Table of contents
Solutions based on the 5A’s Evidence Based Practice approach.
Ask: Appropriate research question for the problem..
Access: Identification of the most up-to-date interventions or strategies for achieving evidence-based practice
Appraise: Evaluation of the quality of evidence identified using appropriate resources 250.
Apply: Barriers and enablers of interventions.
Assess: The ways to measure the success of interventions against the problem..
Evidence based nursing refers to an approach to provide nursing based care on the basis of personal clinical expertise by collecting, processing and implementing research findings. It helps in making quality decisions, solve clinical problems and provide most cost-efficient care to the people. The present study analyses 5A’s Evidence Based Practice approach to identify the solutions for maintaining hand hygiene protocols for the healthcare professions in a medical ward. Research questions are made and appropriate interventions as well as their benefits and challenges are analysed on the basis of current and relevant literature.
Are direct observation and consumption of health hygiene products effective to develop hand hygiene compliance among the healthcare professionals?
As per the case scenario, 30% of the healthcare professionals have compliance with the hand hygiene protocols. Poor hand hygiene creates health risks for the patients. It is identified that transmission of the healthcare associated pathogens to the people through direct and indirect contract that increases healthcare infections. Therefore, proper health hygiene protocols are required to spread antimicrobial resistances and prevent HCAI (Orr et al., 2016). Therefore, the effectiveness of some healthcare measures or strategies like education, regular monitoring, feedback, availability of cleansing products are analysed in this study. The importance of strategies for evidence-based practices are also analysed on the basis of recent and relevant literature to determine the effectiveness of these strategies. It also evaluates whether participation of the professionals is necessary to increase 70% compliance.
As per the guidelines of WHO (World Health Organisation) on “Hand Hygiene in Health Care 2009” that direct observation and consumption of health hygiene products can be taken by the healthcare organisations to increase hand hygiene compliance (WHO, 2020). Some methodologies like Education, audit of hand hygiene practices, performance feedback, reminders and improvement of availability of water, soap and alcohol-based hand rub are effective to hand hygiene compliance among the healthcare professionals. Alongside, it is necessary for the healthcare organisation to monitor the infection rates to track emerging drug resistant pathogens and infectious diseases that can be conducted due to lack of hand hygiene protocols. It has been observed that microorganisms are able to survive at least several minutes on healthcare workers that can spread to the skin of the patients and immediate environment of the patients. Average of 38.7% of the healthcare professions has maintained hand hygiene according to a research (Butenko et al., 2017).
Moreover, lack of active participation in hand hygiene promotion, lack of institutional policies and administrative sanctions of non-compliers affect the safety climate of healthcare organizations. It has increased the epidemic “Health Claims for Auto Insurance (HCAI)” and has increased costs of care and affected the reputation of the organisations (Alzyood et al., 2018). Therefore, participation of the healthcare professionals in hygiene programs and rewards for the compilers are useful for enhancing motivation of the healthcare professional to maintain hand hygiene. a multidisciplinary design and response team can be created by the organization administrators to increase commitment to hand-hygiene compliance. Education and training is required for staff and pocket cards, brochures and posters can be used to educate patients and patient families about hand hygiene.
Reinforcement of hand-hygiene behaviour and accountability through conducting contests and recognising healthcare workers as well as reminders throughout the healthcare setting is effective to improve hand hygiene protocols. A report needs to be created by the organisations in which real-time feedback can be taken from the professions, observers and patients to develop a proper monitoring program. According to “Hand Hygiene Australia (HHA)”, core components that are required for the healthcare professionals to improve hand hygiene are alcohol-based hand rub at the point-of-care, education and performance feedback of the staff (Hand Hygiene Australia, 2020). Submission of compliances data by “Infection Prevention & Control Unit” is necessary to create awareness about hand hygiene among the professionals.
The healthcare workers working for operation theatres need to sterilise their hands before and after operations as well as use of water and soap is necessary to remove the microorganisms. “The Department of Health and Human Services (DHHS)” of Australia assures a safe and healthy working environment for the staff and some reliable indicators are set for hand hygiene compliances (Pires & Pittet, 2017). As per the obligations, all care staff need to be “bare below the elbows” for infection control, nails should be kept short and any breached skin must be covered with waterproof dressings. Additionally, appropriate resources need to be deployed and the professionals need to maintain the local organisational policies regarding hand-hygiene.
The evidence of interventions are collected from different medical literature and resources along with Australian healthcare data setting to determine the strategies for maintaining hand hygiene. The level of certainty of the evidence for different interventions is analysed. It is identified that Education and scent may improve hand hygiene compliance but there is low certainty of evidence but Placement of alcohol-based hand rubs close to the point of use slightly improves hand hygiene compliance and it has moderate centrality of evidence. Performance feedback improves hygiene compliance but it has low certainty of evidence. Randomised trials are conducted to make multimodal interventions (John & Armstrong, 2017).
“Hand Hygiene Australia (HHA)” provides necessary resources and services to implement the hand hygiene improvement programs and supports the hygiene education to prevent health related infections. 5 moments of hand hygiene program is conducted based on Hand Hygiene Australia online learning package to maintain the record of hand hygiene among the health professions. “Australian Commission on Safety and Quality in Health Care (ACSQHC)” HCAI strategies are implemented by DHHS to take hand hygiene initiative and report the healthcare associated infections. Relevant care protocols are outlined and directed by the Secretary or Minister for Health to maintain safety and quality in the medical unit and monitor the program (Li et al., 2017).
It has been witnessed that the rural terrains in Australia are reluctant to manifest hand hygiene as a part of their culture. The basic reason for this is that the people are of the view that excess time on hand hygiene is of no consequence to their health. A survey released by ‘The Brisbane Times’ revealed that more than 65% of the citizens in Australia are prone to allergic hindrances as well as they face irritation on the skin owing to usage of hand hygiene agents (Butenko, Lockwood & McArthur, 2017). The interference with HCW-patient relationships is also one of the key reasons due to which the customers in Australia do not consider buying hand hygiene agents as a part of their health interventions.
Of late, there has also been a decrease in the supply of hand hygiene agents owing to the Covid-19 pandemic in Australia. There is an intense shortage of hand hygiene agents in Australia due to which the people are citing other means of hand hygiene.
However, it has also been seen that the rise in awareness among the local public in Australia has also led the people to manifest hand hygiene agents of primary importance. The educational pattern in Australia has also made the local people worry about their health (McLaws & Kwok, 2018). This is a great sight on the part of citizens of Australia to make sure that they are totally secured in a perfect ambience. Thus, the healthcare personnel in Australia have also shifted to enhancement of personal hygiene levels by usage of gloves while working with medical instruments for their own safety.
There has been an enhancement in the rise of communicable diseases among the health professionals in Australia in the recent past. Therefore, proper hand hygiene interventions can be measured by the decrease in the number of diseases caused owing to communicable diseases. The pharmaceutical companies are also taking steps to manufacture hand hygiene products which do not have chemicals which cause allergic reactions on the skin (Barr et al., 2017). Australian pharmaceutical industries have made progress in manufacturing chemicals which have a soothing effect on the skin and therefore can be preferred by the local folk. Henceforth, the number of people who are using hand hygiene chemicals as an essential aspect for maintenance of hand hygiene can also set a benchmark in developing the base for better health aspects.
In conclusion, hand hygiene is necessary for the healthcare professions to prevent the infection from microorganisms. It is necessary to provide education and training to the professionals, cleaning products like water, soap and alcohol-based hand rubs to increase hygiene compliance. The healthcare organisations need to monitor and take performance feedback to reduce hand hygiene issues. However, it has been seen that the healthcare professionals in Australia are reluctant to the usage of hand hygiene products owing to the skin irritation issues. The availability of the hand hygiene products has also been one of the problems owing to the Covid-19 pandemic.
Alzyood, M., Jackson, D., Brooke, J., & Aveyard, H. (2018). An integrative review exploring the perceptions of patients and healthcare professionals towards patient involvement in promoting hand hygiene compliance in the hospital setting. Journal of clinical nursing, 27(7-8), 1329-1345. https://opus.lib.uts.edu.au/bitstream/10453/127079/4/An%20integrative%20review%20exploring%20the%20perceptions%20of%20patients%20and%20healthcare%20professionals_am.pdf
Barr, N., Holmes, M., Roiko, A., Dunn, P., & Lord, B. (2017). Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care. American Journal Of Infection Control, 45(7), 771-778. https://doi.org/10.1016/j.ajic.2017.02.020
Butenko, S., Lockwood, C., & McArthur, A. (2017). Patient experiences of partnering with healthcare professionals for hand hygiene compliance. JBI Database Of Systematic Reviews And Implementation Reports, 15(6), 1645-1670. https://doi.org/10.11124/jbisrir-2016-003001
Hand Hygiene Australia (2020). Hand Hygiene policies and standards. Retrieved 24 August 2020, from https://www.hha.org.au/
John, K., & Armstrong, M. (2017). Non-compliance and hospital acquired infection: Using design methodologies to improve hand hygiene practices. Infection, Disease & Health, 22, S13. https://idhjournal.com/article/S2468-0451(17)30182-7/pdf
Li, S. M. J., Ryan, E., Thomas, V., Pan, Y., Callard, M., Smuts, A., ... & Maley, M. (2017). Hand hygiene–Relaying the message at five hospitals in the South Western Sydney local health district in 2017. Infection, Disease & Health, 22, S10. https://idhjournal.com/article/S2468-0451(17)30166-9/pdf
McLaws, M. L., & Kwok, Y. L. A. (2018). Hand hygiene compliance rates: fact or fiction?. American Journal of Infection Control, 46(8), 876-880. https://www.researchgate.net/profile/ML_Mclaws2/publication/325270893_Hand_hygiene_compliance_rates_Fact_or_fiction/links/5b459cdcaca272dc385f67ac/Hand-hygiene-compliance-rates-Fact-or-fiction.pdf
Orr, E., Bennett, N., Bradford, J., Johnson, S., Bull, A., Richards, M. J., & Worth, L. J. (2016). Hand hygiene monitoring in residential aged care: National and international perspectives with relevance to Australian facilities. Infection, Disease & Health, 21(3), 129. https://www.idhjournal.com.au/article/S2468-0451(16)30142-0/pdf
Pires, D., & Pittet, D. (2017). Hand hygiene mantra: teach, monitor, improve, and celebrate. Journal of hospital infection, 95(4), 335-337. https://www.journalofhospitalinfection.com/article/S0195-6701(17)30140-8/fulltext
WHO (2020). WHO guidelines on hand hygiene in health care. Retrieved 24 August 2020, from https://www.who.int/gpsc/5may/tools/9789241597906/en/
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