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Hospital Acquired Infections in Relation to Poor Hand Hygiene
Hospital acquired infections is an all too real and current issue. It is also highly preventable through the simple action of hand hygiene. Hand hygiene is a vital part of the hospital system to ensure the continuum of health. The number of professional health care staff who is not abiding by the governing policies on hand hygiene is alarming. It is an issue that is particularly relevant to nurses as they are in constant contact with patients, more so than any other health care professional. This paper shall address the topic of hospital acquired infections in relation to the lack of hand washing and poor hand hygiene. It shall hence be explored the reason behind the issues existence.
Background
Modern infection control is grounded in the work of Ignaz Semelweis who, in the late 1840’s demonstrated the importance of hand hygiene for controlling transmission of infection (Pittet, Allegrazi, & Boyce, 2009) and reduced mortality rate related to hospital acquired infections (Mortell, 2012). Hand hygiene has become an integral part of our culture. Hand washing is taught at every level of school, advocated in the workplace, and emphasized during nursing, medical, and paramedic training programs. The primary objective of hand hygiene recommendations has always been to reduce pathogen transmission and hospital acquired infections which, in turn, should reduce patient morbidity and mortality (Mortell, 2012). Hand Hygiene has been recognized and practiced for more than a century and is supported by evidence. According to NHS and Centers for Disease Control and Prevention (CDC) in the US, hand hygiene is simple, cost effective and an important factor in reducing and preventing hospital acquired infections (Pratt, Pellowe, & Wilson, 2007). Despite CDC guidelines stating that hand washing is the single most important procedure to prevent nosocomial infection and the relative simplicity of this procedure, adherence to hand hygiene recommendations of healthcare workers is unacceptably low, usually well below 50% (Pittet, Allegrazi, & Boyce, 2009).
Nursing-Sensitive Quality Indicator The use of nursing-sensitive indicators as a measure of quality care is a relatively new development in the healthcare industry. It wasn’t until the mid-1990s that many national healthcare organizations and regulatory agencies began to recognize a correlation between certain interventions performed by nurses and the overall quality and safety performance of healthcare institutions (Erickson, 2011). A broad definition of nursing-sensitive quality indicators might be: a set of standardized performance measures intended to help hospitals assess the extent to which nursing interventions have an impact on patient safety, quality, and the professional environment (Erickson, 2011).
Hospital Acquired Infections Nurses play a pivotal role in preventing hospital acquired infections, not only by ensuring that all aspects of their nursing practice is evidence based, but also through nursing research and patient education. As patient advocates, nurses are in the unique position to affect change to improve patient standards. The nurse has many tools available to create a safe environment for patients.
Hospital acquired infections are essentially infections that are acquired through health care professionals during a patient’s duration within a health care facility (CDC, 2013). Healthcare professional can transfer pathogens; colloquially referred to as a germ or virus, from the environment, other patients, or even from themselves (Pittet, Allegrazi, & Boyce, 2009). Particularly in health care facilities, it is evident that immune systems vary between patients (CDC, 2013). Some may be immune-compromised in which their immune system is unable to warn or ward off infections, even patients that are not typically afflicted individuals, individuals with a healthy immune system (CDC, 2013; MedicineNet, 2013). Therefore the spread of a pathogen may be highly dangerous to a new host than it was to the deriving origin (CDC, 2013). Hospital acquired infections impact upon patient care as it can result in prolonged hospital duration, extra excessive costs, and substantial morbidity and mortality (Mortell, 2012). It effects between 5-10% of patients during their admission (CDC, 2013).
Hand Hygiene Hand hygiene is a potent weapon in the nurse’s arsenal against infection, and is the single most important nursing intervention to prevent infection. Effective hand washing may be accomplished with antimicrobial soap and water, and specific guidelines are provided by the CDC for the use of alcohol-based hand rubs as acceptable substitutes (CDC, 2013). Through lack of hand hygiene, cross contamination increases the risk of hospital acquired infections (Queensland Health, 2012). This is a result of the constant contact with healthcare professionals; particularly nurses more so than others. Nurses tend to be more hands on with patients, and the primary mode of transmission is with ones hands (Queensland Health, 2012). Though there are policies and implementations that are currently in place to encourage hand hygiene and occurrence of hand washing, it is constantly missed (Erasmus et al, 2009; Maryland Hand Hygiene, 2012).
Factors that Influence Hand Hygiene Non-Compliance
The single most important thing a nurse can do to prevent infection is to wash hand effectively. Every nurse knows the importance of washing hands; unfortunately nurses do not always wash their hands when they should. Compliance with hand hygiene practice varies between units and professional disciplines and according to working conditions (Nazarko, 2009). Reported reasons for not washing hands include skin irritation and dryness, inaccessible hand washing supplies, wearing gloves, being too busy, or not thinking about it (Akyol, 2007). Healthcare staff may consider that hand washing takes up precious time and may fail to wash their hands because they are busy. Garus-Pakowska, Sobala, & Szatko (2013) found that although nurses spent longer time washing their hands that areas of the hands were missed and transient organisms were not removed effectively. Higher workloads cause that the hospital hand hygiene procedures are more frequently neglected. Hand hygiene procedures are more frequently neglected. Hand hygiene procedures are more frequently disregarded in the afternoon and at night during the morning duty shifts (Garus-Pakowska, Sobala, & Szatko, 2013). Under routine hospital condition compliance with hand washing by healthcare workers including nurses, physicians, and others (e.g., physical therapist and radiologic technicians) is still unacceptably low (Akyol, 2007). Compliance was higher among nurses than among physicians and other health personnel and varied by unit location (Akyol, 2007)
Medstar Franklin Square Hospital Center Policy Medstar Franklin Square Hospital Center is a magnet facility. When a hospital applies for magnet status a hospital must follow the Comprehensive Accreditation Manual for Hospital: The official Handbook 2008 (Joint Commision, 2008). Within the manual guidelines are laid out for surveillance, prevention, and control of infection. In following Joint Commissions guidelines the hospital has set up an Infection Control Committee. The purpose of this committee to develop and implement programs designed to coordinate all activities related to surveillance, prevention and control of healthcare acquired infections, to monitor adherence to the rules of asepsis and antisepsis, to develop guidelines for the for the management of infectious cases in the hospital, to educate all hospital personnel and medical staff members in proper infection control procedures, and act as consultants for bioterrorism plan (Infection Control Committee, 2010). As part of education rolled out to the staff all employees complete annual hand hygiene and infection control competencies yearly. Policies for all infection control including proper hand hygiene are available year round on the hospital intranet (Policies and Procedures, 2012). Signs from the CDC are posted throughout the hospital to remind employees and visitors not only to wash their hand, but also how to properly wash their hands. The signs can be found above the sinks in every patients room and in the bathrooms both employee and public. In regards to measuring the hand hygiene of employees the Infection Control Committee has employed secret shopper to evaluate whether hospital employees practice proper hand hygiene prior to going into a patients’ room and when exiting the room (Appendix A: FSHC Hand Hygiene Observation Tool). The data collected from this tool is then entered into the Maryland Hand Hygiene Collaboration Data Entry Website and a report is generated for every unit in the hospital, giving a percentage of unit compliance. The goal for each unit is to be 90 percent or greater compliance (Maryland Hand Hygiene, 2012). When staff do not know they are being watched the percentage of compliance can be assessed more accurately than those that know they are being watched. Observational studies tend to show that staff fail to assess risk appropriately and therefore make inappropriate choices in relation to hand hygiene. As an employee at Medstar Franklin Square Hosptial Center it is felt that everything the hospital has put into place to ensure proper hand hygiene is by the book and accurate, however numbers from unit to unit have been up and down throughout the years. It is felt that more should be done to drive the issue home among healthcare professionals because everyone does not learn and retain information the same way.

A Nurses’ Reaction and Action to Hand Hygiene Compliance Although hand hygiene has long been advocated as the best method of preventing health care acquired infections many healthcare professionals fail to comply with good hand hygiene practice. Inadequate compliance with the hygiene procedures as well as too short hand washing time point to the need to take action to increase the level of knowledge of hospital hygiene and encourage proper behavior. All staff are patient advocates and therefore have a moral obligation to be caring, compliant, and, most importantly, effective when performing the global standard precaution called hand hygiene. As patient advocates, nurses need to reinforce the concept of moral obligation to adopt effective hand hygiene practices, regardless of empirical views. Urgent need to encourage proper hospital hand hygiene behaviors among nurses had been found to be necessary. Hand hygiene compliance hospital wide was very low. In a letter to the Unit Nurse Manager on the IMC/OO3N/Tele Obs at Medstar Franklin Square Hospital Center (Appendix B) the following recommendations were made to increase hand washing compliance among the unit staff: Mandatory surveillance of all staff as well and performance monitoring at individual and unit levels are needed to ensure good hand hygiene. Techniques such as in-service education, information leaflets, workshops and lectures, and feedback on compliance rates have been associated with transient improvement and encompass all learning styles (Creedon et al, 2008). Complete a monthly presentation at the staff meeting or unit based council. The presentation should include the compliance numbers for the unit and also reinforce hand washing education. Teach employees that not only do they need to wash their hands after using the bathroom and after contact with patients, but also prior to contact with patients (washing of ones hands prior to entering a patients’ room is more of a problem then after contact with a patient). Employees who are noncompliant are treated as they would be if they were given a verbal warning, and with each subsequent violation, additional steps are taken, such as written warning placed in their file. In reaction the letter sent to the unit manager and changes based on recommendations were made the IMC/OO3N/Tele Obs unit has improved their compliance numbers, with many months 90% or greater as required no only by the hospital but the joint commission as well. This has earned the unit a Hand Washing Excellence banner from hospital administration.
Conclusion
Hand washing is a fundamental aspect of care and is one of the most effective measures for preventing infection. With nurses being a possible intermediate host for pathogens, it is important to ensure that contact with patients is of a safe nature. By properly washing and cleaning hand, the spread of infection can be minimized. Promotion of hand hygiene recommendations through education, encouragement from administration, and research tend to drive hand washing compliance. To improve hand hygiene and quality of hand washing compliance substantially, additional factors must be considered, including improving healthcare workers, especially nurses, skin conditions and providing alcohol-based alternatives, hand hygiene techniques and disinfections, focusing on education and motivational programs and providing administrative support. Nurses have the unique opportunity to reduce the potential for hospital acquired infections. Utilizing the skills and knowledge of nursing practice, you can facilitate patient recovery while minimizing complications related to infections.

References

Akyol, A.D. (2007). Hand hygiene among nurses in Turkey: opinions and practices. Journal of Clinical Nursing. 16:431-437. doi:10.1111/j.1368-2702.2005.01543x.
Centers for Disease Control and Prevention. (2013). Retrieved from [website]: www.cdc.gov August 7, 2014.
Creedon, S.A. (2008). Hand hygiene compliance exploring variations in practice between hospitals. Nursing Times. 104(49):32-35.
Erasmus, V., Brouwer, W., vanBeeck, E., Oenema, A., Daha, T., Richardus, J., Vos, M. & Brug, J. (2009). A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and convincing evidence that hand hygiene prevents cross-infections. Infection Control and Hospital Epidemiology. 20(5): 415-419. doi: 10.1086/596773.
Erikson, J.E. (2011). Nursing-sensitive indicators paint vivid picture of organizational commitment. Caring Headlines. 2-3.
Garus-Pakowski, A., Sobala, W., & Szatko, F. (2013). Observance of hand washing procedures performed by the medical personnel after the patient contact. Part II. International Journal of Occupational Medicine and Environmental Health. 26(2):257-264. doi:10.278/s13382-013-0094-2.
Infection Control Committee. (2010). Infection Control Committee Charter. Medstar Franklin Square Hospital Center. Retrieved from [intranet]: http://starport.medstar.net August 5, 2014.
Joint Commission (2008). Comprehensive Accredidation Manual for Hospitals: CAMH The Official Handbook 2008. CAMH Refreshed Core. IC-1-IC-14. Retrieved from [intranet]: http://starport.medstar.net/FSH/Documents/HAP2007.pdf August 7, 2014 Maryland Hand Hygiene (2012). Maryland Hand Hygiene Collaborative. Retrieved from [website]: https://handhygiene.marylandpatientsafety.org August 7, 2014
MedicineNet. (2013) Retrieved from [website]: www.medicinenet.com August 7, 2014
Mortell, M. (2012). Hand hygiene compliance: is there a theory-practice-ethics gap? British Journal of Nursing. 21(17):1011-1014.
Nazarko, L. (2009). Potential pitfalls in adherence to hand washing in the community. British Journal of Community Nursing. 14(2):64-68.
Pittet, D , Allegranzi, B., Boyce, J. (2009). The World Health Organization Guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hospital Epidemiol. 30(7):611-622.
Policies and Procedures. (2012). Hand Hygiene Guidelines. Medstar Franklin Square Hospital Center. Retrieved from [intranet]: http://starport.medstar.net August 5, 2014
Pratt, R.J., Pellowe, C.M., & Wilson, J.A. (2007). National evidence-based guidelines for preventing healthcare associated infections in NHS hospitals in England. Journal of Hospital Infection. 65(Suppl 1):54-64.
Queensland Health. (2012). Prevention and Control of Healthcare Associated Infection: Hand Hygiene Guideline. Queensland Health. Retrieved from [website]: www.health.qld.gov.au August 5, 2014.

* A provider may use the hand rub dispenser just outside the room door, the dispenser inside the room, or the sink.

DO NOT GUESS. If your view is blocked & you cannot confirm if provider performed hand hygiene simply check “Blocked View/Unsure”

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Appendix A: FSHC Hand Hygiene Observation Tool

Appendix B:
Rachel M. McPherson BS, RN
2601 Windsor Rd
Parkville, MD 21234
443-615-6956
rmcpherson@stevenson.edu
August 8, 2014
Anna Wilsman
3T Nurse Manager
Medstar Franklin Square Hospital Center
9000 Franklin Square Dr, Tower 3
Rosedale, MD 21237
Dear Anna Wilsman:
I am a staff nurse on the floor that you manage, and I am writing to you to express my concern about the hand hygiene compliance on our unit. I understand that you are looking for ways to improve the unit compliance for hand hygiene.

I do not believe that our unit is at a loss. I believe that the staff of the unit, my fellow co-workers are capable of maintaining the percentage of hand hygiene compliance above 90% on a consistent basis. Consider: Mandatory surveillance of all staff as well and performance monitoring at the individual and unit level are needed to ensure good hand hygiene. Techniques such as in-service education, information leaflets, workshops and lectures, and feedback on compliance rates have been associated with transient improvement (Creedon et al, 2008). Complete a monthly presentation at the staff meeting or unit based council. Employees who are noncompliant are treated as they would be it they are given a verbal warning, and with each subsequent violation, additional steps are taken, such as written warning placed in their file. According to the Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) recommendations, medical staff are obligated to decontaminate the skin of their hands before and after every patient contact.
If at first we don’t totally succeed, keep trying…. That should be our motto throughout the IMC/OO3N/Tele Obs unit at Medstar Franklin Square Hospital Center. Hand hygiene should no longer be infection controls responsibility; it should become a hospital-wide initiative, however as a unit we can increase compliance on a small scale. The ultimate goal being taking what we have learned as a unit hospital-wide.

Could these recommendations improve hand hygiene compliance on our unit, are they things that our staff and fellow co-workers can embrace, and furthermore, are these recommendations enough to improve our unit numbers? I look forward to your response.

Sincerely,

Rachel M. McPherson BS, RN

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...Quality Management Businesses need to provide quality service to be successful. Many of them, however, struggle to retain their customers, seasoned employees and market share among other vital elements due to the poor quality of their goods and services. Deciding, implementing and execution of quality management initiatives are challenging tasks to many managers of small businesses but it can be easy with good planning. Failure to get this right can spoil the operating environment and destroy businesses’ belief in meeting customers’ need. Businesses and firms need therefore to define and measure their goals, update service tools, motivate employees, and use customer feedback to serve them appropriately. When the management involves all employees, it can engage in tactical quality management approaches such as conducting audits, compliance management, preventive and corrective actions, and statistical process control that drive improvements. When employees are not engaged, they do not feel to be part of the process and, therefore, the firm may lose direction. This paper discusses ten quality management improvement initiatives to improve companies’ poor performances. First, management that is committed to improving quality of its company should provide internal education (Shah, 2013). The modern technology is changing very fast, and so are customers' needs, preferences and tastes. Employees should be educated regularly as a way of making sure they are updated. Existing and new...

Words: 2361 - Pages: 10

Premium Essay

Quality

... Geograhy, Business Economics, Accounting. Higher Education Institution :Bethelsdorp Technical College Year Completed :1992 Qualification Attained :N2 Certificate Subjects Passed :Mathematics, Engineering Science Engineering Drawings, Toolmakers Theory. N3 Drawings. Other Studies/Courses :PC Upgrade and repair Employment Profile Most Recent Employer Name of Company : Autocast SA (Pty) Ltd Dates of Service :2004 to date Current Position Held :Quality Receiving inspector Reporting to :Quality Manager Net Salary : R 8890 Bonus :13th Cheque Other Benefits :None Contact for References :Neil Leyshon, 072 565 9502 :Duwayne Varnfield, 082 940 4303 Duties and Responsibilities : Receiving of all 10...

Words: 307 - Pages: 2