Hand Washing Protocols - Essay Example

Running Head: HAND WASHING PROTOCOLS Hand Washing Protocols [The Writer’s Name] [The Name of the Institution] Hand Washing Protocols Introduction Given that the skin is the most significant and foremost obstruction in the way of infections, it is essential that the skin of the hands be kept as safe and healthy as possible. The skin's water content, intracellular lipids, pH, humidity, and rates of cracking each play a significant role in maintaining the defensive barrier properties of the skin and these features are accounted for in hand hygiene. Certain variations in skin pH connected with hand washing may cause an apprehension on the grounds that some of the antibacterial traits of the skin are related with its usual acidic pH. It has been synthesized that some soaps can cause in venerable changes in skin pH, and as much as, decline in fatty acids, and, consequently, modifications in the microbial flora. (Boyce, 2000, 442-48) Therefore, some hand hygiene exercises e.g. recurrent washing with detergents may be helpful in developing irritation, cracking, skin dryness, and other problems. In the current market, we may observe several antiseptic items are accessible, and many of these are frequently branded antibacterial. These are, to a large extent, detergent-based, needed a traditional hand wash with water. On the other hand, non detergent-based antiseptic products are gels; waterless hand rinses, or wipes, which generally have alcohol as ingredient. (Paulson, 1999, 332-38) These are easily obtainable to the general masses also over the counter. These can be utilizes when water or towels are not available, and, parallel to antiseptic hand washes, have quick and extensive field activity and exceptional microbicidal characteristics. (Girou, 2002, 362) These products, however, are not an alternative for hand washing, especially, when the hands are actually grubby, because they are not high-quality cleaning agents. (Kac, 2004, 129) It has been observed that alcohol-based products, in some cases, may be most beneficial where instant antimicrobial action is desired after encounters that outcome in a lofty likelihood of contamination and furthermore, where running water, soap, and/or towels are not easily obtainable. As regards to this, it may also be kept in mind that moisturizers avert any harm to barrier characteristics, dehydration, loss of skin lipids, desquamation, and refurbish the water-holding capability of the keratin layer, and besides this, enhance the size of coenocytes. These may, sometimes, help to check the spread of micro organisms from the hands. For individuals with damaged or dry skin on the hands, it is vital to employ lotions or emollients to substitute lost fatty acids and resultantly, keep the hands hydrated. (Winnefeld, 2000, 546-50) In the healthcare setting, there may be misconception about the prime purpose of hand washing in the common population (to eliminate or diminish possible contaminating pathogens but, definitely, not to lessen counts of standard, colonizing flora) side by side the efficacy of hand washing (i.e., modest effect on natural flora, and occasionally even an addition to microbial calculations after hand washing, but prospective guard against indicative infection). (Girou, 2002, 362) In laboratory tests of the antimicrobial efficacy of hand washing, it is essential to distinguish whether the transitory flora or the natural colonizing is being measured. Both approaches have advantages and disadvantages. It has been observed that hand washing with a non-antimicrobial soap acts little to amend the natural flora. This type of outcome would be unwanted. In this respect, to healthy persons, the main purpose of hand washing is just to avert or decrease the attainment of momentary organisms that might be prospectively pathogenic. (Larson, 2005, 377-83) This is dissimilar to the healthcare setup in which hand hygiene is especially intended to diminish the clinician's own colonizing flora side by side to foil the cross-transmission of organisms singled out in the way of patient care. Consequently, studies pertaining to the effects of hand hygiene on the quantification of natural flora may possibly not be the most suitable upshot measure for relevance to general public health. Contrary to this, there are certain tests that engage the simulated contamination of hands or other exteriors with transient flora are loaded with threats to dependability and soundness (e.g., deviations in calculations owing to various circumstantial or test environment, inoculums, organism death ratio, etc.) and involve stringent observance to protocol. (Larson, 2005, 377-83) Resultantly, such tests are less expected and their clinical significance is more complicated to appraise. Eventually, the suitable resulting measure to evaluate the significance of hand washing is not a diminution in microbial counts, but implications on the ecosystem of the natural flora and on consequent infection ratio. Numerous multiple community-based researches have transpired momentous reductions in infections, frequently respiratory or gastrointestinal, associated with hand hygiene intercessions. (Larson, 2005, 377-83) This apparent disagreement between a failure of hand washing in order to decrease microbial counts on hands and a defensive effect against infections might be elucidated by various aspects. In this connection, firstly, there is the potential for periodical preconception, i.e. only those studies are published that show a noteworthy effect on infections. Additionally, there might be other methodological shortcomings in the concluding studies. Nosocomial infection has been admittedly a recognized hospital issue, and micro-organisms are spread chiefly via hands. The deleterious impacts of hand washing on skin might unfavourably affect hygiene practices of healthcare workers. Though hand washing is obligatory after every patient contact, it seems to be carried out in less than half of such cases. (Maury, 2000, 324-27) Skin irritation consequent upon recurrent hand washing has been referred to as a cause of poor observance with hand sanitization protocols. In such situation, when skin is scratched by aggressive hand-washing stuffs, it may also turn into more effortlessly colonized by micro-organisms. Therefore, in accumulation of the antimicrobial outcome of hand disinfectants, a maximum level of skin tolerance is vital to acquire efficacy. (Boyce, 2000, 442-48) Whether or not the repeated usage of a certain product as prescribed by hygienic demands can be tolerated from a dermatological perspective, is a matter of query. There has been traced certain efficacy of various hand decontamination actions. It should normally be assessed what really happens in clinical practice and the interface between skin stipulation and microbiological carriage. As regards to this, a hand decontamination agent should join antimicrobial effectiveness and permissibility. (Kac, 2004, 129) This aspect has to be measured in the option of a new hand hygiene agent, for the reason that an efficient product is of no advantage if it is not used. In this connection, alcohol-based hand rinse is better than hand washing with soap, self-assessment gains deterioration considerably more in the group by means of liquid soap than in the group using the antiseptic hand rinse. (Pittet, 1999, 821-26) Amazingly, hand washing with soap appears to enhance the total bacterial count on hands. This has been considered due to an improved release of skin particles as the result of hand wash. Bacteria hard to find to the sampling process before hand washing might also be released. Antiseptic hand rinsing is extensively more useful in eliminating pathogenic passing hand flora than hand washing with liquid soap. (Paulson, 1999, 332-38) Mistakes in hand hygiene practice are perhaps common in everyday practice. As the process of hand washing is more complex than a hand rinse. Getting in touch with the tap or paper towel dispenser might be a probable cause of contamination. Contamination by a hand wash might also take place when soaps used in hand washing are extrinsically contaminated. (Pittet, 1999, 821-26) Observations relating to total bacterial count may also be implemented to transient flora: washing the hands may discharge organisms or else not reachable to the sampling procedure, such as behind rings or in fissures. Hand rinsing with an alcohol-based plan can be excruciating in the incidence of hand damage and this can reduce the quality of the hand rinse or even decrease its rate of recurrence. (Maury, 2000, 324-27) Relations between hand flora, skin condition and the behaviour of staff are multifactorial and complicated. Appraisal under in-use circumstances shows that meagre skin forbearance can compromise the effect of extensively acknowledged hand hygiene stuffs. When hands are not profoundly grubby, alcohol-based hand disinfection should, in such case, substitute hand washing with non-medicated soap, as regards to forbearance and microbiological effectiveness. (Kac, 2004, 129) It has been observed that due to augmented penetration of sanitizer from the interrupt skin barrier caused by detergent, the joint outcome of the antiseptic and detergent applied interchangeably could be predictable to be improved. Nonetheless, appliance of the interchange detergent and disinfectant was traced to reason less clinical irritation and mild harm of the barrier role compared with detergent only and more rigorous clinical irritation and harm of the barrier function evaluated with disinfectant alone. (Boyce, 2000, 442-48) The reaction to the shared revelation was someplace halfway between disclosures to each of the chemical stuffs alone. (Winnefeld, 2000, 546-50) It might be derived that no significant, or clinically applicable, contact between detergents and disinfectant is found in vogue. An infection is caused by the invasion of a person's immunological defences by the deposition of infective agent's often micro-organisms within the body tissues. They are responsible for approximately half of all known human diseases. Bacteria, viruses, fungi, protozoa and worms are the five main groups of organisms capable of causing disease. The micro-organisms capable of causing disease are called pathogens, but the presence of a pathogen does not necessarily mean that an infection will ensue. Pathogens that can live harmlessly in a specific body site such as the gut or on the skin are called commensals. They only become pathogenic and cause an infection when transferred to an abnormal body site. The bacteria Escherichia coli lives harmlessly in the gut and aids digestion, but if this transferred to one of the wound sites in the arm or shoulder it could become pathogenic and cause infection and disease. (Symth, 2000, 79-83) Micro-organisms can enter and leave the body by several routes, which are often described as portals of entry and exit. They are often able to enter the body through the same routes that they can exit from. The source of infection may be determined by knowing the site of infection, the organism involved and the mode or route of spread. This allows an assessment of the degree of risk and the planning and immediate initiation of preventive measures. In the incident, it was obvious the source of the potential infection was from the stoma sight. Implementing the use of appropriate infection control practices to reduce the risk of infection needs to include all who are at risk from exposure to the infective organism patient, family, friends and all health care personnel. (Taylor, 2001, 283-99) Safe practice should ensure that the chain of infection is broken, thereby preventing the transmission of pathogens to potential sites of infection. Reservoirs of infection can be eliminated, sites of entry and exit controlled, and modes of spread minimized by actions such as disposal of body fluids, wearing protective garments, effective hand washing and aseptic procedures. In recent years, the concept of a comprehensive approach to infection control that promotes the use of safe practices to ensure protection to everyone from blood borne infections has been introduced into some hospitals and health authorities (Wilson, 1995, 198-103). Called 'Universal Precautions', it embraces the notion that all blood and certain body fluids are potentially infectious and therefore such practices are to be used with all patients at all times, regardless of whether they are known to have a blood or body fluid infection. Nurse’s Role and Responsibility It is the nurses' responsibility to know the factors that can increase patients' susceptibility to infection (i.e. age, underlying disease, drug therapy, or if they are undergoing surgery), this enables nurses to be able to assess which patients are most at risk so that they can develop a care plan and therefore they will know what extra, if any, precautions to take and protocols to follow. Mallett et al. (2000, p, 40) suggest that the assessment of a patient's risk of infection to others, in nursing care plans, before the commencement of any procedure is a fundamental principle of infection control. Steed states that not all nosocomial infections relate directly to the patients' underlying disease, but that, many are caused by the actions of healthcare workers. Therefore great care must be taken by healthcare workers, especially nurses, who are directly involved in the care of patients. (Steed, 1999, 34-40) Compliance with universal precautions should be rigorous as to avoid spread of infection. For example, failure to change gloves between interactions with different patients can lead to the spread of disease (Piro et al. 2001, 156-58). Ayliffe et al. contended that the regularity of infection caused by multiple types of bacteria could increase to epidemic amounts if aseptic and hygienic measures collapsed. (Ayliffe et al. 1992, 81-83) Evidence supporting the importance of infection control can be seen in a study by Worsley (1993) cited in Mallett et al. (2000, p,47) who found that in 1991 out of 175 patients who had developed nosocomial Clostridium difficile diarrhoea, 17 died and the organism was a contributing factor in a further 43 deaths. Also in a study conducted by Plowman et al. (2001, 198-209) they concluded that approximately 10% of patients will get infected during a stay in hospital and that this can lead to costs of up to one billion pounds per year in the U.K alone. These pieces of evidence and others (Chaudhuri, 1993, 1-6) demonstrate the prevalence of nosocomial infection, the dire effects of it and also the extreme financial losses it incurs. Infection Control Measures General principles of infection control which all nurses must adhere to according to the Royal College of Nursing (1995) are, to: Wash hands before and after general patient care; Cover all cuts and abrasions with impermeable dressings; Use disposable gloves and aprons where necessary; Clean up spills and body fluids immediately according to local guidelines; Use and dispose of sharps safely, do not resheath needles; Dispose of clinical waste according to local guidelines; Handle and transport specimens safely by following local guidelines; Handle soiled linen according to guidelines; Use disinfection and sterilisation procedures following guidelines. Healthcare professionals need to have basic knowledge about the steps in the chain of infection to be able to determine how to control infection itself. These are: the causative agent; the reservoir; the portal of exit from reservoir; the mode of transmission from reservoir to susceptible host; the portal of entry into susceptible host; and the susceptible host. The main ways to interrupt the transmission of infection between humans and therefore break this chain is through the mode of transmission, this is achieved by: hand washing; aseptic technique; sterilisation and disinfection; and isolation procedures. Overviews of epidemiological evidence (Gould, 1991, 1216-25; Sharir, 2001, 55-58) have shown that hand washing techniques are often inadequate and infrequent, and that the quality of hand washing is more important than the quantity (Van der Broek et al. 2001, 297). According to RCN guidelines (1995) hands should be washed: before and after any duty which involves close contact with a patient; before and after aseptic technique or invasive procedures; after contact with body secretions/ excretions; after handling contaminated laundry or equipment; after removal of gloves, masks and aprons; before administration of food, drink and drugs; and at the end of a span of duty. Precautions adopted to destroy pathogens, prevent the spread of infection and to protect patients against infection. These are adopted to increase the patient's resistance to infection, to eradicate the sources or potential sources of infection and to minimise, or if possible stop, the means of bacterial transfer to the uninfected patient. These procedures can only be effective if the healthcare professional, i.e. nurses who are in contact with the patients adhere to the general policies relating to the care of patients, especially infectious ones, such as hand washing and protection of personal clothing. It is nurse’s personal responsibility to ensure that she is fully immunised against common diseases, and diseases the nurse is in contact with in the healthcare setting, if there is a vaccine available. If nurse’s illness may put patients at risk of infection, it is nurse’s duty to inform the necessary people and to stay off work. It is also nurse’s duty to remove any jewellery (with the exception of a wedding ring) before work, to keep nurse’s nails short and clean, and to keep nurse’s hair (if long) tied back. Recent studies have proven the importance of wearing a clean uniform each day to work, and that you should ensure that your uniform is laundered at as high a temperature as the garment allows (Perry et al. 2001, 238-41). Conclusion Infection control is a fundamental element of nursing practice. Nurses have a crucial role in preventing transmission of viruses, bacteria and fungi by simply washing their hands regularly. Hand washing is the most effective method in infection control. Universal Precautions avoid the risk of blood borne and air borne pathogens being transmitted to healthcare personnel and to the hospital population preventing a local epidemic which can shut down wards. The Department of Health (2005) states Clinical governance is the system through which National Health Service organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. According to Elcoat, “evidence-based practice and evidence-based nursing have very strong positions in the Clinical Governance agenda of quality improvement.” (Elcoat (2000, 10) Evidence-based practice can be defined as using contemporaneous best evidence ensuring actions are clinically appropriate cost effective and result in positive outcomes for patients (Trinder & Reynolds, 2000, 67-70). The recommendation of hand washing before and after patient contact is integrated in nursing practice. According to a research report, more than one-third of British hospitals surveyed failed to meet even basic hygiene standards. Less than one-quarter were considered satisfactory in regard to those standards. The results show clearly why an estimated 5,000 patients die each year from infections they catch in British hospitals. Of the 699 hospitals included in the study, 250 were graded "red," indicating that they did not meet basic sanitation standards and 291 had a yellow intermediary grading. Only 158 were rated green or satisfactory. Among the problems cited in the study were dirty linen, untidy wards, uncollected rubbish, and clinical waste and food trays left out for days. (Health Services Journal, Jan. 8, 2001) Hand washing is extremely important in clinical areas, as it reduces the risk of infections. Infections are caused by organisms which invade the host's defence mechanisms. Effective hand washing can reduce the risk of infections occurring and protect the client. The NMC code of professional conduct (2004) also states, 'you should act to identify and minimise the risk to patients and clients'. Therefore protecting the patient is a priority and should be achieved to the highest standard possible. Washing hands is a vital procedure which should be undertaken after every patient contact. Even brief contact can cause millions of colony forming units to the hand, thus hand washing being the essence to reduce patients becoming infected. In order to avoid any form of infections, the nurses must be well aware of precautionary measures. They must learn that hands become visible soiled with food particles and body fluid (saliva), and therefore has to be washed immediately after feeding the client. Saliva can contain infections which can be transferred from one client to another. Ineffective hand washing techniques can mean that hands are still colonized with bacteria. A new class of software is giving hospitals the ability to track infection outbreaks, but as yet there is no silver bullet for annihilating the cleverly persistent bacteria that plague all hospitals. But there are some advances afoot for containing the problem other than the traditional arsenal of antibiotics and infection-control processes. References Ayliffe, G.A.J., Lowbury, E.J.L., Geddes, A.M., Williams, J.D. (editors) (3rd edition) (1992) Control of Hospital Infection, A practical handbook. London: Chapman and Hall Medical. 81-83 Boyce M, Kelliher S & Vallande N (2000), Skin Irritation and Dryness Associated With Two Hand-Hygiene Regimens: Soap-and-Water Hand Washing Versus Hand Antisepsis With an Alcoholic Hand Gel, Infection Control of Hospital Epidemiology, Vol. 21, pp.442-448 Chaudhuri, A.K. (1993) Infection control in hospitals: has its quality enhancing and cost effective role been appreciated? Journal of Hospital Infection, 25: 1-6. Department of Health. (2005). Clinical Governance. Retrieved July 12, 2006, from http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/ClinicalGovernance/fs/enDePoy. Elcoat, Mosby D. (2000). Clinical Governance in action: key issues in clinical effectiveness. Professional Nurse.18 (10) Girou E, Loyeau S, Legrand P, Oppein F & Brun-Buisson C (2002), Efficacy of hand rubbing with alcohol based solution versus standard hand washing with antiseptic soap: randomized clinical trial, British Medical Journal, Vol. 325, pp.362 Gould, D. (1991) Nurses' hands as vectors of hospital-acquired infection: a review. Journal of Advanced Nursing, 16: 1216-1225. Health Services Journal, Jan. 8, 2001. Kac G, Podglajen I, Gueneret M, Vaupre S, Bissery A & Meyer G (2004), Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study, Journal of Hospital Infection, Vol. 62, No. 1, pp.129 Larson E, Cimiotti J, Haas J, Parides M, Nesin M, Della-Latta P and Saiman L (2005), Effect of Antiseptic Hand washing vs Alcohol Sanitizer on Health Care Associated Infections in Neonatal Intensive Care Units, Archives of Pediatric and Adolescent Medicine, Vol. 159, pp.377-383. Mallett, J. and Dougherty, L. (editors) (5th edition) (2000) The Royal Marsden Hospital: Manual of Clinical Nursing Procedures. Oxon: Blackwell Science.39-47 Maury E, Alzieu M, Baudel J, Haram N, Barbut F, Guidet B & Offenstadt G (2000) Availability of an Alcohol Solution Can Improve Hand Disinfection Compliance in an Intensive Care Unit, American Journal of Respiratory and Critical Care Medicine, Vol. 162, No. 1, pp.324-327 Paulson D, Fendler E, Dolan M & Williams R (1999), A close look at alcohol gels as an antimicrobial sanitizing agent, Association for Professionals in Infection Control and Epidemiology, Vol. 27 No. 4, pp.332-338 Perry, C., Marshall, R. and Jones, E. (2001) Bacterial contamination of uniforms. Journal of Hospital infection, 48: 238- 241. Piro, S., Sammud, M., Badi, S. and Al Ssabi, L. (2001) Hospital acquired malaria transmitted by contaminated gloves. Journal of Hospital Infection, 47: 156-158. Pittet D, Dharan S, Touveneau S, Sauvan V & Perneger T (1999) Bacterial Contamination of the Hands of Hospital Staff During Routine Patient Care, Archives of International Medicine, Vol. 159, pp.821-826. Plowman, R., Graves, N., Griffin, M.A.S., Roberts, J.A., Swan, A.V., and Cookson, B. and Taylor, L. (2001) The rate and cost of hospital-acquired infections occurring in patients admitted to selected specialties of a district general hospital in England and the national burden imposed. Journal of Hospital infection, 47: 198- 209. Royal College of Nursing: Guidelines on Infection Control, for nurses in general practice. (1995) London: RCN. Sharir, R., Teitler, N., Lavi, I. and Raz, R. (2001) High-level hand washing compliance in a community teaching hospital: a challenge that can be met! Journal of Hospital infection, 49: 55- 58 Steed, C.J. Nursing Clinics of North America: Contemporary Infection Control for Nurses. Common infections acquired in the hospital, the nurses’ role in Prevention. Vol 34, Number 2, June 1999. 34-40 Symth, E.T.M. (director) Healthcare- associated Infection Surveillance Centre (2000). 79-83 Taylor, L.H., Latham, S.M. and Woolhouse, M.E.J. (2001) 'Risk factors for human disease emergence', Philosophical Transactions of the Royal Society of London, 356: 983-9. Trinder, L., & Reynolds, S. (2000). Evidence-based Practice. A Critical Appraisal. 67-70 Van der Broek, P.J., Verbakel-Salomons, E.M.A. and Bernords, A.T. (2001) Hand washing quality not quantity. Journal of Hospital Infection, 49: 297. Wilson, J. (1995) Infection Control in Clinical Practice London: Baillière Tindall. 98-103 Winnefeld M, Richard M, Drancourt M & Grob J (2000), Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use, British Association of Dermatologists, Vol. 143, No. 3, pp. 546-550 Read More