Hand Hygiene Compliance
Running head: HAND HYGIENE 1
HAND HYGIENE 10
Monitoring for Hand Hygiene Compliance and its Effectiveness at Preventing Healthcare-Associated Infections
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Monitoring for Hand Hygiene Compliance and its Effectiveness at Preventing Healthcare-Associated Infections
Despite the vast body of evidence that correlates proper hand hygiene practices amongst healthcare providers with a decrease in the incidence of healthcare-acquired infections (HAIs), or infections contracted during admission to a healthcare facility, recommended hand hygiene compliance (HHC) continues to be a challenge (Gupta, Gupta, & Bhaskar, 2018). This paper will explore the issue by providing a brief background, discussing the importance to this author, nurses, and the nursing profession, outlining a related clinical question, highlighting current research on the topic, and talking about how this topic can be implemented in nursing practice, both on an individual level, and on a systems level. This author will then present information on how to translate the importance of this issue to the client population through education.
Introduction, Significance, and Importance of Hand Hygiene
When discussing hand hygiene in healthcare, this author is referring to the rudimentary practice of healthcare providers, including nurses, either washing their hands with soap and water or using an antiseptic hand wash or rub, like an alcohol-based hand sanitizer. Centers for Disease Control and Prevention (CDC) (2018) recommends to clean hands before and after contact with clients, after touching items that are close to the client, before and after wearing gloves, after using the restroom, and before eating. Additionally, antiseptic rubs may not be used if the client has Clostridium difficile (CDC, 2018).
The importance of hand hygiene practices can be traced back to the days of Florence Nightingale, who championed the cause by promoting hand hygiene when nursing soldiers during the Crimean War. Despite this longstanding knowledge, HHC continues to be problematic, and potentially preventable HAIs are still occurring in healthcare today. It is estimated that healthcare providers are only washing their hands 50% of the times they should, which very well could be contributing to the one in 25 patients who acquire a HAI (CDC, 2018). In the United States, about 80,000 people die annually as a result of HAIs (McCalla, Reily, Thomas, & McSpedon-Rai, 2017). This author has cared for many patients who acquired HAIs. It is for these reasons that this author has chosen the topic as it impacts both the individual nurse and the nursing profession.
There are many reported reasons why healthcare providers remain out of compliance with recommended hand hygiene. Some identified by Gupta et al. (2018) include a lack of knowledge by the healthcare provider, hand hygiene products that are difficult to find, or placed in out-of-the-way locations, and emergent situations where healthcare providers have to act fast. Masroor, Doll, Stevens, & Bearman (2017) also add that frequent hand hygiene products can be extremely irritating to healthcare providers’ skin which can be as often as 100 times during a 12-hour shift (CDC, 2018).
To ensure proper HHC, as well as lower HAIs and healthcare costs, many healthcare facilities follow the practice of monitoring healthcare workers. The gold standard is direct observation, having someone who is trained watch to see that healthcare workers are washing their hands when they are supposed to (Masroor et al., 2017). As Masroor et al. (2017) note, drawbacks to direct observation are that it is not possible to watch everyone all the time, and when people know they are being watched, they often do what they are supposed to. This is referred to as “The Hawthorne Effect” (Masroor et al., 2017).
Another method for monitoring HHC is to track how much product (hand sanitizer, soap, paper towels, etc.) is used (Masroor et al., 2017). This is relatively easy and provides objective data. One drawback to this method is that only monitoring supplies does not convey who is using the products, or if they are being used as recommended for HAI prevention (Masroor et al., 2017).
A third method to tracking HHC is automated hand hygiene monitoring systems which typically involve a healthcare employee wearing a tracking device that registers and tracks when hand hygiene is performed (Masoor et al., 2017). The benefits are that more hand hygiene events can be tracked, and feedback can be given to specific employees. Drawbacks are that these systems are expensive and that employees might not want to wear them for fear of what could happen or how the data will be used. For some, monitoring is an ethical issue. Lastly, the devices may not be 100% accurate, especially in busy workflow areas (Masoor et al., 2017)
PICOT Question
In nursing science, questions are often formulated utilizing the PICOT format (Population or Problem, Intervention, Comparison, Outcome, Time) to provide a structure for research and the dissemination of best nursing practice (Elias, Polancich, Jones, & Colvin, 2015). This author developed the following clinical question in response to the ongoing morbidity and mortality related to HAIs; in the inpatient population, does the use of electronic monitoring of healthcare provider hand hygiene compared to not using electronic monitoring, decrease the incidence of healthcare-acquired infections?
