EMHA701 The U.S. Healthcare System, Programs, Politics and Policy

Introduction:

According to the world health organization, infection prevention and control is an approach that is a practical and is designed to prevent the harm that is caused by infections to the patients in most cases. There is a need for effective prevention and control infection strategies for nurses and health care staff to abide by. However, there has not been attention given to the prevention and control techniques that the patients in the hospital should be implementing to prevent the spread of infections. This is a clinical issue that is related to the National Quality and Safety Health Service Standards “Preventing and controlling healthcare associated infection standard” (Landers et al., 2012). This paper aims to discuss one of the most common methods that can be used for prevention of infections, which is hand hygiene. This method will be discussed in detail on the patient’s use of this technique to curb infections.

Aim of the paper: To implement hand hygiene in patients to prevent and control spread of infections

Search Strategy:

The databases that were sued to procure the studies included were google scholar and PubMed. The search terms that were used included “hand hygiene”, “infection control”, “prevention of infection”, “patient infection” and “health care workers”

Review of Literature:

The most easily contaminated part of the body is the hand, it has been noted that health care associated pathogens and bacteria are se not be present in the hands of the patients in the hospitals. The acknowledgement of the importance of hand hygiene has been noted to be present in the health care workers. However, in the patient’s hand hygiene is not performed n almost 40% patients and this can pose as a threat to the patient’s recovery rate and process. Patient hand hygiene is an important public health concern that requires the attention of the health care worker (Mathur, 2011). In this study, the researchers aimed to discuss the approaches that can be adopted to improve the patient hand hygiene and understand the patient’s perception of the experiences they had as patients related to hand hygiene. There were 107 voluntary patients that were included in outpatient clinics at post-admission visits from Cleveland VA Medical Center. For the survey tool, a 16-item survey was used as the tool to gather information with. The survey was developed with the help of Behaviour Change Wheel. The primary questions that gave the main data included of patients carried sanitizers when they entered the hospital, if they used the hospitals supplies to wash their hands or sanitize it. Their perspective on the patient hand hygiene as compared with hospital staff. This result produced stated that most participant were able to maintain hand hygiene prior entering the hospital with no difficulty. However, during admission only 19% were able to perform hand hygiene (Michie, Van Stralen & West, 2011). More than half of the participants stated that the hand hygiene of the health care workers was more important than their own. The other half stated that they were not content wit their ability to maintain hand hygiene.

In another study a cross-sectional interview was conducted at University of Wisconsin (UW) Hospital from October 2012 to May 2013. The aim was to determine the factors that were associated with hand hygiene practices of hospital patients.  the researchers strongly believe that decreased hand hygiene at home was associated with similar practices in the hospitals. A total of 207 subjects participated in the survey and the association between the patient characteristics and hospital hand hygiene practices were associated (Barker et al., 2014). It has been noted through this survey that the heath care workers behaviour and attitude does affect the compliance of hand hygiene regulations, however, the intrinsic values that the patients have is also associated with the compliance to hand hygiene as it has been deemed that patients that follow proper hand hygiene practices at home such as washing before and after eating and after using the restroom have better had hygiene practices in the hospitals.    

There was another paper that has specified the importance of hand hygiene among the patient’s hygiene. The best and most inexpensive method to prevent hospital-acquired infections is the implementation of hand hygiene. This paper states that the aim is to improve the patient’s hand hygiene in the hospital setting by promoting the use of hand washing with soap and water, hand sanitizer or both the techniques. This is to ensure that patient education is done to reduce the hospital-acquired infections. There was a patient hand hygiene initiative that was implemented in august 2013 in a 36-bed cardiothoracic surgical step-down unit at University of Michigan Health System. Patients in the unit were provided an alcohol-based hand sanitizer at admission (Haverstick et al., 2017). There was a proper survey that was carried out with a 6 questions survey and that was done before the intervention of providing hand sanitizers and education on hand hygiene and then again after 1,2 and 3 months after the intervention being implemented. The results of the study stated that there was a significant correlation that was identified between the and hygiene and the rates of the infection with vancomycin-resistant enterococci. After the implementation of the hand hygiene interventions there was a decreased rate of infection and it was significantly noted in the patients. This paper has stated that patients hand hygiene has influenced the rates of infection.

The last paper that is being discussed is a study that was conducted through a 8 month period that started from February through September of 2014. There was identification of the particular moments where hand hygiene was required to be followed to ensure that there was less of infections spread in the hospital. The four moments were recognised to be before and after touching wounds or devices, before and after eating and after using the washroom (Sunkesula et al., 2015). Providing the interventions for hand hygiene to the patients was found to be beneficial in ensuring that at these four moments hand hygiene is implemented and that reduced the infection rate of patients.   

Discussion:

The studies that have included in this assignment all have a common goal which is to reduce the rate of infection spread that is hospital acquired and to prevent them as they add to the present medical problems that they are diagnosed with. Infections are avoidable medical problems that cause the patient more distress than what they are already experiencing (Ogden, 2016). The results of these studies stated that health care workers are mostly associated with hand hygiene and they are given more importance the hand hygiene is not specified as much in the case of patients. As the hands are the most contaminated external part of the body that is coming into contact with a lot of surfaces, they need to be kept clean at all times. Papers have stated that hand hygiene is not followed by most of the patients in these cases and that they are either unaware or are non-practicing of hand hygiene (Ardizzone et al., 2013). In the first study the paper has stated that findings of the study will help in enhancing the understanding of the methods that should be employed that will help in incorporating the hand hygiene as technique to control infection in inpatient settings.  The limitations of this study included self-reporting of the hand hygiene practices and the inpatient discharge may not have included the accurate recall of hand hygiene practices (Knighton et al., 2020). In the second paper it has been stated that the healthcare workers recognize that their behaviour and attitude does have an effect on the hand hygiene that is practiced by the patient. In this paper similar to the last one it has been noted that the moments at which hand hygiene is to be followed included moments before and after eating and after using the washroom. Hand hygiene importance has been stressed on all papers and the improvement in the in-patient settings is important (Sunkesula et al., 2015). The findings of both these papers state that they will contribute to implication of development of patient hand hygiene interventions. The main limitations that were seen is the small sample size that ahs been considered in some studies and it is not certain if the improvement in hand hygiene has survived even after the completion of the studies in the hospital settings in the last paper.  

Conclusion:

This is an assignment that has focused on hand hygiene as it is one of the most inexpensive type of prevention methods for infections. It is essential that there is a proper method of prevention that is adopted by the patients in the in patient setting of a hospital to prevent hospital acquired infections which are most commonly seen. In this assignment there are four different papers that have been discussed that state the main goal is to prevent the infection rate in the patients and to enhance the quality of life by doing so. Patients should be well aware and educated about the different steps that they should take to keep their hands clean at all times. Recovery is fast and important devoid of infections.

References:

Ardizzone, L. L., Smolowitz, J., Kline, N., Thom, B., & Larson, E. L. (2013). Patient hand hygiene practices in surgical patients. American journal of infection control, 41(6), 487-491. https://doi.org/10.1016/j.ajic.2012.05.029

Barker, A., Sethi, A., Shulkin, E., Caniza, R., Zerbel, S., & Safdar, N. (2014). Patients' hand hygiene at home predicts their hand hygiene practices in the hospital. Infection control and hospital epidemiology, 35(5), 585–588. https://doi.org/10.1086/675826

Cheng, V. C., Tai, J. W., Li, W. S., Chau, P. H., So, S. Y., Wong, L. M., ... & Yuen, K. Y. (2016). Implementation of directly observed patient hand hygiene for hospitalized patients by hand hygiene ambassadors in Hong Kong. American journal of infection control, 44(6), 621-624. https://doi.org/10.1016/j.ajic.2015.11.024

Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’ hand washing and reducing hospital-acquired infection. Critical care nurse, 37(3), e1-e8. https://doi.org/10.4037/ccn2017694

Knighton, S. C., Richmond, M., Zabarsky, T., Dolansky, M., Rai, H., & Donskey, C. J. (2020). Patients’ capability, opportunity, motivation, and perception of inpatient hand hygiene. American journal of infection control, 48(2), 157-161. https://doi.org/10.1016/j.ajic.2019.09.001

Landers, T., Abusalem, S., Coty, M. B., & Bingham, J. (2012). Patient-centered hand hygiene: the next step in infection prevention. American journal of infection control, 40(4), S11-S17. https://doi.org/10.1016/j.ajic.2012.02.006

Mathur P. (2011). Hand hygiene: back to the basics of infection control. The Indian journal of medical research, 134(5), 611–620. https://doi.org/10.4103/0971-5916.90985

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), 1-12. https://doi.org/10.1186/1748-5908-6-42

Ogden, J. (2016). Celebrating variability and a call to limit systematisation: the example of the Behaviour Change Technique Taxonomy and the Behaviour Change Wheel. Health psychology review, 10(3), 245-250. https://doi.org/10.1080/17437199.2016.1190291

Sunkesula, V. C., Knighton, S., Zabarsky, T. F., Kundrapu, S., Higgins, P. A., & Donskey, C. J. (2015). Four moments for patient hand hygiene: a patient-centered, provider-facilitated model to improve patient hand hygiene. Infect Control Hosp Epidemiol, 36(8), 986-989. http://journals.cambridge.org/abstract_S0899823X15000781

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