Demensions of Quality: Hand Hygiene Adherence in Health Care - Assignment Example

Dimensions of Quality Step 1 Preventing and Controlling Healthcare Associated Infections (HAI) Step 2 Hand Hygiene in Preventing HAI Healthcare associated infections are a major cause of morbidity and mortality in hospitalized patients. Transmission of healthcare-associated microbes mostly takes place through the contaminated hands of healthcare providers and hence hand hygiene is among the most important elements of infection control measures (Fox et al, 2015). In the wake of the increasing burden of healthcare associate infections, the rising severity of diseases and intricacy of treatment, coupled with multi-drug resistant pathogen infections, healthcare professionals have reversed back to infection prevention and control measures such as hand hygiene. Evidence has established that proper implementation of hand hygiene alone can considerably decrease the risk of transmission of infections within health care institutions (Kalata et al, 2013). Even though hand hygiene is extensively recognized to be the single most vital measure for lowering the transmission of pathogens and spread of diseases, evidence indicates that several healthcare practitioners do not practice hand hygiene as required and sometimes fail to use the correct hand hygiene technique. As a measure of preventing and controlling healthcare associated infections using hand hygiene, hands are supposed to be decontaminated prior to and after direct contact with patient and after any activity or contact that can contaminated hands. Studies indicate that is an effective measure of preventing and controlling healthcare associated infections; hand hygiene can be used in improving patient safety in regard to HCAI (Pfoh & Cyrus, 2013). Safety dimension Hand hygiene is an intervention that has the potential of preventing infections and harm. Failure to perform suitable hand hygiene negatively affects patient safety as well as the quality of patient’s lives (WHO, 2014). In addition, failure to do hand hygiene is the leading cause of healthcare associated infections and also the cause of cross-transmission of multi-resistant microorganisms. Still poor hand hygiene has been acknowledged as a major contributor to disease outbreaks (DiDiodato, 2013). There are several factors that contribute to poor hand hygiene among healthcare providers and they include: lack of knowledge among staff regarding the significance of hand hygiene in decreasing spread of infections, poor knowledge on the appropriate hand hygiene technique, inaccessibility to hand hygiene facilities, overcrowding/understaffing, irritation due to detergents used in hand hygiene and also organizational commitment to good hand hygiene. In order to minimize the risks of healthcare providers not adhering to hand hygiene, it is important to implement measures of promoting adherence to hand hygiene (DiDiodato, 2013). The hand adherence measures will include a campaign to encourage healthcare providers to always adhere to hand hygiene and it will encompass promotion of alcohol hand rubs at the bedside, distributing posters that remind healthcare providers to clean their hands, conduction audits regularly along with feedback of compliance as well as providing materials that empower patients to remind healthcare providers to always clean their hands. Educational programs may provide information about when hand hygiene is necessary and provide appropriate hand hygiene methods and techniques of maintaining skin health (GE Healthcare, 2013). Lastly, promotional posters aimed at demonstrating appropriate hand hygiene and reminding healthcare providers regarding the significance of hand hygiene should be availed (WHO, 2014). Effectiveness Dimension Hand hygiene in the hospital setting can be evaluated through additional hand hygiene observations for the healthcare providers and interviewing patients to establish whether health care providers adhere to hand hygiene. Direct observation regarding hand hygiene behavior of healthcare providers is perceived as the “gold standard” of measurement techniques (GE Healthcare, 2013). Observation allows the observer to see the hand hygiene products that healthcare providers are using, the thoroughness of hand hygiene process, the tools and methods utilized for drying, gloves usage and if healthcare providers are performing hand hygiene whenever necessary. In addition, direct observation allows observers to see healthcare providers who are adhering to hand hygiene and those who are not and to provide prompt feedback whenever improvement is required. Additionally, direct observation enables healthcare providers to evaluate facility-factors that might impact hand hygiene standard adherence (Mestre et al, 2012). The outcome will be increased hand hygiene adherence, reduced rate of hospital acquired infections as well as patients’ satisfaction on healthcare providers’ hand hygiene adherence. Accordingly, outcome measures can be evaluating weekly procurement data for alcohol hand rubs and liquid soap for every supplied hospital ward to evaluate usage and compliance as well (GE Healthcare, 2013). Increased usage of alcohol rubs and liquid soap will indicate increased adherence to hand hygiene. Additionally, patients can be interviewed to find out if healthcare providers are adhering to hand hygiene. As well, recording of infection rates will be necessary and this will be achieved by accessing the hospital database on hospital acquired infections. Reduced rate of infections will indicate increased adherence to hand hygiene (DiDiodato, 2013). Appropriateness Dimension Hand hygiene is indicated prior to touching a patient in order to protect the patient from colonization and also against exogenous infection by harmful pathogens on healthcare providers’ hands (WHO, 2014). Hand hygiene should be done prior to helping patient in personal care activities, prior to delivering care and other noninvasive treatments such as application of oxygen mask and also prior to doing a physical noninvasive assessment such as taking blood pressure (Stone, 2013). Secondly, hands should be cleaned immediately prior to accessing a critical site with infectious risk for the patient such as an invasive medical device, before performing vaginal examination, before dressing a wound, before making a percutaneous injection etc. This is done to protect the patient against infections that may occur when pathogens enter the body (Mestre et al, 2012). Thirdly, hands should be cleaned after body fluid exposure risk in order to protect the healthcare provider from colonization or infection with patients’ pathogens and also to prevent spread of pathogens within the healthcare setting. Accordingly, healthcare providers should clean their hands as soon as any activity that involves an exposure risk to any body fluids ends. Such activities include after coming into contact with a mucous membrane, after a percutaneous injection, after insertion and removal of any invasive medical device etc (Pfoh & Cyrus, 2013). Hands should also be cleaning after touching a patient in order to protect the healthcare provider from being colonized with patient’s pathogens and also to prevent spread of pathogens within the healthcare setting. Lastly, hands should be cleaned after touching patients’ surroundings in order to protect the healthcare provider from becoming colonized with patients’ pathogens that might be on surfaces and objects within the patients’ surroundings and also to protect spreading of pathogens within the healthcare environment (Alexandre et al, 2010). Acceptability Dimension Generally, hand hygiene compliance is poor. This is because improving hand hygiene involves changing human behavior and this makes it an intricate interaction of various aspects. However, when there is an understanding what motivates hand hygiene behavior, this can result to improved hand hygiene and thus acceptance and compliance with hand hygiene by the healthcare providers (DiDiodato, 2013). Factors likely to increase acceptability of hand hygiene include material factors such as convenience and accessibility of hand hygiene facilities like fast-drying alcohol hand rubs, no touch sinks, presence of alcohol hand rubs at patients’ bedsides, presence of alcohol hand rubs just outside patients’ wards and rooms and alcohol hand rubs on patients’ notes trolley when performing ward rounds. Additionally, healthcare providers readily accept hand hygiene when preparations do not irritate the skin and when hand hygiene preparations are aesthetically acceptable. Additionally, acceptability of hand hygiene in healthcare institutions is likely to increase when good hand hygiene adherence is rewarded and when there is promotion for positive culture for hand hygiene (Pfoh & Cyrus, 2013). Continuous Improvement Dimension This can involve a hand hygiene compliance system that uses a real-time location system as well as other technologies to detect and report if healthcare providers conduct hand hygiene practices after getting and leaving patients’ rooms according to hospital’s protocol (Mestre et al, 2013). The system has the ability to provide accurate measurements and all healthcare providers should wear badges that record room entries and exits as well as the use of hand hygiene techniques. Afterwards, data collected from the system can then be utilized in modeling and characterizing interactions of healthcare providers and the patients and then develop a comprehensive record of patients’ experiences (Stone, 2013). Since the healthcare providers are aware of the automatic monitoring system, they are likely to keep on improving hand hygiene adherence (Stone, 2013). Moreover, constantly educating healthcare providers regarding hand hygiene can ensure continuous improvement. The continuous improvement ensures reduction of hospital acquired infections. Prevention of hospital acquired infections entails continuous quality improvement to monitor lasting efficacy of hand hygiene adherence by healthcare providers (Mestre et al, 2013). Reference List Alexandre R. Marra, MD; Luciana Reis Guastelli et al, 2010, Positive Deviance: A New Strategy for Improving Hand Hygiene Compliance, Infection control and hospital epidemiology, 31(1). DiDiodato G, 2013, Just clean your hands: Measuring the effect of a patient safety initiative on driving transformational change in a health care system, American Journal of Infection Control, 1-3. Fox C, Wayre T, Drake D, Jones L et al, 2015, Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing, Am J Crit Care, 24(3):216-24. doi: 10.4037/ajcc2015898. GE Healthcare, 2013, Improving hand hygiene A system for continuous monitoring of hand-washing helps a South Carolina hospital monitor compliance with its “wash in, wash out” policy for patient rooms, Waukesha: GE Healthcare. Kalata N, Kamange L & Muula A, 2013, Adherence to hand hygiene protocol by clinicians and medical students at Queen Elizabeth Central Hospital, Blantyre-Malawi, Malawi Med J, 25(2): 50–52. Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Gallemi G, et al, 2012, The 3/3 Strategy”: A Successful Multifaceted Hospital Wide Hand Hygiene Intervention Based on WHO and Continuous Quality Improvement Methodology, PLoS ONE, 7(10): e47200. doi:10.1371/journal.pone.0047200. Pfoh M & Cyrus E, 2013, Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices, Rockville (MD): Agency for Healthcare Research and Quality (US); 2013 Mar. Stone P, 2013, Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureusbacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study, BMJ, 344:e3005. World Health Organisation, 2014, Evidence of hand hygiene to reduce transmission and infections by multidrug resistant organisms in health-care setting, Geneva: WHO. Read More