Handwashing compliance

Handwashing compliance

Introduction

Hand hygiene is one of the first-line intervention for infection prevention. Florence Nightingale found that there was a correlation between hand hygiene and the health outcome of the patients, primarily those who are admitted to the hospital. Hand washing is recommended to be done before and after any nursing procedure. Besides, hand hygiene is effective when done with an antiseptic soap and clean water. According to Alvim & Couto (2019), alcohol-based hand hygiene can be applied in a situation where there are no sinks for the nurses to wash their hands. Among the patients with multidrug-resistant pathogens, it is recommended that the nurses use waterless antiseptic or antimicrobial soap when cleaning their hands. This paper presents a research proposal on handwashing compliance among the nurses in the Critical Care Unit.

Problem statement

Hand hygiene is among the effective methods that help in infection prevention among the health care providers and the transmission of infection from one patient to the other within the hospital. Despite the effectiveness of hand hygiene in infection prevention, the compliance of the procedure among the health care providers is generally low. Hand hygiene can be improved through the implementation of compliance control. Compliance control can be done through direct observation and appraisal of the health care providers (Zil-E-Ali et al., 2018). The essential measures to control and prevention of disease spread among the health care providers are through compliance with the hand hygiene recommendations.

Worldwide, there is poor adherence to hand hygiene, which results in an increase and consistency of preventable nosocomial infections. The WHO recommends that the health care providers should wash hands with running water and soap, especially when the hands are visibly dirty (Alvim & Couto, 2019). However, health care providers can conduct alcohol-based hand hygiene in cases where their hands are not visibly dirty. The alcohol disinfection acts as an alternative option to the standard use of clean water and soap.

According to Musu et al. (2017), the increase in hand hygiene compliance has indicated to reduce the rates of infections caused by resistant microorganisms such as MRSA.  Continuous adherence to hand hygiene further results in reduced rates of acquiring hospital-acquired infections within the hospital.  The nurses, through direct skin contact, always acquire transient microorganisms with patients. Besides, the nurses can acquire transient microorganisms through direct contact with the surfaces within the environment. The transient microorganism is highly associated with nosocomial infections with the hospital. Therefore, the paper aims to determine the effectiveness of handwashing compliance using soap and water compared to the handwashing complain using alcohol-based hand rubs among critically ill patients in the Critical Care Unit within three months of hospitalization to the unit.

PICOT Question

Among nurses working in the Critical Care Unit (P), what is the effectiveness of handwashing using soap and water (I) compared to the use of alcohol-based hand rubs (C) in improving handwashing compliance (O) within 3 months of patient hospitalization in the critical care unit?

Search process

In the search process, I used keywords such as hand hygiene, handwashing compliance, nurses, critical care unit, and direct observation. I used PubMed, Medline, NCBI, WHO websites to search for the systematically reviewed articles and the previous researchers. The search was limited to current articles and was conducted within the past five years. All the systematic reviews were included in the literature review. Exclusion criteria are used was that all the studies which were conducted beyond five years from 2020 were excluded from being reviewed.

Literature review

The majority of health care providers prefer to use hand hygiene when they have been exposed to the patient or the patients’ environment.  In several cases, the health care providers tend to protect themselves from acquiring infection compared to protecting the patient from disease (Clark, Crandall & O’Bryan, 2018). Direct observation of the health care providers helps in identifying the weakness of the hand hygiene compliances, especially concerning the nurses’ behaviors on hand washing. Direct observation also helps in assessing the techniques of handwashing and giving feedback to the nurses for improvement in areas of failure (Demirel, 2019). It is, therefore, essential to measure the compliance of nurses towards handwashing through direct observation.

During a direct observation, some biases can occur, thus influencing the results of the hand hygiene. Hawthome effect is one of the prejudices that influence the direct observation significantly because most of the nurses who are being observed act in a different manner because they are aware that research is being done. Most of the nurses who are on direct observation tend to improve their hand hygiene compliance (Alvim & Couto, 2019). Most of the health care providers prefer the use of soap and water to do their handwashing compare to the use of alcohol-based hand rub (Musu et al., 2017). In other cases, alcohol-based antiseptics delivered a residual effect that was rarely observed in the use of water and soap while washing hands.  Hand hygiene compliance among health care providers is poor, despite the fact that the procedure is simple and cheap. Poor compliance with handwashing could be associated with increased workload among the nurses due to nursing shortage and turnover. Besides, lack of motivation could be another factor in poor compliance with hand hygiene.

Two different types of normal flora colonize the hands. These include the resident florae, which colonize the stratum corneum superficial cells. The second type is the transient flora, which always colonizes the superficial skin layers and can be removed through hand hygiene. According to Clark, Crandall & O’Bryan, (2018), some of the microorganisms that colonize the hands of health care providers include methicillin-resistant S. aureus, Candida spp., vancomycin-resistant Enterococcus, and the Clostridium difficle.  Proper handwashing is the only less expensive intervention to lower the incidence of hospital-acquired infections.  Besides, adequate handwashing helps in reducing the rates at which resistant microorganisms. Hand hygiene compliance reduces infection related outcomes even in hospital setups, where there are high infections rate primarily among critically ill patients.

Recommendations

Lack of motivation acts as one of the factors identified to hinder compliance from handing washing; further research should be conducted to determine measures and interventions to keep nurses motivated to do consistent handwashing according to the WHO five recommendations. Nurses are aware of the importance of hand hygiene, but they are not implementing the knowledge they have concerning hand hygiene in their daily practice. Most of the studies focused on the lack of hand hygiene compliance among nurses. Most of the studies point a figure on the work overload that is associated with the nursing shortage, lack of motivation among the nurses, and lack of proper handwashing techniques among the nurses. Therefore, further research should be conducted on the most effective hand washing techniques and better strategies to handle work overload among the nurses in such a way that proper hand hygiene and handwashing compliance are achieved among the nurses.

References

Clark, J., Crandall, P. G., & O’Bryan, C. (2018). Climbing the intervention ladder to handwashing compliance: A review and directions for future research. Food Control, 84, 544-551.

Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., … & Mura, P. (2017). Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. Journal of preventive medicine and hygiene, 58(3), E231.

Zil-E-Ali, A., Cheema, M. A., Ullah, M. W., Ghulam, H., & Tariq, M. (2017). A survey of handwashing knowledge and attitudes among healthcare professionals in Lahore, Pakistan. Cureus, 9(3).

Alvim, A. L., & Couto, B. (2019). Hand Hygiene Sound Alert: it is a Good Tool to Improve Compliance?.

Demirel, A. (2019). Improvement of hand hygiene compliance in a private hospital using the Plan-Do-Check-Act (PDCA) method. Pakistan journal of medical sciences, 35(3), 721.