Hand Hygiene Newsletter #10


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Hand Hygiene Newsletter #10

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Hand Hygiene Newsletter #10

  1. 1. Volume 10, 2010Impact of Mandatory Online Training onIntentions to Comply With Infection Control GuidelinesDavid Green, Deb CanadaSo what’s the best way to get people to learnabout infection prevention and control practices?Or more appropriately, will knowledge of thesepractices, guidelines, expectations, etc translateinto modified behaviour, and thence to reducedinfection rates? Good questions all, and questionsover which people have been agonizing since thetime of Semmelweis, Lister, and others. Will health-care professionals respond better to voluntarytraining and passive promotion, or is making in-fection control training mandatory the better way.This question was addressed a fascinating articlein the Canadian Journal of Infectious Diseases &Medical Microbiology (Vol 20, No 1, Spring 2009)where the authors sought to evaluate the impactof a making an on-line training program in infec-tion control mandatory.“It is not known whether the objective of improvinginfection control, occupational health and safetyclimate in the hospital environment would be betterserved by requiring all health professionals to suc-cessfully complete a course in infection control as opposed to encourag- The authors - Annalee Yassi, Elizabeth Bryce, Deirdre Maultsaid, Helening them to do so. Therefore, the objective of the present study was to Novak Lauscher, and Kun Zhao, all of Vancouver – conclude that re-compare the perception of safety culture and intention to comply with quiring that health professionals complete a 30 min interactive on-infection control guidelines in health professionals who were required by line infection control module generates a higher intention to complytheir supervisors to take an online learning course, and those who did so with infection control guidelines compared with those who volun-voluntarily, based on having seen promotional material.” tarily access this material. Moreover they recommend that training of this sort should be an important requirement for all healthcareThe study was undertaken with all health care professionals within an workers.urban health region - who were working in acute, rehabilitation, resi-dential, community and pediatric facilities – all of whom had taken It’s an interesting and revealing study, and well worth the time tothe 30 minute on-line infection control course. Some were mandated read and discuss. If we extrapolate that to larger society, just imagineto take the course as a supervisor requirement, others did so volun- the impact on community-based infectious disease if all workplacestarily, having been exposed to promotional posters, pay cheque in- required, as a component of workplace health and safety, that theirserts, word of mouth, etc. No other concurrent standardized infection employees undergo a brief training in socially recognizable infectioncontrol course was offered within the health region, although the in- prevention activities. Imagine …fection control program provided in-services regularly. 1
  2. 2. Building Partnerships- Enhancing Patient SafetyAnne Bialachowski, President, CHICA-Canada, www.chica.orgIt’s often said that two heads are better then one. An that is to ensure that Canadians receive the safestidea is converted into a project or major initiative and healthcare they can. On April 14th, 2010 the leaderssolutions to roadblocks are found. So ask yourself of each of the organizations announced at the CPSIwhat would happen if several national organizations National Conference that the first ever national Stop!with many committed individuals partner to support Clean Your Hands Day would take place on May 5,patient safety initiatives. That is exactly what CHICA- 2010. This national event will coincide with a globalCanada, the Canadian Patient Safety Institute (CPSI) initiative of the World Health Organization’s: Saveand Accreditation Canada are doing. They are part- Lives, Clean Your Hands Day. Tools and resources arenering to support the efforts of health care organiza- available to assist organizations in promoting optimaltions across Canada to maximize their hand hygiene hand hygiene practices in organizations are avail-programs and increase patient safety. able on the CPSI and CHICA- Canada websites. This is a complementary initiative to the Ontario Just Clean Each year in Canada, 8,000 to 12,000 patients die as Your Hands campaign.a result of complications of healthcare-associated in-fections. Through the simple act of practicing optimal CHICA-Canada is proud to be a part of this initiative.hand hygiene, healthcare facilities can reduce that It is grounded on the extraordinary work of the WHOnumber by half and prevent the spread of healthcare and dedicated hand hygiene experts from around therelated infections to our patients who have entrusted us with their world whose research has helped us to understand how to supporthealth and well-being. optimal hand hygiene. We know that if healthcare providers are pro- vided with the tools to enable them to use the right technique in theCHICA-Canada, CPSI and Accreditation Canada each bring a differ- right way, at the right place, and at the right time that all Canadiansent perspective to the initiative but we share a common goal and will benefit.Perceptions, Attitudes, and ily become contaminated with blood, other bodily fluids, secretions and excretions. Outbreaks of pathogenic micro organisms such asBehaviour Towards Patient MRSA and Clostridium difficile yield extensive contamination in single rooms, ward areas and bathrooms.Hand Hygiene Evidence shows that patient’s hands are at risk of frequent contami- nation via direct contact and from the environment and healthcareEmma Burnett, MSc, PGCert, BN, SPQ, RGN equipment and failing to carry out effective hand hygiene practicesUniversity of Dundee, School of Nursing and Mid- can result in the development of infection and further transmissionwifery, United Kingdom of pathogenic micro organisms. While there is a plethora of research exploring hand hygiene practices of healthcare workers, little atten- tion has been paid to patient hand hygiene. Patient safety predomi-We all know that healthcare associated infection remains one of the nantly lies in the hands of healthcare workers, especially in terms ofworld’s leading causes of morbidity and mortality. The importance of patient hand hygiene. Many patients are unable, for various reasons,hand hygiene has been recognized for centuries, from the early work to carry out their own hand hygiene, therefore whether or not theyof Oliver Wendell Holmes in 1843 and Dr Ignaz Semmelweis in 1847. are encouraged and assisted to do so is often determined by theOver the past few decades, research continues to demonstrate that perceptions, attitudes and behaviour of healthcare workers. Despitehealthcare environments provide a major reservoir for pathogenic continuing research, development of policies and the implementa-micro-organisms. Hand contact surfaces such as patient clothing, tion of intervention strategies, the unrelenting rise in the incidence ofpatient associated equipment and furniture, such as beds, tables, healthcare associated infection indicates that significant links in thelockers and curtains, shared and used between individuals can eas- chain of infection have been neglected. It could therefore be argued 2
  3. 3. that patient hand hygiene The statistical model withinpractices may indeed be one this study accounted for onlyof those neglected links. 10% of the variation in self reported behaviour, whichThis study employed a de- confirmed that 90% of thescriptive, cross-sectional variability was accounted forsurvey using questionnaires by other variables. It foundto explore perceptions, at- that significant predictorstitudes and self reported of behaviour were percep-behaviour of clinical ward tions, attitudes, gender, age,nurses towards patient hand qualification level and localhygiene. It also gained fur- infection prevention andther understanding of why control training received.nurses behave the way they The qualitative data gener-do towards patient hand ated from the final questionhygiene. (American Journal may provide some indica-of Infection Control, October tion as to further predictors2009). A questionnaire was of behaviour, which includeddeveloped from previously both individual and organi-validated questionnaires of sational factors. One of theother published studies, consisting of 4 main sections (participant main suggestions was the provision of better hand hygiene facili-characteristics and demographics; perceptions towards patient hand ties such as ‘nicer soap’, ‘softer hand towels’, ‘patient hand wipes’ andhygiene; attitudes towards patient hand hygiene and behaviour to- ‘more sinks’. A large proportion of nurses also suggested providingwards patient hand hygiene). A final open-ended question also asked better infection prevention and control education, and others felt itparticipants to suggest how patient hand hygiene practices could was necessary to employ more nurses to allow them time to assistbe improved. In total, 444 clinical nurses participated in the study, patients with hand hygiene.which provided a wide variety of characteristics such as age, grade,clinical speciality, experience and education and training received. This study not only identified that patient hand hygiene is funda- mental in the prevention and control of healthcare associated infec-It was found that the majority of nurses had good perceptions of tion but gained further understanding as to why practices are poor.patient hand hygiene and felt that this task was an important part It supported other research findings in that human behaviour is ex-of preventing and controlling healthcare associated infection. They tremely complex in nature, and is the consequence of multiple in-also believed that poor patient hand hygiene could contribute to the terdependent influences from biology, the environment, educationacquisition and transmission of healthcare associated infection. Fur- and culture. It reinforced the need to gain further understanding ofthermore, the majority of nurses displayed very positive attitudes to- why people behaviour in a particular way in relation to patient handwards patient hand hygiene, which reinforced the value of their per- hygiene and demonstrated the variety of issues that require consid-ceptions. Despite this however, nurses reported that they frequently eration when developing and implementing infection control inter-failed to encourage and provide patients with facilities in order to vention strategies in order to achieve a sustainable, positive behav-decontaminate their hands. This was especially so after visiting the ioural change.toilet and prior to meal times. Statistically significant predictors ofbehaviour included age, grade of staff and infection prevention and By allowing themselves to be put in the hands of the healthcarecontrol training received. Nurses aged 56 years and over displayed professionals, patients rely and trust them to manage risks for them,the most positive perceptions and attitudes. However, nurses of 26 make good decisions and protect them from harm. This trust has theyears and under reported better behaviour. Highest qualified nurses potential to be undermined if patients are not protected. By investi-were also significantly more likely to demonstrate positive behav- gating patient hand hygiene from clinical ward nurses perspectives,iour, with those who were unqualified least likely. Nurses who had it identified gaps in current practice and should allow healthcare pro-received local infection prevention and control training were statisti- fessionals to utilise these findings, evaluate current practice and takecally more likely to demonstrate positive behaviour towards patient necessary action in a bid to address increasing incidences of health-hand hygiene. care associated infection. 3
  4. 4. Just Clean Your HandsFor Long-Term Care HomesHealth care associated infections (HAIs) 1. BEFORE initial resident / residentcan have a significant impact on the environment contacthealth of residents in long-term care 2. BEFORE aseptic proceduresfacilities and their overall quality of life. 3. AFTER body fluid exposure risk 4. AFTER resident / resident environ-A recent study at Sunnybrook Health ment contact.Sciences Centre, Long-Term Care, inToronto demonstrated the higher the In long term care homes, residentshand hygiene compliance rate the low- gather for shared or group activi-er the norovirus attack rate - meaning ties, such as meal time and social ac-fewer people with diarrhea or vomit- tivities. It is recommended thatresi-ing. dents, staff, volunteers and family members clean their hands beforeHand hygiene is universally accepted and after these group activities to re-as the single most important way to duce the spread of micro organisms.prevent the spread of infections and outbreaks – while reducing theneed for expensive, time consuming precautions. So what’s the bottom line? Simply put, “Improving hand hygiene compliance saves lives.” In fact, an increase of hand hygiene ad-The Just Clean Your Hands program was created by the Ministry of herence of only 20% can result in a 40% reduction in the rate ofHealth and Long-Term Care (MOHLTC) to help hospitals overcome healthcare associated infections.the barriers to proper hand hygiene and improve compliance. An ef-fective hand hygiene program can reduce the burden of illness and The MOHLTC Just Clean Your Hands program contains all the nec-associated costs in long-term care homes. essary tools to help improve hand hygiene and compliance includ- ing a step-by-step implementation guide, training and educationTransmission of Organisms materials. For more information on the Just Clean Your Hands Pro-In an average day, caregivers and healthcare workers do a range of gram for Long Term Care, visit the Ontario Ministry of Health andtasks with many residents and patients. Simple tasks like helping a Long Term Care website at www.health.gov.on.caresident become more comfortable in bed can result in thousandsof microorganisms being transferred onto the hands of the caregiver. To learn more about Deb Canada’s healthcare skin safetyWithout a proper hand hygiene protocol – those microorganisms can program and products, please visit www.debgroup.combe easily transferred from one resident to another.Hand hygiene works and it works differently dependent on themethod used. Alcohol based hand rubs with at least 70-90% alcohol,kills organisms in seconds and is the preferred method when handsare not visibly soiled. Additionally, soap and water with friction willremove these organisms and wash them down the drain.Four Moments of Hand HygieneIn the resident’s environment, where care is taking place – the essen-tial indications of hand hygiene can be simplified into 4 moments: 42 Thompson Road West, PO Box 730, Waterford, Ontario CANADA NOE 1YO Tel: 519 443 8697 Toll Free: 1-888-332-7627 Fax: 519 443 5160 Toll Free 1-800-567-1652 • Email: debcanada@debcanada.com • www.debgroup.com 4