FMHU5000 Infection Prevention And Control In Healthcare.docx
1. FMHU5000 Infection Prevention And Control In Healthcare
Answers:
Introduction
Hand hygiene is concerned with the cleanliness of hands to prevent any germs and
infections from entering the body via hands. It includes washing hands with soap and water
or alcohol-based sanitizer for the reduction of microorganisms on the surface of the
hands (ACSQHC, 2019). With the onset of the COVID-19 pandemic, hand hygiene became an
essential part of lifestyle and routine and its significance increased more than ever
especially in the healthcare sector since healthcare workers work in environments where
they are continuously exposed to contacting contagious viruses (Wang, et al., 2021).
Residents at aged care facilities are more prone to infections of the skin, respiratory or
urinary tract because most have an underlying disease, physical or psychological problems,
and use devices like catheters. They are also in frequent contact with staff and other
residents rendering them susceptible to catching any virus (Bennett, et al., 2018). Hand
hygiene becomes important in aged care facilities as elders are more vulnerable to
infectious diseases because most elders have chronic health conditions and the body’s
immunity levels decrease with age (Mueller, et al., 2020). But there is a proper way of
washing hands as shown in figure 1 which should be followed to ensure maximum
protection from viruses. This essay is a critical evaluation of hand hygiene in residential
aged care facilities in Australia. The essay will explore the meaning and importance of hand
hygiene for the prevention of viral diseases. Additionally, the essay will identify and discuss
the problems in practicing hand hygiene such as lack of proper compliance and the
interventions that are made to improve the problem. The essay will also confer the need
and process of implementing such interventions and the problems faced during the
communication of interventions. Finally, the essay will evaluate the interventions to find out
if they are effective and whether any further interventions are needed.
Figure 1
Source: (Duda, 2020)
2. Background And Context
Practicing hand hygiene and educating the residents at aged care facilities is one of the most
effective ways of fighting infections. Hygiene in hospitals and residential aged care facilities
is crucial in reducing morbidities and prolonged stay at hospitals among patients and
residents (Engdaw, et al., 2019). People frequently touch surfaces and unknowingly invite
many germs on their hands. These germs can pass from person to person through hand-
shakes and can enter the body through the eyes, nose, ears, or mouth because people
generally touch these body parts a lot of times. Hand hygiene can contribute up to 50%
prevention of infections if practiced effectively (WHO, 2021). Hence, hand hygiene is an
important factor to consider for precautionary measures against infectious diseases.
Hand hygiene should be implemented in aged care facilities and the residents and staff
should be educated about the importance and correct implementation of it. The caregivers
at these facilities should be aware of the times at which they should wash their hands to
avoid infections. There are 5 important moments before or after which handwashing is
necessary (figure 2). These moments are before performing any medical examination
(blood pressure test), before insertion of devices like nasal cannula, after insertion of a
catheter, after assisting the residents in bathing, and after coming in contact with resident’s
surrounding objects (Mun Global, 2020). Taking care of these things will ensure maximum
protection of the residents from exposure to harmful viruses.
Figure 2
Source: (Mun Global, 2020)
But the problem arises when there is not enough compliance to the hand hygiene guidelines
among people. Poor compliance can be because of a lack of awareness regarding hygienic
practices. The most common reason for non-compliance of hand hygiene among healthcare
workers is inaccessibility to sink and the attitude of “others do not do it. Why should I?”
(Figure 3). It can be the same for caregivers and residents at residential aged care. This
needs to be addressed by spreading awareness and letting them know the purpose behind
hand washing.
Figure 3
Source: (Engdaw, et al., 2019)
The reasons behind poor compliance in residential aged care facilities could be
3. inaccessibility to sinks, handwash products causing skin damage and irritation, and a lack of
knowledge regarding proper ways to wash hands and its implications. Elders are less likely
to walk long distances to wash hands and the location and visibility of sinks directly impact
the frequency of times people wash their hands (Deyneko, et al., 2016). Risks of skin
infections also increase with age because with age there are changes in skin structure with
the thinning of dermis and epidermis and fragmentation of elastic and collagen (Chambers
& Vukmanovic-Stejic, 2019). Frequent handwashing can lead to skin drying and skin rash.
These issues need to be addressed to ensure adherence to hand hygiene guidelines.
Interventions to solve these issues become important for promoting better hand hygiene
and the reduction of viral diseases. This becomes even more significant in the present times
because of the rampant global pandemic called Corona which is caused by a SARS-CoV-2
virus that adversely affects people’s respiratory tract. Hand hygiene has proved to be the
most effective way of preventing viruses and residents should be encouraged to wash their
hands before eating and after using the toilet as a minimum (Doherty Institute, 2018).
Promoting these habits will result in the active containment of viruses in old-age homes.
Identification of barriers to hand hygiene can help implement suitable interventions that
can work in many ways to improve compliance with hand hygiene. Education about hand
hygiene and the right ways to wash hands can encourage people to adopt correct
techniques contributing to better outcomes. Audit and feedback after implementation help
in ensuring continuous compliance to rules. Reminders at specific time intervals can compel
people to take action. Finding out about people’s problems with hygiene products and
accessibility to sinks can encourage proper interventions in this area as well (Gould, et al.,
2017). Getting the staff to actively participate in practicing and promoting hand hygiene will
also help to a large extent. This shows that compliance with hand hygiene can be increased
through the right interventions.
Strategy
To warrant maximum compliance to hand hygiene, education can prove to be a great tool.
Educating the residents and caregivers at residential aged care facilities about the risks of
infections from poor hand hygiene, how bacteria travel from hand to body, the effectiveness
of washing hands regularly, and the positive impact of hand hygiene on their health can be
beneficial for ensuring adherence to hand hygiene guidelines (Yang, et al., 2019). Raising
awareness through teaching will improve hand hygiene behaviours among residents.
The care providers at aged care homes should be provided with adequate knowledge about
the right way of practicing hand hygiene. Government guidelines advocate for care
providers to wash their hands at 5 important moments that are: before touching the
residents or doing their routine health check-up, after touching the resident or anything in
his surrounding environment like bed-linen, after a procedure in which there has been a
body substance exposure (NHMRC, 2019). This will ensure that they do not knowingly or
4. unknowingly expose the older adults to any viruses.
Intervention for preventing any skin infection or rash among the residents is also important
since their skin is more sensitive. Many factors can lead to dermatitis such as preservatives
or fragrances in ABHR, washing hands regularly that may contribute to skin drying, using
hot water to wash hands, use of low-quality paper towels, or not using enough
moisturizers (Hand Hygiene Australia, 2022). This can be avoided by providing the
residents with hand rubs, soaps, or paper towels according to their specific needs and
preferences (NHMRC, 2019). There should be the availability of moisturizers at all times to
prevent skin drying. This will ensure the elimination of skin problem risks and maximum
compliance to hand washing throughout the day.
One more intervention can be setting reminders for the residents at specific time intervals
to remind them of washing hands if they forget. These reminders can be vibration, bells,
light sound, or even human announcements (before eating, after using washrooms, or after
doing some activity that included touching surfaces of things) to gently remind them to
wash or sanitize their hands. Data shows that there has been a significantly positive effect of
voice reminders on handwashing (figure 4). The graph shows how at first without voice
reminders the compliance to hand hygiene was low and it increased drastically after using
reminders. Then again when reminders were turned off, there was a drop in handwash
compliance which again increased after turning them back on. This proves the effectiveness
of reminders in improving compliance with hand hygiene.
Figure 4
Source: (Hermann, 2019)
Another intervention would be to improve the accessibility of hygiene products. If these
products are within reach and there is little to no effort required to reach and use them,
then hand hygiene practices will be more disciplined. Sinks or ABHR should be conveniently
situated at places that are easily accessible and there should be no shortage of sinks. This is
a proven way to implement effective hand hygiene in healthcare or aged care centres.
Creating a culture that encourages a positive attitude towards hand hygiene will also help to
a great extent. This has to be done at all levels of management at the facility for maximum
benefits. This type of culture can be created through promotion of hygienic packaging for
products that are used in the facility, installation of systems that provide for limited touch,
providing better accessibility to sinks, keeping all the places within and surrounding the
facility clean and hygienic, making a strategy for the long-term and ensuring procurement of
hygiene equipment is cost-efficient (Veridia, 2021). The creation of culture will contribute
to the creation of hygienic values among all the residents, staff, and management of the
5. facility and will have a long-term positive effect.
Feedback is another intervention that should be implemented to evaluate how much
adherence there has been to the guidelines for hand hygiene. It is believed to motivate
people to keep up with good hygiene practices but research and survey show that feedback
does not have an impact on hand hygiene behaviours (Scherer, et al., 2019). But the
importance of feedback should not be completely ignored. Implementing technological and
automatic ways of recording and evaluating hand hygiene behaviour regularly can help in
comparing the actual performance to the set standards, finding deviations, identifying
reasons for those deviations, and then finally making a strategy to eradicate the root cause
of the deviation (Theißen, 2019).
Evaluation
Implementing the interventions is not enough, it needs to be made sure whether the
interventions are working and are having a decent impact on hand hygiene compliance or
not. Various evaluation methods are used to measure compliance to hand hygiene
guidelines. These evaluation methods help improve hand hygiene compliance since people
tend to be more disciplined when they are being monitored. Studies have shown a visible
difference in compliance before and after observation and monitoring (Lenglet, et al., 2019).
Hence, it can be said that evaluation is necessary for hand hygiene compliance at aged care
facilities.
Monitoring can be done through various direct or indirect methods. Observation is a direct
method wherein a trained observer is appointed to first calculate all the opportunities
(appropriate times for handwashing) and then observe how much these opportunities are
being utilized by people to assess compliance. This method can be very useful in the way
that it provides directly observed data and is done by a professional observer. However, it
requires the facility to hire the right observer who is trained and experienced enough to do
this and is willing to work long hours. One more problem with this method is that it is
subjected to the observer’s own biases that can negatively impact the credibility of the data
collected (Masroor, et al., 2017). The indirect method is to measure the hygiene product
usage across a specified period. This is done by measuring how much the product (paper
towels, hand rubs, and soap) has been used and then this data is used to estimate the
number of hygiene events that took place. It is a cost-effective method and does not require
any trained observer which is why it is free from any biases but observing the quantity of
products is not a clear indicator of whether all the handwashing events happened at
appropriate times or not (Masroor, et al., 2017). Both of these methods are cost-saving and
can be adopted in facilities with limited resources and can help in improving obedience to
hand hygiene.
Automated systems can be installed at the facility to evaluate performance without human
efforts. These automated systems can be used to electronically monitor the use of sinks and
6. hand rubs. This will provide precise quantitative data and cost will only be included in the
installation and repair of the systems. The electronic system can also be used to set
reminders for hand washing and for providing feedback data. Studies have shown a
significant increase in hand hygiene compliance when feedback and reminder systems are
used together (Hayashi, et al., 2016). Embedded reminder systems have shown an increase
of 97% in compliance and a decrease of 90% in cross-contamination (Lorenzi, 2021). This
shows the relevance of automated systems in improving hand hygiene at facilities.
Auditing is used to evaluate the effectiveness of hand hygiene programs. The Australian
Commission on Safety and Quality in Healthcare provides facilities with an auditing tool
called HHCApp which can be used to audit hand hygiene compliance with the 5 moments
guidelines (ACSQHC, 2021). Currently, this tool is recommended for facilities with great
staff/resident activities for recording and auditing a higher number of moments in a short
period. As per studies, groups, where auditing and feedback are used, show less compliance
(50%) than groups where incentives are used as an intervention (78%) but the compliance
here was more sustainable than any other intervention’s compliance (figure 5). Therefore,
auditing can be used to increase the compliance of residents and staff in aged care facilities.
Figure 5
Source: (Moghnieh, et al., 2017)
Australian government’s Hand hygiene Initiative that advocates for strategic interventions
and auditing in accordance with the 5-moment hand hygiene has been effective in
improving hand hygiene compliance in healthcare workers. Since, its inception in 2009, the
participation and compliance for hand hygiene in healthcare facilities has only increased
which shows how much effective it is for controlling infections through hand hygiene
(figure 6). This compliance has been consistently increasing even after the 2020 audit in
which the compliance for National Hand Hygiene reached 88.2% (figure 7). This proves that
the government of Australia is dedicated to improving the hand hygiene of the country to
prevent infectious diseases and their Hand Hygiene Initiative can help aged care facilities to
implement significant changes for hand hygiene.
Figure 6
Source: (Grayson, et al., 2018)
7. Figure 7
Source: (AIHW, 2022)
One more technology-oriented method for the evaluation of compliance is video-
surveillance systems. This can be done through the installation of cameras at places near
the sink and hand rubs to monitor the hand hygiene behaviour among the residents and
staff (Mckay, et al., 2020). This method can be beneficial because of the objectivity in
observation but it can be a little expensive. Also, cameras should only be installed with the
prior permission of everyone to avoid a breach of privacy. This technology in aged care
facilities can improve real-time data collection and can compel the residents to improve
their hygiene behaviour.
Conclusion
To conclude, hand hygiene means keeping the hands clean and free from foreign germs and
bacteria. It is done through handwashing with the help of soap and water or alcohol-based
hand rubs. Hand hygiene is important because it is said to be the backbone for preventing
infectious diseases and it became all the more important after the onset of global pandemic
Corona. Older adults are more vulnerable to infections which is why hand hygiene has to be
followed in residential aged-care facilities properly.
In this regard, the government of Australia has implemented the Hand Hygiene Initiative
that aims to improve hand hygiene in healthcare facilities. In aged-care facilities, the staff
has to follow the 5 moments approach for handwashing at appropriate times. These
moments include times before and after coming in contact with the residents or their
environmental things.
However, there are many hurdles in ensuring proper compliance to hand hygiene
guidelines. These include lack of knowledge of the importance and proper ways of
handwashing among residents and staff at facilities, faraway placement of sinks and ABHR,
the negative impact of frequent handwashing on the skin of the older adults, and
undisciplined behaviour of people towards hand hygiene.
These barriers can be solved with the right interventions such as education programs to
raise awareness towards hand hygiene, providing the residents with products that meet
their specific preferences and do not harm their skin, correct placement of sinks that will
make them accessible by everyone, installation of reminder systems to remind people of
handwashing at appropriate times, and implementing a monitoring/feedback system to
ensure that everyone is following the correct hygiene behaviour.
The interventions have to be measured regularly. This helps in continuous compliance and
positive behaviour towards hand hygiene. Evaluation can be done through direct
8. monitoring (hiring a trained observer who will calculate the opportunities for handwashing
and will monitor residents’ behaviour according to that) and indirect monitoring through
measurement of the quantity of hygiene products. This can also be done through a video
surveillance system through the placement of cameras near sinks and hand rubs. Another
way is auditing for which tools are provided by ACSQHC but it is recommended to be used
in facilities with more staff/resident interactions to collect and audit more data in lesser
time. Auditing has proved to result in sustainable compliance. All this shows that the
problems with hand hygiene can be solved through the right interventions and those
interventions can be evaluated through various techniques for improving compliance to
hand hygiene.
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