Nurses are the ones who are in the hospital 24 hours a day and 7 days a week. We are the great “multi-taskers” of the healthcare industry from executing doctors’ orders, granting patients’ requests, preparing a variety of medications, writing interventions to maintain an organized designated area. These are just a few, and many are not yet mentioned.
It just points out that nurses always have direct contact with every patient who has different kinds of diseases. And in that case, nurses’ health is at risk as well as being a susceptible host to the chain of infection is highly possible. That is why we play an important role in controlling nosocomial infection, and the most convenient and inexpensive practice we can focus on effective hand hygiene.
How important is hand hygiene?
According to the Centers for Disease Control and Prevention, “Hand hygiene is a general term that applies to routine handwashing, antiseptic handwash, antiseptic hand rub, or surgical hand antisepsis.” For it to be an effective measure, it not just a mere washing of hands with water with a couple of seconds but requires proper procedures and specific parts of the hands.
The target of proper hand hygiene is to break the infection chain, which composts of six elements, and one of which that we can intervene is through a mode of transmission. Microorganism has numerous ways to enter our body, and “direct contact” by means of our hands is one of the most common. Eliminating them can be a two-way benefit for both patient and nurse.
It is to prevent the patient from acquiring hospital-borne diseases like bloodstream infection, urinary tract infection, surgical site infection and pneumonia due to nurses handling several patients and also preventing the nurse to accumulate the microbes they may get from patients.
How effective is hand hygiene to reduce diseases?
Several researches had been conducted to prove the effectiveness of proper hand hygiene. One of the recent intervention studies last 2016 is from Guizhou Provincial People’s Hospital in Guiyang, China, in which they had series of instruction compliance and product measurement on HH (hand hygiene) with monitoring skills as a measure to improve compliance.
After 17 months of execution on 27,852 observations, there was a significant increase in hand hygiene compliance based on the increased consumption of hand wash and hand rub products. Lastly, the most favorable result is that during the same period, there was a decrease in the prevalence of hospital-acquired infection.
Soap and water VERSUS alcohol-based hand sanitizers
“Proper hand washing is best.”
“Alcohol-based hand sanitizers can reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.”
Taken from CDC, soap, and water is better than sanitizer, especially for reducing Cryptosporidium, Clostridium difficile and norovirus. If the first is not available, the latter can be a substitute but it should contain 60% alcohol or more. And if your hands are visibly dirty, soap and water with a 20-seconds hand washing is a must.
Is there a word for “too-clean’?
“Irritant contact dermatitis” is a condition for people, especially health workers who wash hands frequently characterized by redness, burning, and cracked skin. The natural oil of the skin is removed by soap, and using it often makes it dry, rough, and cracked.
Dermatologists suggest that you can use alcohol-based sanitizers if your hand looks clean and feels fine, and use it five times in everyone time you wash with soap. But if you are already experiencing the condition, you can use hand lotions to bring back the moisture and heal your broken skin.
Failure in Hand Hygiene Practice
Reasons for the lack of compliance to hand-cleaning practices include:
- Lack of time. This is due to work overload. Nurses’ work demands from challenging patients, continuous paper works, and medicine preparation take the majority of work time.
- Lack of equipment. Not all hospitals are capable of providing complete equipment for quality patient care, especially in public or government-owned.
- Inadequate training
- Human environment (superiors, colleagues, unscrupulous patients)
- Other health care professionals skin irritations caused by frequent hand-cleaning
- Forgetfulness and laziness
Ways to Improve Hand Washing Compliance
WHO hand-hygiene compliance strategy – consists of five main components:
- Ensuring health-care workers have access to alcohol-based hand rub at the point of patient care;
- Training and education of health-care workers on the most important times in patient care for hand hygiene;
- Monitoring and feedback on compliance;
- Visual reminders at the point of care in the workplace;
- Creation of a culture of attention to patient and health-care worker safety within the institution.
“Guide to Hand Hygiene Programs for Infection Prevention” –New guide compost of eight components by the Association for Professional in Infection Control and Epidemiology (APIC) and a nurse named Timothy Landers is the lead editor of the guide.
- Establish ongoing monitoring and feedback on infection rates
- Establish administrative leadership and support
- Establish a multidisciplinary design and response team
- Provide ongoing education and training for staff, patients, families, and visitors
- Ensure hand hygiene resources are accessible facility-wide and at the point of care
- Reinforce hand hygiene behavior and accountability
- Provide reminders throughout the health care setting
- Establish ongoing monitoring and feedback of hand hygiene compliance
Being a role model will have a great impact in the society, and starting with yourself is the key to succeed in HH compliance. As nurses who are always with the patient, practice regular and proper hand hygiene,, and share the knowledge that you have to patients and even to the people that surround you like in your home and community.
Ensuring that today’s medical professionals make handwashing a priority is essential. Be a person to reinforce hand washing, make sure to address in your facility the availability of soap on every sink, alcohol-based sanitizer in every hospital corner, reminder posters and knowledge about the effect of proper hand washing are some of the measures you can start with.
But it should not be limited inside the hospitals. It can also be in nursing schools and even in any medical schools who can begin to emphasize the importance of hand hygiene to the students to develop the habit. Public establishments like malls and fast-food chains are also included to have enough hand washing products. Authorities like the Department of Health or antimicrobial soap’s advertisements to always remind the public are the ones who really influence the majority must also share their part.
- WHO Strategy 2013- http://www.who.int/mediacentre/news/notes/2013/hand_hygiene_20130823/en/
- APIC Guide –http://apic.org/Resource_/TinyMceFileManager/implementation_guides/APIC_handhygiene.pdf
- Handwashing Research Summary by Global Handwashing Partnership 2016
- International Journal of Nursing and Clinical Practices, “Hand Hygiene of Nurses and Patient Safety” by Maria Malliarou 2017
- Effectivity in HH Compliance 2016 – http://www.sciencedirect.com/science/article/pii/S1413867016300885