Hand Washing Case Study

Hand Washing Case Study

Introduction

Hand washing has been established to be a simple but effective way of prevention infections. There have several campaigns carried out to promote hand washing practice. Some of the campaigns have been carried out by government in partnership with companies like soap companies while others have been executed by different organizations. In this report, a case study on hand washing is going to be covered. The case study considered in the hand washing campaign carried out by the Mafraq Hospital in Abu Dhabi. This hospital is owned and operated by the Abu Dhabi Health Services Company (SEHA). Management of the hospital is carried out by Bumrungrad International. The hospital commenced its hand washing initiative in 2010. From the time when the initiative commence, the hospital has been carrying out several of activities, with the goal of educating as many people as possible in accordance with importance of hand hygiene (Mafraq Hospital, 2011).

Importance of Quality Hand Hygiene Practices in Hospital Settings on Patient Safety

With respect to Khuan (2012), transmission of pathogens from one patient to another in the hospital settings takes place as a result of contamination of the hand of the health workers. Accordingly, hygiene has to be integrated in healthcare as a way of ensuring the safety of the patients and the health workers. Nevertheless, this author postulates that hand hygiene has been poor comprising of baseline rates from 5 to 81 percent. The overall range is 40 percent. Poor hand hygiene in the hospital settings leads to healthcare associated infections which can be prevented though washing hands. In harmony with Khuan (2012), according to Sydnor and Perl (2011), health care associated infections are a major problem implicating the safety of the patients. Accordingly, these infections result into excess deaths, high costs to patients and their families, additional financial burden, elevation in resistance of microorganism, long-term disability and prolonged hospital stays (Sydnor & Perl, 2011). Accordingly, ensure had hygiene is a way of elevating the quality of services provided to patients, speeding up the healing process and shortening hospital stays (WHO, 2009).

Consequently, Khuan (2012) explicates the importance of hand hygiene by focusing on the safety of the patient. In the same lines, the report by WHO (2009) does not only consider safety of the patients but goes further to explicate both direct and indirect costs of poor hand hygiene. In the same lines, in a study was carried out in a hospital through which a hand washing intervention was executed. The staff at the hospital was educated on hand washing techniques and introduced to hand rub. Moreover, hygiene reminders were integrated in the intervention (Uneke et al., 2014). The resulted generated pointed out that with reminders, the compliance rate can be escalated. In the same context, the compliance rate when it comes to washing hand was highest when after being exposed to fluids from patient. Accordingly, even though hand hygiene is effective in ensuring the safety of the patients, the health practitioners do not adhere to the practice at all times as explicated by Uneke et al. (2014).

Khuan (2012) elucidates that even though medical practitioners have to work in line with the ethical standards pertaining to infection and infection control practices, some do not comply. While on the other hand, some do not adopt to good and effective practices due to ethics but as a result of self-interest. As a consequence, the author argues that the decision as to whether a health practitioner will ensure hand hygiene or not is solely behavioral. Therefore, the staff has to be motivated to ensure hand hygiene and therefore, enhance the health of the patients. Nevertheless, Uneke et al. (2014) counter this by arguing that the health practitioners may be willing to ensure their own and the safety of their patients through ensuring hand hygiene. However, they may lack the necessary equipment or reminders to clean their hands in between patients. In harmony with Uneke et al. (2014), Squires et al., (2013) explain that healthcare practitioners consider the safety of their patients and their families to be paramount, however lack of the necessary equipment such as lack of soap, lack of paper towels and broken soap dispenser limit hand hygiene. In addition to this, educational gaps in infection control make it hard for the practitioners to enhance the safety of their patients through hygiene.

Therefore, WHO (2009) and  Sydnor and Perl (2011) concur with Khuan (2012) while Uneke et al. (2014 )  and Squires et al. (2013) counter by explicating that the quality of hand washing hygiene and the available equipment and reminders determine the effectiveness of hand hygiene in promoting patient safety.

Factors Which May Influence Abiding by Hand Hygiene

The rate of health care associated infections was 1.6 per 1000 patient days in Mafraq Hospital in April 2010. This was higher when compared to the Centers for Disease Control & Prevention (CDC) benchmark for 2009 which was at 0.4 per 1000 patient days. Indicators for the high number of health care associated infections acted as an outcome indicator. At the same time, it was realized that there was poor compliance with the hand hygiene standards by the healthcare practitioners. Accordingly, a relationship was established between poor hand hygiene and health care associated infections. It was decided that if hand hygiene was improved, then the rate of health care associated infections would decrease. This led to various changes in the policies and procedures of the hospital that had to be incorporated into practice by all the healthcare practitioners (Khuan, 2012).

It was hard for health practitioners to comply with the five moments of hand hygiene which has been integrated in the policies and procedure due to the threats (WHO, 2009). Thus, all employees were forced to comply with the set standards or else, they risked losing their employment. Consequently, they did not the freedom to choose compliance. As a result, the adhered to the practice not as way of ensuring their personal and the safety of their patients, but as a way of ensuring job security. In such situations, it becomes hard for a practitioner to effectively act and ensure the safety of the patient. In addition to this, the change was abrupt (Khuan, 2012). The hospital and its systems were not checked to ensure that they had the ability of supporting the new changes. Additionally, the healthcare workers were not well-prepared for the changes. Accordingly, they were not equipped with the necessary hand hygiene skills.

Change is constant. Conversely, it is hard to adjust to change if not fully prepared for it. Thus, employees are supposed to be alerted of the necessary changes and, helped and given time to adjust to the changes. While adjusting to change, all impediments have to be removed to allow for smooth flow with respect to (Schmitz et al., 2014). Aside from this, the human and personal factors of the medical staff at the Mafraq Hospital were not put into account. For instance, hand washing is affected by religion and personal beliefs that were not ensured. In the same lines, some of the practitioner can react to the available detergents due to sensitive skin. Therefore, due to lack of background checks, the healthcare practitioners found it hard to adjust to the new practice. They viewed the new practice not as a way of enhance the quality of healthcare, but as one of the rules that has to be adhered to due to being an employee of the hospital.

Comparison of Hand Hygiene at Mafraq Hospital with South Australian Hand Hygiene Self-assessment Tool

With respect to the South Australian framework, alcohol-based hand rub has to be available in different places. It has to be accessible and continuous supply has to be ensured (SA Health, 2014). In Mafraq Hospital, alcohol-based dispensers have been mounted in Time & Attendance machines and near all elevators. The dispensers are at convenient locations (Khuan, 2012). However, the hospital is not on line with the framework in the sense that it does not have a single room to be used for the purpose of infection control. Additionally, the guidelines stipulate that hand washing basins have to provide in all rooms within the en-suite for patient use (SA Health, 2014). On the contrary, even though the hospital has installed hand hygiene equipment in convenient places, the hospital did not install hand washing facilities in patient rooms.

According to the framework, liquid soap and single use towels have to be available at each sink. This is also in concurrence with Chen et al. (2011) who explain the importance of availing all the necessary utilities allied with hand washing and hygiene. Additionally, these authors point out that, soaps should not be shared and a way of mitigating this is through use of hand wash liquid. Nevertheless, the hospital has not adhered to this. The hospital installed the alcohol-based hand rub but did not provide for sinks, soaps and single use towel. Moreover, the guidelines point out that the hospital must have a realistic plan which should be geared towards improving the infrastructure of the healthcare facility (SA Health, 2014). The hospital has an audit plan but has not explicated how improvement of infrastructure will be done.

Training is mandatory and had to be executed on frequent basis. The hospital has an education plan through which training has to be accomplished. However, the frequency of the training has not been fully explored. The training has to also be in categories those, for those commencing employment and then ongoing training which should be on annual basis (SA Health, 2014). The education and training plan at the hospital is bequeathed with the goal of making certain that all the healthcare workers at the hospital are trained. The trainers are professionals in line with these guidelines. Thus, they are professional specialized in infection prevention. Moreover, with respect to the South Australian guidelines, reminders in form of posters have to be available to enhance hand hygiene. The hospital has adhered to this since there are reminders at every hand hygiene facility. The reminders are in bright colors hence can be seen (SA Health, 2014).

Comparison on Mafraq Hospital Interventions to the JCI HANDS Framework

In accordance to the Joint Commission Center for Transforming Healthcare framework, solutions to causes of poor hand hygiene have to focus on habit, active feedback, data, systems and inclusion of all the people. With respect to habit, hand hygiene has to be a part of the individual (Cedars-Sinai Health System et al., 2013). The hospital has tried to ensure this through training and education programs. It has also used reminders to cultivate the habit of cleaning hands. In accordance with active feedback, the hospital has adhered by reminding the staff through reminders and education programs. The expectations of the hospital have been stated as using hand hygiene to improve the safety of patients. The staff has been engaged through participating in education program. In addition to this, the hospital has also been able to incorporate the use of technology based reminders through electronic medical record implementation.

Furthermore, the hospital has been able to establish improvement in hand hygiene. As a result of the improvement, healthcare associated infections have decreased to below 0.4 per 1000 patient days (Khuan, 2012). All the health workers at the hospital have been incorporate into the program irrespective of their departments and profession. This is in line with the guideline pertaining to no one should be excused. With regard to data driven solutions, information was gathered from the first phase which showed negative results. This data was used to inform the second phase which ensured effective results. On the other hand, prior to the commencement of the program, systems were analyzed and effective changes made to sustain the hand hygiene program (Khuan, 2012).

Conclusion

Poor hand hygiene in hospital setting is a contributing factor elevation in healthcare costs, deaths, longer hospital stays and morbidity. However, this can be reversed if hospitals adapt to hand hygiene practices. The Mafraq Hospital has been able to enhance its hand hygiene practices. The hospital is on the right track and has been able to reduce healthcare associated infections. However, the hospital needs to avail hand washing facilities in patient rooms for easier accessibility.

References

Cedars-Sinai Health System et al. (2013, Oct). Facts about the Hand Hygiene Project. Retrieved Jul 16, 2014, from Joint Commission Center for Transforming Health: http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HH_Fact_Sheet.pdf

Chen, J., Sheng, W., Wang, J. et al. (2011). Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections. PLoS ONE, 6(11), e27163.

Khuan, N. (2012). Leading hand hygiene from the circle of concern. International Journal of Infection Control, 8(2), 1-7.

Mafraq Hospital. (2011, May 5). Mafraq Hospital carries on ‘Clean Hands Save Lives’ campaign and supports WHO’s Global Hand Washing Day. Retrieved Jul 16, 2014, from Mafraq Hospital: http://www.mafraqhospital.ae/NewsItem.aspx?SectionID=8&RefID=168

SA Health. (2014, Feb). Hand Hygiene Self-Assessment Tool. Retrieved Jul 16, 2014, from South Australia Health: https://www.sahealth.sa.gov.au/wps/wcm/connect/f4bcab80408cca2e9f83bf222b2948cf/HH-self-assessment-tool-acute-hosp-setting_V3.1-phcs-ics-20140225.pdf?MOD=AJPERES&CACHEID=f4bcab80408cca2e9f83bf222b2948cf

Schmitz, K., Kempker, R., Tenna, A. et al. (2014). Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia. Antimicrobial Resistance and Infection Control, 3(8), 209-17.

Squires, J., Suh, S., Linklater, S., & et al. (2013). Improving physician hand hygiene compliance using behavioural theories: a study protocol. Implimentation Science, 8(16), 544-55.

Sydnor, E., & Perl, T. (2011). Hospital Epidemiology and Infection Control in Acute-Care Settings. Clinical Microbiology Reviews, 24(1), 141-73.

Uneke, C., Ndukwe, C., Oyiboc, G., & et al. (2014). Promotion of hand hygiene strengthening initiative in a Nigerian teaching hospital: implication for improved patient safety in low-income health facilities. Brazilian Journal of Infectious Diseases, 18(1), doi.org/10.1016/j.bjid.2013.04.006.

WHO. (2009). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care is Safer Care. Geneva, Switzerland: World Health Organization.