Hand Hygiene Practices for Healthcare Centres (Infection Control Practices, Procedure and Policy)

Hand Hygiene Practices for Healthcare Centres (Infection Control Practices, Procedure and Policy)

 

Introduction

Health care workers are at the critical risk of being contaminated by harmful microorganisms. These organisms are mainly evident while treating patients within health care institutes or centres. Therefore, a framework is needed to establish provision for the health care workers to eliminate the risk of such infections. Hence, based on the given risk type global health organisations have considered framing policies for infection prevention and control, which is not limited to risk reduction among health workers, however, it specifies the needed guidelines to enforce infection control protocol for health care services and centres.

The design of the infection control process is based on the core objective of reducing infections and their spreading. Hence, the focus on creating a more inclusive framework that can be employed within regions that lack quality resources and healthcare facilities. Thus, based on the infection control process and practise the following study is conducted. The study aims to analyse the prevention measures and ways they can be applied for nursing homes and health care centres. In doing so, the study also examines practical application of infection control by analysing hand hygiene practices in aged care services. Further, the study will provide recommendations for the future sustainability of infection control practices and ways to enhance it further.

Critical evaluation of infection prevention and control practises, process and policies

Clinical care institutions have basic protocols for infection control where multiple methods are employed to gain optimum results. Studies on infection control and practises have illustrated different management systems for respective methods to control infections and provide safety to the health workers. These methods are used to minimise the risk of spreading and any further health impact on the health workers. Apart from various other methods, hand hygiene is considered as a standard precaution towards the practise and control of infection and its prevention. According to clinical health studies, it has been noted that health professionals recommend the practise of hand hygiene for infection prevention due to its potential to reduce the maximum number of microorganisms that are most likely to have on the hands of the health care professionals. Therefore, based on the definition of infection control and policy practice stated by the world health organisation as the process and procedure of infection control is a scientific approach, which requires a practical solution, thus, it can be said that using proper guidelines and policy framework that is supposed to be compliance for the health care staff will help in minimising the risk of infection or its contamination among the health workers.

In this context, global institutions such as the world health organisation have formulated a framework that allows them to tackle the issue of infection prevention and control by working in key areas for the safety of patients and healthcare workers. In doing so, it has recognised hand hygiene to be one of the key actions to be taken in the said direction. Therefore, the matter of discussion on the given key action should be on the procedure to follow while practising hand hygiene in the clinic or the nursing homes. Therefore, in this regard, the National Health Hygiene Initiative has adopted certain procedures that help in structuring the hand hygiene practices within the public health sector.  In this regard, the authority has highlighted the use of tools and resources and its placement and use to ensure that practise of infection control is accessible and simple enough to ensure it is regular practised.

Apart from the identification of feasible models for hand hygiene, it is critical for the health authorities to conduct a risk assessment and identify the stakeholders that are at major risk. In this regard, the focus of such practices as per Houghton et al. (2020) should be based on the identification of the purpose of the policy or the framework and the stakeholders that need to comply with the guidelines or the infection control practices. However the (World Health Organization. 2020) in this regard has stated that health workers or the stakeholders need to be aware of the overall significance of compliance for infection control practices through proper training and education. Thus, the illustration of the world health organisation on infection prevention and control clearly highlights the spread of infection in healthcare. As it is discussed that health care institutions do use standard precautions of infection control, however, it is necessary for the health care workers to understand the chain of infection with the healthcare facility. Surveys conducted on risk and safety management of healthcare workers have identified that more than 26% of healthcare workers are either exposed or are vulnerable to infections that exist with the healthcare facility.

In the same context, the report of the global organization has identified three areas or factors that contribute to the risk of infection among health care workers. These factors are mainly, source, susceptible person and transmission. The source is further described as the areas where infectious agents can survive along with the environment, which refers to the length of physical hygiene around the patients and the overall facility as well as the visitors that visit the patients or hospitals. In the case of susceptible persons, the health workers along with the patient and the visitors are included majorly; however, the report states that individuals with weak immune systems can also be risky for the health care workers and the other stakeholders. The crucial factor out of the three is transmission as there is a high chance for the health care workers to be exposed to the infections as they touch and handle the patients, apart from that, unnoticed types of equipment or cut and prick through such pieces of equipment can be the cause of spreading infection among the health care workers. Therefore, the report further in the section of controlling infection firstly recommends hand hygiene as hand are the first point of contact that can lead to major transmission among the health workers and also by the health workers with the larger community.

Even considering the current pandemic, hand hygiene has been given major significance as Rutala & Weber, (2019) in this regard has stated that hand hygiene should be based on appropriate ways to practise and should be implemented as a compulsory process for infection control practice. Studies made by Magiorakos et al. (2017) on the correct techniques for hand hygiene have highlighted certain actions to be performed while practising hand hygiene. Washing hands for specific timing, using appropriate soap or hand wash and ensuring that the hygiene facility is easily accessible for the health care workers. The framework that is evaluated through various research studies on hand hygiene indicates certain touchpoints while following the approach for correct hand hygiene techniques. The touchpoints can be further illustrated as consideration of staff training on hand hygiene, engaging in patient hygiene and educating the patient and the stakeholders on ways to maintain hygiene within the facility or for regular practises, these approaches as per studies have proven to be effective in achieving hygiene goals for the nursing homes or the healthcare institutions. Moreover, these practises have further proven to be effective in risk mitigation among health care workers.

 

Discussion on hand hygiene as an effective method for infection control practices, procedure and policy

Considering evidence-based discussion for the current evaluation of infection control in a specific work area, thus, the infection control protocols applied by healthcare workers in aged care services can be highlighted to gain a detailed overview of hand hygiene practice in a practical scenario.

The protocols for infection control in the aged care services clearly mentioned the purpose of the protocol along with the provision to handle infections and the policies and procedures to follow. The procedure of hand hygiene developed by the National Hand Hygiene Initiative has been adopted in the aged care services, wherein the procedure developed by NHHI signifies 5 moments for performing hand hygiene for healthcare workers. Since hands are contaminated in the first place, therefore, the 5 moments will allow the health care workers to keep in mind each moment and as they experience these moments they would perform the hand hygiene protocol. The 5 moments are mainly prior to touching the patient, before starting the procedure, after a procedure or body fluid exposure risk, after touching a patient and after touching a patients’ surroundings. In the same context, it is also noted that these aged care services or the care institutes use cues for hand hygiene behaviour. The service centres use ABHR dispensers for strategic placement making the products accessible for continuous or frequent use by the health care workers in the facilities.

There is various evidence of barrier while practising effective hand hygiene, non-compliance and lack of available resources are the major contributing factors. Moreover, individual suffering from allergies can also act as a barrier towards proper hand hygiene process. Therefore, the need for an effective hand hygiene solution requires consideration of different challenges that can act as a barrier and thereby making plans in accordance with the challenges. Lack of training and education are another important factors acting as a barrier in hand hygiene.

The general guidelines for placement of product or placing the ABHR are the identification of all the point-of-care, which includes patients’ bed ends, trolleys or the clinical areas. However, as per the guidelines stated by National Hand Hygiene Initiative recommends a specific size of ABHR, which should not exceed 500 ml. Further, the guidelines provides recommendations for providing wall mounted brackets at a suitable height for easy access and at the same time the NHHI guidelines provides basic do not in product placement, which is mainly to avoid placing the ABRH over carpets within the healthcare facility. Apart from that,  using signage for conveying hygiene messages is recommended, however, wall mounted brackets should not be near the sinks within the care centre.

Establishing the procedure as compliance is highly effective as discussed above, however, Hillier, (2020) has also suggested performing a proper monitoring regime for compliance adherence for gaining optimum results. Thus, in this regard, it has been noted in the aged care services that the management has implemented an auditing process for compliance adherence, thereby, conducting audits at regular intervals to ensure that health workers are not exposed to high risk or get contaminated by infections or other microorganisms.

Furthermore, it is noted that most of the health centres and aged care services employ hand hygiene methods based on HHI guidelines, which allows the centres to deploy a methodical approach towards effective hand hygiene practise. Thus, as per the prescribed guidelines, it has been stated to ensure adequate educational resources to facilitate training and practise for the health care staff in order to make the staff aware of the significance of hand hygiene. Similarly, effective hand hygiene guidelines also highlight the potential causes of transmission of infection and the possible consequences of poor hand hygiene. According to the national hand hygiene initiative recommendations, it is advised to sanitise ornaments and accessories in close contact with an individuals’ skin.  In this regard, the NHHI procedure on hand hygiene reports that proper hand hygiene is facilitated by maintaining skin integrity by applying moistures provided by the health care centres. Accordingly, sleeves should not extend past the elbow and jewellery should be avoided. Nails should be short and clean as well as nail polish should be avoided at the same time.

As discussed earlier ABHR or Alcohol Based Hand Rub, is highly recommended to the health workers, as per the clinical studies on hand hygiene alcohol based hand rub is considered the gold standard for practising infection control and procedure. A 40-60 seconds time frame is advised for hand washing using soap and water for better results in warding off harmful microorganisms while treating patients in healthcare facilities and aged care services. However, specific to health workers gloves is highly recommended as it has been stated under the hand hygiene initiative that lacks full utilisation of gloves while conducting infection control practices in a healthcare institute can be considered as an undermining effort towards the said cause. Therefore, health workers need to prioritize wearing gloves and maintaining full compliance with the national hand hygiene initiatives guidelines.

In addition to this, a significant aspect of maintaining hand hygiene is being aware of the potential risk and impact in case of lack of proper adherence to the procedure. The health workers need to consider the events that can pose major threats. As provided in the report illustrated by the national health council, direct patient care is one such event where the health worker and the patient are in direct contact. Exposure to body fluid risk, which is events where the possibility of exposure to body fluids may occur that may later result in contaminating the environment including the health workers.

From an organisational perspective, the role of the health authority is to determine the purpose of the policy so that the stakeholders can have a better comprehension of the cause and outcome of the policy. Hence, the aged care centre highlights the need for the policy by stating its significance in improving the quality of life of the health care workers and thereby minimising the risk of infection while treating patients in the aged care centre or the nursing homes. Accordingly, the policy points out the major stakeholders that is required to comply with the policy guidelines, which includes the overall employees, volunteers and the contractors. Apart from that, the policy intent is also clearly highlighted in the workplace for the stakeholders, wherein, the policy aims to implement standard protocols for preventing infections, engage in management practices for managing infectious diseases and further clinical significance. In doing so, the aged care service highly considers the implementation of an effective monitoring process along with strict surveillance for complete adherence to the NHHI guidelines. Using innovative and integrated methods the aged care service has the objective of risk elimination and develops a better risk management system.

Reflection on infection control process, safety and cost effectiveness as well as cultural influence

The infection control process in the current era is formulated by consideration of various factors, which includes culture and lifestyles of regions, however, the focus as per Ramai et al. (2019) in the study of infection control and risk mitigation has highlighted that integrated efforts are being made. This refers to the collaboration of the global institutes or organizations with local and national public health authorities. This approach seems feasible in order to gain detailed information regarding different lifestyle habits and the other elements that may have an impact on infection control practices. This model helps in developing a common framework for the overall regions that can ensure the optimum impact of a public health policy and positive adherence.

In reference to the cost effectiveness of infection control, it is a matter of tools and resources utilised to execute the process. In non-monetary terms, the analysis of cost benefit for a particular health care service for infection control according to Aguiar et al. (2020) depends on the methods implemented to achieve infection control objectives. Therefore, in this context, Bearman et al. (2020) refer to the use of infection control mechanisms that fit the healthcare needs and overall interest of the patients. Apart from that, using third party outsourcing for hygiene maintenance can help health care organisations to gain more control over infection control practices.

However, according to Cari et al. (2017) the approaches for infection control are scientific in nature; practical implications in certain areas may have cultural challenges. For instance, alcohol based hand rub is clinically advised for better hand hygiene, however, certain cultures prohibit the use of alcohol, hence, these differences in cultural norms have an influence on cultural values.

Recommendations to improve hand hygiene practices for health care centres

Based on the overall discussion it can be stated that hand hygiene is the first step in the practise of infection prevention and control. Therefore, efforts of the public authority should be on educating the stakeholders on the significance and effects of proper hand hygiene (Hand Hygiene Australia | HHA. Hha.org.au. (2021). In doing so, the global models for hand hygiene can be considered for further developing customised hygiene processes for local and national institutes. However, it can be recommended that a common fundamental can be highly appreciated as the same can be regarded as the most effective method in practicing hand hygiene.

Apart from that, based on the guidelines provided by the world organisation, the local authorities and health care centres can focus on the utilisation of quality resources for the health care workers to support risk reduction and ensure the healthy well being of the health care workers (Who.int. 2021). In addition to this, technology can play a major role in this regard, using devices to measure health status and infection contamination rate can influence health care workers to indulge more towards infection control and prevention practises. Moreover, the health care workers can use alternative solutions of hand hygiene, which may include quick sanitisers or lotions that restrict contamination while treating patients, which can also act as an early intervention in this aspect.

Conclusion

The study has highlighted the process and procedures to be followed in order to ensure proper hand hygiene. Moreover, the study has allowed us to comprehend the framework required to implement effective hand hygiene for health care centres. The identification if the study is hand hygiene being the most significant approach in the process of infection control and prevention. The study has shed light on the ways that contaminate hands and the ways healthcare workers are highly exposed to such infection. Therefore, based on the given discussion, it can be said that health authorities need to invest more in the risk management process for reducing the risk of healthcare workers engaged and exposed to harmful infections within the healthcare facilities. The five moments identified in the study, which was developed by the NHI, are highly significant for the health care workers. The most important aspect of the hygiene protocol is that the same has been established as compliance for the health care workers. This approach will ensure full adherence to the infection prevention and control procedure and policy.

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