Hand Hygiene and Reduced Cross Contamination, Research Paper Example

The quality of healthcare is closely related to the knowledge, responsibility, and care of healthcare professionals, particularly nurses. Managing quality cuts down on associated risks of low quality in healthcare settings. Therefore, quality improvement initiatives are necessary as an on-going process that continually identifies areas of improvement as it relates to quality healthcare, and takes steps to make the improvements. The continuous quality improvement (CQI) process is a major responsibility of healthcare professionals, particularly nurses, as they interact on the frontline with patients, as they are integrated into the hospital setting.

The CQI Process

Patient safety in the healthcare setting is the focus of CQI. CQI focuses on quality management and constructs itself on common quality assurance techniques through organization and systems processing. CQI is centered on a process instead of specific people in the healthcare setting, and is a part of total quality management (TQM) initiatives. According to CQI (2009), continuous quality improvement is a system of processes that serve the purpose of improving provisional services, while focusing on future resutls.

The responsibility of CQI is both that of internal and external associates of the healthcare organization, and it highlights the necessity for objectivity in data analyzing and improving system processes. Managed care organizations have grown significantly in the healthcare industry, and this has resulted in increased awareness of the consequences of insufficient healthcare quality, as it relates to patient safety. This is a concern for various entities in healthcare, including public health agencies, healthcare providers, organizations, and consumers (McLaughlin & Kaluzny, 2005). Patient safety, as it relates to CQI is tied to safety goal initiatives that are effective in reducing cross contamination in the healthcare setting.

Patient Safety Goals

Cross-contamination infections in healthcare-associated settings are the cause millions of disease and illness cases each year all around the world. These cases result in serious illnesses and extended hospital stays, as well as long-term disabilities and deaths. These cross-contaminations are the result of non-compliance with hand washing protocols in the healthcare setting, although hand washing is a simple and easily modifiable risk factor that significantly reduces the possibility of the spread of infections and pathogen-related cross-contaminations (Dark & Mitchell).

The Joint Commission National Patient Safety Goals include infection prevention as a means of improving patient safety. Infection prevention guidelines are highlighted, as recommended by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), which include preventing infections in difficult to treat wounds, in blood from central lines, in surgery, and in the urinary tract caused by unsterile catheters, as well as other cross-contamination prone areas of the healthcare setting (NPSG, 2013). This Joint Commission safety goal is related to the importance of hand hygiene, as hand hygiene is an integral part of preventing cross-contamination. According to Dark & Mitchell, state that proper hand cleansing technique is important to prevent the spread of infection and germs, and should include alcohol-based hand cleansing, particularly in nursing settings. It is noted that the hygiene behavior of nurses needs to include proper hand washing techniques.

Current Status of Hand Hygiene Compliance

Despite policy, procedure and protocol guidelines, there are still instances of non-compliance with hand hygiene in healthcare settings, which is why there are still so many cases of cross-contamination. This is a universal problem that affects healthcare settings worldwide. Erasmus, et al., (2010) suggests guideline measurements should be standardized, as well those for research and monitoring for compliance. This is because the problem of healthcare setting-acquired infections are all too common. More than one million people are victims of cross-contamination infections, in healthcare settings, at any given time. Estimates show that 80,000 deaths in the United States and 5,000 deaths in the United Kingdom are attributed to hospital-acquired cross-contamination infections, each year (Erasmus, et al., 2010). This issue is the focus of public attention and hand hygiene is identified as the most important measure for preventing hospital-acquired cross-contamination infections and the spread of the pathogens associated with them.

Reasons for Compliance or Noncompliance

Risky hygiene behavior in healthcare settings is the main culprit of the spread of these infections. Hand hygiene compliance rates among healthcare workers, particularly nurses, have major room for improvement. A recent research study done on behalf of The Society for Healthcare Epidemiology of America shows hand hygiene compliance rates of physicians were 16% lower than that of nurses. Compliance rates were also lower in intensive care units (ICUs) than in other healthcare settings, and this is particularly alarming. The study also assessed hand hygiene compliance before and after patient contact, and concluded that hand hygiene compliance had a median rate of less than 20% before patient contact, but showed an increase to 30%-40% after patient contact (Erasmus, et al., 2010).

The study also indicates that there are various factors that affect compliance and non-compliance of good hand hygiene among healthcare professionals. For instance, nurses may perform better with hand hygiene after patient contact because it is associated with completing tasks that may have exposed their hands to uncleaniness. Also, physicians may have lower compliance rates because they touch the patients less than the nurses. In addition, low compliance rates in the ICUs may be because of the activity level in that area. People are just all so busy; however, this should not be an excuse to ignore hand hygiene procedures.

It is interesting to note that high compliance rates were consistent in cases where the healthcare profesisonals perceived their tasks as dirty or unclean, whereby they used alcohol-based cleansing for the hands, as opposed to hand washing with soap and water only. This may also be associated with the ease and availability of hand cleansing products available at the time. This may be a factor in compliance improvement intervention initiatives, as well as compliance measurements (Erasmus, et al., 2010).

Significance of Hand Hygiene in Nursing Practice

Good hand hygiene is a simple and controllable measure for preventing cross-contamination infection and illness in the healthcare setting, and this is something that is significant to the nursing profession. Cleanliness prevents these types of infections, and nurses need to keep hands and surfaces clean for patient safety and to be in compliance with standards and guidelines that mandate patient safety initiatives. Effective hand hygiene practices are key preventive steps in healthcare settings for the prevention of potentially harmful infections that may spread to patients as well as healthcare workers.

Accroding to Holly (2011), hand hygiene relevance for nursing includes awareness of healthcare-associated infections as a global concern that affects millions of people each year, and hand hygiene is often a first line of defense against this problem. Consequently, hand hygiene compliance among healthcare professionals is imperative.

The Cross-Contaminiation Process

Holly (2011) reports there are approximately 100,000 deaths associated with the 2 million cases of healthcare-associated infections each year. These infections are mainly spread by direct contact through a chain of events associated with infection. Studies show that “Indications for hand washing are closely linked to the sequential steps involved in cross contamination of pathogens, therefore effective hand washing is the most effective action in breaking the chain of infection” (Dark & Mitchell). Hand hygiene can interrupt the cross-contamination process, and this is something that nurses can easily do with compliance. Infections do not just automatically spring up after the first second of exposure, but they develop slowly after initial contact (Holly, 2011). This is why it is imperative that nurses and other healthcare professionals use continual hand hygiene techniques to prevent the spread of infection.

According to Holly (2011), cross-contamination infections spread, due to poor hand hygiene, is usually associated with transient microorganisms such as bacteria and other infectious substances, namely, viruses and fungi, on hands and other upper body skin surfaces acquired from direct contact of an infected surface or body part. These microorganisms are easily removed with hand hygiene procedures. As stated, cross-contamination is a process, and it involves five sequential steps which are: (1) the presentation of microorganisms, (2) the transferring of microorganisms, (3) survival of microorganisms, (4) hand hygiene noncompliance, and (5) cross-contamination point of contact.

To break the process down, it is noted that microorganisms on a patient’s skin, clothing, hair, bed linens, or personal belongings are present. These organisms are then transferred to a nurse or other healthcare worker by direct contact, specicially via the hands. Infected organmisms then are able to survive for several minutes, or longer, on someone’s hands or even on their gloves. If the healthcare worker does not use proper hand hygiene technique, then the organisms remain and are the source of cross-contamination when the healthcare worker touches something or someone else with the contaminated hands (Holly, 2011).

Processes to Assess Outcomes

The cross-contamination process can be significantly reduced by compliance with hand hygiene protocols. This would result in better patient outcomes, as well as better outcomes for healthcare workers and the healthcare facilities through saved costs and liabilitiy issues.

Improving hand hygiene compliance in the healthcare setting is directly related to changing the behaviors of healthcare professionals, which includes enforcing interventions and mandating compliance more heavily, particularly in the field of nursing. In addition, hand hygiene eduction is effective as included in basic nursing school curriula, as it is a way to instill good hand hygiene behavioral concepts in new nurses entering the field. This includes the awareness of targeted intervention programs for non-compliance of hand hygiene guidelines, such as the Multimodal Hand Hygiene intervention campaigns (Kelcikova, Skokdova, & Stefan, 2012). This intervention program reported findings of less than 51% hand hygiene compliance rates for healthcare professionals in 2000 prior to the educational program, and after the program the compliance rate increased to 83%. Significant improvements are reported after similar intervention program campaigns. This is part of a successful plan to achieve compliance outcomes.

Achieving Outcomes

Implementation of intervention strategies is a way to facilitate compliance with hand hygiene guidelines. This is for the improvement of hand hygiene in healthcare facilties across the board by changing systems such as ensuring alcohol-based hand cleanser is available at patient care points, as well as access to clean water, soap and towel supplies. Additionally, adequate training and education about hand hygiene and cross-contamination risks is essential, as well as monitoring of compliance and practices to include performance feedback initiatives. Achieving outcomes is also facilitated by posted workplace reminders for healthcare personnel and the encouragement of a culture of safety in the workplace led by healthcare management (Mathai, Allegranzi, Kilpatrick, & Pittet, 2010).

These strategies make it easy for healthcare personnel to show prepardness and readiness when the need arises for action to be taken in the event of infection exposure. Also, evaulations are for the purpose of analyzing situations relating to hand hygiene compliance and making sure they are enforced. This is done by effectively introducing improvement goals and initiatives to all healthcare personnel and encouraging their participation for compliance. An article on NursingTimes.net suggests “selling” the concept of hand hygiene to healthcare staff, as if marketing a product or service, as a way to initiate complaince, which should then be measured (Times, 2003). Completion of achieving outcomes is through follow-up of the evaluations to see how the implementation of the new processes impact compliance. Understanding the current situation of hand hygiene compliace is done through measuring the impact of interventions associated with it.

Advantages of Hand Hygiene Achievement Outcomes

Cross-contamination affects everyone, from the patients to the healthcare staff to the healthcare facility to the community, and this is evident worldwide. The advantages of implementing, enforcing and achieving better hand hygiene outcomes can impact all associated with it. Preventing disease and illness by reducing the number of cases involving healthcare-associated infections also decreases costs, morbidty and mortality. In addition, it is advantageous to patient-centered care initiatives, as it is another step in protecting the welfare of patients while in the care of hospitals and other healthcare facilities, and this is in line with best practice guidelines and the creed to do no harm to patients. Good hand hygiene is the best way to prevent complications to patients through cross-contamination including: increased hospital and long-term care stays, extended recovery times, increased costs for treatment, unnecessary discomfort and pain, permanent disability, or death (Joint Commission Resources, 2008). Effective hand hygiene initiatives is an integral part of the CQI process.

CQI Process Awareness

This research highlights the signficance of hand hygiene in the success of the CQI process in healthcare settings. It is shown that the CQI process is critical for improving quality of care, especially as it relates to protecting patients from healthcare-associated infections. The implementaiton of appropriate programs for the purpose of intervention is of particular significance. CQI processes focus on taking corrective action in areas that need improvements and where problems are likely to occur, or have already occurred. Corrective action initiatives seek to solve the problems. However, it is best to prevent the problems initially. This is why good hand hygiene measures are important. They can prevent infections from occuring. Identifying and resolving a problem before it gets out of hand is the best defense. Additionally, the CQI process includes continous improvement in areas of concern. This is often done when previous problems have been resolved and new information is learned for future use. Continuous improvement includes raising the bar for quality so that future problems can be avoided. It is no doubt, the responsibility of leadership is driving continuous quality improvement by implementing corporate initiatives for healthcare staff, and correcting problems as the arise, while identifying problems that can be prevented along the way.

Conclusion

Quality of healthcare is a growing concern across the globe, particularly as it relates to CQI initiatives. Healthcare professionals, particularly nurses, are responsible for managing quality to reduce the associated risks of non-compliance in healthcare settings. This includes non-compliance with hand hygiene protocols. This is an ongoing problem, currently, and needs an ongoing solution such as with CQI. This is a primary responsibility for healthcare professionals as the primary people interacting with patients on a daily basis.

Patient safety is of the utmost importance, and this is a major focus of CQI. Quality management of common quality assurance in healthcare organizations requires managing processes and systems within the organization. This is essential for both the internal and external customers in an organization. Managed care needs focus on processes and organizations in the healthcare industry and are successful through efficiently-maintained processes.

Patient safety goals, as it relates to cross-contamination infections in healthcare settings, are driven by the millions of diseases and illnesses caused each year that can be prevented. The key to prevention is adequate hand hygiene behavior and activities on behalf of healthcare staff. This is the primary defense against healthcare-acquired infections and a key component to understanding the concept of quality improvement in the healthcare setting, particularly in the field of nursing.

References

CQI. (2009). In Mosby’s Medical Dictionary (Vol. 8th). Elsevier.

Hospital National Patient Safety Goals. (2013, January 6). Retrieved from The Joint Commission: http://www.jointcommission.org/assets/1/6/2013_HAP_NPSG_final_10-23.pdf

Dark, S., & Mitchell, S. (n.d.). Hand washing indications and techniques for nurses. Logan Campus Griffith University, School of Nursing and Midwifery, Queensland.

Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., et al. (2010, March). Systematic Review of Studies on Compliance with Hand Hygiene Guidelines in Hospital Care . Infection Control and Hospital Epidemiology, 31(3), 283-294.

Holly, C. (2011, September). Interventions to improve hand hygiene compliance in patient care. International Journal of Evidence-Based Healthcare, 9(3), 276-277.

Joint Commission Resources. (2008). Hand Hygiene: Toolkit for Implementing National Patient Safety Goal #7 (1st ed.). Joint Commission Resources.

Kelcikova, S., Skokdova, Z., & Stefan, S. (2012, March-April). Effectiveness of Hand Hygiene Education in a Basic Nursing School Curricula. Public Health Nursing, 29(2), 152-9.

Mathai, E., Allegranzi, B., Kilpatrick, C., & Pittet, D. (2010, April). Prevention and control of health care-associated infections through improved hand hygiene. Indian Journal of Medical , 28(2), 100-106, 7, 2.

McLaughlin, C., & Kaluzny, A. D. (2005). Continuous Quality Improvement in Health Care: Theory, Implementation, and Applications (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers.

Times, N. (Ed.). (2003, February 18). Improving hand hygiene compliance. Retrieved from http://www.nursingtimes.net/nursing-practice/clinical-zones/practice-nursing/improving-hand-hygiene-compliance/205394.article