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There are germs everywhere and every one of us is prone to germs. In fact our bodies are covered with germs that help us stay healthy. Along with the germs that are usually present on our body, we also get germs from other people or surrounding with whom we come in contact. These germs are very easy to get contaminated from one place to another or from a person to another person. And due to this these germs cause us or others to fall sick. Although people think that the only medium through which germs get spread is air, but the important and not ignorable fact is that our hand contact spreads the germs most easily. The only best possible way to stop the germs from spreading is to wash or decontaminate our hands. There is a new term given to Hand Washing or decontaminating and that is HAND HYGIENE. Physically germs are removed from our hands by washing them that creates friction and then to rinse them through drain. Special alcohol based substances like solutions, gels or foams are used for Decontaminating hands that reduce the amount of germs that are present on our hands.
There are two advantages of alcohol based preparations over soaps and water used for washing hands that are:
They are capable of killing more germs
They produce less drying to our skin
These alcohol preparations can only reduce the germs on our hands, however they are and capable of removing visible soil or contamination from our hands. It is a must that we wash our hands with soap and water whenever we see them dirty.
(Hand Hygiene Australia, N.D.)
A research has shown that the infections that are acquired from the hospital have generated great concerns across the North America and this poses a significant threat to the health of the population. World Health Organization (WHO) in 2009 has announced that the Swine flu (HINI influenza) is nearing to infect most of the people. The major concern for all the nurses who are present 24/7 in every healthcare setting is the safety of the patients. So there is a need to guide nurses for the safety concerns that they should take in order to keep the patients safe. According to the survey of Centre for Disease Control and Infection (CDC) that was conducted in 2002, the infections acquired in the hospital account for an estimated 1.7 million infections and approximately 99,000 deaths each year. Studies have shown that most pathogens acquired in the hospital are transmitted from one patient to another through the hands of nurses and healthcare workers. Nurses play a very important role in patient's safety and infection control as they come daily in contact with their patients.
Every year 4ÂÂthÂDecember to 10th December is celebrated as National Hand washing Awareness Week. The main goal of this celebration is to increase public awareness about the importance of hand washing. For nurses and other Health care worker, hand washing is part of their routine operating procedure. For such professionals who have hands-on daily contact with their patients, hand washing is a vital requirement. And in such conditions it is only washing of hands before and after holding something is the only way possible through which they can control the spread of infection from nurse to patient or from one patient to another. Hand washing may look to be a very simple task for nurses but has a very vital role in making safety of their patients against various infectious diseases.
(Smith, Lokhorst, 2009)
These are the following sequence of events that are necessary for the transmission of health care associated pathogens from one patient to another via the hands of Health care workers:
The hands of nurses must get contaminated by the organisms that are present on the skin of the patient or in the nearby surrounding.
The organisms when once get transferred to the hands of nurse must survive for several minute.
Then the hand washing or hand antiseptics used must be less or inappropriate so that it could kill the organisms.
Finally, the hands of the nurse must come in direct contact with another patient, or with an object that will come into direct contact with the patient.
Health care associated pathogens can not only be found from wounds, but also from patient's skin. The wounded are of the patient contains more no. of pathogens but the hands and other exposed parts of the body can also have pathogens. The no. of organisms like KlebsiellaÂ spp., andÂ AcinetobacterÂ spp. present on exposed areas of the skin of the patients vary from 100 to 25,29,31,33. S. aureusÂ kinds of pathogen are found in persons having diabetes, or patients undergoing dialysis. Since the infected skin containing viable microorganisms shed daily from patient's skin the clothes of the patient, bed sheet, furniture kept nearby, and other objects present in the patient's surrounding can easily become contaminated with patient pathogens.
A very limited amount of data is available that shows the type of activities that result in the transmission of patient's microorganisms into the hands of nurses. Nurses get their hands contaminated with 100--1,000 CFUs ofÂ KlebsiellaÂ spp.Â in activities like taking a patient's pulse, blood pressure etc. Recently, researchers studied the contamination of Health care workers hands during caring that involved direct patient-contact for wound care. 0 to 300 CFUs were recovered from the fingertips of such workers. Data collected from this research showed that direct patient contact was most likely to contaminate the fingers of caregivers.
A recent research showed that the nurses who were in contact only with surfaces contaminated with the infants' secretions also acquired microorganisms. Other studies also have shown that nurses get their hands contaminated just by touching any objects that is present in patient's rooms.
Some other studies have shown the contamination of hands of nurses with potential health care associated pathogens. Another study found lower levels of contamination on the hands of Health care workers working in a neurosurgery unit.
In US, FDA's Division of Over-the-Counter Drug Products regulates antiseptic hand wash products that are intended for the use by Health care workers. Standardized method is used for evaluating products intended for use as health care workers. Tests are performed in compliance with usage directions for the test material. Standardized method is also used for evaluating the products that are intended for the use as surgical hand scrubs.
Hygienic hand-rub test method is the method most widely test used in Europe to evaluate the effect of hand-hygiene. 12 to 15 test volunteers are required for this method. Hands are immersed in metacarpals for 5 seconds after being washed with a soft soap and dried. Then hands are removed from it and the excess fluid is drained off, the hands are dried by hot air for 3 minutes. Various hand washing products are tested on this basis and then the products that have reductions generally less than approximately 4 log10Â reduction are been classified as not meeting the standard.
Because of different standards for hand wash efficacy, criteria cited in US's FDA TFM and the European EN 1500 for alcohol-based hand rubs vary. Alcohol based hand rubs that meet the US standards may not meet the standards of European document. On the other hand studies conducted by scientists have not established the extent to which number of bacteria or other microorganisms on the hands need to be reduced to minimize transmission of pathogens in health-care facilities. Various other means have been also used to measure the efficacy of antiseptic cleansing agents against various viral pathogens.
(Smith, Lokhorst, 2009)
Infections that are acquired from the hospitals have a very serious threat to all those people who are admitted to hospital or who get admitted to the hospital. Hand hygiene reduces the transmission of pathogens are easily transmitted on the hands of health care workers'. There exist Evidence-based guidelines for hand hygiene practices of health care workers' however; there is very low compliance with such guidelines internationally. The current studies have shown that a multifaceted behavioural training may affect the rate of compliance and health care workers' knowledge, attitudes, and beliefs, about hand-hygiene guidelines.
Infection acquired from hospital and compliance of health care workers with hand washing guidelines:
Transmission of infection from one person to other has been a serious problem since the hospitals were built for the sick. Many great individuals like Semmelweiss, Lister showed that there is a direct proportionality between the infection control practices importantly washing of hands of health care workers and the rate of the people who acquired infection while their stay in the hospital. In today's date, roughly 6% to 10% of the people who are admitted to the hospital and up to 26% of patients who are admitted in ICUs acquire an infection. Getting infected turns nasty majorly to the patient and to the health systems as well. Major researches conducted in this context have shown that the rate of infection acquired from the hospital can be minimized up to 33% just if health care workers wash their hands carefully and stick to the hand washing guidelines. However, in current scenario the compliance with the hand washing guidelines barely exceeds 45%. As told by the health care workers the reason for poor compliance rates with hand washing guidelines are their busyness, less amount of time, inaccessibility of the equipment, and is irritation in skin .
Several unaffected interference, like provision of instructional programs, psychological feature programs, automatic instrumentation, and alcohol rubs, and use of role models, has had very little success in rising compliance rates. Others ended that any single innovation or intervention to influence behaviour modification example hand washing would be ineffective unless it was a part of a program recognizing the complicated Hand washing practices, nature of behaviour and also the profound difficulties of modification. This analysis provides information on health care workers' compliance with hand washing tips in Australian health care setting and factors that influence their activity compliance. This analysis conjointly provides info on the consequences of hand-hygiene program aimed toward activity modification. This study is bestowed against a background of a scarcity of revealed analysis work health care workers' hand hygiene practices in Australia.
The primary purpose of this study is to observe health care workers' compliance with hand-hygiene guidelines during taking care of the patient in Australia before and after implementation of hand hygiene program. And the secondary purpose is to look for the beliefs, knowledge and attitude of the health care workers' in respect to washing hands before the implementation of a hand-hygiene program. This research posited two main questions. These are:
Can a multifaceted hand hygiene program positively affect health care workers' hand washing strategy?
Can a multifaceted hand hygiene program positively affect health care workers' knowledge, attitude and beliefs about hand washing?
(Creedon, 2006, PP-3)
TwoÂ analysisÂ instruments wereÂ utilized inÂ this study:
StructuredÂ experimentalÂ schedule designed to captureÂ experimentalÂ knowledgeÂ on health care workers' compliance with handÂ washing techniques.
Self-reportÂ formÂ designed to elicitÂ infoÂ within theÂ kind ofÂ written responses inÂ reference toÂ attitudes, beliefs, andÂ dataÂ concerningÂ compliance with handÂ washing techniques.
The experimentalÂ Schedule
It is based on Centres for illness management and avoidance hand-hygiene techniques and consists of seven items:
Starting and/or resuming care.
Coming in Contact with patients.
Prior to presumptuous procedures.
Post touching quiescent objects possibly to be contaminated followed by activities for taking care of patient.
Pre and post touching wounds.
When coming directly in contact with body substance, and
When taking care of an infected patient or one who is likely to be colonized.
The Self-Report Questionnaire
It comprises of six subscales (A to F), two of them are related to attitudes, three are related to beliefs, and one of them to knowledge. Participants were asked to retort to linguistic differential rating scales (1 to 7) to explain attitudes and beliefs. One to three scores portrayed negative beliefs and/or attitudes, four represented neutral, and five to seven portrayed positive beliefs and/or attitudes. Attitudes was defined as "consistent and enduring thoughts, beliefs and feelings that individuals have regarding . . . problems, individuals or events" and operating in two alternative ways. For example, "Hand washing on my unit is convenient." Other adjectives embody frustrating, practical, irritating, necessary, and harmful. Participants were asked to rate agreement with what they thought others would wish them to try and do. These things were worded as "My co-workers firmly think that I should abide by the hand washing protocols." Various other referents were nurse manager, doctors, patients I look after, and others. Beliefs were outlined as a conviction that a development or object is true or real and were working as expressions of outcomes (e.g., "I believe my patients can have lesser health infections") or personal beliefs (e.g., "My data regarding the hospital's hand washing protocol is excellent"). Beliefs regarding skin condition (e.g., "I believe my skin is exceptionally dry") were additionally investigated. Knowledge was described as specific info for a subject or an expected behaviour and was operating as when hand washing should be carried out. Queries asked associated with a particular hand washing technique and have three potential responses (yes-the respondent acknowledge that the item was a protocol; no-the respondent did not admit that the item was a protocol; and don't know-the respondent didn't knew if the item was a protocol). KnowledgeÂ on health care workers'Â data wasÂ thought aboutÂ nominal.Â EveryÂ stem used directlyÂ portrayedÂ a suggestion.
(Creedon, 2006, PP-3)