Hand hygiene has emerged as the only single strategy that has the potential for reducing hospital-acquired infections. Evidence indicates that hospital-acquired infections pose an immense hazard for patients within the hospital environment, and healthcare workers, including nurses are involved in the transmission of these infections (Pittet, Allegranzi & Boyce, 2009). According to World Health Organization [WHO] (2010), the prevalence and incidence of hospital-acquired infections among the global population has been increasing with more than 1.4 million people suffering from these infections, worldwide. Evidence indicates that transmission of hospital-acquired infections from patient to patient occurs often through the hands of healthcare workers (Al-Busaidi, 2013). This implies that enhancing hand hygiene among healthcare workers holds the potential for reducing and preventing hospital-acquired infections. In most cases, patients experience hospital-acquired infections during their hospital stay, but appearance after discharge has been reported. Additionally, hospital-acquired infections affect hospital staff as occupational infections. In Australia, hospital-acquired infections are considered as one of the issues that threaten patient safety. This phenomenon has been reported worldwide. As reported by Huis et al. (2012), 4.6 to 9.3% of hospitalized patients in Europe are affected by hospital-acquired infections, accounting for about 135,000 deaths, whereas 99,000 hospital-acquired infections-associated deaths occur in the US, annually. As such, hand hygiene is considered as a significant preventive approach for reducing hospital-acquired infections. This explains why health organizations such as WHO, The Joint Commission and Centers for Disease Control have embarked on spearheading education and awareness on hand hygiene (Pittet, Allegranzi & Boyce, 2009; The Joint Commission, 2009). Despite these efforts, evidence indicates that healthcare workers continue to exhibit low levels of hand hygiene compliance (Erasmus et al., 2010). Therefore, this essay will demonstrate how nurses can assume a leadership role within the hospital settings in accordance with the health safety standards (National Safety and Quality Health Services) as outlined by the Australian Commission on Safety and Quality in Health Care [ACSQHC]. I will discuss how nurses can adopt hand hygiene strategies to improve compliance to the national hand hygiene initiative in the wards as one of the key approaches for preventing and controlling hospital-acquired infections.
Despite extensive efforts to improve hand hygiene among healthcare workers, the rates of hand hygiene compliance have not been optimal. However, it is apparent that different groups of healthcare workers demonstrate varied hand hygiene compliance levels. In one cross-sectional study that was carried out by Chavali, Menon and Shukla (2014), nurses were found to have hand hygiene compliance rate compared to compliance rate of other healthcare workers. Based on the WHO hand hygiene guidelines, overall compliance for participants in this study was high. This implies that compliance rates for nurses were relatively lower than the WHO guidelines. Additionally, nurses recorded the lowest hand hygiene compliance before aseptic procedures in the surgical Intensive Care Unit. Therefore, findings of this study explains the rationale for adopting appropriate hand hygiene strategies which can improve nurses’ compliance to hand hygiene guidelines in the wards as one of the main approaches of improving patient safety. On the other hand, hand hygiene compliance enhances the implementation of the Australian national healthcare standards related to patient safety. The ACSQHC (2012) outlines the national safety and quality health service standards which are meant to improve patient safety. Specifically, Standard 3: focuses on reducing hospital-acquired infections across the continuum of healthcare. Therefore, nursing leadership approaches can have a significant contribution to health safety through hand hygiene given that nurses constitute the largest portion of the Australian healthcare workforce (Twigg, Duffield & Evans, 2013).
Multi-modal educational strategy is the first hand hygiene strategy that can improve compliance among nurses, as well as other healthcare workers. Over the decades, education has been adopted as one of the main strategies for improving compliance to hand hygiene guidelines. Overall, knowledge is very essential in the healthcare profession. As such, adopting educational programs on hand hygiene can help in enhancing hand hygiene compliance among healthcare workers, including nurses. In practice, disease preventive and control interventions are designed and taught to healthcare workers through education and training. Therefore, theoretical knowledge on hand hygiene is essential for medical students, as well as professional healthcare workers. However, evidence indicates that knowledge about hand hygiene among medical students is not adequate. According to Prabhakumar et al. (2016), medical students exhibit sub-optimal knowledge on hand hygiene. In this study, knowledge levels on hand hygiene among medical students were found to be far below the expected levels based on the WHO guidelines. As a result, they recommend the inclusion of hand hygiene in the educational curricula, an aspect that has not been implemented in Australia. Instead, nurses, as well as the other healthcare workers acquire much of the hand hygiene knowledge at their workplace during their professional practice. This explains the need for further education and training on hand hygiene within the clinical setting.
From a critical perspective, the effectiveness of multi-modal educational strategy in enhancing hand hygiene compliance among healthcare workers has been studied extensively. According to Martín-Madrazo et al. (2009), there is sufficient evidence that educational programs on hand hygiene are effective in improving compliance to national regulations and international protocols which are aimed at reducing hospital-acquired infections. These educational programs achieve their efficacy for improving hand hygiene compliance through increasing the knowledge regarding hand hygiene among healthcare workers. They also promote positive attitudes regarding hand hygiene among healthcare workers, an aspect that improves compliance to international protocols and national regulatory guidelines.
Evidence on the effectiveness of multi-modal educational programs regarding hand hygiene compliance can be provided by a cross-sectional study that was carried out in Bangladesh. In this study, Ara et al. (2014) investigated the effectiveness of this strategy in reducing hospital-acquired infections based on compliance to hand hygiene guidelines. The objective of this study was to improve hand hygiene compliance among healthcare workers as a reliable approach for controlling and preventing hospital-acquired infections. These investigators used an educational/training intervention to raise awareness on the significance of hand hygiene among healthcare workers, primarily nurses and physicians. The findings of this study indicated that education and training improves compliance to hand hygiene guidelines among healthcare workers. Overall compliance was found to increase compliance with nurses recording a higher compliance compared to physicians. Additionally, education serves as the most appropriate approach for passing emerging research knowledge to professional nurses, as well as other healthcare workers. Over the past decades, healthcare transformation has been based on evidence-based practice whereby new evidence from research is transformed into practice within the clinical setting (Stevens, 2013). In the same way, hand hygiene guidelines which have been developed through evidence-based approaches can be introduced into nursing practice through educating nurses on new knowledge regarding this preventive practice.
Teaching programs based on hand hygiene guidelines are being developed. For instance, WHO has developed a multi-modal educational program based on what is referred to as “My 5 Moments for Hand Hygiene”. This approach focuses on improving patient safety by preventing and controlling hospital-acquired infections. It encourages hand hygiene during five critical moments; before touching a patient, after touching a patient and patient’s surroundings, before aseptic procedures, and after exposure to body fluid (WHO, 2010). This educational program has been found to be effective in improving hand hygiene compliance among healthcare workers, including nurses. In the recent quasi-experimental trial that was carried out by Farhoudi et al. (2016) who investigated the impact of WHO’s multi-modal hand hygiene strategy in 14 hospital wards. Investigators in this study carried out an educational intervention that involved hand hygiene teaching sessions based on the WHO’s five moment program and assessed its impact on compliance over 12 months. Nurses were enrolled in hand hygiene related educational courses. According to the findings of this study, compliance among nurses increased significantly after intervention. Similarly, compliance among doctors increased following the intervention. This demonstrates that educational programs improve compliance to hand hygiene protocols among nurses.
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- Patrick Kimuyu (Author), 2017, Improving Hand Hygiene Compliance by Healthcare Workers, Munich, GRIN Verlag, https://www.grin.com/document/378995