Health Promotion Project: Hand Washing

Hospital acquired infections pose a genuine threat to anybody seeking treatment from a hospital facility. In the hospital environment, pathogens are readily transmitted from the patients to the health care workers hands.

The negative health effects of this continual passage of pathogens can only be prevented through hand washing which substantially reduces the concentration and the rate of proliferation of microorganisms. Hospitals have adopted hygiene practices but the overall compliance to these practices are generally internationally low.

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In a quasi experimental design study carried out to determine the levels of compliance. Based on the Predisposing, Reinforcing, Enabling Constructs in Educational Diagnosis and Evaluation Health Education Theory as a theoretical framework, three hundred workers were taken through an observation of behavior and predispositions(beliefs, attitudes and knowledge).

All classes of medical professionals(nurses, physiotherapists, care assistants and doctors) took part in the study. After the full implementation of the multifaceted interventional behavioral hand hygiene programme, the researcher was able top improve overall compliance to hand hygiene guidelines by between 51-83%, P<0.001.

Additionally, participants believed that there was significant improvement on their skin conditions coupled to a better understanding of the hand washing guidelines.  The research concluded that in order to have an effective disease prevention programme in the hospital, a multifaceted model should be employed.

Funnel, R., Lawrence, K., Koutoukidis, G., Tabbner, A. R. (2004). Tabbner’s Nursing Care:          Theory and Practice. Elsevier Australia. p. 335-337

In the implementation of standard precautions for the prevention of disease transmissions, hand hygiene presents itself as one of the major interventions used to interrupt the flow of infection. Hand hygiene applies to routine and aseptic hand washing.

The use of antimicrobial skin cleansers and aseptic hand rubs in hand washing helps rid the hands of microorganisms that may be detrimental to health. Since hands are completely difficult to protect from contamination, hand washing is an essential precaution employed in the prevention of disease spread.

Hand washing does not in any way sterilize the skin, nonetheless it removes  resident and transient microorganisms. Hand washing basically reduces the number and inhibits the proliferation of microorganisms in hands.  Constant dermal exposure to contamination means that hand washing should be performed as frequently as possible.

Health professionals advice on three distinct types of washing procedures. A routine hand wash washing procedure is performed before handling any form of food or utensils. An aseptic hand wash procedure is carried out before non surgical clinical operation. Asepsis is aided by antimicrobial soap. A surgical hand wash procedure is mainly employed before undertaking any form of invasive surgery.

This procedure involves a scrub in combination with antimicrobial skin cleanser. This is a mandatory procedure before surgical gloves are adorned. Unless advised otherwise, aseptic and surgical hand washing procedures are confined mainly to the hospital environment while routine hand wash is a basic disease prevention measure that should be espoused by everybody.

Larson, Elaine. (2001). Hygiene of the Skin: When Is Clean Too Clean? Emerging Infectious             Diseases. Vol. 7, No. 2, March-April 2001. 225-230

For centuries, skin hygiene, especially the hygiene of the hands has been touted as a primary mechanism for the reduction of the contact and fecal oral transmission of a variety of bacterial, viral, fungal and other infectious agents.

The causal link between contamination of the hands and the transmission of infectious diseases is widely documented in clinical and general health safety practices. For this reason routine hand washing has become a effective procedure aimed at restoring skin integrity and consequently limiting the risk of infection.

In the clinical care setting, the frequent use of antiseptics in hand washing has orchestrated a novel phenomenon of microorganism resistance to antiseptics and consequently cross resistance to antibacterial drugs.

Based on the temporal relationship between improved cleanliness and improved health, the Author carried out a historical and causal inference and cross evidence search and their association to better health outcomes.

The results indisputable affirm that when such a study is carried out in the general population, general waste disposal methods, sanitary conditions and the use of hand washing as a means of disease prevention profoundly impact on disease transmission. Although the levels of personal hygiene are quite difficult to measure, the use of hand washing before food handling has been found to positively impact on disease prevention.

As a health promotion option, hand washing should be carried out in conjunction with health education, decontamination of the water supply, household sanitation, improvement in waste disposal and general personal hygiene. It is only through such a multifaceted health promotion program that the negative effects of the causal link between personal hygiene and the transmission of dermatological and intestinal diseases can be obliterated.

Lautenbach, Ebbing. (2001). Practices to Improve Handwashing Compliance. Chapter 12 In             Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Evidence             Report/Technology Assessment, No. 43. AHRQ Publication No. 01-E058, July 2001.             Agency for Healthcare Research and Quality, Rockville, MD. . p. 119-126.

Infections acquired in the hospital environment exact a tremendous toll in terms of morbidity and mortality. Since these infections are mainly transmitted from one hand to the other, effective hand washing procedures remain the only reliable options for preventing the transmission of these diseases.

Studies have shown a temporal association improved hand hygiene by health care workers and reduction in the infection rates. This reduction heavily relies on compliance rates and compliance has generally been disappointing in the long run.

Many studies have produced valuable recommendations for compliance but compliance does not usually hold in the long run. While initial compliance is promising, long term compliance is key for better health outcomes. For this reason focus should be diverted to the identification of risk factors promoting non compliance. Interventions designed should focus on sustainability. To achieve sustainability, researchers posit an understanding of behavioral theories.

Rumbua, O. Raquel., Yu, T. Catherine., Pena, C. Adrian. (2001). A Point in Time     Observational Study of Handwashing Practices of Healthcare Workers in the Intensive           Care Unit of St. Luke’s Medical Center. Phil J Microbiol Infect Dis 2001;30(1): 3-7

As the paradigm shift of medical care delivery transcends towards the outpatient setting, patients who are in need of hospitalization are continually exposed to nosocomial infections. Generally between 7-10% of patients with acute illnesses admitted in the hospital develop additional complications associated with hospital infections. Hand washing remains one of the most effective methods of preventing nosocomial infections.

In an observational study carried out to determine compliance to hand washing guidelines by patient care workers, the study found out that average compliance stood at 31%. Nurses showed a high compliance rate of 43% followed with other health care workers; 28%. Moreover high compliance was only noted during procedures that required intensive care.

With regard to these findings, the research recommended that there is need for a revaluation of programs so that these are strict adherence to hand washing guidelines in the Intensive Care Unit.