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Hand Hygiene And Hospital Acquired Infections

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Data Processing And Analysis

Hospital-Acquired Infections (HAIs) and Hand Hygiene – Fundamentals of Nursing

For completeness and consistency, the collected data were rechecked. Data were entered in Epi-Info version 3.1 software and exported to SPSS version 23 for further analysis. Descriptive statistics was employed for the socio-demographic characteristics of the respondents. Bivariable and multivariable logistic regressions were carried out to identify significantly associated variables with hand hygiene compliance by backward logistic regression variable selection method. Crude Odds Ratio, and Adjusted Odds Ratio with 95%CI were computed to determine the associated factor of hand hygiene compliance and P- value less 0.05 was considered as declared statistically significant. Hosmer and Lemeshow goodness of fit were used to test the fitness of the model during analysis.

Screening And Cohorting Patients

There is increasing political and community concern because multiple approaches have failed or struggled to control the spread of HCAIs, resulting in high morbidity and mortality due to AMR infections developed during hospital stays.150155 Strategies aimed at minimizing and controlling HCAIs comprise active surveillance cultures , contact isolation of patients colonized with epidemiologically significant pathogens, and pre-emptive isolation of high-risk patients.156

Improving Patient Hand Hygiene

Meyers and King identified a lack of handwashing facilities as contributing to poor patient hand hygiene. While patients who are mobile can access bathroom handwashing facilities, those who are confined to bed or have mobility problems are often unable to do so. A number of products have been introduced into hospitals to help improve patient hand hygiene in such situations, such as personal handwipes and alcohol-based handrub at the bedside. Barker et al found that 89.4% of patients thought a bottle of ABHR by the bed would be helpful, and 87.2% supported antimicrobial handwipes on food trays.

While ABHR is not advised for soiled hands or social hand hygiene, antimicrobial hand wipes have been shown to be as effective as soap and water in reducing transient micro-organisms from the hands when applied for 60 seconds . Interventions, such as providing patients with a bowl of soapy water and wet cloths, or bringing a mobile sink before meals, are more labour intensive .

It is also important that the facilities or products are appropriate for, and acceptable to, the patient. Factors to be taken into account include patient mobility, dexterity and vision. Alcohol-based products may be unacceptable to some patients for religious reasons and ABHR may be inappropriate for those with problems related to alcohol misuse.

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Transmission Of Microorganisms Via The Hands Ofhealthcare Workers

The 2009 World Health Guidelines for Hand Hygiene forHealthcare settings identifies five ways the nosocomialtransmission of pathogens from one patient to another via ahealthcare workers hands can occur.

a) Microorganism must be present on the patients skin orhave to be shed into the patients environment such as nearbyinanimate objects, such as the bedside table.

b) Microorganisms must be transferred to the hands of thehealthcare worker

c) The microorganisms that have contaminated the workershands must be able to survive on the hands.

d) The healthcare worker must either omit hand hygiene orinadequately perform it.

e) The healthcare workers contaminated hands mustcome into direct contact with either another patient or witha inanimate object that will come into contact with a patient,such as a shared portable vital signs monitor.

Patients Hand Washing And Reducing Hospital

(PDF) Use of a Patient Hand Hygiene Protocol to Reduce ...
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  • Stacy Haverstick, Cara Goodrich, Regi Freeman, Shandra James, Rajkiran Kullar, Melissa Ahrens Patients Hand Washing and Reducing Hospital-Acquired Infection. Crit Care Nurse 1 June 2017 37 : e1e8. doi:

    Hand hygiene is important to prevent hospital-acquired infections. Patients hand hygiene is just as important as hospital workers hand hygiene. Hospital-acquired infection rates remain a concern across health centers.

    To improve patients hand hygiene through the promotion and use of hand washing with soap and water, hand sanitizer, or both and improve patients education to reduce hospital-acquired infections.

    In August 2013, patients in a cardiothoracic postsurgical step-down unit were provided with individual bottles of hand sanitizer. Nurses and nursing technicians provided hand hygiene education to each patient. Patients completed a 6-question survey before the intervention, at hospital discharge and 1, 2, and 3 months after the intervention. Hospital-acquired infection data were tracked monthly by infection prevention staff.

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    Hand Sanitizer Vs Soap And Water

    The CDC recommends using alcohol-based hand sanitizer when your hands are not visibly dirty because it is potentially more effective at killing hand germs and less irritating and drying to your skin than soap. Plus, its easier to use during the course of care.3

    A 2014 study on strategies to prevent healthcare associated infections recommended performing hand hygiene with an alcohol-based hand rub as well. However, the study recommended using an antimicrobial or nonantimicrobial soap when hands are visibly soiled and during norovirus or C. difficile outbreaks.6

    Another study found that 100% hand-hygiene compliance using soap and water would take 16 hours of nursing time for a 24 hour shift. However, using alcoholic hand disinfection at the bedside to achieve 100% compliance requires only 3 hours.5

    Selecting Hand Hygiene Products For Health Set

    The major determinants for product selection are antimicrobial profile, user acceptance, and cost,,. Post-contamination hand hygiene products must have at least bactericidal, fungicidal , and virucidal activity. Since hands of HCWs are frequently contaminated with blood during routine patient care, activity against coated viruses should be included in the minimum spectrum of activity of an agent for hand hygiene. Additional activity against fungi , mycobacteria, and bacterial spores may be relevant in high risk wards or during outbreaks. Pre-operative hand hygiene should be at least bactericidal and fungicidal , since the hands of most HCWs carry yeasts and surgical- site infections have also been associated with hand carriage of yeasts during an outbreak.

    Hospital administrators should also take into account the acceptability of product by the users and its allergenic potential,. When comparing the cost of hand hygiene products, it has been found that the excess hospital cost associated with only 4-5 HAIs of average severity may equal the entire annual budget for hand hygiene products used for in-patient care areas,.

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    Normal Flora Of Hands

    There are two types of microbes colonizing hands: the resident flora, which consists of microorganisms residing under the superficial cells of the stratum corneum and the transient flora, which colonizes the superficial layers of the skin, and is more amenable to removal by routine hand hygiene. Transient microorganisms survive, but do not usually multiply on the skin. They are often acquired by health care workers during direct contact with patients or their nearby contaminated environmental surfaces and are the organisms most frequently associated with HCAIs.

    Reliability Of The Article

    Wash Your Hands to Prevent Infections | Nucleus Health

    Reliability is based on ensuring consistency of measurement tool that were employed in a study . The research article used Hand Washing Observation Tool. Which may produce different scores when retested and would lead to higher testing errors. Outcomes were assessed on the basic of time each person took while following proper hand washing based on CDC recommendations as hand hygiene practice .

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    Ethics Approval And Consent To Participate

    Ethical clearance was approved and obtained from the Institutional Review Board of the University of Gondar College of Medicine and Health Sciences, Institute of Public Health. Then the official permission letter was collected from the Central Gondar Zone health department and from each Public Primary Hospital admin offices. Written informed consent was obtained from each study participant after they were included in this study. The purpose of the study was explained to study participants before giving consent. We deliver information on the right to interrupt the observation and refuse to fill the self-administered questionnaires.

    Hand Hygiene Compliance Application

    The Hand Hygiene Compliance Application has been developed for use by Australian hospitals to conveniently report their Hand Hygiene Compliance rates as part of the National Hand Hygiene Initiative. The HHCApp can be accessed from a mobile web browser, allowing the use of mobile devices to gather data.

    For further information or to login please go to the HHCApp page at Hand Hygiene Australia.

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    History Of The Leading Guidelines

    Prior to the WHO guideline release, two tertiary hospitals in the US evaluated the impact of an active methicillin-resistant Staphylococcus aureus screening of all ICU admissions. The hospitals also experienced multiple concurrent infection prevention strategies including the 5 Million Lives Campaign, surgical infection reduction initiatives, Keystone ventilator and central line bundles, and a CDC-led hand hygiene campaign. The screening program commenced when hand hygiene compliance rate reached > 70%, and after 6 months the ventilator-associated pneumonia rate reduced from 0.954 days to 0.171 per 1,000 patient-days and the bloodstream infection rate from 0.219 to 0.128 per 1,000 patient-days. The reduction in infection may have been the effect of screening or due to other singular or multiple strategies including high hand hygiene. Alternatively, the effect may have been an additive effect between hand hygiene and the other concurrent infection control strategies.

    Our #1 Hai Prevention Tip: Hand Hygiene

    Hand Washing

    Clean hands are a crucial part of preventing the spread of deadly germs and HAIs to patients as well as preventing healthcare providers from acquiring infections from patients. The CDCs Clean Hands Count campaign highlights this important infection prevention step.

    Check out this video created by Toronto General Hospital on the importance of hand washing!

    This video may seem a little silly, using green paint to visualize germs, but it also highlights an important point and allows you to see why hand washing matters. When we dont wash our hands, the germs spread and can lead to healthcare-associated infections.

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    Why Is Hai Prevention So Important

    Preventing hospital acquired infections is part of your responsibility to your patients, your co-workers, and yourself. Its an important part of keeping everyone healthy and safe.

    HAI prevention practices can lead to an estimated $25-$31.5 billion in medical cost savings.2 Prevention saves hospitals money and allows medical professionals to focus on the primary condition of patients in their care.

    Strategies For The Prevention Of Covid

    In order to combat the COVID-19 crisis, health systems leaders around the world have had to adopt rapid multiple lines of attack to appraise critical requirements and address areas of weakness.215 This includes taking a rigorous approach to reduce the rates of COVID-19 infection, hospitalization, morbidity, and mortality.216,217 The appropriate strategy for preparedness to face COVID-19 or any future pandemic must be based on reputable guidelines, protocols, and direct experiences of those working on the front line during the COVID-19 pandemic.216,218 The foundations of an operational COVID-19 preventive vigilance and action plan include: 1) mitigating local transmission 2) conserving, supporting, and protecting staff 3) eliminating non-urgent strains on the system and 4) coordinating communication.216 Because hospitals and clinics are considered as core areas for the transmission of COVID-19,219 three principal measures should be implemented to reduce preventable exposure and transmission of COVID-19: 1) restrict both visitors and other non-COVID-19 patients to the health care facility 2) specific healthcare workers need to work in the COVID-19 zone and 3) every person must be screened and tested regularly before and after entering the hospital facility.216,219,220

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    How Nurses Can Prevent Hospital Acquired Infections

    Nurses can make a big difference in preventing hospital acquired infections through evidence-based practice, nursing research, and patient education. Following these basic steps can help keep your patients healthy.9

    • Follow universal infection prevention precautions
    • Follow hand hygiene guidelines, using soap and water or alcohol-based hand rubs
    • Prevent urinary catheterization when possible, if necessary intermittent catheterization is preferred
    • Irrigate cutaneous wounds between dressing changes, debriding necrotic material effectively and dressing a wound appropriately to absorb exudates
    • Ensure neutropenic patients receive frequent oral care
    • Use full barrier precautions during CVC insertion
    • As soon as it is deemed unnecessary, promptly remove catheter
    • Replace catheter dressings immediately when damp, soiled or loosened
    • Replace IV administration sets, extensions and secondary sets every 72 hours
    • Educate patients on infectection precautions
    • Create a safe environment for healthcare personnel where errors and near misses can be reported and reviewed to improve the system and prevent future errors
    • Focus on the task at hand – if something is distracting you during your task take steps to limit it
    • Create a personal checklist to keep your thoughts organized and ensure the proper steps are followed

    Patient Support And Education

    Helping hospitals with hand hygiene

    To adhere to appropriate hand hygiene, patients require access to appropriate hand-hygiene products. They also need to understand its importance, and know when they need to clean their hands and how to do so effectively.

    Barker et al found that many patients do not realise that good hand hygiene can protect themselves and others against infection, and that patients are less likely to practise hand hygiene in hospital than at home although those with good hand-hygiene practices at home are more likely to practise hand hygiene in hospital. Health professionals compliance with hand-hygiene practice was also found to affect patient behaviours: 80.8% of patients wished to be directly encouraged by staff and 73.4% wanted visual reminders such as posters .

    In studying the relationship between nurses perceptions, attitudes and behaviour related to patient hand hygiene, Burnett found that 97% of respondents agreed or strongly agreed that infection rates could be reduced by good patient hand hygiene. However, while 85% said they always encouraged patients to decontaminate their hands after visiting the toilet, only 23% did so before patients had meals this may indicate a lack of understanding of the implications of micro-organisms spread via the faecal-oral route such as viral vomiting/diarrhoea , from hands touching a contaminated surface . This could cause cross-infection if the patient with contaminated hands then handles and eats food.

    Box 1. Hand-hygiene advice for patients

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    Chemical Agents For Hand Washing

    a) Surgical hand scrubs- an antiseptic containing preparationthat substantially reduces the number of microorganisms onintact skin .

    b) Antiseptic hand washers- antiseptics containingpreparation designed for frequent use, reducing the number ofmicroorganisms on intact skin to an initial baseline level afteradequate washing, rinsing, and drying.

    c) Patient preoperative skin preparations-fast acting, broadspectrumand persistent antiseptics containing preparationthat reduce the number of microorganisms.

    Strategies To Prevent Healthcare

    HCAIs are a significant global public health burden about which concerns have been raised from all healthcare stakeholders, including health professionals, patients, and the public.4548 Their impact has dramatically increased because of the advent of multidrug-resistant pathogenic microorganisms.4951 Currently, almost all available antimicrobials are resistant52,53 and very few antimicrobials are in the process of being developed for widespread use.5456 Amongst these pathogens, Klebsiella pneumoniae, which is the most common resistant pathogen, especially in ICU settings, is a significant concern.57,58 The prevention and control of HCAIs is therefore very complicated, and a multi-dimensional approach and strategies are required to address this significant public health concern.36,50,5963

    In the following sections, we discuss the primary ways of addressing the impact of HCAIs as determined in the papers identified in the search and published in well-regarded journals36,45200 These are the main issues identified in these papers, noting that some articles report on a single issue, whereas others report on a number.

    • Hand hygiene
    • Maintaining a safe, clean, hygienic hospital environment
    • Screening and categorizing patients into cohorts
    • Public health surveillance
    • Following patient safety guidelines

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    Importance Of Hand Hygiene

    Proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of HAIs and the spread of antimicrobial resistance,. Several studies have demonstrated that handwashing virtally eradicates the carriage of MRSA which invariably occurs on the hands of HCPs working in ICUs,. An increase in handwashing compliance has been found to be accompanied by a fall in MRSA rates. The hand hygiene liason group identified nine controlled studies, all of which showed significant reductions in infection related outcomes, even in settings with a high infection rates in critically ill patients,,. Transmission of Health-care-associated Klebsiella sp. has also been documented to reduce with improvement in hand hygiene,,. The evidence suggests that adherence to hand hygiene practices has significantly reduced the rates of acquisition of pathogens on hands and has ultimately reduced the rates of HAIs in a hospital,,,.

    Colonization Of Hands With Pathogens And Their Role In Transmission

    Preventative Healthcare Associated Infections Through Hand ...

    The hands of HCWs are commonly colonized with pathogens like methicillin resistant S. aureus , vancomycin resistant Enterococcus , MDR-Gram Negative bacteria , Candida spp. and Clostridium difficle, which can survive for as long as 150 h. Approximately 10 skin epithelial cells containing viable microorganisms are shed daily from the normal skin,, which can contaminate the gowns, bed linen, bedside furniture, and other objects in the patient’s immediate environment. Hand carriage of resistant pathogens has repeatedly been shown to be associated with nosocomial infections. The highest rates of hand contamination are reported from critical care areas, which also report most cases of cross-transmission. The hands may become contaminated by merely touching the patent’s intact skin or inanimate objects in patients rooms or during the clean procedures like recording blood pressure.

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    How The Hand Hygiene Tst Works

    The Hand Hygiene TST uses Robust Process Improvement® methodology in its design and structure. RPI is a fact-based, systematic and data-driven problem-solving approach that incorporates tools and concepts from Lean Six Sigma and formal change management methodologies. The Hand Hygiene TST can guide organizations like yours through a step-by-step process to: accurately measure your organizations actual performance, identify your barriers to success, and direct you to proven solutions that are customized to address your organizations particular needs.

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