Essay Sample: Nursing Hand Hygiene

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Evidence and evaluation in the development of nursing practice in hand washing to reduce hospital acquired infections.

Introduction

Infections associated with healthcare are drawing large attention from insurers, regulatory bodies, governments and patients. This is not only due to the magnitude of the issues in terms of the cost of treatment, mortality and morbidity but also because of the increasing identification that most of these are avoidable (Staniford & Schmidtke et al., 2020). Hand washing practice is common in nursing.

The healthcare community is observing extraordinary advancements in accordance with the understanding of the patho-physiology of some of the infectious diseases and the universal spread of the multi-drug resilient contagions in health care related settings. These aspects compounded by the scarcity of obtainability of new anti-microbials have required a re-look into the part of basic activities of the prevention of infection in contemporary day health care. There is now acknowledged evidence that severe devotion to hand hygiene decreases the threat of cross transmission of the infections (Staniford & Schmidtke et al., 2020).

Hand hygiene is considered as one of the vital aspects of the activities related control of infection. In the rise of the developing burden of infections associated with healthcare, the rising severity of the difficulty of the treatment and illness, overlaid by healthcare professionals and pathogen infections that are resistant to multi-drugs are retreating back to the basics of infection preclusions by simple measures like that of hand hygiene. This is because sufficient indication supports the surveillance that if accurately applied, hand hygiene can largely decrease the threat of cross-transmission of the contamination in healthcare amenities.

The NMC code of the professional conduct an individual should behave to decrease as well as detect the risk to patients and clients (The Code, n.d.). Maintaining and accomplishing high levels of compliance to infection control is complex. There are very few researches that consider the background of barriers or care as well as opportunities to enhance compliance (Gao, 2020). The objective of this research is to evaluate the development of nursing practice in the area of hand washing to decrease hospital acquired infections.

Literature Review

The literature research was undertaken by using three databases including EBSCO host, PubMed and Google Scholars. Some of the keywords that were utilized in searching included hand hygiene, hand hygiene audit, hand hygiene audit in nursing, healthcare audit, hospital acquired infections and hand washing. After reviewing the preliminary search outcomes, I narrowed down the search by studying the abstracts for related information. After reviewing abstracts the relevant articles were picked and full text was investigated in order to find the major results and points relevant to the topic. 

` Hands of nurses are often contaminated while doing routine patient’s care because of the close proximity with patients. Contamination could occur while auscultation, touching different objects, changing of clothes and palpation etc. Hence, hygiene of hands is one of the most important, inexpensive and impactful source of cross-contamination’s prevention.

Regardless of the environment, this procedure is composed to protect the lives and to provide healthy atmosphere to patients and health care workers for treatment. Different researchers have used different terminologies for hygiene of hands i.e. decontamination, disinfection, hand antisepsis or de-germing etc. hygiene of hands has two meanings. It either refers to disinfecting of hands by using hand-rub alcohol or washing of hands by soap having antimicrobial properties (Salmon et al., 2013).

Purpose of hand cleaning is the prevention of cross contamination among patients by removing the impurities and reducing the amount of microbial present on skin. It is mandatory for nurses to work in the alignment with the rules of hand cleaning and keep the patients safe as they are working 24 by 7 in healthcare environments. Moreover, nurses are bound by the registered council of regulations to protect the patient’s life and work as their advocate in the NMC (Nursing and Midwifery Council) of UK (Hammerschmidt & Manser et al., 2017).

NMC is the code of conduct for nurses and practitioners. It requires nurses and health care practitioners to provide exceptional care and practice to the patients all the time. Despite of the rules for hand cleaning, some of the nurses still don’t care about their responsibility of preventing cross-contamination and consider it as the duty of staff working for controlling infection. Research has shown that mostly nurses don’t clean their hands because it seems like hand cleaning take time and it is difficult for them to take some time from their busy schedule to clean their hands. Moreover, most of the nurses assume that gloves are the alternative of hand cleaning. Most often, they took off the gloves and wear those gloves again to provide care to several patients without cleaning their hands.

Merely, 20% nurses wash their hands after removing gloves. Nurses avoid cleaning their hands with alcohol based hand-rubs due to the fear of developing skin infection i.e. dermatitis. Hand cleaning should be taken into consideration before doing extensive procedures, after dealing with contaminated patients, devices or objects. Hand cleaning must be done before and after work, and after going bathrooms and toilet as well. (Jeanes et al., 2020).

The requirements related to hand hygiene rely on the kind of procedure, tenacity of the anti-microbial action on skin and contamination degree. When nurses devote an extended time on hand hygiene their strategy is sometimes poor as compared to other health care employees regarding leaving huge regions unwashed. Generally, physicians have remarkable hand hygiene abilities as compared to the nurses. Compliance related to hand hygiene is seem more in the junior nurses and recently employed staff.

Hand hygiene acquiescence is higher amongst the nurses as compared to other health care workers. Behaviors and attitudes regarding hand hygiene is a multi-faceted problem including the perception of the effectiveness, values and beliefs of staff and current barriers. In order to accomplish high rates of compliance with hand hygiene the defaulters should be controlled even though they have violated the policy of hospital, beginning with the individual counselling to vocal warning and ultimately to an engraved warning mentioned in their file.

Hand hygiene is not the responsibility of the nurses but it is a mutual responsibility among the administration of hospital, stakeholders, patients and key leaders. The involvement of patient increases the compliance of hand hygiene by fifty percent. Nevertheless, some patients think that asking health care workers to wash their hand prior to a delivery related to healthcare is a disloyalty and some of them even think that they might be considered as a trouble maker and hence they do not prefer to do so. Usually, the patient feels relieved if she or he observes healthcare care worker’s hand washing practice in the environment of the hospital.

Hand hygiene requires a multiple interventions strategy to make it a justifiable practice in the healthcare. Hand hygiene is not only the accountability of the department of infection control and suggests a multi-disciplinary strategy. The administration of the hospital, nursing leaders and some other key leaders are the major key to success for the compliance of hand hygiene in a hospital. The healthcare workers and atmosphere of the hospital should consider the department of infection control as a partner and resource instead of an enforcer. Therefore, the staff of infection control should play an important role in the compliance of hand hygiene by encouraging the monitoring of the patients’ hand hygiene through observation.

A number of researches were found to sustain the significance of the education regarding hand washing. A researcher conducted a research to evaluate the knowledge about hand hygiene of the nurses along with their attitude, self-reported performance and perception. A researcher pointed out well-structured and specialized education about hand hygiene regarding the improvement of the attitudes and perception of the healthcare staff should be carried out.

It was also pointed out that with the help of performance feedback posters, education and seminars would increase the proportion of the compliance of hand washing. A study proposed that observing hand hygiene along with education amongst the anesthesia personnel can enhance the compliance of hand hygiene (Ganesan et al., 2020). 

A multi-modal intervention was conducted in order to enhance the compliance of hand hygiene in a tertiary care center and major improvements in the compliance of hand hygiene including all kinds of health care employees were observed. In general, proficient evidence demonstrated education plays a significant role in the compliance of hand washing. In general, strong evidence showed education plays an important role in hand washing compliance.

Discussion of leadership

In accordance with the test results my leadership style is transformational leadership. It inspires workers to strive beyond the needed expectations to work in the direction of a mutual vision. Learning to balance a certain style can help the leaders to reach their complete potential. The test that I used to recognize my leadership style is leadership and followership style test. This test involves statements regarding the kind of the boss the employees prefer. It involves statements regarding the kind of boss preferred. 

Transformation leadership encompasses the process which transforms people via an exceptional kind of impact on the followers to accomplish surplus as compared to what is mostly expected of them and it also aims to provide a business with a novel tenancy of life. A leader who follows leadership style encourages other people to innovate novel and significantly enhanced norms to deject the normalcy to shift the environment effectively (Al-Mashhadi, 2021). The optimum profile of the leader is denoted by the presence of specific characteristics of the transformational leader. The traits of the transformational leaders include individualized consideration, idealized impact, intellectual replication and inspirational motivation.

Leaders with idealized impact show conviction, present vital purpose and values, trust, ethical implications of a certain decision along with commitment. Inspirational motivation includes the process where the leaders inspire the subordinates to align the individual goals of the employees with the organization (Svanberg, et al., 2017).  It was emphasized by the researchers that intellectual simulation allows the development of the workers and their devotion to the success of the organization. Individualized consideration is a process that includes the ability of a leader and enthusiasm to provide nurturing support to the followers. A leader should provide support and the required directives to the followers in a company. The support and guidance by the leader will develop a rapport with the workers and will enhance their performance (Toader & Howe, 2021).

A study recognized that transformational leadership positively impacts the performance of an organization (Toader & Howe, 2021). Transformational leadership supported the organization by developing an environment of motivation for the workers. This energized and motivated workers enables them to accomplish institutional objectives hence enhancing the performance. A research was carried out found a relation among transformational leadership as well as organizational residency performance or behavior (Currie & Lockett, 2007). Moreover, a study was carried out on impacts of leadership style on the performance of an organization by utilizing chosen small scale initiatives (Suputra, et al., 2020).

Most of the transformational leaders are charismatic and they try to develop a vision of the future and provide and inspiration to the followers to question the status quo as well as the urge for the originality. Transformational leaders act like role model for their supporters and are respected, trust and admired. The style of transformational leadership can be defined by five facets including idealized impact (behavior and attributed), inspirational motivation, individualized deliberation and intellectual simulation. Leaders tend to attach with their supporters by considering individual requirements, giving them attention and care and empowering power (Iriyadi & Yadiati, 2017).

Leader is regarded as an individual who has the capabilities to impact others. Leadership is regarded as one of the management functions which propose that each manager should act as a leader. Decision making is considered one of the important traits of an efficient leaders. There are various types of leadership and the decision making depend on each of these approaches. Svanberg et al. (2017), argues that individuals have various decision making approaches and these styles differ in accordance with the number of the alternatives utilized, quantity of data and the degree they coordinate distinct resources of the input. There is an existing relation among the styles of leadership and the styles of decision making. Transformational leaders utilize more comprehensive style in accordance with the decision making. Some researchers argue that transformational leaders are the logical decision makers.

Researchers found that leaders who are emotionally intelligent are more committed in the direction of the organization. Some leaders utilize positive emotions to enhance their decision making and embed a sense of trust as well as cooperation amongst the workers via interpersonal relations. Emotional intelligence includes the capability to accurately perceive, demonstrate emotion and appraise the capability to access or produce feeling when they facilitate thoughts, the capability to comprehend emotional knowledge and emotion and the capability to control emotions to promote intellectual and emotional development (Viator, 2001).

A positive correlation was found among emotional intelligenece and transformational leadership. Moreover, there is also a positive relation among transformational leadership style and intuitive, spontaneous, rational, dependent and avoidant decision making. Transformational leaders are considered as the logical decision makers. 

Critical analysis of how an audit would be undertaken

Audit and feedback both are professional strategies that aim at encouraging professionals to evaluate and improve their clinical practice. Audit, as a strategic approach, is a systematic and methodological review of a person’s or company’s performance based on precise criteria or explicit standards (Berger et al., 2021). This data is subsequently sent or fed back to the relevant professionals in a well managed and structured manner.

The basic underlying assumption or precision for audit and the strategic feedback is that rightly motivated clinic and health professionals who get information based on their clinical and health care practice is not consistent and aligned with desired and targeted practice, as enlisted in evidence-based instruction manual guidelines, and/ or as compared to peers, shall divert their attention and energies to focus on the niches and areas where betterment is needed.

Most of the audit and feedback processes are used to measure adherence and accuracy to recommendations and usually include guidelines and measures of structures, including the processes and/or consequences of health care; one or all three of the domains of health quality may be achieved through easily: effectiveness of the guidelines, security measures and/or clients or patient centeredness (Berger et al., 2021).

The clinical aspect of the topic that covers audit and feedback should be selected very carefully and particularly. Audit and feedback are more effectual when the major focus is on providers that are consistently performing poorly at baseline. Policies should always clearly mention the goals and targets and a limpid action plan mentioning and asserting on all the necessary steps and procedures to achieve the goals and targets. The feedback and audit should convey a clear and comprehensible message that brings the attention of the professionals to actionable, practical and achievable tasks that can be helpful in improving the overall patient care and the health care quality.

Organizational commitment to a non punitive and constructive approach to consistent quality and standard improvement is necessary and essential, with recursive cycles of cross media and multimodal feedback and audit provided from an authentic and credible source (Berger et al., 2021). Moreover, local conditions, for example the availability of credible and reliable, ordinarily collected information that is considered valid and rational, have a significant impact on the price of an intervention (Esposito et al., 2014).

Clinical and health professionals are normally assumed to be hard working and motivated individuals that have the right dedication to provide high-quality and effective health care. However, it is also very significant that a lot of patients are unable to access recommended and necessary health care and that there are some major variations in clinical practice, which is not easy to be explained by a disorder or illness by medical science.

Some of the explanation for this particular prodigy is likely that even experts don’t have unlimited ability to precisely assess their control and performance. Hence, data regarding how they perform professionally compared to the normative or character standards can be a significant motivator for inflicting change amongst professionals (Fox et al., 2014).

As many other strategies to improve quality, audit and feedback are conceptualized as a recursive cycle of processes that is made of five steps: (1) preparation for audit; (2) selection of criteria; (3) measurement of the performance; (4) improvements; and (5) sustaining the changes and improvements. The first half mainly deals with auditing of performance, and the second one works with feeding the data and information to the professionals (Kamwara & Kyongo, 2017).

Whether or not the changes related to practice takes place relies on a number of factors which have been discovered qualitatively in a number of studies. There are a number of theories that explain how audit may direct to changes in the professional practice. Some of the theories emphasize on the change within the healthcare professional while others focus on the change in the social setting or in the economic or organizational context. In accordance with the theories audit may shift the awareness of the receivers along with their beliefs regarding existing practice which will consequently result in variations of clinical practice.

Moreover, audit may shift apparent social norms as well as direct attention to a certain set of tasks or the sub-goals. The degree to which audit successfully fulfills the anticipated reaction relies upon the aspects of the intervention, the directed behavior change and how these communicate with features of the receiver and their environment (Gould et al., 2016).

Observing the compliance of hand hygiene will be the principle quality indicator in all kind of healthcare settings. The monitoring of hand hygiene can be executed by direct observations of hand hygiene practices, carrying out a survey, measuring the use of product and recently via electronic scrutiny and video monitoring. While direct observation is still regarded as the gold standard approach as compared to other contemporary available techniques as it will also provide with the data like duration and volume of used hand hygiene products, compliance to a number of steps of hand hygiene techniques and drying technique. Moreover, it is feasible method in the setting where there are limited resources.

The audit will mainly focus on hand hygiene and how it is an effective and significant measure in the prevention of the infections associated with the healthcare. Compliance to hand hygiene was one of the superior indicators of the infection control in the hospital when the company applied for the process of accreditation along with engraved protocols, posters at the planned locations, never-ending supply of water, suitably situated functional sinks with elbow functioned taps, obtainability of paper towels along with liquid handwash. The auditor can adapt leadership theories in the healthcare related audit. The application of a certain leadership strategy to this relation allows analysis of the interplay of behavior among the clients and auditors that takes place in their environment. 

Conclusion

Audit can contribute towards enhanced quality of care and can be applied with minimal price in case of availability of data. Nevertheless, it is not the ideal approach for all the clinical issues and design aspects of audit have a significant influence on the effectiveness. The research shows that interventions aimed at enhanced hand hygiene in the nursing homes will show positive impact if not supported by a mutual attitude by nursing managers and nurses that hold hygiene management as a priority for the safety of a resident. In order to raise the awareness and facilitate the compliant behavior of hand hygiene will need the establishment of a safety culture along with a change in the conceptualization of the nursing homes with high risk of infection.

To reduce the threat of cross-infection amongst the residents, the staff and nursing managers should be guided by the recommendations by WHO for the nursing homes. Nursing managers tend to play an important role in enabling the process in role of leadership and they also act as the role models. Regardless of the institutional priority in the background of the imminent final authorization process, the compliance of hand hygiene is still low. It can be credited to the high rate of staff attrition, absence of the administrative sanctions for the non-compliance and attitude of healthcare workers. 

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