Constraints vs. Outcomein regards to Hand Hygiene ComplianceJess Morritt
Some Facts• Strict compliance with hand  hygiene occupies at least one  quarter of nursing time• Implementing strict pract...
Skin Irritation• Soaps and detergents can  damage skin when applied on  a regular basis• Better information is needed  abo...
Skin Irritation: Possible Solutions                    • Providing hand lotions or                      creams to minimize...
Sink Availability• Adherence with hand hygiene  with varying sink‐to‐bed ratios• Adherence was less than 50%  in all units...
Lack of Soap and Paper Towels                  • Use of soap and water on                    hands soiled with visible dir...
Time Constraints• If hands are not visibly soiled,  alcohol rub is sufficient, which  saves time and is easy to  implement...
Advantages of alcohol-based handantisepsis vs. handwashing                   • Faster and of greater efficacy             ...
Ethical Considerations• The ethical constraints we are highlighting here;  is that there is a limit to the amount of resou...
Constraints vs. Outcome in regards to Hand Hygiene Compliance
Constraints vs. Outcome in regards to Hand Hygiene Compliance
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Constraints vs. Outcome in regards to Hand Hygiene Compliance

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  • Observed Risk FactorsPhysician statusNursing assistance statusMale sexWorking in the intensive care unitWorking during the weekWearing glovesAutomated sinkActivities with high risk of cross-contaminationHigh number of opportunities for hand hygiene per hour of patient careSelf-Reported Factors for Poor Adherance with Hand HygieneHamdwashing agents cause irrittion and drynessSinks are inconveniently locatedLack of soap and paper towelsOften too busy/insufficient timeUnderstaffing/overcrowdingPatient needs to take priorityHand hygiene interferes with health care worker relationship with patientsLow risk of aquiring infection from patientsWearing of gloves/ beliefs that glove use negates the need for hnd hygieneLack of knowledge of guidanceNot thinking about it/forgetfulnessNo role model from colegues or superioursSkeptisicm regarding the value of hand hygeineDisagreement with the recommendationsLack of scientific information of definitive impact of improved hnd hygiene on health care associated infection ratesAdditional percieved barriersLack of active participation in hand hygiene promotion at individual or institutional levelLack of role model for hand hygieneLack of institutional priority for hand hygieneLack of administrative sanction of noncompliance/rewarding compliersLack of institutional safety climateThe Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from: http://www.cdc.gov/handhygiene/Measurement.html
  • Studies in clinical areas such as adult intensive care units, where patient contact is high, showed that strict compliance with hand hygiene occupies at least one quarter of nursing time, and implementing strict practices may affect the quality of patient care, a formidable drawback.However, in NICUs, modern neonatal nursing emphasizes the concepts of minimal handling; this coupled with clustering of nursing care, the situation may become more optimisticLam, B, & Lee, J. (2004). Hand Hygiene Practice in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection. Retrieved January 16, 2012, from http://www.pediatricsdigest.mobi/content/114/5/e565.fullImage sourced rom:http://www.nimblecreative.com/print/vch-hand-hygiene.html
  • Challenges/barriers to adherance with hand-hygiene complianceNot thinking about it/forgetfulnessToo busy/insufficient timePatient needs take priorityLack of role model from collegues or superiorsUnderstaffing/overcrowdingHand-hygiene agents cause irritation and drynessSinks are inconveniently located/lack of sinksBelief that glove use negates the need for hand hygieneLow risk of aquiring infection from patientsBlue = major challengeYellow = miror challengeGreen = not a challengeImaged sourced from:http://www.matmanmag.com/matmanmag/images/2008images/0807MMH_Fig8.jpg
  • Skin irritation constitutes an important barrier to appropriate compliance. Because soaps and detergents can damage skin when applied on a regular basis, health care workers need to be better informed about the possible effects of hand hygiene agents. Lack of knowledge and education on this topic is a key barrier to motivation. Emollients and hand lotions help to protect skin and may reduce microbialshedding.Pittet, D. (2003). Hand Hygiene: improved standards and practice for hospital care. Retrieved January 16, 2012, from http://birdflubook.com/resources/Pittet327.pdfImage sourced from:http://www.dermis.net/bilder/CD003/550px/img0060.jpg
  • providing HCWs with hand lotions or creams to minimize the occurrence of irritant contact dermatitis associated with hand hygiene actionPittet, D. (2003). Hand Hygiene: improved standards and practice for hospital care. Retrieved January 16, 2012, from http://birdflubook.com/resources/Pittet327.pdfImage sourced from:http://imworld.aufeminin.com/dossiers/D20110223/hand-cream-115255_L.jpg
  • One study I found, observed adherence with hand hygiene in 14 units at 4 hospitals with varying sink‐to‐bed ratios (range, 1:1 to 1:6). Adherence was less than 50% in all units and there was no significant trend toward improved hand hygiene with increased sink‐to‐bed ratios.Infection Control and Hospital Epidemiology. (2003). Retrieved January 16, 2012, from http://www.jstor.org/stable/10.1086/502193Image sourced from:http://www.sciencephoto.com/image/270798/large/M3900862-Hospital_sink-SPL.jpg
  • Use of soap and water on hands soiled with visible dirt or contaminant. Soap mixes better with dirt and soil on the surface of the skin to clean them more thoroughly. Proper hand-washing technique requires you to wet your hands, apply soap, scrub all surfaces of your hands and wrists for at least 20 seconds, rinse your hands with warm water and turn off the faucet using a towel.Hand Washing vs. Hand Sanitizer in the Hospital. (2011). Retrieved January 16, 2012, from http://www.livestrong.com/article/289787-hand-washing-vs-hand-sanitizer-in-the-hospital/Image retrieved from:http://blogs.orlandosentinel.com/features_momsatwork/files/2010/03/towels.jpg
  • If hands are not visibly soiled, alcohol rub is sufficient, which saves time and is easy to implement through the hospital.Image retrieved from:http://www.nursinghomeabuseadvocateblog.com/uploads/image/Blog%20-%20Handwashing%202.jpg
  • Faster and of greater efficacy than soap & water handwashingImproved accessibilityNo sinks (plumbing) requiredIn rooms, corridors, nursing stationsEffective against wide array of organismsCurrent Best Practices in Hand Hygiene. (n.d.). Retrieved January 16, 2012, from http://www.webbertraining.com/files/library/docs/117.pdfImage sourced from:http://www.wormsandgermsblog.com/uploads/image/HandsHygiene_Logo_1%201.JPG
  • Constraints vs. Outcome in regards to Hand Hygiene Compliance

    1. 1. Constraints vs. Outcomein regards to Hand Hygiene ComplianceJess Morritt
    2. 2. Some Facts• Strict compliance with hand hygiene occupies at least one quarter of nursing time• Implementing strict practices may affect the quality of patient care• Modern neonatal nursing emphasizes the concepts of minimal handling• Clustering of nursing care
    3. 3. Skin Irritation• Soaps and detergents can damage skin when applied on a regular basis• Better information is needed about the possible effects of hand hygiene agents• Lack of knowledge and education on this topic is a key barrier to motivation• Emollients and hand lotions help to protect skin and may reduce microbialshedding
    4. 4. Skin Irritation: Possible Solutions • Providing hand lotions or creams to minimize the occurrence of irritant contact dermatitis associated with hand hygiene action
    5. 5. Sink Availability• Adherence with hand hygiene with varying sink‐to‐bed ratios• Adherence was less than 50% in all units and there was no significant trend toward improved hand hygiene with increased sink‐to‐bed ratios
    6. 6. Lack of Soap and Paper Towels • Use of soap and water on hands soiled with visible dirt or contaminant • Soap mixes better with dirt and soil on the surface of the skin to clean them more thoroughly
    7. 7. Time Constraints• If hands are not visibly soiled, alcohol rub is sufficient, which saves time and is easy to implement through the hospital.
    8. 8. Advantages of alcohol-based handantisepsis vs. handwashing • Faster and of greater efficacy than soap & water handwashing • Improved accessibility ▫ No sinks (plumbing) required ▫ In rooms, corridors, nursing stations • Effective against wide array of organisms
    9. 9. Ethical Considerations• The ethical constraints we are highlighting here; is that there is a limit to the amount of resources ie. time and money, that can be put into an initiative to maintain it• Hand hygiene for example, is also dependent on motivation to comply with these guidelines is dependant on the staff, their morals and their training

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