CRITICAL R

7

Poor Hand Hygiene In Hospitals

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Poor Hand Hygiene In Hospitals

Poor hand hygiene is the leading factor for the increased prevalence of healthcare-associated infections (HCAIs) in hospitals (Guest et al., 2019). It forms a critical source of health complications across the care continuum and poses a severe threat to patients admitted to health facilities. During patient care, unless in full compliance with the hygiene recommendations, caregivers' hands are often contaminated with microorganisms, therefore serving as an excellent vehicle for transmitting the HCAIs to patients, staff, and visitors in the hospital. 50% of all HCAIs are through the healthcare professionals' hands, making it the main transmission mode (Engdaw et al., 2019). These infections affect the length of hospital stays, morbidity, and healthcare costs. Many hospitals, including my organization, are struggling with this poor health practice of poor hand hygiene.

           Failing to comply with hygiene protocols hinders the delivery of safe care services, increases the risk of HCAIs, and allows the spread of antibiotic-resistant bacteria. About 60% of healthcare professionals need to adhere to the best handwashing practices, even when the necessary supplies and resources are available (Garba & Uche, 2019). Poor hygiene practices, especially hand hygiene among caregivers, lead to increased rates of HCAIs, high risk of antimicrobial resistance (AMR), and increased burden on healthcare systems due to AMR, HCAIs, and increased hospital stay. According to Guest et al. (2019), complications due to hygiene issues come with economic burdens among clients due to the increased cost of caring HCAIs and longer hospital stays.

           HCAIs are developed during patient care in hospitals and are prevalent today, with poor hand hygiene attributed to the prevalence. Garba & Uche (2019), reveal that HCAIs prolong the hospital stay and recovery time, which increases medication costs, disability, and risk for life-threatening health conditions among patients. 55% of neonatal deaths among babies born in health facilities result from HCAIs (Bouzid et al., 2018). Compliance with hand hygiene alone is believed to reduce the risk of spreading HCAIs by 40%. Antimicrobial resistance (AMR) happens when microorganisms change and become resistant to the medicines they are treated with (Ravichandran et al., 2019). AMR threatens patient safety and reduces the efficacy of medicines used for treating HCAIs and other diseases, including pneumonia and tuberculosis.

Intervention to Improve Hand Hygiene Compliance in Hospitals

           Good hand hygiene is the best way to prevent the spread of germs in hospitals. Healthcare professionals should always clean their hands before and after taking care of a patient. Patients, relatives, and visitors should practice hand hygiene (Ravichandran et al., 2019). Millions of patients die every year across the globe from infections acquired during their patient care. Hands are considered among the major pathways for transmitting germs when the patient is receiving care. Therefore, compliance with hand hygiene is the most reliable measure to prevent harmful germs transmission and healthcare-related infections (Engdaw et al., 2019). Studies and organizations like the World Health Organization have recommended a multimodal intervention to improve hand-hygiene compliance in hospitals (Vermeil et al., 2019). The intervention combines various strategies including system changes, training and education, reminders, evaluation and reciprocity, and improved safety culture to improve hand hygiene compliance (Vermeil et al., 2019). Each of the elements requires equally crucial, specific, and integrated efforts to achieve implementation and sustainability effectively. Evaluation and feedback activities should be repeated and rejuvenated periodically and become a central part of the quality improvement program to ensure sustainability. Once implemented, hand hygiene monitoring and promotion should be a continuous process. According to Ben Fredj et al. (2020), the multimodal approach is found suitable for controlling hospital-acquired infection, and therefore it is the right intervention to implement and enhance hand hygiene compliance in hospitals, including my organization, where the infection rate is high (Ben Fredj et al., 2020). Sustained and successful hand hygiene improvement can be achieved through the implementation of different actions to address various structural and behavioral barriers in healthcare organizations.

           The strategy's system change element involves ensuring changes that guarantee the necessary infrastructure to allow healthcare professionals to practice good hand hygiene (Valim et al., 2019). This element includes two crucial elements; ensuring readily accessible alcohol-based hand sanitizer at different points of care and access to continuous and safe water supply, towels, and soap. Training and education is the second element of the multimodal hand hygiene strategy and involves the provision of regular training about the importance of complying with hand hygiene as indicated in the "My 5 Moments for Hand Hygiene" model and the appropriate hand-rubbing and handwashing process for all healthcare professionals (Valim et al., 2019). The feedback and evaluation element involved monitoring practices of hand hygiene and infrastructure along with the associated knowledge and perception among care providers while providing performance feedback on the matter to the employees. Reminder involves reminding caregivers about the value of hand hygiene and the best way to practice it. Institutional safety culture is about establishing the right perceptions and environment to increase patient safety awareness while prioritizing hand hygiene at all levels (Lotfinejad et al., 2021). Additionally, the intervention must reflect the three dimensions of evidence-based practice, including patient values, professional expertise, and evidence-based research.

Patient Values

           Nursing interventions must, including the multimodal hand hygiene strategy, must respect and integrate patients' values throughout their implementation. A strong and direct relationship exists between patient values and nursing practice interventions. Evidence-based interventions should be in the patient's best interest, with the goal of improving their health outcomes (Molina-Mula & Gallo-Estrada, 2020). Well-being is one of the critical patient values, which is achieved through interventions that address different aspects of care, including the physical, social psychological, and emotional needs of patients (Molina-Mula & Gallo-Estrada, 2020). Nursing intervention must be around providing the best value to the patient to improve their quality of life. Implementing the intervention that enhances hand hygiene compliance addresses

           The intervention seeks system changes that would facilitate patient safety and quality. The anticipated changes should meet patients' preferences and meet their unique needs. Patients would prefer if hand washing practice is made easy for them to comply with by providing suitable resources. System change is a critical element in all health organizations and involves ensuring the organizations have the required infrastructure to facilitate hand hygiene compliance. Hand hygiene compliance is only possible when health organizations have sufficient resources and a reliable supply of hand hygiene products at the right time and in the required state and quantity (Pomare et al., 2022). With a reliable system that fully supports hand hygiene compliance, the hospital will likely have handwashing sinks at each clinical setting, complete with soap, running water, and disposable towels. This organizational support would always ensure the availability of alcohol-based hand rubs at every point of care.

           Patients feel safe and better when health organization implements intervention that guarantees dignified and safe care (Pomare et al., 2022). Seeing strict adherence to safety protocols inspires significant confidence among patients. Healthcare professionals wash their hands in five moments in a healthcare setting regarding hand hygiene compliance. These moments include before touching a client, before an aseptic procedure, after exposure to body fluid, after touching clients, and after touching the patient's environment. Complying with these protocols improves patient satisfaction and health outcomes, a critical element of moral care.

           Hand hygiene compliance intervention can have economic value on the part of patients by reducing the cost of treating HCAIs, and avoiding prolonged hospital stays (Clancy et al., 2021). Complications due to hygiene issues come with economic burdens among clients due to the increased cost of caring HCAIs and longer hospital stays. Increased healthcare cost is a critical barrier to healthcare access among patients, especially those with low-income backgrounds.

           The different cultural aspects must be accommodated in quality improvement interventions in the nursing practice. Hand hygiene compliance must provide options to respect cultural diversity. Some cultures believe that using chemicals like hand sanitizers can result in some diseases like cancer. Therefore the intervention should not force patients to use sanitizer (Clancy et al., 2021). The current intervention will meet these diverse needs by providing patients with options to use running water, soap, or hand-based sanitizer on the walls. This will avoid cultural conflict while boosting satisfaction and experience during the hospital stay.       

Professional Expertise/Experience

           No doubt, health professionals' hands are the main vehicle for transmitting healthcare-Associated Infections, therefore, a central center of focus when implementing interventions to boost hand hygiene in health organizations. Hand hygiene compliance is as simple as cleaning hands with water and soap or with antiseptic hand rub to watch out for transient microorganisms; however, it has been hard for many caregivers, giving different reasons (Clancy et al., 2021). Most health organizations are reluctant to hand hygiene, especially among healthcare professionals. The healthcare workers mention various reasons for not complying with hand hygiene, including that "my hands are clean, have no time, sinks are far, I wear gloves, clients get offended, and others professionals are not practicing the hygiene." Many hospitals, including my organization, are struggling with this poor health practice of poor hand hygiene. Healthcare professionals are advised to comply with hand hygiene protocols using alcohol-based hand rubs (ABHR) at different times of the day. Caregivers should observe handwashing before handling an inversive patient care device, and touching the patient after contact with the patient's body fluid, non-intact skin, mucous membrane, and wound dressing.

           While in the hospital, healthcare workers come in contact with clients, medical equipment, and many other items in the patient rooms. There are many hand hygiene opportunities to help in keeping patients safe. Making sure nurses, doctors, and support staff wash or clean their hands often is vital for preventing illness spread. Systematic implementation of a multimodal approach can establish a virtuous behavior and care safety climate. Using multimodal strategy tools like Hand Hygiene Self-Assessment Framework" (HHSAF) requires significant efforts by health professionals and leaders. Still, it is worth it as it offers information on attention towards hand hygiene, creating room for improvement and subsequent reduction in HAIs (Ratti & Graves, 2021). Active support by the institution is always a key determiner of the intervention's success. Additionally, when the government supports interventions like multimodal strategy through establishing suitable policy, they become more successful and effective in solving nursing problems.

Evidence-Based Research 

           Evidence-based research lays strong background to inform nursing interventions for better nursing solutions. Evidence-based research provides valid, credible, and reliable information to support evidence-based projects that address critical nursing problems. Studies find multimodal strategy as effective in enhancing hand hygiene and healthcare outcomes (Valim et al., 2019). The intervention boosts and sustains healthcare workers; compliance to hand hygiene. The intervention's main elements include changing the system, education and training, observation and feedback, reminders in the health facilities, and safety climate. Additionally, practical training and habit change programming for caregivers and support staff can establish a safety culture by boosting hand hygiene compliance.

           The nursing workforce needs full training on the benefits of hand hygiene and the appropriate procedures for hand rubbing and washing. Training health workers induce cultural and behavioral change to adopt the best nursing practices, including hand hygiene compliance. Healthcare organizations should establish a robust educational program on hand hygiene and offer regular training to all their employees (Valim et al., 2019). Basic training and education, support system change, leading to better compliance with hand hygiene protocols.

           Repeated monitoring and evaluation of hand hygiene indicators, perceptions, and infrastructure greatly contribute to increased hand hygiene compliance. Continuous monitoring helps assess the induced change after implementing the multimodal hand hygiene intervention; to know if the intervention is effective in enhancing hand hygiene knowledge, practices, and perceptions among healthcare professionals and decreasing HCAIs (Bella-Anacleto et al., 2019). Reminders in health organizations serve as critical interventions to remind and prompt healthcare professionals about the value of hand hygiene and the right day to do it. Additionally, posters serve as reminders providing an action plan for care professionals to comply with hand hygiene. The institutional safety culture involves establishing an environment that supports increased awareness about issues of patient safety, including HACIs, resulting from poor hand hygiene.

           The multimodal strategy aimed at improving hand hygiene compliance fits in this aspect as it helps prevent germs. Unsanitary conditions, inadequate hand hygiene supplies, insufficient medical waste disposal, poor hand hygiene practices, and overcrowding create favorable conditions for spreading infections. According to Bella-Anacleto et al. (2019), compliance with hand hygiene alone is believed to reduce the risk of spreading HCAIs by 40%.   

Recommendations

           Good hand hygiene should be non-negotiable for health organizations. It is important to keep staff, patients, and visitors safe and prevent them from HACIs. Instilling a hand hygiene culture at hospitals is challenging and requires commitment from different stakeholders, including leaders, departments, and staff (Tan et al., 2019). Various recommendations can help improve hand hygiene compliance on top of the multimodal hand hygiene strategy.

Implementing interdepartmental competition on hand hygiene compliance within the organization can help prevent poor hand hygiene practices. Healthy competition is a great way to get employees engaged in doing something, and people would always wish to win. Quarterly departmental competitions on hand hygiene compliance can be a great strategy. The hospital should obtain the audit from a certified hygiene manager who observes how well employees are complying with good hand hygiene practices (Atif et al., 2019). The report should be provided after a specific time with compliance percentage, and the winning department should be rewarded.

Hospitals can use digital screen displays, called electronic message boards, across the hospital to remind care professionals about hand –hygiene compliance (Lotfinejad et al., 2021). Regular reminders about hand hygiene will motivate all people within the hospital to comply as it demonstrates the priority with which hygiene is treated.

Healthcare organizations should make hand hygiene compliance part of rounding. Hospitals should make it a habit to remind employees in different departments about hand hygiene. This encourages habit-forming behavior to integrate appropriate hand hygiene practices in the hospital culture.

Healthcare facilities should establish a financing budget to ensure adequate resources to support handwashing infrastructure in the facility and allow the implementation of IPC strategies. Monitoring systems should be strengthened to streamline health evaluation and surveillance and validate mechanisms for reporting HACIs. It is important to work with other stakeholders and partners like the private sector and come up with supply chains for accessing low-cost hygiene supplies.

Finally, hospitals should prioritize implementing the WHO multimodal strategy for hand hygiene. Healthcare organizations should provide comprehensive, regular training and behavior change programs on IPC and hand hygiene to all nursing employees in the facility (Ilesanmi et al., 2021). Care facilities should encourage caregivers to utilize effective habit change intervention and supply crucial products for complying with hand hygiene.

Conclusion

           Poor hand hygiene is a serious problem in the health system, leading to an increased prevalence of HACIs. Millions of patients die every year across the globe from infections acquired during their patient care. The HACIs adversely affect patients' health outcomes while increasing the financial burden on their family members due to prolonged hospital stays and treating resulting complications. Caregivers' hands serve as the main vehicle for contracting HACIs among patients, other care professionals, and visitors. Hand hygiene compliance is the most reliable and effective way of preventing HACIs spread. The multimodal hand hygiene strategy is effective in improving hand-hygiene compliance in hospitals. The intervention combines various strategies, including system changes, training and education, reminders, evaluation and reciprocity, and improved safety culture to improve hand hygiene compliance. Changes in hospital policies, infrastructure, and culture can help support hand hygiene compliance efforts.

References

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Belela-Anacleto, A. S., Kusahara, D. M., Peterlini, M. A. S., & Pedreira, M. L. (2019). Hand hygiene compliance and behavioural determinants in a paediatric intensive care unit: an observational study.  Australian Critical Care,  32(1), 21-27. https://www.ipac-canada.org/photos/custom/CJIC/CJIC_Spring2019_Atif.pdf

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