HAND HYGIENE. Why Compliance is Important? Nicole Prins
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1 HAND HYGIENE Why Compliance is Important? Nicole Prins
2 VIDEO
3 LEARNING OBJECTIVES 1. Define hand hygiene 2. Assessment & inferences 3. Quality implications
4 HAND HYGIENE OBJECTIVE #1
5 WHAT IS HAND HYGIENE? Hand hygiene is a general term that applies to routine hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis (Boyce, Pittet, 2002)
6 Ignaz Semmelweis BACKGROUND Correlated illness and infection with not performing hand hygiene 1847 required all students and Dr. s to wash hands with chlorine solution 1961 U.S. Public Health Service Training film for healthcare workers on proper HH Antiseptic agent believed to be less effective than hand washing 1975 & 1985 CDC Written formal guidelines on hand washing practices 1995 Association for Professionals in Infection Control Support use of antimicrobial wash in clinical settings
7 TYPES OF HAND HYGIENE Routine Hand wash Antiseptic Hand wash Antiseptic Hand rub Surgical Antisepsis
8 PROPER HAND WASHING PROTOCOL Turn on water (warm preferably) Wet hands & get a dollop of liquid soap Scrub palm to palm Palm to back Then your thumbs Between your fingers Scrub knuckles to palm(cuticles) Scrub fingertips (Fingernails) Rinse & dry hands Use paper towel to turn off sink also SCRUB FOR seconds!!
9 NURSING THEORY Environmental Theory Florence Nightingale Patient-care theory Seven assumptions to improve a patient s environment Ten environmental theories to improve. Based on the patient
10
11 PSYCHOLOGY THEORY The Theory of Planned Behavior Icek Ajzen Six ideas that represent a persons idea to control behavior Behavioral intent (motivation), behavioral control (ability) and normative
12 THEORY OF PLANNED BEHAVIOR
13 ASSESSMENT & INFERENCES OBJECTIVE #2
14 STUDY #1 Effect of hand sanitizer location on hand hygiene compliance. Cure & Van Enk (2015). Quantitative Study. See if hand hygiene compliance increases with visibility of hygiene stations Findings: 3 year observation period, 26,707 hand hygiene compliances observed 81.6% compliance rate 79 observations per room
15 STUDY #2 Adherence to hand hygiene guidelines- Significance of measuring fidelity Korhonen et al., (2015) Cross-Sectional Observational Study Evaluate fidelity and hand hygiene compliance Findings: 830 occasions observed with 2302 actions where hand hygiene should have been preformed Hand hygiene compliance rate: % Hand hygiene lasted 30 seconds+ 10% of cases (avg. for nurses 15.3 seconds)
16 COMPLIANCE RATES
17 WHY DO NURSES NOT PERFORM HAND HYGIENE? Skin irritation Lack of time Inaccessibility of hand washing stations or antiseptic stations Understaffed or overcrowded Patient needs more important
18 WHAT DOES THIS MEAN FOR PATIENTS? Increased risk of nosocomial infection Increased suffering Increased morbidity Increased mortality Increased costs
19 WHAT DOES THIS MEAN FOR A HOSPITAL? Increased costs Lawsuits Increased Morbidity Increased Mortality
20 ROOT CAUSE ANALYSIS Staffing Time Hand hygiene compliance Overcrowding Education Usability
21 QUALITY IMPLICATIONS OBJECTIVE #3
22 QSEN RECOMMENDATIONS Patient Centered Care Teamwork and Collaboration Evidence Based Practice Quality Improvement Safety Informatics
23 ANA STANDARDS Standard 8: Education The registered nurse attains knowledge and competence that reflects current nursing practice Standard 9: Evidence-Based Practice & Research The registered nurse integrates evidence and research findings into practice Standard 16: Environmental Health The registered nurse practices in an environmentally safe and healthy manner
24 QUESTIONS? Do you think it is possible to reach 100% hand hygiene compliance within a hospital setting? Have you ever seen any instances during clinicals where a nurse has not performed hand hygiene properly? How would you improve hand hygiene compliance?
25 REFERENCES Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50(2), American Nurses Association (2010). Nursing: scope and standards of practice (2 nd ed.). Silver Spring, Maryland. Boyce, J. M., & Pittet, D. (2002, October 25). Guidelines for hand hygiene in health-care settings. Morbidity and mortality weekly report, 51. Centers for Disease Control. (2003, May). Hand Hygiene in Healthcare Settings. Centers for Disease Control and Prevention. Cure, L., & Van Enk, R. (2015). Effect of hand sanitizer location on hand hygiene compliance. American Journal of Infection Control. doi: /j.ajic Korhonen, A., Ojanpera, H., Puhto, T., Jarvinen, R., Kejonen, P., & Holopainen, A. (2015, May 31). Adherence to hand hygiene guidelines- significance of measuring fidelity. Journal of Clinical Nursing. doi: /jocn
26 REFERENCES McLaws, M., Maharlouei, N., Yousefi, F., & Askarian, M. (2012). Predicting hand hygiene behavior among Iranian health care workers using the theory of planned behavior. American Journal of Infection Control. doi: /j.ajic Petiprin, A. (2015). Environmental theory. Nursing theory. QSEN Institute (n.d.). Competencies. SaskatoonHealthReg. (2014, November 17). Hand hygiene for health care workers- Get smart [Video file]. Van De Mortel, T. F., Kermode, S., Progano, T., & Sansoni, J. (2011, April 26). A comparison of the hand hygiene knowledge, beliefs and practices of Italian nursing and medical students. Journal of Advanced Nursing. doi: /j x
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