Hand Sanitization: What You Need to Know

PICOT Question 

Among patients in the oncology unity, the use of alcohol-based solutions for hand hygiene is more effective than hand washing using soap and water in reducing nosocomial infections within two to three hours. 

This question is set to determine the most effective antisepsis method for use in the oncology unit that would result in the least possible chances of contamination. This is a comparison between the use of hand cleaning techniques that use soaps and simple alcohol rub. Answering the question will determine the way forward for nursing and how they should handle antisepsis. Also, it will determine the most appropriate timing for antisepsis for which one can treat patients without the risk of causing infection. 

Literature summary 

In comparing the antimicrobial effectiveness of hand rubs on alcohol-based solution hand rubs and conventional methods of sanitization, Shen et al., (2015) found the alcohol-based technique to be more efficient than the use of traditional styles. The research involved 128 healthcare workers who either used alcohol solutions or a non-alcohol surgical scrub in routine practices of preoperational preparation. They were then subjected to hand sampling and cultures after the operation. Before the operation, the favorable culture rates for alcohol solutions were 6.2% before and 10.8% after the procedures. On the other hand, those that used common nonalcoholic based solutions led 47.6% formerly and 25.4% after the procedures. The researchers concluded that the alcohol-based solutions were more efficient for surgical antisepsis than conventional scrubs hence best alternative in the operative theater. 

Catalan et al., (2013) compared the efficiency of use of alcohol-based and non-alcohol sterilizers in the elimination of germs by determining and identifying microbial load before and after treatment. This involved swabbing the hands of volunteers before and after the application of hand sanitizers and streaking the culture in plates filled with Agar. In this experiment, the researchers found out that alcohol-based sanitizer inhibited microbial growth within 5 minutes while alcohol-free sanitizers used more time to achieve the same. Results show that only alcohol-based sanitizers resulted in a significant reduction in several microorganisms. 

Evidence from the two articles supports the rubbing technique that uses alcohol-based solutions to eliminate nosocomial infections in healthcare settings. Alcohol-based hand rub is a simple technique that involves the use of licensed commercial solutions for antisepsis in healthcare. Through this technique, healthcare workers can effectively eliminate the risk of nosocomial infections in practice. 

Evidence-Based Practice 

There is plenty of research on antisepsis techniques in the healthcare setting including all the departments of a hospital. However, the methodology for achieving optimal antisepsis level vary and different recommendations are used in various settings. Evidence indicates the efficiency of alcohol-based hand sanitization relative to other techniques not involving alcohol-based solutions. Different factors are considered in using alcohol solutions for sanitization in the healthcare setting including time, department or procedure involved and patient factors. Among patients, factors such as irritation, religious believes and measures of effect are among the important and determine acceptability. However, research indicates that the use of alcohol is effective in eliminating nosocomial infections within a few minutes with a longer lasting effect than hand washing by the use of soap. Evidence indicates that alcohol-based rub is less time consuming and hence more likely to be utilized by nurses. 

An effective alcohol rub takes only a few seconds to accomplish effective nosocomial infections elimination. An alcohol-based massage takes an average of ten seconds. Hand washing takes about six minutes ( Catalan et al., 2018) . The nurses should hence opt for an alcohol rub rather than hand wash when taking emergency cases. Also, the effects of the alcohol rub stay for substantially more time than a simple hand wash. Consequently, a nurse should stay for a relatively long time before conducting another rub. 

Also, healthcare workers should use alcohol at least ten seconds after the rub. Research indicates the presence of irritation on patients when fresh alcohol touches open wounds ( Shen et al., 2015) . If patients experience irritation due to the usage of alcohol-based solutions by the physicians, nurses and other workers in a hospital, they may start resisting the practice and instead prefer the less effective hand washing. To avoid resistance from patients, the practitioner must use the alcohol rub in a way that does not irritate. This will enhance the acceptability of the practice among the consumers of healthcare. 

Dissemination Plan 

The dissemination of knowledge on the best antisepsis practices is essential for the improvement of nursing practices and other healthcare practices. The information from the PICOT study will be disseminated using three different methods that include publishing, nursing continuous medical education meetings and use of billboards. 

At first, I will talk with the Nursing leadership and present the findings through a simple presentation of the main points. By indicating the need for change, I will request for assistance and permission to go forward with the dissemination plan. The full report will be published in significant nursing and health journals for complete reading and dissemination in other areas. Secondly, there will attend a session to present the findings and recommendations among nurses during monthly continuous medical education sessions. Thirdly, the results and recommendations will be summarized and printed out for posting on the billboard and other areas frequented by nurses and other health care workers. 

Reference 

Catalan, M. P., Albarracin, E. L., Espiritouso, S. E., Lindio Jr, V. A., Parantar, K. K. A., & Patis, M. A. P. (2018). Comparison of the Effectiveness of Alcohol-based and Alcohol-free Hand Sanitizers by Microbial Load Determination and Identification.  Optima ,  1 . http://research.uic.edu.ph/ojs/index.php/optima/article/view/150 

Shen, N. J., Pan, S. C., Sheng, W. H., Tien, K. L., Chen, M. L., Chang, S. C., & Chen, Y. C. (2015). Comparative antimicrobial efficacy of alcohol-based hand rub and conventional surgical scrub in a medical center.  Journal of microbiology, immunology, and infection ,  48 (3), 322-328. https://www.sciencedirect.com/science/article/pii/S1684118213001503