Within the essay I am going to discuss whether good hand hygiene practices are the single most important factor in preventing cross infection. Some may argue for this statement others against. Jeanes A (2005) refers to the NMC code of professional conduct (2004) who state that you must act to identify and minimise risk to patients and clients.
Hand hygiene is everybody's job, including the patients. Linda Pearson (2006) refers to AL Damouk et al (2004) who suggests that inviting patients to become partners in their care maybe an appropriate response to reports of the rising incidence of healthcare associated infections and difficulties with ensuring healthcare staff was their hands effectively and at appropriate times. From previous work on the ward, implications were in place whereby patients were encouraged to wash their hands before and after meal times , after elimination or at any point they felt their cleanliness was been jeopardised. Matron carried out weekly audits and noted how many individuals successfully used the hand gel and soap provided at the appropriate times. However some individuals failed to follow protocol. Gould D (1994) suggested that when it is performed it is not always at the most appropriate times and the technique used does not always result in effective cleansing of all hand surfaces.
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Hospital acquired infections can be a result of bad hand hygiene. Methicillin-resistant staphylococcus aureus (MRSA) is one of the hospital infections that can be picked up from the hospital environment, mainly because patients' defence systems are low. Platt AT (2001) states that MRSA is becoming more prevalent, especially in intensive care environments. Transmission can be prevented by all patients and healthcare workers following the same infection control procedures. Present on my ward was the regime of asking every person on entering and leaving the ward to wash their hands with the alcohol gel provided. Linda Bissett (2007) refers to Widmer (2000) who says that a 'a thorough hand wash takes approximately one minute and yet research indicates that conformity to hand hygiene guidelines rarely exceed 40%.
Hand hygiene protocols are easy to follow. Firstly is palm to palm, secondly right palm over left dorsum and vice versa, thirdly palm to palm however this time fingers interlaced, fourthly backs of fingers to opposing palms with fingers interlaced, fifthly rotational rubbing of the right thumb clasped in left palm and vice versa, then lastly backwards and forwards with clasped fingers of right hand in the palm and vice versa. It is essential that you are thorough when following protocol, after this your hands should be fully decontaminated. Gould D, Drey N (2008) states that thoroughness is encouraged using ultraviolet lights, you wash your hands in a fluorescent solution which on exposure to the light reveals the skin that has escaped the soap, thus enabling staff to identify areas of weakness. This procedure was shown to me during Mandatory training within the NHS by the infection control team and I believe that it is an effective way of showing how important it is to employers and employees of the NHS with regards to preventing cross infection.
It's perfectly ok washing our hands but equally important is drying our hands. Often on the ward environment paper towels were not readily available and patients were seen to be patting their hands on their clothes. Its good practice for staff to pat their hands dry on paper towels rather than rubbing them dry as this helps to reduce damage to the skin Bissett L (2007). Following hand decontamination and drying , 'all staff should use a good quality, aqueous based hand cream to protect their skin from damage' Linda Bissett L (2007).
Preventing cross infection is essential for nurses in everyday practice. However hand hygiene may not be the only best way to prevent this. The use of aprons within direct nursing care can also prevent cross infection. Candlin J, Stark S (2005) refers to Nicol et al (2001) who states that nurses when working directly with patients and body fluids should wear protective aprons. Relating back to my previous work I noted that it was essential that nurses wore aprons during patient care, ensuring that they discarded of them after patient contact. Not only does wearing an apron act as a barrier it is also recognised as a type of PPC (Personal protective clothing). Cadlin J, Stark S (2005) suggests that the Health and Safety Executive (HSE) (1991, 1992) says 'Health and Safety Regulations require that all healthcare employees are provided with personal protective clothing'. However McCullough (1998) suggests that nurses' uniforms are not considered protective clothing and that protection within the NHS is provided by the use of disposable aprons. Surprisingly some healthcare workers and qualified nurses were not discarding aprons after patient contact, not only is this bad practice but it increases the risk of cross infection between patients. Babb et al (1983) within Candlin J, Stark S (2005) article found that 'although micro-organisms can survive for varying lengths of time and adhere to plastic aprons, they do not multiply and are difficult to redistribute'.
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Gloves are another form of PPC that can help to prevent cross infection. On the ward where I worked gloves came in different sizes and various types. To adhere to allergies some gloves where latex free or nitrile gloves. Nitrile gloves are used mainly for activities dealing with body fluid or blood. Within Chalmers C, Straub M (2006) article Korniewicz et al (1990) states that 'vinyl gloves are looser fitting and, although reported to be more likely to develop holes than latex, this is only with prolonged use'. Some individuals tend to wear gloves instead of adhering to hand washing protocols. Gloves should not be considered as an alternative to hand decontamination hands must be cleaned before and after use Damani (2003).
Some may argue that there are other factors that influence the significant role of hand decontamination within the NHS. Chalmers C, Straub M (2006) state that Wilson (2001) believes that factors that affect hand decontamination include workload, staff shortage, poor facilities and lack of knowledge. Working in the hospital myself I noticed that the staff to patient ratio was inadequate and that the skills mix between healthcare workers and staff was disjointed thus affecting the team work present on the ward. Broken taps in side rooms or bays meant that hot water wasn't readily available for patients and staff to use. Ward D (2003) refers to Meyres and King (2000) who 'distributed a hand washing questionnaire to 33 patients with such diseases, with a 91% response rate, the results highlighted that a high proportion of those who participated were always offered hand washing facilities after using the toilet or commode however, problems identified included tap water being too hot, hand basins being too small, difficulties operating taps and paper towel and soap dispensers, and inability to reach soap'.
While it is important to educate the staff as well as patients on the theoretical and practical aspects of the significance of hand hygiene, education is not the sole barrier of compliance Storr J, Clayton-Kent S (2004).The information and education given within the hospital where I worked was very minimal, in fact hand hygiene was mentioned briefly in mandatory training. To gain more compliance within this subject, education and information present for staff, relatives and patients should be more substantial. Storr J, Clayton-kent (2004) refers to Colombo et all (2002), Jenner et all (2002) and O'Boyle (2001) who say that 'teaching interventions can improve compliance but this must be underpinned by other strategies that address the lack of reinforcement of the behaviours in real life situations in the health service.
In conclusion I believe that good hand hygiene practices are not the single most important factor in preventing cross infection. My essay indicates that there are other factors that affect prevention of cross infection. Hand hygiene is an important aspect within the NHS and practitioners as well as patients and relatives need to be aware of that. Good role models, management and organisational support will allow an increase in compliance towards hand hygiene. Peoples' attitudes and behaviour towards the importance of hand hygiene may influence how others view its importance.