Importance of Hand Washing Among Health Practitioners - Essay Example

Importance of Hand Washing Among Health Practitioners Irene Mudzingwa Trent Executive summary The simple act of washing ones hands could rescue one’s life especially when it is practices regularly, frequently and thoroughly among health practitioners. Many deaths and injuries have been recorded and witnessed in all health facilities with no exemption to the long term care setting (LTC). This has been a challenge both for developing countries and the western countries which are considered to be so industrialised. (Boyce et. al. 2002). According to centre for disease control and prevention (CDC) 2002 policy recommendations for LTC facilities hygiene policies, hand washing is the most fundamental way of preventing and controlling the spread of infections. The policies cover impartation of knowledge and motivational activities with the focus of highlighting the cruciality of hand hygiene. (Richards and Chesley, 2002). Murray et al (2009) argue that the use of pre and post intervention test outcomes that show health workers knowledge level about prevention and control of infections caused by not washing or improper hand washing will go a long way in reducing the level of such related infections. Proper washing and scrubbing of hands by health workers has proven to be cost effective in preventing and controlling of nosocomical infections. This has been realised through drastic drop in the number of HAI transmitted by contaminated gloves and hands and thereby reduced morbidity and mortality rates. This would mean loss of human, social and economic capital (Whitby et al. 2006). The outstanding challenge to LTC has been and still remains to be placement and availability of alcohol based hand sanitizers to be utilised by the doctors, health workers and residence in an appropriate manner. A brief overview/description of the issue and the scope of the issue/problem It was found out that Personal Support Workers and nurses at Whitby Long term care were not washing hands before and after providing care on each patient. The practitioners fail to wash their hands despite having the knowledge that LTC facilities serves an exceptional group of people and experience unique environmental challenges thereby making them the highest transmitters of infections. Infection is the principal cause of mortality and morbidity and also gives rise to the highest number of transfers of patients from LTC to acute care hospitals. (Richards and Chesley, 2002). I have chosen this issue because the hand washing hygiene remains to be the most significant procedures in preventing and controlling hospital acquired infections (HAI). Upholding compliance and sustaining hand hygiene habit after knowledge impartation, motivation and response still remains a problem. Infections brought about by bacteria such as Streptococcus pyogenes which is the causal agent of the fatal puerperal fever amongst expectant women. Other contagious diseases like common flu spread without difficulty through dirty hands (Boyce et. al. 2002). The pathogens that are encountered in the LTC settings include but not limited to Streptococcus auras, which is methicillin resistant, (MRSA), multi-resistant strains of Klubsiella, and respiratory virus of syncytial strain that has proven risky to infants in the intensive care unit without exempting the health practitioners who attend to the children. One of the most widespread means of transmission of disease causing organisms is through hands and this would mean hand hygiene is the perfect remedy to preventing infections especially those related to the LTC setting (Richards and Chesley, 2002). Identify a model or approach to change. Buonocore (2004) building on Lewin’s model is going to be used in this situation. Provide a rationale for why this is the most appropriate model or approach for implementing the change. The Lewin’s model involves four straightforward steps as outlined below; reflecting on what one already know about the existing problem. This is then followed by planning on the way forward from the problem. Thirdly, taking action as per the outlined plan and finalising by observing the outcome of the action taken in order to overcome the problem. The Lewin’s model is the most suitable for this case since it is straightforward and easy to comprehend framework for managing change (Marquis and Huston, 2009). By getting to understand the stages involved, I will be able to plan and implement the change required such as leading change, handling or dealing with difficult staff or even what is needed to deliver results which is the weightiest matter to many bosses. The stages of change (SOC) gives the specific stages and gives direction on how best to help participants be made aware of the call for to change consider and get ready for change and act to uphold that change as exhibited in Table1. Discuss my leadership role within this model or approach. Being a transformational leader, these are things I will do. I will facilitate change through motivating doctors, nurses and personal support workers to change their perception and habit/behaviour that washing hands is a waste of time, and others argue that they do not wash hands since as they dislike using common towels to dry their hands after washing. I will introduce the idea of hand washing compliance; here they health workers compliance to hand washing will be observed. This will be effective since studies have shown that people behave differently after realising that their activities are being monitored. (Sullivan et al, 2005). Swansburg and Swansburg (2002), belief and euphoria from colleagues that hand washing have little or no value (unfreezing). This phase is built on the theory that human behaviours are markedly influenced by past learning through observation and cultural influences. In order for change to be realised, addition of new forces or deletion or getting rid of certain factors that encourages the habit/behaviour. This will only be achieved only when the top official like the nurse manager, chief physicians and other department leaders take part actively in the hygiene programmes. Secondly I will have to make changes where change is required (moving to a new situation). This will include but not restricted to regular issue, re-issue, revision and updates of infection prevention guidelines accompanied by cognitive empowering the nurses and nurse manger with the knowledge, technical the actual practical training on the step to step process of hand washing and giving incentives and rewards to those who embrace thorough hand washing between patient contact. A concise perception of the new situation is needed to point out the gap that lies between the current situation and one which is being advocated (Swansburg and Swansburg, 2002). I will ensure that permanent change is made (freezing) by organizing continuous staff training on hand washing and ensuring that adequate supplies of hand washing detergents and hand washing locations where necessary. Mechanisms for constant supervision and reporting needs to be set up without forgetting to acknowledging and rewarding desired practices (Sullivan et al, 2005). Outline your proposal and plan for the change guided by the model you have chosen. Buonocore (2004) building on Lewin’s model suggests the 4 stage model: Diagnose the problem, develop solutions, implement change, and re-establish balance Diagnose the problem: It has been proven that personal support workers and nurses at Whitby Long term care are not washing their hands before and after providing patient care on every patient despite the fact that hand hygiene is the most vital procedure for preventing and controlling the transmission of antibiotic resistant organisms(ARO’s). (Boyce et. al. 2002). Hand washing is the most decisive way of preventing and controlling the spread of infections in all health care settings. Therefore, medical personnel should wash their hands before taking part in invasive processes, This include but not limited to before looking after susceptible patients such as those who are severely immunocompromised as the elderly persons and newborns to avoid passing to them nosocomical infection such as flu-like infection, urinary tract infection, Methicillin-Resistant Staphylococcus Aureus, diarrhoea, tummy bugs and food poisoning. Before and after coming into contact with wounds of either surgical, traumatic or device associated nature. (Murray et al, 2009). Developing solutions Ensuring that there are sanitizers in every patient room, nurse station and sinks with water and soap are in the patient restrooms and in the medication rooms. The sinks need to be placed conveniently for the staff. Furthermore, portable water taps for hand washing needs to be placed in each ward (Murray et al, 2009). Potential costs (fiscal or otherwise, and how you will implement this plan (including a timeline if it is necessary. Implementation of this plan can cost thousand dollars to pay off -duty and on duty healthcare workers to attend a monthly meeting. In addition, the in-service training to all Personal Support Workers and nurses will be expensive to carry out. (Sullivan et al, 2005). For instance, inviting the infection control person to do supervisions and coaching visits for the hospital would cost about five hundred dollars. This is because it is a recommended to do training on the importance of hand washing in any long term care setting every three weeks. According to Sullivan et al (2005), initiation of interdisciplinary committee meant to oversee infection prevention needs comes in handy at this point and time. Posters from Public Health or MoHLTC comes in handy as the public gets enlighten on the importance of ensuring that health practitioners have their hands washed before attending to them (Swansburg and Swansburg, 2002). How can one implement this plan (including a timeline if it is necessary) Just as in certain countries like the U.S, patients are encouraged to demand that doctors, nurses and medical student wash their hands before attending to them. I will come up with such a policy for my nurses in order for patients to help in advocating for faster adoption of the new set reforms (Sullivan et al, 2005). Appointment of nurse supervisors whom shall consult, communicate and get me informed regularly about health care workers on the underlying issue. All these will be with the aim of stressing to the nurses and supervisors the importance of the hand washing (Marquis and Huston, 2009). Creating opportunities for outsiders to participate in the hand hygiene program will contribute to it success. It is wise that people from around be included in the program so that they may be informed on the importance of hand washing as far as avoidance and control of hospital acquired infections. Having hand hygiene related interview before admission or employment of health workers followed by educational programs as its reinforcement will have a positive impact to realising the programs set objectives (Richards and Chesley, 2002). Ensuring that hand washing sinks is made assessable. For the case of patients who need assistance, sanitizers will need to be availed by their bedside within their reach. Such patients will have to be supplied with sanitizers whenever they are served with their meals. Before they leave room for social places or even to the theatre room, they will have to be offered with hand hygiene (Boyce et. al. 2002). Identify the expected outcomes from implementing your project. Support these conclusions and try to think as broadly as you can about the implications for your project. Results from the Hand hygiene compliance audit showed a rise in areas that needed to be embraced for hand washing hygiene to be realised; things such as employees required to have nails which are short, clean and trimmed, the staff do they have necessary things to wash their hands. If change continues as measured by results from hygiene compliance audit, attending monthly meetings, change become a norm at long term care (Whitby et al. 2006). According to Murray et al (2009), proper washing and scrubbing of hands by health workers has proven to be cost effective in preventing and controlling of nosocomical infections. This has been realised through drastic drop in the number of HAI transmitted by contaminated gloves and hands and thereby reduced morbidity and mortality rates. This would mean loss of human, social and economic capital. Identify any anticipated issues, pitfalls, barriers and problems related to plan and how. Workers can lose morale to continue because the issue is not reinforced. This attitude will be eliminated through education and training that will accompany the laid down policies. Marquis and Huston (2009) argue that it will cost the hospital extra money to pay nurses off-duty in order for them to attend meetings on the importance of hand washing. This is because most nurses have insufficient training in infection avoidance. “Despite the fact that hand washing might be the convincing argument for infection control and prevention activity, it has remained a self-monitoring activity” (Downe, 2011). Some of the reasons attached to this have been linked to degree of awareness, education, the development of antiseptic ethics, lack of essential facilities such as soap, sinks, antibacterial detergents amongst others (Whitby et al.(2006). How my leadership and related skills can be applied to address those problems. As a transformational leader, these are things I would do. I will instruct that posters, brochures and signage can be put in the most visited places such as the patient reception areas of the hospital to reinforce on the importance of hand hygiene. I will advocate for monthly meetings to reinforce the issue. This will be accompanied by giving the nurses ample time to allow for a smooth transition that is the time period when the new initiative is adopted (Marquis and Huston, 2009). Bibliography Boyce et. al. (2002) "Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/ISDA Hand Hygiene Task Force."  Infection Control and Epidemiology, 23 (12): S3-S40. Richards and Chesley. (2002)"Infections in Residents of Long-Term Care Facilities:  An Agenda for Research Report of an Expert Panel", 3(20) 570-576. Whitby et al. (2006) Why healthcare workers dont wash their hands: A behavioral explanation. Infection Control and Hospital Epidemiology, 27: 484-491. Murray, P. R., Rosenthal, K. S., & Pfaller, M. A. (2009). Medical microbiology (6th ed.). Philadelphia: Mosby/Elsevier. Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing: theory and application (6th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Swansburg, R. C., & Swansburg, R. J. (2002). Introduction to management and leadership for nurse managers (3rd ed.). Sudbury, Mass.: Jones and Bartlett Publishers. Sullivan, E. J., Sullivan, E. J., Decker, P. J., & Decker, P. J. (2005). Effective leadership and management in nursing (6th ed.). Upper Saddle River, N.J.: Pearson/Prentice Hall. References Downe, S. (2011). Essential midwifery practice: expertise leadership and collaborative working (pp. 87). Oxford: Wiley-Blackwell. Appendix 1 Table 1 Stages of changes model applied to hand hygeine Stages Description/Definition Explanation Precontemplation Recognition of the problem is avoided, and ignorance is maintained. Participant is unaware of the need to change often through avoidance or rationalization. Contemplation Change is recognized but has yet to occur. Participant is aware of the need to change but is still stuck. Preparation Plans, sets time to change and makes it known to others. Participant plans and makes ready for change to occur in the near future. Action Change occurs as action is taken by modifying the environment and instituting rewards and social supports. Participant begins by taking small steps and progressing towards goal. Cues, reminder, and rewards are in place. Maintenance Commitment is stressed, and rewards are internalized while being aware of what tempts us to relapse. Participant overcomes hassles of hand hygiene by using prompts and rewards. Termination Not appropriate since behavior is maintained, not terminated. Not appropriate Source: E.P. Trunnell & G.White Read More