has explored some of the causes and implications of hand hygiene noncompliance and provided recommendations on how to improve hand hygiene compliance in medical settings. It is established in this paper that, HH noncompliance is undoubtedly one of the biggest problems facing the fight against transmission of nosocomial infections by HCWs. In order to reinforce compliance to suitable HH practices, measures should be put in place to ensure that HH practices and protocols are adhered to. It is HCWs moral responsibility to subdue the frequency of HAIs by observing HH protocols. Nevertheless, reminders, training and monitoring programs, availability of hand washing amenities and resources can also play a crucial role in combating HH non-compliance. Generally, noncompliance to HH protocols is a global problem facing health centres all over the world, therefore it is important that standardised HH guidelines are developed to ensure effective eradication of noncompliance to HH by HCWs. References Aboumatar .H.Polly, R. Richard O.D. Carol,B.T. Lisa, M. Cosgrove, S. Rosenstein, B.& Perl,M (2012). “Infection Prevention Promotion Program Based on the PRECEDE Model: Improving Hand Hygiene Behaviours among Healthcare Personnel”. Infection Control and Hospital Epidemiology 33(2):144-151. Alsubaie .S. Abdallah, M. Waddah A. Ayshah D.A. Mariam T. Ali M.S.Abdulkareem, A. Abdulaziz, A.B., (2013). “Determinants of hand hygiene noncompliance in intensive care units”. American Journal of Infection Control 41:131-5. Boscart,V., Levchenko, A.I. & Fernie, G.I. (2010). “Defining the configuration of hand hygiene monitoring system”. American Journal of Infection control 38(7):518-522. Cummings L.K. 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