Hygiene as a Pivotal Method of Preventing

¶ … Hygiene as a pivotal method of preventing infection in a health care setting

Hand Hygiene as a Pivotal Method of Preventing Infection in a Healthcare Setting

Carpetti, G.M., Sandri, F., Trridapallli, E., Galleti, S., Petracci, E., & Faldella, G. (2007).

Nosocomial infection in very low birth weight infants. American journal of infection control, 36(6), 430-435.

To increase the chances of survival of VLBW infants, there are continued improvements in neo-natal management. However, the risk of infection during their stay in hospital is especially because they undergo diagnostic and therapeutic procedures. In order to eliminate the infections, and provide more chances of survival, the article suggests that hand washing is the only effective measure to prevent the transmission of microorganisms. In addition, it suggests that it is the most important precaution in infection control. In the study, sixteen VLBW infants, in the "before" period and five others in the "after" period had an infection after 72 hours of life.

This study confirms that hand hygiene was efficient, especially during CVC colonization. It decreased the incidence of colonization from 16.6% to 5.8%; and reduced the incidence of bloodstream infections in VLBW infants. Overall, the improvements in neo-natal management, will reduce the mortality rates, but owing to the fact that practitioners must handle VLBW infants, in comparison, the latter will efficiently reduce the rate of infections. For VLBW infants, hand hygiene compared to neo-natal management techniques, will increase their chances of survival by reducing mortality rates.

Andrej, T., & Andreas, W.F. (2004). Hand hygiene: A frequently missed lifesaving opportunity during patient care. Mayo clinic proceedings, 79(1), 109-216.

In this article, nosocomial infections affect almost 10% of the hospitalized patients. This presents a serious health problem in the healthcare facilities. The result of this is increased length of stay, increased morbidity and mortality, and increased expenses. This article suggests that the hands of health care workers are the main mode of transmission of multi-drug resistant pathogens and infections to hospitalized patients. However, appropriate hand hygiene is the least expensive, simplest, measure of preventing such infections. After Semmelweis commanded students and physicians to scrub their hands using chlorinated lime solution, when they were about to examine patients, the maternal mortality rate reduced to less than 3%, and the trend remained in the following years.

For this article, rubbing hands with alcohol saves the time used in cleaning the hands, as compared to a mere hand wash. In addition, it is less likely to cause skin problems. Therefore, alcohol hand rubs will produce better results as a hand hygiene method as compared to washing hands using soaps, which may harbor pathogens and increase the rates of re-infection. In the hospitalized patients, alcohol hand rubs compared to washing hands using soap and water will reduce the rates of nosocomial infections in the hospital environment.

Asare, A., Enweronu-Laryea, C.C., & Newman, J.M. (2009). Hand hygiene practices in a neo-natal intensive care unit in Ghana. Journal of infection in developing countries, 3(5), 352-356.

Infections are the primary cause of neonatal mortality in the developing countries, especially at home because the newborns die without medical care. This is a global health problem; therefore, there have been increased efforts to reduce the mortality and morbidity by improving referral pathways, and overall care when handling sick newborns. The study is aware of the significance of hand hygiene in preventing the incidence of infections; therefore, owing to the varied hand hygiene practices in healthcare facilities, there is a need to improve the practices among the health workers.

In the study for this article, there were a total of 97 contacts; 49 high risks and 48 low-risks. However, the healthcare associated infections are also increasing in the neo-natal units of the developing countries. Therefore, the study suggests that there is a need to improve hand hygiene practice strategies because they will help in preventing infections. In order to eliminate the mortality rates of newborns, the study encourages improved hand hygiene practices over improved neo-natal management practices because the former has shown substantial proof in reducing the mortality rates in the developing countries.

Chuck, B. (2009). Semmelweis revisited: Hand hygiene and nosocomial disease transmission in the anesthesia workstation. Anna journal, 77(3), 229-37.

This article takes us back to the 1840s, when there was an observation by Semmelweis, which 20% of women experiencing childbirth in the Viennese obstetrician, died of a febrile disease. It was later discovered by Semeweis that some toxin, in a way, reached the patients from the care provider's hands. Owing to this, he demanded that every staff involved in the obstetrical delivery should wash their hands between the patient's contacts. Later on, they came to discover the disease was the puerperal fever. In addition, the literature provided in this article suggests that proper cleansing of the hands is very effective and it is the simplest measure in efforts to prevent noscomial infections.

The author further suggest that anesthesia staff are the main causes of the inconsistent hand hygiene practices; notably, the randomized study affirms that personal hand hygiene resulted in fewer events of patient contamination. The author also notes that there are chemical advances to kill microbes, but compared to hand hygiene, the latter is simpler, practical, and low-cost, and has proved to reduce the incidence of nosocomial infection. For women experiencing childbirth, hand hygiene practices compared to chemical advances to kill microbes, will significantly reduce the incidences of puerperal fever.

Won, S., Chou, H., Hsieh, W., Chen, C., Huang, S., Tsou, K., & Tsao, P. (2004). Hand

washing program for the prevention of nosocomial infections in a neo-natal intensive care unit. Infection control and hospital epidemiology, 25(9), 742-746.

Nosocomial infections are major problems and cause substantial mortality and morbidity for patients in the neo-natal intensive care unit (NICU). The article suggests that the rates of nosocomial infections in the NICUs range from 11-22%. Conversely, the authors suggest that hand washing is a simple and economical measure that can lower the incidence of nosocomial infection. Some of the interventions such as prophylactic antibiotics, immunoglobins, and physical barriers are not effective in the prevention of these infections, and the incidence of the infections in these settings remains high. However, in comparison to the hand hygiene program, there was an increase in the compliance rate, and subsequent infections reduced.

This supported by empirical evidence; after the institution adopted hand washing, the rate of infections reduced from 15.13 in a 1000 patient days before adoption, to 10.45 and 11.86 in a 1000 patient days, after adoption. The rate of nosocomial infection rate in the NICU reduced after adoption of the hand hygiene program. For patients in the neo-natal intensive care unit, hand hygiene practices when compared to the use of prophylactic drugs, immunoglobins and physical barriers, will increase the compliance rates, which in turn will reduction of nosocomial infections.

Chen, Y., Sheng, W., Wang, J., Chang, S., Lin, H. (2011). Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections. PLoS One, 6(11).

Healthcare-associated infections (HAIs) are global healthcare problems, which cause concern in respect to the safety and quality of healthcare provision. Therefore, patients are not safe because the infections occur in a healthcare setting, where they thought was a safe place. The study provided in this article suggests that compliance with hand hygiene is the most important intervention in tackling this global phenomenon. In the study, compliance with the hand hygiene program led to decreased trends for hospital-associated infections, especially those caused by MRSA and XDRBA.

In addition, this approach was cost-effective. However, not all hand-washing programs are as effective, but in comparison, the most appropriate approach was to rub the hands with alcohol. Many patients may find themselves hospitalized in hospitals, which makes them vulnerable to hospital-associated infections. The single most important intervention is the use of hand hygiene practices; in particular, rubbing hands with alcohol, compared to other hand hygiene practices because it led to decreased trends for HAIs especially those resulting from MRSA and XDRBA.

Tran, J. (2009). Comparison of hand hygiene evaluations: A literature review. The University of Texas School of Public health, ProQuest, UMI Dissertations Publishing. 1467437.

The article suggests that the hands are the most common method of transmitting bacteria and infections, which later lead to development of hospital-acquired infections. However, the most significant intervention is the utilization of hand hygiene practices. The practices comprise of the most effective methods of preventing further spread of the pathogens, hence limiting the incidence of healthcare-associated infections, and decreasing the transmission of multi-drug resistant organisms. However, the compliance rates to utilize these measures are very low. The study suggests that after training, the compliance rates rose from 6.3% to 81.2%, a positive move, which suggests reduced rates of infection.

Mortality rates in clinics under the supervision of medical students were high than in the clinics cared for by midwives. This was after the students; the students washed their hands using water and soap. However, after they rubbed their hand suing chlorine solution before provision of care, mortality rates decreased from 10% to 1%. For patients in a healthcare setting, rubbing hands with alcohol-based solutions compared to washing hands with soap and water will reduce the incidence of HAIs.

Mathai, E., Allegranzi, B., Kilpatrick, C., & Pittet, D. (2010). Prevention and control of healthcare-associated infections through improved hand hygiene. Indian journal of medical microbiology, 28(2), 100-6.

Millions of patients experience healthcare-associated infections, annually, and this is a global healthcare problem. Nevertheless, most common types of infection are urinary tract, surgical site, lower respiratory tract and bloodstream infections. This situation is preventable, and one of the measures for reducing the HCAI infections is through compliance with hand hygiene. Although this is a simple measure, which does not require skill, the article suggests that compliance to the approaches. There is empirical evidence linking hand hygiene practices to the prevention of the spread of infections. Notably, the traditional approach to hand hygiene is the washing of hand using plain soaps, the article suggests that this is effective only for the mechanical removal of extraneous matter.

The plain soaps may not remove all the pathogens from the hand. On the other hand, alcohol-based formulations are effective for rubbing hands. This is because the germicidal activity against bacteria. The article further states that compliance with the later, alcohol-based hand hygiene approach produced positive results; decreased the rate of infections. For patients experiencing HAIS, alcohol-based hand hygiene approach, will substantially decrease the rates of infection in comparison to hand hygiene approaches, which utilize soap and water.

Allerganzi, B., Pittet, D. (2009). The role of hand hygiene in healthcare-associated infection prevention. Journal of hospital infection, 73, 305-315.

The health workers hands plays an important role in the propagation of microorganisms within a given healthcare setting and finally to the patients. The staff contaminates their hands by getting in contact with the hospital environment or the skin during the provision of care, sometimes even if they are in gloves. This is because the organisms have the capacity to survive in the hands for several minutes after contamination. A significant intervention stated in the article is the utilization of hand hygiene, especially because there is scientific evidence.

In more than 20 hospitals used in this article, the results show a relationship between improved hand hygiene practices and decreased infections. Although some health workers may perceive the use of gloves as effective. In addition, hand hygiene should utilize alcohol-based hand rubs, as compared to the use of gloves, or washing hands with soaps. For healthcare workers, using alcohol-based hand rubs compared to the use of gloves when handling or providing care to the patients, will substantially reduce the contamination rates because it will kill the microorganisms.

Zerr, D., Allpress, A.L., Heath, J., Bornemann, R., & Bennett, E. (2005). Decreasing

hospital-associated rotavirus infection: A multidisciplinary hand hygiene campaign in a children's hospital. The pediatric infectious disease journal, 24(5), 397-403.

Apparently, between 5 and 10% of all hospitalized patients are likely to develop a hospital-associated infection. The main reason for this is the poor hand hygiene among the staff, and this is a common phenomenon in the globe. The article further suggests that children in hospitals show incidence of developing rotavirus infection rates ranging from 2-33%. This virus can survive for long periods on the hands of the workers. The article further suggests that the frequency of hospital-associated infection reduced as the hand hygiene increased.

The results suggested that there were 5.9 cases of the virus per 1000 discharged patients in 2001, whereas there were 2.2 cases per 1000 discharged patients in 2004. However, a major intervention is the maintenance of hand hygiene practices, which most of the workers do not uphold. In the hospital, the common method for hand hygiene was the use of soap and water, however, the hospital later adopted alcohol hand gel. For the hospitalized patients in a hospital, the utilization of alcohol gel as compared to the use of soap and water will reduce the rate of hospital-acquired infections.

Cochrane, J. (2003). Infection control audit of hand hygiene facilities. Nursing standard,

17(18), 33-38.

This article suggests that hospital-acquired infections kill 5,000 patients annually, and this has raised global concern over the safety of patients. Although hand hygiene is the most important intervention, the rate of compliance poses a significant challenge in embracing this principle in a healthcare setting. This aspect explains why there will always be case of hospital-acquired infections in healthcare settings. This further called for interventions to increase the compliance to hand hygiene practice. Therefore, the organizations posted hand hygiene posters in the facilities. The extension to have proportional number of sinks as compared to wards, was positively related to hand hygiene compliance, and in turn would reduce the infections.

Others extended or added sinks, which practitioners could use to clean their hands before and after handling the patients. The latter intervention showed a positive move towards improving hand hygiene because the staff could access the facilities without scrambling. On the other hand, posters could fall, or people could just remove them. In order to reduce deaths associated with HAIs, increasing the sinks as compared to pinning posters, will increase the compliance rates of hand hygiene practices, and in turn reduce the number of deaths.

Timothy, L., Said, A., Mary-Beth, C., James, B. (2012). Patient-centered hand hygiene: The next step in infection prevention. American journal of infection control, 40(4), 11-17.

Scientific evidence suggests that the patient's flora and the hospital environment contribute greatly to development of numerous infections, which practitioners may help in transmitting to the patients. The article recognizes that hand hygiene is the most significant means of preventing transmission, and further development of infections. This has led to placing great emphasis on improving hand hygiene, and improving hand hygiene compliance forgetting to involve the patients, who constitute as monitors or auditors of the hand hygiene practices. In addition, the incidence of patients acquiring these infections once in the hospital environment is high. After seven days in the health facility, patients tested for infection suggesting potential contamination. Another study suggests that 39% of patients had a hospital-acquired infection 48 hours after their admission.

The significant intervention in such a setting is the involvement of patients in the hand hygiene program. This has led to positive results; one study in the article supports the concept. Implementing the patient-centered hand hygiene program led to 305 HCWs compliance, and reduced MRSA infections by 51%, subsequently decreasing the mortality rate by 71%. In comparison with the using of staff workers alone in the hand hygiene program, the patient centered hand hygiene program could work to eliminate infections. To reduce infection rates, including patients in hand hygiene programs as compared to including HCWs alone, will lead to higher rates of reduction of the infections.

Pittet, D., Allerganzi, B., Sax, H., Dharan, S., Pessoa-Silva, L.C., & Donaldson, L. (2006).

Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet infect Dis, 6, 641-652.