Preventing Healthcare-Associated Infections through Hand Hygiene - Literature review Example

Mini-Literature Review Preventing Healthcare-Associated Infections through Hand Hygiene World Health Organisation (WHO) guidelines stipulate that healthcare providers are supposed to practice appropriate hand hygiene prior to touching the patient, after touching the patient, after touching inanimate objects near the patients such as bedside table or blood pressure cuffs, prior to clean/aseptic procedures and after being exposed to bodily fluids. Correct hand hygiene is the most effective means of preventing Healthcare Associated Infections (HAIs) as well as preventing the spread of antimicrobial resistant (Garrett, 2013). A study conducted by Mathur (2011) showed that hand washing eliminates the carriage of methicillin resistant S. aureus (MRSA) which is always present on the hands of healthcare providers working within ICUs. The study results also indicated that improvement in hand hygiene reduced transmission of Healthcare associated Klebsiella sp and also compliance to hand hygiene practices decreased the rates of acquisition of microorganisms on hands and in the end decreased the rates of HAIs within a healthcare setting (Mathur, 2011). Basically, healthcare practitioners transmit pathogens through their hands because their hands are normally colonized by transient and resident flora and hence as evidence shows effective hand hygiene prevents the transmission of these microorganisms and hence ultimately reduces healthcare associated infections. According to Garrett (2013) since hand hygiene is the most effective intervention of reducing spread of HAIs due to the fact that hands are vectors for microorganisms’ transmission between individuals and devices such as blood pressure cuffs, it is important for healthcare practitioners to practice regular hand hygiene. Effective hand hygiene practice reduces the risk of transmitting microorganisms to patients, decreases the risk for healthcare provider colonization and also decreases the mortality, morbidity and costs allied to treating HAIs (Garrett, 2013). This study is supported by Yawson & Hesse (2013) who argue effective hand hygiene removes microorganisms from the hands of healthcare providers and hence avoids transmission of microbes. Yawson & Hesse (2013) found that the transient flora colonizes the most superficial layers of the skin and this is easily eradicated from the hands after performing hand hygiene. A cross section observational study by Kong (2013) indicated that when healthcare providers handle patients, particularly the immune-compromised patients, the patients’ reduced immune system place the healthcare workers at higher risk for infections necessitating antibiotics. In addition, the review found that most HAIs resulted from cross-infection from the hands of healthcare providers. This is because the hands of healthcare practitioners regularly act as vectors for the transmission of microorganisms between patients and the hands are also major reservoir for microorganisms with antimicrobial resistance. Therefore, as Yawson & Hesse (2013) suggest, effective hand hygiene is the most effective strategy of reducing nosocomial infections. According to Ellingson (2014) indications for hand hygiene among healthcare providers include washing hands with water and soap when the hands are soiled, visibly dirty or in case of contamination with proteinaceous material, blood, or other body fluids and when one is exposed to Bacillus anthracis. Recommendation of physical action of washing the hands and rinsing in such situations is necessary since alcohols, chlorhexidine, iodophors, as well as other antiseptics have poor activity against spores (Ellingson, 2014). Ellingson (2014) further explains that when there is no visible soiling of the hand, healthcare providers should customarily use alcohol-based hand rubs to decontaminate their hands prior to having any direct contact with patients; prior to wearing sterile gloves during insertion of a central intravascular catheter; prior to insertion of indwelling urinary catheters or any other invasive devices; after coming into contact with the skin of the patient for instance when measuring blood pressure or lifting the patient; after coming into contact with body fluids, mucous membranes and wound dressing in case there is no visible soiling of the hands; after coming into contact with inanimate objects such as blood pressure cuff; after removing gloves and when one moves from a contaminated body location to a clean body location during patient care (Ellingson, 2014). A study by Laustsen & Lund (2011) indicated that hand washing with soap only removes the microorganisms but does not kill the microorganisms but hand hygiene using alcohol hand rubs or other antiseptic agents eradicates and also kills microorganisms but antiseptic agents and alcohol rubs are not effective in cleaning soiled hands. The study results further indicated that hand washing with plain soap for 15 seconds has the ability of killing microbes but it was observed that normally healthcare providers take less than 10 seconds during hand washing. Therefore, hand washing with plain soap might not eradicate all transient microorganisms especially if there is high contamination (Laustsen & Lund, 2011). A study conducted by Steinmann et al (2012) found that alcohol hand rubs (concentrations between 62%-95%) are more effective against bacteria as compared to plain hand washing or hand washing with antimicrobial soap. The study also indicated that alcohol hand rubs have a higher likelihood of protecting against numerous respiratory and enteric viruses on the hands as compared to plain hand washing or hand washing with antimicrobial soap (Steinmann et al., 2012). According to the studies, hand washing using soap is recommended only when the hands are visibly dirty or soiled because it effectively removes the microbes but does not kill the microbes. After hand washing, alcohol hand rubs should be used to kill the microorganisms and also because hand washing dries the skin which presents risk for contamination and potential colonization of the skin. Studies demonstrate that alcohol hand rubs kills nearly all types of microbes during hand hygiene practice in comparison to other hand hygiene methods like hand washing using soap and hence alcohol hand rubs are more effective than other hand hygiene techniques (Laustsen & Lund, 2011). A cross-sectional study by Rykkje et al (2007) showed that adherence to hand hygiene was low among healthcare workers within all the service provision centers that were investigated. Among the doctors the overall hand hygiene was between 9.2% - 57% while among nurses hand hygiene compliance was between 9.6% - 54%. The study further found out that hand hygiene compliance was higher when healthcare providers perceived the risk of infection to be higher and this observation was indicated by higher percentages of hand hygiene compliance after healthcare providers coming into contact with patients, that before touching the patients. Compliance was also higher in high-risk patient contact service centers such as wound dressing, labor ward and accident ward when compared to medium-risk patient contact centers such as general inpatient wards (Rykkje et al., 2007). Similarly, a cross-sectional study by Garret (2013) also found out that adherence to hand hygiene was low. This therefore clearly indicates that compliance to hand hygiene among healthcare providers is lows and this leads to increased risk of cross-transmission with microorganisms and thus high risk of HAIs. According to Grayson et al (2009), even though adherence to hand hygiene is low among healthcare providers, hand hygiene compliance significantly increases with alcohol hand rubs. Higher compliance to hand hygiene with alcohol hand rubs is attributed to product location within the environment, convenient when using and also less time is need when using alcohol hand rubs when compared to hand washing. In addition, alcohol hand rubs do not cause irritation on the skin (Grayson et al., 2009). As studies indicate that there is low compliance to hand hygiene in hand washing and hand hygiene was shown to improve significantly when using alcohol hand rubs and thus alcohol hand rubs are more effective in both removal and killing of microorganisms from the hand and also in improving hand hygiene compliance (Garret, 2013 & Grayson et al., 2009). This therefore makes alcohol hand rubs ideal replacement for hand washing whenever hands are not soiled or visibly dirty because they are more effective in killing microorganisms and there is increased compliance to hand hygiene with alcohol hand rubs and hence this can lead to reduced rates of healthcare associated infections within healthcare settings. Due to the low compliance in hand hygiene, there are various strategies that increase compliance. According to Pittet et al., (2000) monitoring is an important element in improving processes and compliance to hand hygiene. For instance, using “secret shopper” has demonstrated to be a successful measurement tool in measuring compliance to hand hygiene. The monitoring is supposed to be carried out routinely and the records documented. After the monitoring records are evaluated, any healthcare provider who does not adhere to the hand hygiene standards is supposed to be right away counseled to ascertain prompt remediation (Pittet et al., 2000). Evidence indicates that interactive educational programmes in collaboration of free availability of hand antiseptics increases hand hygiene compliance significantly. For instance, an educational programme that involved lecturing healthcare workers on basic hand hygiene protocols had major and sustained effect in improving hand hygiene adherence in a Dutch hospital (Huis, 2013). The study results also showed that using indicators for hand hygiene benchmarking, having survillience systems in the hospital to audit consumption rate of alcohol hand rubs and auditing of hand hygiene adherence among the healthcare providers as well as educating the healthcare workers in all wards on advantages of using alcohol hand rubs over hand washing greatly increased hand hygiene compliance in the hospital (Huis, 2013). Other factors that have been seen to improve hand hygiene compliance include positive role modeling where senior healthcare providers and leaders act as role models in hand hygiene adherence and utilization of performance indicators. In addition, alcohol hand rubs are supposed to be availed at the point of care in adequate amounts (Laustsen & Lund, 2011). Recommendations 1. Alcohol-based hand rubs should replace hand washing as the preferred hand hygiene technique. According to the evidence, alcohol hand rubs are kill all microorganisms on the hands unlike hand washing which only removes the microbes but does not kill the microorganisms. In addition, evidence shows that there is increased compliance with alcohol hand rubs and also they do not cause skin irritation that occurs in hand washing. However, whenever there is visible soiling of the hand, hand washing should be done followed by alcohol hand rubbing. 2. Monitoring of hand hygiene compliance through observation and use of “secret shoppers” should be implemented. Evidence indicates that monitoring of hand hygiene has been proved to be an effective measurement tool in gauging hand hygiene compliance. Monitoring should be carried out routinely and any healthcare worker who is identified as not being compliant should be instantly guided and advised to ensure prompt remediation. 3. Educational programmes should be carried out to educate healthcare workers regarding hand hygiene and the importance of hand hygiene. References Ellingson, K, 2014, Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene, Infection Control and Hospital Epidemiology, 5(8). Garret H, 2013, Evidence-Based Approaches to Hand Hygiene: Best Practices for Collaboration, Infection Control & Clinical Quality, 5 (1). Grayson ML et al 2009, Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers, Clinical Infectious Diseases, 48:285–291 Huis A, 2013, Explaining the effects of two different strategies for promoting hand hygiene in hospital nurses: a process evaluation alongside a cluster randomised controlled trial, Implementation Science, 8:41.  DOI:10.1186/1748-5908-8-41. Kong K, 2013, A quality improvement project in a hospital in rural Nepal: improving infection control practice using the ‘Plan, Do, Study, Act’ (PDSA) cycle, International Journal of Infection Control, 9(3): 1-7. Doi:10.3396/IJIC.v9i3.025.13 Laustsen S & Lund, E., 2011, Evidence-based clinical guideline for hand hygiene: Clinical guideline for hand hygiene in hospital staff, Denmark: Aarhus University Hospital. Mathur P, 2011, Hand hygiene: Back to the basics of infection control, Indian J Med Res, 134(5): 611–620. DOI:  10.4103/0971-5916.90985. Pittet, D et al, 2000, Role of hand hygiene in healthcare-associated infection prevention, Journal of Hospital Infection, 73(4): 305–315 Rykkje L, Heggelund A &Harthug S., 2007, Improved hand hygiene through simple interventions, Tidsskr Nor Laegeforen, 127:861–3. 4 Steinmann J, 2012, Comparison of virucidal activity of alcohol-based hand sanitizers versus antimicrobial hand soaps in vitro and in vivo, J Hosp Infect, 82:277–280. Yawson a & Hesse J, 2013, Hand hygiene practices and resources in a teaching hospital in Ghana, J Infect Dev Ctries, 7(4):338-347. doi:10.3855/jidc.2422. Read More