World Health Organization (2009) highlighted that the
magnitude of HCAI burden worldwide which should be emphasized as an important
issue and it is overly underestimated. According to Allegranz
and Pittet (2009), the hospital-wide studies and long-term follow up reports
showed that there is a temporal association between improved hand hygiene
practice and reduced infection rates. In their review paper, therefore, they
spotlighted that hand hygiene is the leading measure to prevent transmission of
HCAI and antimicrobial resistant.They also found out that optimal level of hand
hygiene compliance among health care providers is low in most of the setting. It
is to promote hand hygiene through multimodal
interventions which appeared to be the most suitable strategy to behavioural
change. Allegranz and Pittet (2009) also noted
that introduction of alcohol-based hand rubs and continuous educational
programmes are key factors to challenge barriers to hand hygiene compliance.
Larson, Quiros and Lin (2007) conducted a study to evaluate
compliance with CDC hand hygiene guidelines and compare the rates of HCAI
before and after guidelines recommendations. They designed pre-and post-guidelines
implementation site visits and surveys in 40 US hospitals, using direct
observation of hand hygiene compliance and guideline implementation score.
Their study results showed that hand hygiene compliance rate remained low and
there is no impact of guidelines implementation on HAI rates.
They found out that there was no evidence of multidisciplinary programs to improve practice of hand hygiene. Larson, Quiros and Lin (2007), therefore, concluded that wide dissemination of guidelines is not a sufficient intervention to promote hand hygiene unless multidisciplinary programs are initiated in hospital setting.
They found out that there was no evidence of multidisciplinary programs to improve practice of hand hygiene. Larson, Quiros and Lin (2007), therefore, concluded that wide dissemination of guidelines is not a sufficient intervention to promote hand hygiene unless multidisciplinary programs are initiated in hospital setting.
In twenty-four-hour observational study on compliance of hand
hygiene in hospitals conducted by Randle, Arthur and Vaughan (2010), the rates
of hand hygiene compliance among nurses and allied health professionals were
improved, and the rates are still low among doctors and ancillary workers. They
found out that compliance for head hygiene was high before performing
procedures with asepsis techniques, after body fluid exposure and after contact
with patients. However, the rate of compliance was low before contact with the
patients and after contact with surrounding objects, which indicated that
hospital staffs’ concerns to wash hand before contact with patient is poor and
necessary to improve. Randle, Arthur and Vaughan (2010) concluded that hand
hygiene is influential and cost effective to reduce HCAI rates, and implementation
of numerous strategies have impact on hand hygiene compliance.
Mathai et al (2011) stated that HCAI prevention
programs are more widely implemented compare to specific hand hygiene promotion.
They reflected the recommendation of WHO that hand hygiene is to be encouraged
in health care setting as quality indicator. They noted that there has been 59%
of current active initiatives at national and sub national level incorporating
hand hygiene in measurement for quality of care. There are more initiatives
requires to incorporate hand hygiene compliance as quality indicator, and to
implement multiple strategies in health care setting all over the world.
Critical
analysis on the issue for poor hand hygiene practice is important to find out
the barriers or factors affecting these poor practices, and solutions to combat
the problems of health care related infections. In review of scientific data
related to hand hygiene, perceived
barriers to adherence with hand hygiene practice are skin irritation caused by hand
hygiene
agents,
inaccessible hand hygiene supplies, interference with staff-patient relationships,
patient needs perceived as a priority
over hand hygiene, wearing of gloves, forgetfulness, lack
of knowledge about guidelines, insufficient time for hand hygiene, high workload and
understaffing, and the lack of scientific
information showing a definitive impact of improved hand
hygiene on increasing nosocromial infection rates (World Health Organization, 2009).
World Health Organization ( 2009) also reported additional perceived barriers to recommended hang hygiene practice which includes; lack of active participation in hand hygiene promotion at individual level, lack of institutional priority for hand hygiene, lack of administrative sanction for non-compliers and rewarding of compliers, lack of knowledge, lack of role model from colleagues and superiors and disagreement with recommendations. This comprehensive report gives the insight that it is a need to remove these barriers to promote hand hygiene practice among staff, and that nurse leaders and managers must be role model in practicing hand hygiene according to the established guidelines.
According
to Centre for Disease Control and Prevention (2002), education is a cornerstone
for improvement with hand hygiene practices, and it is recommended to be
addressed by educational
programs include with; 1)scientific information for the
definitive impact of improved hand hygiene on healthcare associated infection
and resistant organism transmission rates; 2) awareness of guidelines for hand
hygiene and indications for hand hygiene; 3)
knowledge concerning the low average adherence rate to hand hygiene by the
majority of hospital staff; and 4) knowledge concerning the appropriateness,
efficacy, and understanding of the use of hand-hygiene and skin-care–protection
agents. Informed knowledge creates awareness of their problematic behaviours
among staff and directs them to change behaviour towards compliance to hand
hygiene practice.
Report from World Health
Organization (2009) included with determinants or self-reported factors for
good adherence to hand hygiene, which are peer behaviour, perceived expectation
from colleague, being perceived as role model, perception that hand hygiene is
easy to perform, perceived risk of infection, beliefs in performing hand
hygiene and participation in previous hand hygiene campaign. Therefore, Center for Disease Control and Prevention
(2002) recommended that Interventions to promote hand hygiene in hospital need
to consider various factors including intentions, attitude towards the
behavior, perceived social norm, perceived behavioral control, perceived risk
factors, hand hygiene practices, perceived role model, perceived role model and
motivation.
From these points, the author realized that extrinsic
motivators such as rewards and punishments, having easy access to sinks and
hand rub and regular auditing are not enough to promote hand hygiene practice
among staff. The management team needs to consider about internal motivators
such as giving opportunity to take part in hand hygiene initiative, giving some
responsibilities on hand hygiene promotion program and being empowered nurses
as future leader to hold perceived role model for the younger generation.
References:
Centers for Disease Control and Prevention (2002) Guidelines for Hand Hygiene In Health-Care
Settings, Morbidity and Mortality Weekly Report: Recommendations and
reports, V. 5, No. RR-16.
Larson, E. L., Quiros, D., and Lin, S. X.
(2007) “Dissemination of the CDC’s Hand Hygiene Guideline and impact on infection
rates,” American Journal of Infection
Control, 35(10), 666-675.
Mathai, E. (2011) “Promotion hand hygiene in healthcare through
national/subnational campains,” Journal
of Hospital Infection, 77(4), pp. 294-298.
Randle, Arthur and Vaughan (2010)
“Twenty-four-hour observational study on hospital hand hygiene compliance,” Journal of Hospital Infection,76(3),
252-255.
World Health Organization (2009) WHO Guidelines on Hand Hygiene in Health Care, First Global Patient
Safety Challenge Clean Care is Safer Care, Geneva.
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