Factors Affecting Hand Hygiene Compliance in Intensive Care Units
- Introduction, Identification and relevance of topic
In the world of health and medical studies there is a term named HAI which is abbreviated for Hospital Acquired Infections. HAI’s are a major problem in health industry. HAI’s are also identified by World Health Organization as a top priority for Global Patient Safety Challenge. Around the world there are 1.4 million cases of hospital acquired infections. This article was written to assist forming an understanding of hospital acquired infections are and how they affect our daily lives. This article also gave some insights into how we can avoid hand hygiene compliance in intensive care units. According to an estimate given in the article hospital acquired infections can result in 14 extra days in hospital until you can fully recover. By eliminating hospital acquired infections we can also save millions of people trouble of paying much extra in treatment and get to a safe recovery point soon.
A brief introduction to hand hygiene is also given stating all the facts about the topic. Author has researched and presented results about individual factors affecting the hand hygiene compliance. The abstract of the article is very concise and aim, background and methods are also to the point which makes it statistically relevant.
- Literature review
The literature provided in the article very much helped author to accurately portray his findings and to support his claim. Author has referenced and used World Health Organization and its researches several times as it is a very reliable source. Overall to review and gather information about factors affecting the hand hygiene compliance author used like Medline (Ovid), PubMed, and EBSOHost. Hand Hygiene refers to generally wash hands to make sure they are germ free to avoid contact with germs and transferring of germs across people. Hands can be sanitized generally by washing them off by water, antiseptic or any type of anti-bacterial soap. As the paper mainly focuses on hand hygiene compliance in ICU’s so literature review is done using articles like, studies conducted on subjects which are health care workers and they work in Intensive care units. Original studies are also included about facts stating hand hygiene compliance. Some researches about general hospital settings are also mentioned so that there should be a balance of facts while arguing. Studies not focusing mainly on factors affecting HH compliance are not included so this is a to the point article proving arguments of the author. This article appears to be providing facts affecting HH compliance in ICU’s on two different levels i.e. Individual and Institutional. Moreover, author made sure that the literature included in the article convince the point being proved and it did a great job. According to this study a lot of illness can be avoided just by making hand hygiene sure. There is a perfect balance of the literature provided in the article.
The author of the article chose quantitative design for the research. A total of 1206 papers were selected for the literature review. Out of those 1206, 823 papers were excluded as they were interventional studies and 383 potentially papers were screened based on regulations made to make sure that the review or paper is neutral and based on accurate and updated facts. Out of those 383 only 14 papers were selected for this systematic review. Studies were selected on the basis of several factors covered in previous works based on observational prospective cohort study, survey, questionnaires based on theory of planned behavior and direct observational. Out of 14 studies selected for the article 11 were observational studies so the article itself is a observational type focusing on real life data for the HH compliance.
While carrying out the research on those studies several important factors were pointed out which affected Hand Hygiene Compliance. Shocking facts were introduced that only 17 – 19% physicians adhere to hand hygiene compliance. Among other facts there were age, gender, behavior determinants, disrupted workflow, level of working experience, level of contact with hands, excessive use of gloves, perception of being a model, awareness of being observed, and forgetful in washing hands. Other institutional factors included Workload, Type of ICU’s, use of alcohol-based hand hygiene products, lack of sinks and administrative apathy.
- Ethics consideration
The chief priority with ethics is that the participants are protected and informed adequately prior to commencement of the study and again at its conclusion. (Richardson-Tench, 2011) As this articles were purely observational and was based on several studies conducted on the HH compliance so there were no direct subjects in front of the author. 14 studies selected for the article included several hundred subjects studied over a bunch of different study designs and different sample sizes and those subjects were informed of the study being conducted both before and after.
- Significant results
Studies conducted and results were divided into two categories that were affecting hand hygiene compliance in intensive care units. Results concluded that a number of important individual factors were affecting hand hygiene practices across ICU’s. These included professional category, awareness of being observed, age, gender, use of gloves, behavior determinants, hand irritation and dryness, contagious status of patients, disrupted workflow, perception of being a model and forgetfulness. Of all the individual factors being studied fundamental differences in origin and attitude towards HH compliance among different type of professional groups definitely draws different patterns of HH compliance. Despite of the studies being conducted large rate of HH compliance originated in intensive care units as compared to other facilities. This is due to higher number of hand hygiene and contact in intensive care units. High workload and mutual care by a single physician to different patients increases the risk of HH compliance. To sum up the individual factors we can say that where there is greater need for hand hygiene there is low rate of compliance. This also states the fact that intensive care units have always lowest compliance rates compared to other facilities.
Institution, Hospital or medical facility also affects the compliance rate. Factors including workload, use of alcohol-based hand hygiene products, type of ICU, poor availability of sinks and health hygiene products and administrative environment are all related to the HH compliance. Higher compliance rate was observed in neonatal intensive care unit compared to other types of intensive care units. This was because of lower intensity of care in NICU. Generally comparing all health care workers there is greater chance of HH compliance in intensive care units. All systematic reviews of studies conducted result in consistent compliance rate among intensive care units. Further studies can reveal the reason behind this fact. As high work load is a key factor in HH compliance at both individual and institutional level so releasing workload in health care worker may result in low compliance rates.
- Discussion / Reflective critique
Detailed analysis of the article reveals factors which can increase and decrease hand hygiene compliance rates in health care workers residing in intensive care units. In order to analyze the effects of hand hygiene compliance there should be put standards. If there are standards and the interventions deployed in intensive care units are systematically reviewed, then we can definitely improve health safety and benefit a large number of patients. This article provides a wide overview of the factors affecting HH compliance and how they were studied but there are no accurate directions to practice hand hygiene and avoid hospital infected diseases. Article is limited in a sense that the studies were conducted on western culture and HH practices vary across the globe. All of the studies included were observed on different genders, age groups and opportunities so there is no standard way to compare them.
We can never achieve 100% submission rates in hand hygiene practices. But we can improve its percentage by implementing several interventions presented by the author in this article.
- Education with performance feedback
Education to health care workers with performance feedback can definitely improve their adherence to hand hygiene practices in intensive care units.
- Tailor-made interventions for different professional categories
As the reason for hand hygiene compliance is different in each professional category so there should be tailor made interventions for each category to achieve better results.
- Decrease workload
High workload also is the reason behind hand hygiene compliance which can be eliminated by promoting alcohol-based hand sanitizers which decrease the time by conventional hand sanitization.
- Tackle hand irritation and dryness
Hand irritation and dryness to be avoided by health care workers in order to avoid irritant contact.
- Keep HCWs alert
Posters and awareness signs should be put up in medical facilities.
- Enhance behavior determinants
Attitude of HCW’s towards HH compliance can be improved by education and motivation.
- Increase awareness of being observed
Accreditation visits and audits are needed to prompt health care workers that in result can improve their behaviors.
- System level initiative
System level change is needed to change the mindset of people and avoid hospital infected diseases.
- External motivator and compatible hospital policies
Furnishing with good HH products and rewards on good HH practices can also result in lower compliance rates.
Lau, C. (2012a). Factors affecting hand hygiene compliance in intensive care units. Retrieved from http://hub.hku.hk/bitstream/10722/179908/1/FullText.pdf?accept=1
Richardson-Tench, M (20-1 1). Research in nursing: evidence for best practice (4lh ed.. ed.). South Melbourne, Vic.:Cengage Learning.
World Health Organization. WHO guidelines on hand hygiene in health care. First global
patient safety challenge: clean care is safe care: WHO, 2009