How does hand hygiene compliance amongst nurses reduce the risks of infection to vulnerable patients?

by frostysgirl6789 (student)

University Degree Subjects allied to Medicine

In order to address the question formulated for this assignment, it will demonstrate why evidence and knowledge are important both academically and professional when becoming a nurse in reference with key issues that were raised from the case study. Furthermore, will discuss the search strategy used to gather relevant literature to obtain evidence based information in hand hygiene compliance and how this would reduce the risk of infection to vulnerable patients within a hospital environment. Finally the assignment will also be supported and accurately represented by reference to literature by using the Sheffield Hallam University (SHU) Harvard system.

Evidence -based practice is defined by Dawes et al (2005 p.7) as

“Decisions about health and social care based on the best available, current, valid and relevant evidence and decisions should be made by those who are receiving the care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources”.

Evidence- based practice is becoming extremely important within the healthcare sector (Craig and Smyth 2007). All health care professionals need to base their professional practice on evidence based practice to insure that they are delivering the best possible care to patients instead of providing patients with out of date practice which may no longer seen as good practice (Aveyard and Sharp 2009). But in doing so will also improve patient experiences within health care (Craig and Smyth 2007).

For nurses, the Nursing and Midwifery Council (NMC) also includes within their code of conduct that all practitioners should deliver should maintain “high standards of care and practice at all times” and to “deliver care based on the best available evidence or best practice” (NMC 2008 P.4). The NMC code also declares that all nurses are accountable for the care they deliver and therefore should be able to justify their decisions made (NMC 2008).

An electronic literature research was carried out, in order to gain relevant evidence to address the question raised within this assignment, in the form of published articles from nursing journals. The databases used to find the information for the assignment was gained from CINAHL (Current Index to Nursing and Allied Health Literature), Internurse and Nursing Standard Archive, this is because of their large variations of published journals which cover many aspects of health including nursing which is relevant to the case study given within this assignment. Also information was gained from government based websites such as Department of Health and National Patient Safety Agency (NPSA).

Having identified key concepts within the case study provided, these were then used use to provide the basics of conducting a search within the different databases mentions above. The key concepts used were ‘hand washing’ or ‘hand hygiene’ and ‘compliance’ or ‘good practice’ and ‘nurs*’. A truncation (*) was used to provide all possible endings to key words used to get more results. Connector words such as ‘AND’ ‘OR’ were also placed within the search criteria to narrow down the number of hits gained, to give more relevant information need in order to address the question within this assignment.

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Having found many articles from the databases mentioned. The articles were narrowed down further after using a CASP (Critical Appraisal Skills Programme) tool. A CASP tool acts like a checklist when reading articles gained as it helps to evaluate the evidence gained to determine whether the information is relevant to support the assignment question (Aveyard and Sharp 2009).

Firstly to address the question to this assignment, it essential that all nurses understand and acknowledge the basics in hand hygiene and understanding why it’s fundamental part when providing care to their patients. Having looked at the research found, the World Health Organisation (2009) believe that all nurses hands often become contaminated with microbes when undertaking daily routines such as assisting patients with their personal hygiene needs, making beds or performing wound care. It is seen that nurses undertake approximately 80% of patient care (Storr and Clayton-Kents 2004). Therefore this would be seen as nurses having a vital part to play in reducing the risks of harm bacteria being transmitted across to patients. So nurses having a good standard of hand hygiene when involved in patient care is seen as the most effective measure in reducing the spread of health care associated infections (Department of Health 2008). According to Jeanes (2005), nurses hands often contain transient flora that has been acquired from either direct or indirect contact from patients in their care, therefore if the transient flora hasn’t been washed off their hands, could result in harmful pathogenic microbes being passed on to vulnerable patients. However Storr and Clayton-Kents (2004) also argue that resident flora is something that every nurse also has on their hands naturally, as these act like a natural defence mechanism to protect the body from harmful bacteria, but resident flora being transferred to vulnerable patients, increases the chances of infections occurring, if basic hand hygiene has not been carried out.

Having a good standard of hand hygiene technique is also an essential factor in reducing the risk of infections to patients (Gould et al 2008). In having good hand technique requires all of the nurse’s hands to be decontaminated by using soap and water or the use of alcohol hand gel when need (Jeanes 2005).

Even though hand hygiene has been highlighted to be an effective measure in reducing health care associated infections (WHO 2009), there seems to be evidence to show that there is a low compliance rate due to a range of factors for example Rickard (2004) indicated that nurses have a lack of time in able to wash their hands in between patients. In which Storr and Clayton-Kents 2004 argue having 100% compliance to hand hygiene could interfere with the quality of care given to their patients. However Gould et al (2008) would argue that the use of alcohol hand gels when nurses are unable to wash their hands may result is nurses be more compliant to hand washing procedures and reducing the risk of infections to vulnerable patients.

Due to low compliance both the World Health Organisation (WHO) and the Department of Health are working together to improve hand hygiene amongst all health care professionals. The WHO (2009) issued a campaign called "Save lives: clean your hands" which is aimed to reduce healthcare associated infections and saves lives by health care workers cleaning their hands correctly and washing their hands between each patient after caring out evidence based research which showed that it would reduce cross contamination of harmful pathogens being transmitted to patients. In conjunction to the WHOs campaign, the NPSA realised the campaign ‘clean your hands’ in 2004 which is aimed directly to all members of staff working for the NHS trusts, to improve hand hygiene compliance when providing patient care. This campaign also takes into account behavioural and system factors which contribute to low compliance to hand hygiene. According to NPSA (2009) the Care Quality Commissions (CQC) survey in 2008 indicated that approximately 76% of nurses clean their hands in between patients, compared to 69% in 2005, which shows there has been a significant increase in nurses in cleaning their hands since this campaign has been introduced. The National Audit (2009) included within their research that hand hygiene compliance was linked to the reduction of rates of health care associated infections such as MRSA.

Overall in order to address the question raised within this assignment in relation to the case study given, it’s demonstrated the importance of evidence based practice within nursing. It also identified a search strategy when carrying out a literature research to obtain evidence based information in how does hand hygiene compliance amongst nurses reduce the risks of infection to vulnerable patients by understanding why nurses should be educated in the importance in washing their hands and identifying the link between hand hygiene and health care associated infections. It also mentioned global and national improvements in improving had compliance amongst all health care professionals. Finally the assignment was also supported with accurately represented by reference to literature by using the SHU Harvard system. Having carried out this assignment, its helped with the understanding the need as nurse to support their practice by evidence both academically and professionally, as this has a significant impact on their delivery of care to their patents. Therefore having up to date knowledge and understanding on hand hygiene which is supported evidence is seen as good practice in reducing health care associated infections to vulnerable patients. The assignment has shown that hand hygiene is vitally important in reducing the number infections that are transferred patents when nurses are providing care. Therefore all nurses should adhere to both hospitals policies and procedures and also adhering to the NMC code of conduct, in not complying with these guidelines could result in formal action being taken as this is seen as a fundamental part in reducing the number of health care associated infections and saving patients lives as a result of this.

References

AVEYARD, H., SHARP, P. (2009), A Beginners Guide to Evidence Based practice, Maidenhead, McGraw-Hill Open University Press.

CRAIG, J.V., SMYTH, R.L., (2007), the evidence-based practice manual for nurses, 2nd ed., Edinburgh, Churchill Livingstone Elsevier.

DAWES, M., SUMMERSKILL, W., GLASZIOU, P., CARTABELLOTTA, A., MARTIN, J., HOPAYIAN, K., PORZSOLT, F., BURLS, A., OSBORNE, J. (2005), Sicily statement on evidence-based practice, BMC 5(1): P-7. Last accessed 8th march 2010 at:

DEPARTMENT OF HEALTH (2008), Clean, Safe care: reducing infections and saving lives (online) last accessed 27/02/2010 at:

GOULD, D., DREY, N., (2008). Hand hygiene technique (Online), Nursing Standard, 22(34), 42-46. Article from nursing standard last accessed 14th February 2010 at:

JEANES, A.,(2005), Hand washing (online), Nursing Times 101(27), 28-29. Article found from nursing times last accessed 10/03/2010 at:

NATIONAL AUDIT OFFICE, (2009), Reducing Healthcare Associated Infections in Hospitals in England (Online) last accessed 02/03/2010 at:

NATIONAL PATEINT SAFTEY AGENCY, (2009), CQC survey shows patients thinks hand hygiene of doctors and nurses is improving (Online). Last accessed 21/03/2010 at:

NATIONAL PATIENT SAFETY AGENCY, (2008), Campaign to improve the hand hygiene of all NHS staff (Online) last accessed 15/03/2010 at:

NURSING AND MIDWIFERY COUNCIL (NMC), (2008), Standards of Conduct, Performance and ethics. Last accessed 1st of March 2010 at:

RICKARD, N., (2004), Hand hygiene: promoting compliance among nurses and health workers (Online), British Journal of Nursing, 13(7), 404-410. Article from Internurse last accessed 15th February 2010 at:

STORR, J., CLAYTON-KENTS, S., (2004), Hand hygiene (Online) Nursing standard 16(5), 45-51. Article from nursing standard last accessed 14th February 2010 at:

WORLD HEALTH ORGANISATION (WHO), (2009), Hand hygiene: a global call to action, (Online) last accessed 01/03/2010 at:

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