Introduction
The problem identified and requires intervention is the issue of poor hand hygiene among healthcare workers. It requires education and collaboration with all healthcare workers to adopt methods that can facilitate adoption of best practices in hand hygiene. The proposed interventions would involve developing evidence-based education programs on hand hygiene to ensure that healthcare providers can identify causes of poor hand hygiene and then adopt the best practices to prevent infections. On this note, healthcare workers must be educated about hand hygiene evidence-based practices that they can adopt to prevent the spread of infections in hospitals.
The proposal for the nursing research utilization project is to educate healthcare workers on the relevance of following recommended hand hygiene procedures by using evidence-based practices and demonstrating how they can adopt them to reduce cases of infection.
Background
The idea of ensuring that nurses and physicians observe hand hygiene is not new. The Hungarian physician, Ignác Fülöp Semmelweis (1818–1865) first adopted this intervention in 1840s when he elaborated the importance of hand hygiene among physicians to prevent the spread of microorganisms (Samuel, Almedom, Hagos, Albin, & Mutungi, 2005). Semmelweis observed that when healthcare workers washed their hands systematically and regularly, they could avoid infections and save lives.
It however seems that since the period of Semmelweis to present, little or nothing has improved in hand hygiene practices among contemporary physicians because hospital-associated infections have continued to increase across different units. Hand hygiene practices in healthcare facilities refer to hand washing with any form of approved antimicrobial disinfectants, soaps or alcohol-based disinfectants to eliminate infection-causing pathogens.
Why are healthcare workers so poor in hand hygiene?
The Joint Commission has noted that measuring healthcare worker adherence to hand hygiene practices is not a simple task because of variations in opinions and misinformation from different sources (Joint Commission, 2009). It noted that evaluating the what, when, why, and how in hand hygiene performance was a challenging task because healthcare workers should make such decisions independently. Further, any positive outcomes were often unsustainable (Joint Commission, 2009). Consequently, many hospital associated-infections are caused by common pathogens, including multi-drug resistant ones. A study by Flodgren et al. (2013) noted the presence of hospital-associated infections that were major threats to patient health and safety, and they were related to mortality and morbidity that ranged between 5% and 35% specifically in the intensive care unit (ICU).
Despite many cases of infections associated with hand hygiene, hand hygiene practices among healthcare workers have remained regrettably low (Akyol, Ulusoy, & Ozen, 2006). Some healthcare workers have argued that they have much work while others consider hand gloves as alternatives to hand washing (Nazarko, 2009). In most cases, they normally to use a single glove for several roles and fail to wash their hands after medical procedures. In addition to dry skin cases, nurses also avoid hand washing for fear of contracting skin diseases such as dermatitis associated with the use of alcohol-based sanitizers (Nazarko, 2009).
Studies have demonstrated that attitudes and behaviors among healthcare workers have significant influences on observing hand hygiene practices (Ott & French, 2009). In most instances, healthcare workers have doubted the effectiveness of hand washing practices. Further, personal values and belief systems are constituents of barriers that inhibit effective adoption of hand hygiene guidelines. Other studies have noted a lack of scientific evidence and awareness as major contributors to poor hand hygiene (Akyol et al., 2006). In some cases, training opportunities offered have not introduces nurses to practical concepts of hand washing and observation with patients in real-life situations.
Another notable factor that has contributed to poor outcomes in ensuring hand hygiene practices is misconception about the practice. This may entail situations in which healthcare workers use gloves to substitute hand washing. In addition, they have also claimed that certain skin conditions arise from frequent hand washing with some hand washing gels. Moreover, nurses and physicians have experienced increasing workloads, constrained time, poor staffing, lack of mentors, organizational support, different views about the recommended hand hygiene practices and poor motivation (Akyol et al., 2006).
Possible Interventions
Bischoff, Reynolds, Sessler, Edmond, and Wenzel (2000) noted that training and feedback interventions had positive outcomes among healthcare workers in various units. The introduction of easily accessible hand hygiene facilities and products was noted as effective. However, the researchers also noted that education/feedback intervention and patient awareness programs did not increase hand washing compliance, whereas the introduction of “easily accessible dispensers with an alcohol-based waterless hand washing antiseptic led to significantly higher hand washing rates among healthcare workers” (Bischoff et al, 2000). Therefore, education to enhance hand washing practices and compliance should be complemented with the required hand hygiene products and facilities.
Intervention activities should concentrate on a given problem and adopt role-oriented strategies alongside education and feedback to improve hand hygiene compliance. At the same time, such activities should be multifaceted with to tackle personal and facility related factors to enhance outcomes.
It is also necessary for healthcare facilities develop or adopt existing measures for assessing the effectiveness of hand hygiene practices.
Conclusion
While hand hygiene practices are rather simple, they have remained poorly practiced for several centuries. Consequently, these poor practices have led to the spread of nosocomial infections. Researchers have identified many factors, including lack of enough time, poor attitudes and behaviors, lack of adequate hand hygiene products and facilities, scientific knowledge and training on suitable hand washing techniques, variations in personal beliefs and the recommended guidelines among others as inhibitors of best hand hygiene practices. In addition, all stakeholders in healthcare facilities should collaborate in hand hygiene implementation to improve outcomes and promote change. It is also vital to recognize that unless healthcare providers change their behaviors and attitudes, hand hygiene practices and outcomes will remain critically low and disappointing across various units.
To improve hand hygiene practices among healthcare workers, evidence-based education programs on hand hygiene would be used to ensure that healthcare providers can identify causes of poor hand hygiene and then adopt the best practices to prevent infections and improve patient outcomes.
References
Akyol, A., Ulusoy, H., & Ozen, I. (2006). Handwashing: a simple, economical and effective method for preventing nosocomial infections in intensive care units. Journal of Hospital Infection, vol. 62(4), 395-405.
Bischoff, W. E., Reynolds, T. M., Sessler, C. N., Edmond, M. B., & Wenzel, R. P. (2000). Handwashing compliance by health care workers: The impact of introducing an accessible, alcohol-based hand antiseptic. Archives of Internal Medicine, 160(7), 1017-21.
Flodgren, G., Conterno, L. O., Mayhew, A., Omar, O., Pereira, C. R., & Shepperd, S. (2013). Interventions to improve professional adherence to guidelines for prevention of device-related infections. Cochrane Database System Review, 3, CD006559.
Joint Commission. (2009). Measuring Hand Hygiene Adherence: Overcoming the Challenges. Web.
Nazarko, L. (2009). Potential pitfalls in adherence to hand washing in the community. British Journal of Community Nursing, 14(2), 64-68.
Ott, M., & French, R. (2009). Hand hygiene compliance among healthcare staff and student nurses in a mental health setting. Mental Health Nursing, 30(11), 702- 704.
Samuel, R., Almedom, A., Hagos, G., Albin, S., & Mutungi, A. (2005). Promotion of handwashing as a measure of quality of care and prevention of hospital- acquired infections in Eritrea: The Keren study. African Health Sciences, 5(1), 4– 13.