Infection Control and Hand Hygiene - Literature review Example

Infection Control and Hand Hygiene Introduction Hand hygiene is an important and a well researched subject especially in penetrating how it could improve the lives of patients already admitted in hospitals and how it could prevent them against deadly infections. Various researches have proved that hand hygiene is closely related to infection control and if promoted among the nursing staff then it could help reduce or eliminate transmission of bacteria from the nursing staff to patients. It is not easy to practice hand hygiene as it involves a lot of things and each one of it has to be monitored very well. Firstly the nursing staff should be aware of the proper procedure and principles of hand hygiene. They should know the correct technique to follow it. Secondly they should have the will to follow it. They should feel morally responsible for the patients and value their life. Lastly a great deal of effort has to come from the hospital to educate the staff and supply them with proper supplies related to hand hygiene. Secondary Research This is a qualitative research on the topic infection control and hand hygiene. The purpose of the research is to discuss various issues to help understand what infection control and hand hygiene is and how the two are related. The research will look to cover range of theories and articles in order to elucidate what is being discussed. For the research, following key terms and phrases were identified: Hand hygiene nursing Hand hygiene practice Hand hygiene and infection control Hand hygiene and WHO Ways to motivate hand hygiene in hospitals hand hygiene and infection prevention Maintaining hand hygiene in hospitals Infection control and hand hygiene statistics Lack of hand hygiene in hospitals Hand hygiene compliance Hand hygiene and infection control books The above keywords and phrases were researched in different academic databases like PubMed to find suitable articles and study. A large chunk of research was done from nursing books online from reputable authors and editors. Newspaper and online articles of only trusted sources like BBC and the guardian have been included for the research. Keywords Phrases E-Books and Newspapers online Book/article Selected PubMed Articles Selected GOOGLE Database Articles Selected A Hand hygiene nursing 993 1 2,200,000 3 B Hand hygiene practice 45,500 2 1,171 2 14,400,000  3 C Hand hygiene and infection control 12,100 1 3,234 1 D Hand hygiene and WHO 745 1 10,700,000 2 E Ways to motivate hand hygiene in hospitals 934 2 F hand hygiene and infection prevention 27,900 1 2,483 2 6,020,000 2 G Maintaining hand hygiene in hospitals 1,680,000 1 H Infection control and hand hygiene statistics 2,240,000 2 I Lack of hand hygiene in hospitals 1,950 1 1,420,000 3 J Hand hygiene compliance 851 4 1,550,000 2 K Hand hygiene and infection control books 1,540 4 Definition of infection control Infection control looks to prevent those who might be in danger of acquiring deadly diseases and infections. Infections could come from the community as well as from the nursing staff in case a person is already admitted to a hospital. Infections develop due to poor hygiene and the most basic aim of infection control is to counter the environment that allows unhygienic practices (WHO, 2013). Glasper and Richardson, in their book Children’s and young people’s nursing explain that for infection to occur there must be a host, a germ or bacteria that could be transferred and finally a transmitter. If any of these three things are not present then it is not possible to transmit infection (Glasper & Richardson, 2007). Nizam Damani in his book ‘infection prevention and control’ explains the two most basic ways of catching infections in hospitals. Transmission of infection comes from direct and indirect contact made to the patient. Direct contact could be made through bathing, injecting or feeding while indirect contact takes place as a result of poorly kept environment in the hospitals. Examples include garbage lying in front of patients or letting flies roam around in the wards or rooms (Damani, 2012). Covens and Berus discovered that hand decontamination greatly reduces the threat of infection. If blood is washed off properly wiping all microorganisms from hands then patients have a better chance of not catching any sort of diseases (Covens, et al., 2013). Dancer and Humphrey further elucidate Coven’s and Berus’s research saying the proper measures that can be taken against hand decontamination includes washing the hands under running water while rubbing it and drying it with paper rolls or tissues. They explain that drying the hands is also a very essential factor as bacteria could still be present in wet hands. When gloves are removed then a better effort should be made in washing and drying it (Dancer & Humphreys, 2012). Cost related to lack of infection control Jane Dreaper, a health correspondent in BBC, ponders upon the issue on how the authorities can actually treat people with infectious diseases. Health officials are trying to investigate this issue and are working on new laws to control vulnerable infections caused by poor hygiene. Jane points out that a lot of people are asked to stay back at the hospital by the magistrates every year when they catch infection from the hands of the nursing staff. This is a big concern which she thinks is not being taken care of as it should be (Dreaper, 2007). Andrew Gregory from the Mirror reports that the National Health Society (NHS), UK, were forced to pay £20 million last year, in 2012, to people who caught up with infections on a ward. Around 43,000 people were estimated to catch a superbug that made their condition severe and delayed their stay in the hospital. Andrew compares the number of patients from previous years and notices that they have nearly doubled. In 2012, a reported number of 22,488 people were estimated to have caught infection from hospitals while the number in patients nearly doubled in 2012. As a result of this, each patient had to be paid £90,000 in damages last. (Gregory, 2012). Efforts and improvements that are being made to tackle the problem According to the health care quality commission, Milton Keyes is one of the hospitals that are trying very hard to improve their infection control measures. The nursing staffs in this particular hospital were penetrated to perform routine work without protective clothing. A high number of complaints were registered against the hospital last year. Recent inspections have shown that the hospital has become much more responsible. They now look to store equipments in wards instead of just keeping them in the open at the hospital. Equipments are cleaned after routine check and wastage is disposed in secure rooms (BBC, 2012). On the other hand, a hospital trust in Liverpool has managed to cut infection rates by nearly 80%. The Royal Liverpool and Broadgreen University Hospitals NHS trust has managed to save over £2 million this way. It was named as one of the most careless hospitals in terms of maintaining hygiene but working hard to achieve cleaning standards have helped them achieve their goals (BBC, 2012). Remedies and strategies that could be applied Paul Elliot in his book infection control: A psychological approach to changing practice discusses that marketing techniques should be applied to motivate the healthcare workers. These techniques should carry some kind of benefits for workers in order to motivate them. He points out how successful social marketing has been before when applied to public smoking and using phones while driving (Elliott, 2009, p. 218). Hand hygiene definition and technique WHO recommends rubbing and washing hands with alcohol based formulations. According to their research it kills bacteria more efficiently and cure cuts and wounds in palms compared to soaps that leave it unhealed (WHO, 2009). According to the research by Gould D. Drey, a person should allow his hands to be washed under running water for about 15 seconds with just little soap or antiseptic in his hands. The hands should be rubbed while washing the soap and finally the hands should be dried up with tissues or paper towel (Gould, et al., 2007). Denise Winterman, a correspondent at BBC, gives very valuable statistical information regarding bacteria present in our hands. He says that a person on average carries 3,000 bacteria on his hand. According to his the most common sources are the basic things we use in everyday life like cell phones, credit card and bank notes (Winterman, 2012). Meters and Sobel in their book ‘Clinical and Epidemiological Aspects’ talk about the direct contact between the nursing staff and patients and the threats it carries. If proper hand hygiene is not maintained then there is a high risk that the patient can be infected with bacteria called methicillin-resistant Staphylococcus aureus (MRSA). According to them it is the most common type of direct disease transmitted from people to people (Mayers & Sobel, 2009, p. 1258). Causes According to an investigation conducted by BBC, the main cause of infection is microbes that are not visible to the naked eyes. It is estimated that every year about 4.5 million people suffer from severe illness, stomach aches, headaches and all sorts of other problems because of these microbes. The only way to get rid of these microbes is to repeatedly wash the hands several times every day (BBC, 2012). Dennis Campbell from the guardian reports that the doctors from the NHS staff do not regularly wash their hands. He claims that because they do not tend to do so, they do not also encourage the nurses to practise this habit. Dennis Campbell is of the opinion that doctors should lead from the front and set an example for the nurses and other staff members to follow them (Campbell, 2009). A research done by BBC found women washing their hands more frequently than men. In some cases men did not bother to open the tap to clean their hands under water. The lengthy research included 250,000 people. Only 32% of men washed their hands while of the total, 64% of women did manage to clean follow and maintain hand hygiene (BBC, 2009). Barrett and Randle, during their research, penetrated that the nursing staff found non compliant with hand hygiene procedure said that they had too much work to complete and had no time to wash their hands. A few said that work overload made them forget that they had to clean their hands before visiting the next patient. Barrett and Randle point out that some of the things that could help in these kinds of situations are effective communication, workshops about infection control, constant reminders from their supervisors and neatly placing the equipments and disposing garbage at the right place (Barrett & Randle, 2008). Things that can be done to encourage people to wash their hands Rose George from the guardian reports that signs in public washrooms that read “make sure the person standing next to you are washing his hand” were the most effective kind of promotional activities. Maybe these kinds of strategies could be applied in hospitals too (George, 2012). ‘Clean your hands’ was one campaign that was very successful. The campaign introduced in NHS trusts in England and Wales encouraged visitors to wash their hands before meeting with patients. During this campaign, that lasted nearly 1 year, NHS noted that there were a significant number of reductions in people falling ill from transmitted infections. NHS also discovered that the supply of soaps purchased for hospitals had nearly tripled in amount (the guardian, 2012). A study from Phil Winter, Mail Online, penetrated that thousands of lives have been saved because doctors have been more cautious and regular in washing their hands. This effort owes much to the campaign ‘clean your hands’ because of which MRSA rates have significantly dropped down. Phil reports that 10,000 lives were saved during the campaign which has only motivated the doctors to wash their hands and prevent from transferring diseases to the patients (Vinter, 2013). Wayne Thibodeau, a correspondent in the guardian, reports that he could not find any patient that asked the doctor if he had washed his hands before visiting him or her for a check up. He feels that patients should not feel shy when it comes to their health. He believes patients should take responsibility for themselves (Thibodeau, 2008). Lucy Shakeshaft from the Mail Online reported earlier this year that the Royal Liverpool Hospital kept urging its patients to ask the doctors to wash their hands before the routine checkups. This is what Wayne Thibodeau emphasized upon. The hospital launched an advertisement on TV sets to warn its patients about the potential infections that come from unwashed hands. The advertisement that became known as ‘don’t give them a hand’ cost £11,000 and is only the first effort made towards the ideology of reporters like Wayne Thibodeau (Shakeshaft, 2013). Lautenbach and Malani in their book Practical Healthcare Epidemiology talk about motivating the health force in order to maintain consistency in washing and drying hands as the required rule set by UNO. They believe that motivation could be verbal and rewarding as well. The doctors must use the correct terms and body language to inspire the health force. Lautenbach and Malani believe that because the entire staff cannot be rewarded in terms of gifts and money, a simple pat at the back could help to accomplish the trick (Lautenbach & Malani, 2010, p. 252). Infection control and hand hygiene According to Wellington, Boxall and Cross, pollution has to be very well monitored in hospitals to keep control over infection. Pollution can come from clinical wastage and any kind of accumulated garbage stored at a particular place. The garbage has to be disposed before it rots especially when food items are also thrown or stored. This increases a risk of flies getting to the garbage and carrying bacteria to the patients. Wellington and Boxall investigated that in many events the thrown gloves by the doctors attracted the most amounts of flies like mosquitos and resulted in malaria for many patients (Wellington & Boxall, 2013). This research article by Skyman and Hellstrom explains how important hand washing facilities are to avoid diseases and infections. If the wash basin is kept clean by the hospital then the employees will automatically be encouraged to wash their hands while if the surrounding is dirty then they will avoid using it. It is also very important for the hospitals to maintain the proper supply of soap, gel and towel. Paper towels are preferred to cotton ones as they are disposable and employees won’t mind using it (Skyman & Hellström, 2003).http://www.ncbi.nlm.nih.gov/pubmed/12900188 How lack of hygiene leads to infections and what can be done William and Wilkins in their book Lippincott's nursing procedures talk about the damages nails or artificial nails could do to a patient. They have studied cases where paint from nail polish was found to create havoc in a patient’s body that worsened their conditions. Patients felt discomfort and high levels of pain when chemical mixed nail polish was found to be mixed with blood inside. In some cases, artificial nails have also been found from inside a person’s body. These types of nails do not easily break down and the germ it contains tends to weaken human body. William and Wilkins suggest that it is better for nurses to trim their nails and refrain from wearing artificial nails. Hospitals must also take a stand and discourage women from wearing nail polish (Wilkins, 2009, p. 172). Dianne Josephson believes that the size of nails should not be more than 0.5 centimetres. Even nails this short should be cleanly washed in running water each separately one at a time (Josephson, 2004, p. 72). Wearing gloves by health care workers is very important to avoid microbial dissemination to the entourage and from transmitting germs to the patients. Though it has not yet been clearly established how wearing gloves prevent from controlling infections, a research by Ibler and Jemec talks about the danger that could be avoided by not wearing gloves especially in operation theatres when a patient’s body lie exposed. Ibler and Jemec also advise nurses to wear gloves during or else it could cause skin infections to patients (Ibler & Jemec, 2012). Moore, Dunhill and Wilson conducted a research to penetrate if wearing gloves actually reduced infections in hospitals. They found out that the material gloves were made up from played an important role in controlling infections. Nitrile gloves were considered to be very safe and transmitted fewer amounts of infections while hydrophobic gloves have a 20% chance of transmitting infections. They reached a judgement that there is no guarantee of transfer of germs to patients even with wearing gloves (Moore, et al., 2013) Faqernes and Lingaas believe that jewellery worn by women like finger rings and wrist watches often accumulate dirt around its surrounding. The bacteria they carry are hard to wipe out even by constant hand wash. In such instances it is advisable for women to take off their rings when serving in hospitals (Fagernes & Lingaas, 2009). Zoe Diana in her book Cosmetic Dermatology explains that health workers do not effectively follow instructions. In some hospitals there are no instructions provided to workers and so they do not feel obliged to wash their hands. Zoe is of the opinion that all the hospitals should clearly order the staff to wash their hands after they have visited a patient (Draelos, 2010, p. 28). Ebbing Lautenbach in his book Practical Healthcare Epidemiology explains that giving positive feedback especially from senior officials to the junior ones is a great way to appreciate their efforts. He explains how encouraged a person feels when he is appreciated for his hard work. Hand washing is that arduous task for nurses in a hospital and the senior doctors must make an effort in constantly giving them a positive feedback. Ebbing thinks that performance declines when efforts go unnoticed. So nurses would automatically restrain from an act that requires effort but goes unnoticed. Hand hygiene is an issue that cannot be disregarded at any cost. If doctors have to give a positive feedback to members of the health staff even 10 times each day then they should look to do just that (Lautenbach, 2010, pp. 252-253). Mercier in his book infection control discusses that cotton towels should be avoided for drying hands as they may raise concerns regarding contamination. According to him a few hospitals were still using this traditional technique of drying hands through shared towels in public washrooms. He believes that hot air dryers are not expensive to install and are a better alternative than cloth towels (Mercier, 1997, p. 111). According to Robert A., senior editor at Joint Commission Resources, the nursing staffs needs to be reminded about hand hygiene on a more regular basis. He feels it is possible that they forget to wash it due to work overload but constant reminders would help to solve this problem. There are different ways to remind the staff like using voice recorders when the nursing staff members are leaving a particular area or using signs and posters to guide them to wash rooms. Robert knows that it could be a little costly and baffling at the start but the long term benefits are way more than the short term costs (Joint Commission Resources, 2008, p. 58). Anthony D. Slonim argues that though MRSA starts with skin infection but could end up in more serious diseases like cancer if left untreated. He says that nurses should be more responsible with hand hygiene and must realise that if they are not, it could result in serious damages and probably deaths for patients in future (Slonim, Wolters Kluwer Health, p. 262). Nancy Caroline, in her book ‘Emergency Care in the Streets’ discusses the ways MRSA could be prevented. Nancy believes that avoiding contact with people infected with skin infection is the most important thing. Germs aggravate the infection and make it worse. If contact is made then it is mandatory to wear disposable gloves (Caroline, 2008, p. ch 36 pg 23). From 2005 to 2011, all major hospitals in Frankfurt were observed by the German Commission to measure the response of the health force when they were motivated and promoted to practice hand hygiene. By 2011 fewer diseases were discovered in patients than in 2005. Heudorf and Hausemann believe that motivating and constantly reminding the healthcare workers about hand hygiene helps to control infections (Heudorf & Hausemann, 2012). Lucille and Barbara in their book ‘Essentials of Administrative and Clinical Competencies’ discuss that health staff should morally feel responsible for the safety of patients around them. If they practice hygiene just for the sake of the policies and holding their job then it will not have a very effective impact. On the other hand if they practice hand hygiene considering the health of the patients then they will automatically make sure that they wash they hand as required by the standards of WHO and other health commissions (Keir & A. Wise, 2002, p. 265). Chris McCarthy, editor of ‘Innovation with Information Technologies in Healthcare’ believes that a strict check helps to force hospital employees to wash their hands whenever it is expected from them. A few hospitals have also deployed agents to report the administration about how strictly the hygiene rules are being followed. Growing concerns over health infections have created these kinds of an environment and Chris McCarthy believes that overall the results are very positive (McCarthy, 2013, p. 202). . Ethical Consideration The sole purpose of this academic research is to penetrate the relationship between infection control and hand hygiene. The research aims to add value in knowledge for the students. There was no sort of physical and mental harm done to acquire information in making this research. Similarly this research does not target a particular group or an organization and in no way tries to offend the feelings of the community as a whole. The aim of the research was to acquire information through reliable sources without plagiarising any content. An analysis has been made by considering the work of reputable authors and editors. The research might contain some negative elements about nursing and health environment but the purpose was to make people aware of some of the common threat it carries rather than mock the services. With all due respect to the health department, this research paper is just a basic endeavour to learn and teach through the articles and books of others. Conclusion There are many things that could be done to improve hand hygiene among the workers in the health force. The research discovered that in order to succeed, there should be a joint effort coming from the hospital, doctors and nursing staff. First of all the hospital should make sure that all the supplies are placed in the right position and fit to use. Soaps, gel and disposable tissue papers are the most important things in making a hand washing activity successful. The hospital must make sure that these things are not short at any time. The wash basin should also be clean and free from impurities. It should be reachable and not at a place far away from the doctors and nurses. The hospitals should also display reminders, posters and if required then repeat audio recordings to remind the staff about washing their hands. Training on regular basis should be provided as well. Doctors are the senior staff members and often considered role models for nurses and students in hospitals. They are the inspiring kind of people in the healthcare department. In order to successfully implement the hand washing ‘laws,’ doctors should leas from the front. They should constantly keep a check on the junior staff and monitor their activities. For that they have to adhere to the washing procedures and that they must do. They should keep motivating the junior staffs whenever they wash their hands until at least until the staff gets accustomed to it. This motivational technique is highly recommended and important as juniors like getting complimented from seniors rather than employees from the same status. Doctors should try to educate the staff by conducting seminars related to hand hygiene and keep reminding the staff to value human life. It has also been discovered that sometimes stern or strict actions have to be taken against the workers if they are not agreeing to the terms. Doctors are mostly present in the hospitals together with the nurses and this duty falls upon them to check and in the most extreme scenarios act strict in order to maintain hand hygiene. The hand hygiene cycle ends with nurses as penetrated in the research. They are the ones who are the most in contact with patients and the focus of hand hygiene is mostly put upon them. The research discovered that it is very important for the nurses that they put their heart and soul in maintaining hand hygiene. It should not be forced to them or they will not faithfully adhere to the procedure. Hand washing is not just about keeping hands in running water and they should follow the correct procedure of applying soap, rubbing their hands and drying it as by the rules of WHO. This could only be done if they are involved in making the lives of the patients better from the fathom of their heart. Though it is discouraged and not advisable for women to wear rings and other kind of jewellery, some of them are still found to be wearing it while in contact with the patients. These acts have to be given up for the sake of patients who are already ill and being treated. Nurses should try to practice hand hygiene without anyone telling, encouraging and motivating them. They should have a desire within themselves to act responsible as it is someone else’s life that they are dealing with. It is known through research that nurses act as expected when being observed or a subject of study. Hand hygiene will improve and infections will decline if they only manage to act in a similar fashion without being observed. List of References Barrett, R. & Randle, J., 2008. Hand hygiene practices: nursing students' perceptions. Journal of Clinical Nursing, 17(14), pp. 1851-7. BBC, 2009. Shame 'boosts hand-washing rate'. 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Ambler: Walters Kluwer Health. Winterman, D., 2012. BBC. [Online] Available at: http://www.bbc.co.uk/news/magazine-19834975 [Accessed 29 March 2013]. Read More