It is a disturbing fact that some patients who are hospitalized in hospitals may end up acquiring infection as a result of poor hand hygiene. Nonetheless, washing of hands is a solution for preventing the spread of these infectious diseases among the healthcare professionals and patients who are admitted McLaws, (2015) . In this article, a literature review will be conducted to explore the existing knowledge on the role of hand washing to ascertain whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address the issue.
Role of Hand Washing
According to Al-Busaidi, (2018), the role of hand washing is key in maintaining hand hygiene which in turn helps to prevent the Healthcare Associated Infections (HAI). These infections are also referred to as nosocomial infections or hospital-acquired infection, and they are developed as a result of treatment in hospitals. Notably, the fight against HAI started in 1847, as noted by Al-Busaidi, (2018) by a Hungarian obstetrician in Semmelweis. He observed that puerperal fever was common in maternity wards as compared to other wards, where the health care professionals were contaminating their hands as they performed an autopsy and later attended to the patients. He became the first person to recognize the importance of washing hands in the prevention of infections.
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Similarly, Florence Nightingale contributed to the awareness of the need to wash hands in the prevention of HAI during the Crimean war in 1854 (Al-Busaidi, 2018). She called for the need of essential public health in hospitals that belonged to the military in Scutari by ensuring that there was increased personal hygiene, and the food and living conditions were up to standards. Her efforts led to decrease in the number of death in the hospital significantly. She was the first to develop a connection between infection control and nursing.
On the contrary, according to research carried out by Al-Busaidi, (2018), although good hand hygiene helps to HAIs, nonetheless, it cannot singularly inhibit the influence of formidable risk factors” for example, admission to the ICU, acquisition of HAI at an old age. Al-Busaidi, (2018), states that evidence-based practice dismisses the assumption that the HIA can be decreased by relying on hand washing interventions. In supporting their argument, they state they conducted a multicentred study of ten hospitals in which an infection control strategy for MRSA that used contact precaution, screening and decolonization was compared against an enhanced hand hygiene program. Four hospitals were allocated to each intervention, and the remaining two received a combined strategy. Consequently, the hand hygiene method was highly comprised and failed to show that this method would be relied on for controlling HAI.
In health care, as noted by Al-Busaidi, (2018), nurses come into contact with patents regularly and are contaminated during their routine such as when touching contaminated surfaces, palpation and auscultation. As such, hand washing is considered critical yet cheap means of preventing cross infection. The role of hand washing is to remove dirt as well as limit microbial counts on one’s skin to prevent a cross-transmission of pathogens between health caregivers and patients.
The Rate of Compliance with Hand Washing
The rate of compliance by nurses in healthcare settings is significantly low as per the set standards. Although the NMC’s “Code of Standard and Conduct, states that midwives and nurses would provide practice that is of high standards, still some nurses feel that it is not their obligation. As mentioned by Longuenesse et al., ( 2017) other nurses fail to maintain high standards of hand hygiene because they feel that it is too much work for them and takes much of their precious time. He also notes that some nurses presume that the gloves they are given can function just as well in preventing these conditions. He also noted that only 20% of the nurses wash their hands after they have removed their gloves. Longuenesse et al., ( 2017), states that the nurses might also be afraid that washing their hands regularly could lead to the development of skin problems such as dermatitis due to use of alcohol hand-rubs.
The rate of compliance between physicians and nurses is, however, a subject which seems to have raised a lot of contradictions. Some scholars such as Longuenesse et al., ( 2017) state that physicians are known to maintain their hand hygiene to higher standards as compared to nurses. On the other hand, he states that nurses are known to wash their hands more regularly as compared to physicians. He also sees that compliance with hand washing as being related to personal attitude and behaviors, and well as the perception of the individual to its effectiveness and usefulness. Thus he suggests that disciplinary measures should be introduced to people who default this requirement.
The Normal Flora of hands
Notably, there are two types of microbes which colonize the hands, that is transient flora and the resident flora. The transient flora is found on the superficial layer of the skin and is easily removed by regular hand wash. Theses microorganisms survive on the skin but do not multiply. The resident floras consist of microorganism which resides “under the superficial cells of the stratum corneum,” (Labrague, et al., 2017). In most cases, health care workers acquire the transient flora due to direct contact with patients as well as contaminated surfaces.
The outcome of embracing hand washing among patients and healthcare workers
According to (Labrague, et al., 2017 ), hand hygiene has been found to decrease the prevalence of Hospital-acquired Infections as well as reduce the spread of antimicrobial resistance. He states that hand washing has to a more considerable extent eradicated the carriages of MRSA which are in most cases occur in the hands of the healthcare practitioners working in the ICU’s. In sectors where the compliance rate of hand washing is high, the rate of MRSA is low. Additionally, the transmission of Klebsiella sp., a healthcare-associated infection has been reported to be low in places where there is a high standard of hand hygiene (Longuenesse et al., 2017). All evidence, therefore, point out to the fact that maintaining high standards of hand hygiene reduces the rate of pathogen acquisition and reduces the rates of HAI significantly.
Barriers
According to McCalla, Thomas, & Reilly, (2014), many factors contribute to poor hand hygiene among the healthcare workers. Lack of awareness, as well as scientific knowledge, is considered to be among the leading cause of poor hand hygiene. Subsequently, a lack of effective infection control programs during training, whereby the students observe other healthcare works with patients, has also been found to be a leading cause of poor hand hygiene. In addition to this, misconception about the role of hand washing also contributes to low compliance which in turn leads to many cases of HAI’s. However, he states that staff training and a follow-up training is critical in encouraging hand washing practice.
In conclusion, it is evident that hand washing plays a critical role in reducing cases of HAIs and other pathogens which can be transmitted through contact. The rate of compliance between nurses and physicians is wanting with some scholars arguing that the rate of compliance by physicians higher and others scholar opposing this idea. Nonetheless, findings suggest that there are transient floras which reside on the skin and can be easily removed by hand washing. Thus the research shows that there is need for health care workers to change and adopt have high hand hygiene.
References
Al-Busaidi, S. (2018). HEALTHCARE WORKERS AND HAND HYGIENE PRACTICE: A LITERATURE REVIEW. Diffusion: The Uclan Journal Of Undergraduate Research , 6 (1), 13.
Labrague, L., McEnroe-Petitte, D., van de Mortel, T., & Nasirudeen, A. (2017). A systematic review on hand hygiene knowledge and compliance in student nurses. International Nursing Review . http://dx.doi.org/10.1111/inr.12410
Longuenesse, C., Lepelletier, D., Dessomme, B., Le Hir, F., & Bernier, C. (2017). Hand dermatitis: hand hygiene consequences among healthcare workers. Contact Dermatitis , 77 (5), 330-331. http://dx.doi.org/10.1111/cod.12825
McLaws, M. (2015). The relationship between hand hygiene and health care-associated infection: it’s complicated. Infection And Drug Resistance , 7. http://dx.doi.org/10.2147/idr.s62704
McCalla, S., Thomas, R., & Reilly, M. (2014). Hand Hygiene Compliance: “Going Back to Basics”. American Journal Of Infection Control , 42 (6), S134. http://dx.doi.org/10.1016/j.ajic.2014.03.288
