Hand-Washing Reduces Nosocomial Infections, Research Paper Example

Introduction

Regarding the practice of universal precautions, it seems elementary to recognize that washing one’s hands with soap and water is an integral measure of an individual’s hygiene, particularly in a healthcare facility. However, the World Health Organization contends that the connection between the spread of diseases and hand-washing has only been recognized in the last two centuries (Prevention of Hospital-Acquired Infections: A Practical Guide, 2002.) Research that was conducted in Boston confirmed that hospital nosocomial infections (currently known to be caused by infectious agents) were transmitted through the hands of healthcare workers and patients (WHO Guidelines on Hand Hygiene in Health Care (advanced draft), 2006). Within the hospital community, hand hygiene has been acknowledged to be a significant method of controlling and preventing infectious diseases, and has the capacity to minimize the burdens created by diseases.

A nosocomial infection, also referred to as hospital-acquired disease, is defined by the World Health Organization (Prevention of Hospital-Acquired Infections: A Practical Guide, 2002) as an infection acquired by a patient who was admitted to a healthcare facility for reasons unrelated to that infection. Nosocomial infections describe occupational infections among healthcare staff who transmit an infection during the admission of a patient, and which later appears after discharge from the hospital. Patient care is provided in healthcare settings that range from front-lines equipped with only fundamental amenities to highly serviced technologically advanced institutions of higher learning (Burton, 2011.) Despite the tremendous changes that have affected the healthcare sector, diseases have continued to plague both patients and healthcare workers in hospitals. This paper will discuss the complications caused by nosocomial infections as well as reviewing a selection of literature that examines whether hand-washing in medical facilities succeeds in minimizing the chances of patients and staff becoming infected by hospital-acquired diseases.

The population studied in these various research efforts will include a wide range of patients who have experienced hospitalization with a variety of presenting illnesses or conditions. The intervention will be exposure to healthcare providers who have practiced varying degrees of hand hygiene. The comparison will involve healthcare providers who have not washed their hands consistently as opposed to providers who have washed their hands using water only, as well as healthcare staff who have washed their hands with water as well as anti-microbial soap.

There are many factors involved in the potential transmission of infection among hospitalized patients. These variables include decreased immunity among patients, ever-increasing variety of medical procedures as well as invasive techniques that result in possible pathways for infectious bacteria, as well as the transmission of drug-resistant bacteria in crowded hospital settings which may produce adequate infection control procedures that enable transmission (Prevention of Hospital-Acquired Infections: A Practical Guide, 2002.) Infections that develop in healthcare settings can be deadly, and result in increased morbidity rates affecting patients in the hospital.

Nosocomial infections contribute to the functional disability as well as the emotional stress of patients, and in some situations, may cause disabling conditions that have a direct impact on reducing the patient’s quality of life (Prevention of Hospital-Acquired Infections: A Practical Guide, 2002.) Besides representing one of the leading causes of death and the hospital, they present tremendous costs to the healthcare sector. One of the reasons for this is the increase in the length of hospital stays for patients with, for example, surgical wound infections as opposed to patients who are in the hospital for gynecological or other surgical reasons. Lengthening the stay in a hospital increases both expenses to patients and insurance companies as well as indirect expenses because of lost hours on the job. In addition, these infections result in additional use of drugs, the requirement for isolation from other patients, and using additional lab and other diagnostic tools, all of which result in higher expenses. Overall, nosocomial infections contribute to an imbalance between the allocation of resources for both primary and secondary medical care by redistributing funds that are already in short supply to the management of conditions that are absolutely preventable. Although patients are inevitably exposed to a range of micro-organisms when they are hospitalized, such exposure does not necessarily lead to the development of infection. As discussed, there are other factors which impact the nature and the frequency of nosocomial infections, including the characteristics of the microorganisms, resistance to anti-microbial ages, and the amount of infective material (Prevention of Hospital-Acquired Infections: A Practical Guide, 2002.)

The most common nosocomial infections are those involving surgical wounds, urinary tract infections, and lower respiratory tract infections; in addition, most of these infections occur in intensive care units as well as acute surgical and orthopedic wards. An additional complication commonly resulting in these infections involves patients with heightened susceptibility because of advanced age, underlying diseases, and chemotherapy. One study found that consistent hand hygiene is perceived as an effective measure for prevention of hospital-acquired diseases such as MRSA-related diarrhea (Burton, 2011.). However, in this particular research, there was not enough evidence to demonstrate that washing hands with soap is more effective than washing hands using water only. The research that was conducted examined how hand-washing with soap compared with hand-washing using only water, i.e., whether it was more effective in reducing diarrhea in patients. Twenty volunteers took part in this study in which they deliberately contaminated their hands by touching various surfaces of healthcare facilities in which they worked. Afterwards, the volunteers were randomly selected based on no hand-washing, hand-washing using anti-microbial soap, and hand-washing using water only. The study yielded 480 samples during which every participant went through the same procedure 24 times. The findings of the study revealed that some traces of bacteria were found in the volunteers who did not wash their hands (44% of samples) while the participants who washed their hands using water alone were found to have reduced cases of bacterial contamination (23% of samples). However, those participants who washed their hands using both water and plain soap reduced their chances of being infected by bacteria that causes diarrhea (8% of sample). Burton concluded that washing hands using water alone is less effective than washing hands using water and anti-bacterial soap. The author concluded with the recommendation that hand-washing using water and anti-bacterial soap should be utilized as a preventive measure against hospital-acquired infections.

In another article, Kampf, Loffler and Gastmeier conducted a literature review to examine whether hand-washing with soap is more effective in reducing hospital–acquired infections than using hygienic hand disinfection. The findings of this particular study indicated that hand-washing is less successful at minimizing the chances of patients and health care workers being infected with nosocomial infections when compared with hygienic hand disinfection. Kampf et al. recommended that hygienic hand disinfection should be utilized by health care workers prior to and after having contact with patients (Kampf, 2009.) The healthcare providers’ hands should be washed continually whether or not they are visibly soiled. Although some patients and healthcare workers may experience irritation after washing their hands with soap, water or even by putting on gloves for a prolonged period of time, these practices are essential in order to provide competent healthcare procedures. In order to ensure compliance with these practices, training is essential for all staff to emphasize the critical role played by correct hand-washing practices. Kampf concluded that enhanced observance of hand hygiene with increased and effective utilization of alcohol-based hands rubs can significantly decrease the infection of hospital-acquired diseases by around 40% (Kampf, 2009.)

Weber conducted a study with the goal of determining whether hygienic hand disinfection is more effective in reducing cases of hospital-acquired diseases when compared with washing hands using water and soap (Weber, 2003.) The findings of the research revealed that hygienic hand disinfection is significantly more effective that washing with water and soap. Surprisingly, washing with water and soap does not even minimize the skin’s resident flora; rather, it minimizes the transient flora by about 3 to 2 log 10 levels, a measurement of the amount of flora present on the skin (Weber, 2003.) This study further concludes that because of the short duration of the benefits associated with hand-washing, the effectiveness of anti-microbial soap in reducing the probability of being infected with hospital-acquired diseases does not override that of ordinary soaps. This conclusion may possibly explain why ordinary soaps, rather than anti-bacterial soaps, are generally used in healthcare facilities.

Kampf and Kramer argue that despite the fact that hand-washing is utilized as a method of preventing the infection of hospital-acquired diseases, there are numerous shortcoming associated with hand-washing (Kampf, 2004.) Recurrent washing of hands by healthcare workers or patients can result in irritation if and as a result, it can have a tremendous effect on the proper condition of the skin. Due to frequent washing, the skin repeatedly loses liquid elements and fats, thereby making it vulnerable to the entry of noxious substances.

According to Inweregbu, Dave and Pittard, the study conducted by EPIC (European Prevalence of Infection in Intensive Care) established numerous factors that predispose a hospitalized patient and staff of healthcare workers to hospital-acquired diseases. The findings of the study revealed that poor hand hygiene plays an integral role in 40% of the entire number of infections acquired by patients after being admitted in hospitals (Inweregbu, 2005.) In addition, Inweregbu et al. assert that various studies have demonstrated that proper hand hygiene has the capacity to minimize the chances of a patient being infected with hospital-acquired diseases. Access to hand- washing stations as well as the utilization of alcohol gel in cleaning the hands of patients and health care workers enhances compliance with hand-washing. The reason that many people prefer using alcohol gel is the fact that it is veridical, fungicidal, and bactericidal and has the ability to dry quickly (Inweregbu, 2005.) As noted in the same study, various researchers have demonstrated that many nurses wash their hands more frequently than doctors. The areas that are commonly missed when washing hands include thumbs, web spaces, and tips of fingers and back of hands.

A study conducted by Allegranzi and Pittet reveals that the hands of health care workers play a significant role in propagating micro-organisms responsible for causing hospital-acquired diseases (Allegranzi, 2009.) The transmission of micro-organisms from one patient to another through the hands of healthcare workers involves five crucial steps. First, the skin of the patient can be contaminated by micro-organisms that are within the patient’s immediate surroundings. The health care workers can in turn contaminate their hands by touching the skin of the patient in the course of their daily routines. The sequence can continue until many patients are infected by the same micro-organisms transmitted from the first patient. This study concludes that as a result of this evidence, engaging in adequate hand hygiene can play a significant role in minimizing chances of patient and health care workers being infected by hospital-acquired diseases (Allegranzi, 2009.) Hand hygiene is, in fact, considered to be the cornerstone of preventing nosocomial infections. Some of the specific site infections that can be prevented by proper observance of hand hygiene include ventilator-linked pneumonia, surgical site infection, catheter-associated urinary tract infection as well as catheter-associated bloodstream infection (Allegranzi, 2009.)

Conclusion

It is evident that most of the researchers examined for this project have concluded that proper compliance with hand hygiene procedures can play an integral role in minimizing the probability of hospital-acquired infection experienced by admitted patients as well as healthcare workers. Studies reveal that those patients or health care workers who do not wash their hands have higher chances of contracting nosocomial infections as opposed to those who frequently wash their hands with either soap or water or even with water only. However, more research is needed to compare the efficacies of using regular vs. anti-microbial soap in reducing the chances of patients and healthcare workers becoming infected with nosocomial infections within the healthcare setting. Other prevention measures that can be employed to minimize the transmission of hospital-acquired diseases should also be explored to determine their efficacy; these methods might include increasing staff training about the importance of hand-washing, providing incentives to staff who comply with these practices uniformly, as well as monitoring staff for such behaviors and including the results as part of the annual review process.

References

Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73, 305-315.

Burton, M., Cobb, E., Donachie, P., Judah, G., Curtis, V., & Schmidt, W. (2011). The effect of hand-washing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health, 8(1), 97-104.

Inweregbu, K., Dave, J., & Pittard, A. (2005). Nosocomial infections. Continuing Education in  Anaesthesia Critical Care & Pan, 5(1), 14-17.

Kampf, G., Kramer, A. (2004). Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clinical Microbiology Reviews, 17, 863–893.

Kampf, G., Loffler, H., & Gastmeier, P. (2009). Hand hygiene for the prevention of nosocomial infections. Deutsches Arzteblast International, 106(40), 649 -655.

Weber, D.J., Sickbert-Bennett, E., Gergen, M.F., Rutala, W.A. (2003). Efficacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands. The Journal of the American Medical Association, 289, 1274–1277.

World Health Organization (2002). Prevention of hospital-acquired infections: A practical guide. Retrieved January 2^th, 2013, from: http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf

World Health Organization (2006). WHO Guideline on hand hygiene in health care (advanced draft). Retrieved January 2^th, 2013, from: http://www.who.int/patientsafety/information_centre/Last_April_versionHH_Guidelines%5B3%5D.pdf