Weighing the Evidence

Running head: LITERATURE REVIEW

LITERATURE REVIEW 5

A Literature Review of hand washing practices among health care workers and its role in Health Acquired Infections

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Literature Review

While improvement in technology has led to improved medical equipment and medicinal products, mortality rates among inpatients is still high in the most hospital all around the globe. Research has indicated that the poor hand hygiene practices among healthcare givers are one of the leading causes of deaths. This paper provides a relevant literature review on this topic. Specifically, the paper examines the importance of hand-washing in healthcare situations, barriers to proper hand hygiene practices among healthcare workers and strategies of improving high hand hygiene standards.

Importance of hand washing as a proper hand hygiene practice among healthcare providers

Though various studies have rated hand washing to be less effective in reducing infection compared to disinfectants, it has been accepted as one of the less costly practice (WHO, 2010). Also, its limited benefits have been associated with greater risks for health care providers. According to WHO (2010), washing hands for several minutes hardly reduces the skin resident flora. Furthermore, hand washing is associated with the risk of cutaneous irritation and hand eczema (Kampf et al. 2010). When hands are frequently washed, the epidermis skin loses fats and water binding factors, which impairs its protective function leading to the development of eczema (Kampf et al., 2010).

Nonetheless, hand washing is still important when the hands are visibly soiled or contaminated with materials that are proteinaceous in nature (WHO, 2010). Hands should also be washed when they are soiled with blood and other body fluids. It is also recommended that hand washing should be done when it is proven that they were exposed to Bacillus anthracis. Healthcare providers should as well wash their hands after using restrooms, before and after having food. Studies done on the effectiveness of hand washing have demonstrated that the practice eliminates MRSA, which is carried by health care providers working in the Intensive Care Unit (WHO, 2010). Another study demonstrated that adherence to hand hygiene through hand washing reduces the rate of acquisition of pathogens on hands.

The existing literature indicates that while hand washing may be cheaper than disinfectants, it is not effective in reducing HAIs. Use of disinfectants such as alcohol hand rubs has been recommended in especially when the hands are not soiled.

Barriers to high hand hygiene compliance

There are both professional and organizational barriers that reduce hand hygiene compliance. Lack awareness and scientific knowledge concerning good hand hygiene practices are cited in various studies (Mani et al., 2010). Another barrier is inadequate training programs where health care workers can be educated on good practices. Misconceptions associated with some hand hygiene practices also contribute to low compliance. For instance, Mani et al. (2010) report that some hand hygiene practices such as the use of gloves were declined on the basis of skin irritation. Inadequate hand hygiene products and facilities such as sinks, antiseptic soaps, running water also contributed to low compliance with hand hygiene practices (Kampf & Loffler, 2010). Lastly, lack of incentives such as tokens to health care providers who maintained high hand hygiene practices is also cited in various studies (Sax, 2007).

Strategies for improving hand hygiene compliance

Sjoberg and Errikkson (2010) reports that interactive educational programmes can increase hand hygiene compliance. An adequate supply of hand hygiene products, such as lotion, disposable towels, sinks easily accessible by health care workers increased compliance (Schneider, 2009). Other strategies suggested include governmental support, development of national surveillance systems for auditing alcohol-based hand rub consumption and auditing hand hygiene compliance, the introduction of incentives and positive role modeling improved hand hygiene compliance (Magiorakos et al., 2010; Schneider et al. 2009; Erasmus et al., 2010). The various strategies identified imply that high hand hygiene compliance can be achieved through a multimodal strategy, which utilizes more than one strategy.

References

Erasmus V, Daha TJ, Brug H. (2010). Systematic review of studies on compliance with hand hygiene guideline in hospital care. Infection Control Hosp Epidemiology, 31:283–94

Kampf, G. & Loffler, H. (2010). Hand disinfection in hospitals-benefits and risks. Journal of the German Society of Dermatology, 8:12, 978-983.

Magiorakos AP, Leens E, Drouvot V. (2010). Pathways to clean hands: highlights of successful hand hygiene implementation strategies in Europe. Retrieved from: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19560 

Mani, A., Shubangi, A.M. & Saini, R. (2010). Hand hygiene among healthcare workers. Indian Journal of Dental Research, 21:1, 115-118.

Sax H, Uckay I, Richet H, Aegranzi B, Pittet D. (2007). Determinants of good Adherence to Hand Hygiene among healthcare workers who have extensive exposure to Hand Hygiene campaigns. Infection Control Hosp Epidemiology, 28:1267–74. 

Schneider J, Moromisato D, Zemetra B, Rizziwagner L, Rivero N, Mason W.(2009). Hand hygiene adherence is influenced by the behavior of role models. Pediatr Crit Care Med, 10:1–5. 

Sjoberg S, Eriksson M. (2010). Hand disinfectant practice: the impact of an education intervention. Journal of Nursing, 4:20–4.

WHO (2010). Guidelines on Hand Hygiene in Health Care. First Global Patient Safety Challenge. Clean Care is Safer Care. Retrieved from: http://www.who.int/patientsafety/en/