Effective Hand Hygiene in Clinical Settings - Literature review Example

?Effective Hand Hygiene in Clinical Settings According to SARI (2004), hand hygiene, popularly referred to as hand washing, is the act of cleaning the hands for the purpose of getting rid of dirt, soil and pathogens including bacteria and viruses. The cleaning can either be done with water or another liquid or soap. Hand hygiene prevents infections associated with healthcare by lowering the incidence across infections. Although it is a simple measure, healthcare hygiene is often poorly carried out and compliance with its recommendations is usually a problem for most healthcare professionals (NHS, 2008). Hand hygiene is very important for the general public especially those who handle food and those who work in medical centers as poor hand hygiene may cause respiratory infections such as influenza and common cold according to the Joint Commission Resources (2008). The Joint Commission Resources (2008) and Mulder (1999) concur that in healthcare provisions, hand hygiene is the responsibility to all people involved. This is because when the health practitioners have contaminated hands, the patients are put at risk of developing infections. Therefore, to prevent infections, the healthcare practitioners must decontaminate their hands before and after each and every episode of direct contact or care with a patient (AORN, 1999; Lautenbach, Woeltje & Preeti 2010). Currently, hand hygiene is recognized to be important in providing quality care to the patients and is included in the standards for hospital accreditation. There have been new developments in the area of medical care and due to these developments most research bodies have reviewed the available literature and come up with new guidelines for hand hygiene. The guidelines are intended for use by all healthcare practitioners within the healthcare settings. Bacteria on the skin There are two main groups of microorganisms that are found on the skin, that is, resident flora and transient flora. Transient floras are bacteria that colonize the superficial layer of the skin. The transient floras are commonly associated with healthcare infections but can easily be removed by hand washing or social hand hygiene. An example of transient flora is staphylococcus aureus. The resident floras colonize the deeper layer of the skin and are difficult to remove. Examples include diphtheroids and coagulase negative staphylococci. The resident floras are usually not associated with healthcare infections according to CDC (2002) and Lindh, Pooler and Tamparo (2009). Hand hygiene is intended to reduce colonization with transient flora. Removal of the transient flora can be achieved through hand washing or hand disinfection. Hand washing is the use of water alone or the use of water and unmedicated detergent to clean the hand according to Mulder (1999) and CDC (2002). The main objective of hand washing is to prevent cross transmission of disease causing organisms. Hygienic hand wash is also similar to hand washing except that instead of unmedicated detergent, an antiseptic agent is used. Hand disinfection refers to the use of antiseptic solution, either medicated soap or alcohol to clean the hand. Substances used in hand hygiene There are different types of substances used in hand hygiene for cleaning. The substances used include soap and detergents, antibacterial soap, hand antiseptic and water. These substances are used to clean different dirt. For example, water alone cannot be used to clean the skin because on its own it cannot remove fats, oils and pathogens; it has to be used together with soaps and detergents. The temperature of the water used in cleaning the hands also varies, for in some instances warm water is used and in some cold may be used. For instance, when cleaning oils or fats it is advisable to use war water (World Health Organization, 2006). Antibacterial soaps are those with antibacterial agents that help in fighting or cleaning the bacteria and the hand antiseptics are non water based hand hygiene agents. The hand antiseptics are more effective against bacteria but not against viruses thus are less preferred. The CDC (2002) recommends the use of soap and water (hand washing) over hand antiseptics (hand sanitizing) because it is effective in preventing the spread of pathogens. Techniques used in hand hygiene According to CDC (2002), there are three recommended techniques for hand hygiene which ensure that the hand hygiene undertaken suit the task being performed. The efficacy of the hand washing depends on the adequate amount of a suitable hand hygiene agent, correct duration of time and proper drying of the hands. The techniques include: Social hand hygiene The social hand hygiene technique involves the use of plain soap and warm running water to clean all surface of the hands thoroughly. The objective of this technique is to remove dirt, transient microorganisms (flora), organic materials and dead skin. This technique require the hand to cleaned or washed with soap and warm running water for a bout twenty seconds then drying it with a clean disposable towel or otherwise. The use of towel is necessary because a part from removing excess water, the towel also removes the suspended contaminants (SARI, 2004). After cleaning the hand and drying, it is recommended that the health practitioner uses a dry paper towel to turn off the water and open the exit room if one is in a room. It is also advisable to use liquid soap rather than bar soap because bar soap are difficult to store dry at a sink. In health care settings it is recommended that hands should be washed at the beginning and end of a work shift, before and after each contact with a patient and after removing the gloves. Hand antiseptic hygiene During hand antiseptic hygiene, a hand antiseptic or alcohol rub is used to clean the hands. The cleaning is expected to take about 25 seconds. Like social hand hygiene, the aim of antiseptic hand hygiene is to remove all transient organisms. However, this technique is much quicker and more effective than social hand washing. Hand antiseptics and alcohol rubs also do not dry out the skin as soap and water does (CDC, 2002). Surgical hand hygiene The surgical hand hygiene technique often is performed with either an antiseptic scrub or an alcohol rubs before all surgical procedures. However, the antiseptic agent chosen for use should be validated for use in the surgical hand disinfection according to the defined standards. The aim of this technique is to remove all transient floras and substantially reduce the resident flora. Current research discourages the use of nailbrush because repeated scrubbing may damage the skin. This technique involves washing the hand and fore arms up to the elbow for about two to five minutes. It is also requires that all jewelry are removed and the nails cut or kept short as bacteria may be harbored in these areas (SARI, 2004). The practice of hand hygiene in medical practice Hand hygiene has received a lot of praises within the field of health care settings and a lot of people and organizations have come out strongly to ensure that it is thoroughly practiced in all sectors of the public. Hand hygiene is hailed for contributing to the minimal spread of influenza, prevention of diarrhea and respiratory infections and reducing infant deaths after home birth or deliveries. However, although this practice have received these tremendous praises, it is has received criticism. The main criticism to the practice is that sometimes hand cleaning using certain cleaning agents damages to the skin thereby predisposing the individual to infection (World Health Organization, 2006). A study condiucted among dentists registered by the New York State Dental Association showed that about 25% of dentists maintain poor hand hygiene in their practice (Myers, Larson, Cheng, Schwartz, Da Silva & Kunzel, 2008). Approximately 30% of the practitioners were conversant with the current CDC guidelines relating to hand hygiene. From the study, it was noted that most of practitioners use water and soap as opposed to alcohol-based hand cleaning agents frequently (Myers, Larson, Cheng, Schwartz, Da Silva & Kunzel, 2008). Factors influencing noncompliance with hand hygiene Although it is a simple measure, healthcare hygiene is often poorly carried out and compliance with its recommendations is usually a problem for most healthcare professionals. Factors that cause non-compliance with hand hygiene have been identified objectively so as to improve compliance. Among the factors that have been identified to cause poor adherence to hand hygiene practices include inconveniently located sinks or shortage of sinks, cause of irritation and dryness by hand washing agent, unavailability of soap and paper towels, lack of adequate time and understaffing or overcrowding (Friedman & Petersen, 2004; American Operating Room Nurses Association 1999). Other factors include low risk of acquiring infection from patients, forgetfulness, poor attitude towards recommendations, the belief that use of gloves obviates the need for hand hygiene, skepticism about the value of hand hygiene and lack of a role model from colleagues or superiors (Joint Commission Resources, 2005; Friedman & Petersen, 2004) These barriers to hand hygiene behaviors are not only linked to the institution but also to the health care workers. Therefore, both the institution and the health care workers should be considered in the implementation of a system change so as to improve the hand hygiene practices (CDC, 2002). Conclusion and Recommendation Beyond doubt, it is evident that the dangers of not practicing hand hygiene in health care areas are very great. Good hygiene practice is largely recognized as the most effective tool in preventing harmful bacteria from spreading. Therefore, it is unacceptable for health practitioners or workers to ignore these dangers and perform their duties without cleaning their hands. Although it is something forgettable in busy occasions, the health workers should develop a good attitude towards practice and make it a routine in their line of work. Hand hygiene is very important and the fact that most people especially health practitioners have become non compliant towards the practice is regrettable. Most health organizations have become concerned and about this fact and have given various recommendations towards improving hand hygiene within the health care settings. It is recommended that part from the sinks used for cleaning equipment, there should be other accessible sinks in each health care setting CDC (2002). Furthermore, each clinical area should have a disposable paper towel in a dispenser to be used for drying the hands after washing. In each clinical area there should be a poster that demonstrates the correct procedure of hand washing. Yet again, health care workers should be provided with better education on the need for hand hygiene. Manufactures should also develop hand hygiene agents with low irritancy potential so as promote the hand hygiene among the health workers. There should always be soap in the sinks and the soap should be a liquid soap at all times as recommended by WHO (2006) and CDC (2002). References American Operating Room Nurses Association (AORN) (1999). Recommended Practices for Surgical Hand Hygiene. AORN 69(4): 842 - 850 CDC (2002). Guideline for Hand Hygiene in Health-Care Settings (Vol. 51 / No. RR-16). U.S. Department of Health and Human Services, Atlanta, GA 30333. Friedman C. & Petersen H. (2004) Infection control in ambulatory care. Jones & Bartlett Learning. Joint Commission Resources. (2008) Hand Hygiene: Toolkit for Implementing the National Patient Safety Goal. Joint Commission Resources. Joint Commission Resources (2005) Contracted staff and patient safety. Joint Commission Resources, Inc. Lautenbach E., Woeltje F., & Preeti N. (2010) Practical Healthcare Epidemiology. University of Chicago Press. Lindh Q. Pooler M. & Tamparo C. (2009) Delmar's Clinical Medical Assisting. Cengage Learning. Mulder M. (1999) Practical guide for general nursing science, Part 2 Pearson Publishers. South Africa. Myers R, Larson E, Cheng B, Schwartz A, Da Silva K, Kunzel C. (2008) Hand hygiene among general practice dentists a survey of knowledge, attitudes and practices. J Am Dent Assoc 2008;139:948–957. http://www.dentalpbrn.org/uploadeddocs/Hand%20Hygiene%20Practices%20of%20General%20Dentists.pdf NHS (2008). Supporting Resource 29- Myths about Hand Hygiene. National Patient Safety Agency. SARI (2004). Guidelines for Hand Hygiene in Irish Health Care Settings. World Health Organization (2006). WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) World Alliance for Patient Safety, WHO, Geneva. Read More