MEDICAL the surveyor should consider: — “Will the results

MEDICAL TECHNOLOGY PROJECT

 

 

MEASUREment
and COMPLIANCE of HAND HYGIENE

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Karen quinlan k00132819

 

Medical technology project year 3 2017

 

 

 

RESEARCH
QUESTION INTRODUCTION:

“Hand hygiene is the single most important
measure in preventing spread of infection. Hand hygiene refers to both hand
washing with soap and water or hand rub using an alcohol gel/rub (without the
use of water). There are three recommended levels of hand hygiene to ensure
that the hand hygiene performed is suitable for the task being undertaken.”
(Sari, 2005)

Hand hygiene in the healthcare setting reduces the
transmission of any types of pathogens and the occurrence of healthcare associated
infections. The use of gloves does not compensate for the lack of correct hand
hygiene.

 

 

Are people
generally aware that there is a correct method for handwashing?

How
effective is Hand Hygiene in LIT, example of the general public?

Do people
know how to wash their hands correctly and the implications of not using the
correct method?

LITERARY
REVIEW

 

LITERATURE
REVIEW ON CONDUCTING SURVEY

“The principal objectives of a survey
should always be to collect reliable, valid, and unbiased data from a
representative sample, in a timely manner and within resource constraints.”
(McColl, 2001, p1.)

However the
Joint Commission (2009) advises that where hand hygiene surveys are conducted
the surveyor should consider:  

—    
“Will the
results accurately represent the population?

—    
Will
everyone in the survey population have an equal opportunity to respond? — What
is your desired response rate?

—    
How much
follow-up is needed to obtain that response rate?

—    
What might
the differences be between survey responders and non-responders?

–         
How
readable and understandable are the survey questions, particularly to
non-health care workers?” (p64)

 

 

 

 

 

 

Huge emphasis
is currently placed on reducing healthcare-associated infection through
improving hand hygiene compliance
among healthcare professionals. It is perceived by the media that there is poor
hand hygiene compliance among healthcare staff. The aim was to report the
outcomes of a systematic search for peer reviewed and published studies. As well
as clinical trials which focused on hand hygiene compliance among healthcare
professionals. Searches were done on the topic of hand hygiene from Literature
published between December 2009, after publication of the World Health
Organization (WHO) hand hygiene guidelines, and February 2014, which was
indexed in PubMed and CINAHL on the topic.

There were
examinations of relevance and methodology of fifty seven publications initially
and sixteen clinical trials were used.  Most of the studies were conducted in the USA
and Europe. The intensive care unit was the primary focus, followed by care of
the elderly facilities.   The Nurse was
the focus of healthcare workers, followed by the healthcare assistant and then
the doctor. Four studies used for analysis ‘my five moments for hand hygiene’ as
set out in the WHO guidelines, the others unique multimodal designs of analysis.
The conclusion was using adopting a multimodal approach to hand hygiene,
whether guided by the WHO framework or by another testing framework, resulted
in moderate improvements in hand hygiene compliance.

 Of the sixteen papers reviewed, four research
designs were explicitly guided by the ‘my five moments for hand hygiene’
framework, as set out in the WHO guidelines.

 Locally designed multimodal approaches using
various unique behavioural approaches and even though there was a lack of
uniformity in these approaches, positive outcomes were achieved.  Adopting a multimodal approach to hand
hygiene improvement intervention strategies, whether guided by the WHO
framework or another tested multimodal framework, has been shown to achieve
slight to moderate improvements in hand hygiene compliance.

 Other areas for additional research is more
knowledge, attitudes and awareness of future practitioners (e.g. medical and
healthcare students, interns, healthcare facility managers, patients and carers.  Also, the adoption of technology-driven
solutions for both delivery of ABHRs (alcohol based hand rub) and monitoring their
use.  Using such data for analysis of
patient and healthcare professional movements for outbreaks, may lead to
enhanced compliance and understanding of the challenges involved. (Kingston, 2015)

 

CHAPTER 3

 

METHOLOGY

 Indications for hand
hygiene

HAND HYGIENE – DEFINED BY THE WORLD HEALTH ORGANISATION

The 5 Moments for Hand Hygiene approach defines the key
moments when health-care workers should perform hand hygiene.

This evidence-based, field-tested, user-centred approach is
designed to be easy to learn, logical and applicable in a wide range of
settings.

This approach recommends health-care workers to clean their
hands

before
touching a patient,
before
clean/aseptic procedures,
after
body fluid exposure/risk,
after
touching a patient, and
after
touching patient surroundings.

 

 

Clean hands
according to the WHO ‘5 moments for hand hygiene’: – l immediately before each
episode of direct patient contact or care (IB) l immediately before a
clean/aseptic procedure (IB) l immediately after contact with body fluids or
excretions, mucous membranes, non-intact skin or wound dressings (IA) l
immediately after each episode of direct patient contact or care (IB) Immediately
after contact with objects and equipment in the immediate patient environment
(IB) Your 5 Moments for Hand Hygiene.

 

 

 

 

 

 

 

 

SURVEY ON
HAND HYGIENE IN LIMERICK INSTITUTE OF TECHNOLOGY

In December 2017, the Author conducted a Survey of
random students of mixed age and gender. 
The Survey consisted of a UV machine, the property of a nearby hospital
and a gel. The machine was in a public area in view of anyone passing by.  There were many enquiries about the survey
and how it worked.  They were advised
that it was totally anonymous and that they were welcome to get involved. The
participants were asked if they knew there was a correct procedure for
handwashing.  Most were unaware of this,
however, they felt quite confident of their ability to do it correctly.

Everyone was shown a chart, showing a) most
frequently, b) frequently and c) less frequently missed areas on the front and
back of hands. There are different colours on the chart to indicate the
different areas. They were shown the machine, the gel and how it all
worked.  They were invited to use the
machine in order to obtain a result on their performance with their handwashing
technique.  They were given a small
amount of gel which shows up the ultraviolet light on the hands below.

A total of thirty five students were invited to
participate in this anonymous survey. 
Twenty seven agreed to it and eight declined.  It was quite difficult to get agreement initially
as it was seen as their personal hygiene was being evaluated, but after
explaining in detail the reason for the survey, they were put at ease and
agreed and were quite happy afterwards for getting involved.  They were also competing with friends so it
was enjoyable for most.

The UV machine is quite a simple apparatus, yet can
give very interesting results.  It is
lightweight and portable.  It uses normal
domestic power and the light shines downwards on the object being tested.  The conductor of the experiment released a
small amount of UV compatible gel on the participant’s hands and they were
asked to use the same motion as if they were washing with soap, making sure
they covered all the areas of their hands. 
When they had completed doing this and were happy with their attempt,
they were asked to put both hands, palms downwards into the machine.  With the chart beside them, they were able to
check their results especially in the most frequent areas.  They then turned their hands, palms upwards
to check the next results.

Generally most volunteers were happy they had
participated and called over friends to watch. 
Overall the survey was quite successful, it made students think about
their handwashing techniques and how important it may be in a clinical setting
to do it correctly.  They could see quite
clearly how areas can easily be missed and how that may impact a vulnerable
person who is ill and needs basic handwashing to be done before and after
dealing with each patient.  The overall
experience showed the positive impact that good handwashing techniques can
have.  In hospitals, handwashing
solutions could easily be moved to entrances and exits of hospitals, clinics
and GP waiting rooms.  At the moment
these devices are optional but should be compulsory when entering and
exiting.  An easy change could have a
huge impact.

 

 

The table below is broken down into:

1.     
Male/Female

2.     
Most Frequently  (Purple) y/n

3.     
Frequently (Pink) y/n

4.     
Less Frequent (Grey) y/n

MALE/FEMALE             

MOST FREQ
 Y/N
PURPLE

FREQ
Y/N PINK

LESS FREQ
Y/N GREY

TOTAL
YES

TOTAL
NO

CLIENT 
1       M

BACK        
Y
FRONT     
Y

BACK      
N
FRONT   
N

BACK      
N
FRONT   
N

       2

      4

CLIENT 
2       M

BACK        
Y
FRONT     
Y

BACK      
Y
FRONT    
Y

BACK      
Y
FRONT   
N

       5

      1

CLIENT 
3       F

BACK        
Y
FRONT     
Y

BACK       
Y
FRONT    
N

BACK      
N
FRONT   
N

       3

      3

CLIENT 
4       M

BACK        
Y
FRONT     
Y

BACK       
Y
FRONT     
Y

BACK      
Y
FRONT   
N

       5

      1

CLIENT 
5       M

BACK        
Y
FRONT     
Y

BACK       
Y
FRONT    
Y

BACK      
N
FRONT   
Y

       5

      1

CLIENT 
6       M

BACK        
N
FRONT     
Y

BACK       
N
FRONT    
Y

BACK      
N
FRONT    
Y

       3

      3

CLIENT 
7       F

BACK        
Y
FRONT     
N

BACK       
Y
FRONT    
N

BACK      
Y
FRONT   
N

       3

      3

CLIENT 
8       F

BACK        
Y
FRONT     
Y

BACK       
N
FRONT    
N

BACK      
N
FRONT   
N

       4

      2

CLIENT 
9       M

BACK        
y
FRONT     
N

BACK       
Y
FRONT    
N

BACK      
N
FRONT   
N

       2

      4

CLIENT 10     
F

BACK        
N
FRONT     
Y

BACK       
Y
FRONT    
Y

BACK      
Y
FRONT   
Y

       5

      1

CLIENT 11     
M

BACK        
Y
FRONT     
Y

BACK       
Y
FRONT    
Y

BACK      
Y
FRONT   
Y  

       6

      0

CLIENT 12     
M

BACK        
Y
FRONT     
N

BACK       
Y
FRONT    
N

BACK      
N
FRONT   
N

       2

      4

CLIENT 13     
F

BACK        
Y
FRONT     
N

BACK       
Y
FRONT    
N

BACK      
N
FRONT   
N

       2

      4

CLIENT 14     
F

BACK        
Y
FRONT     
Y

BACK       
Y
FRONT    
Y

BACK      
Y
FRONT   
Y

       6

      0

CLIENT 15     
M

BACK        
Y
FRONT     
Y

BACK       
N
FRONT    
Y

BACK      
N
FRONT   
N

       3

      3

CLIENT 16     
M

BACK      
  Y
FRONT     
Y

BACK       
Y
FRONT    
N

BACK      
Y
FRONT   
N

       4

      2

CLIENT 17     
F

BACK        
N
FRONT     
Y                           

BACK       
Y
FRONT    
Y

BACK      
Y
FRONT   
Y

       5

      1

CLIENT 18     
M

BACK       
 Y
FRONT     
Y

BACK       
Y
FRONT    
Y

BACK     
N
FRONT   
Y

       5

      1

CLIENT 19     
M

BACK       
Y
FRONT    
Y

BACK       
Y
FRONT    
Y

BACK     
N
FRONT   
Y

       5

      1

CLIENT 20     
M

BACK       
Y
FRONT    
Y                         

BACK       
Y
FRONT    
Y

BACK     
N
FRONT   
Y

       5

      1

CLIENT 21     
F

BACK       
Y
FRONT    
N

BACK       
Y
FRONT    
Y

BACK      
Y
FRONT   
N

       4

     
2  

CLIENT 22     
F

BACK       
N
FRONT    
Y

BACK       
Y
FRONT    
Y

BACK      
N
FRONT   
N

       3

      3

CLIENT 23     
F

BACK       
Y
FRONT    
Y             

BACK       
Y
FRONT    
Y   

BACK      
Y
FRONT   
Y

       6

      0

CLIENT 24    
M

BACK       
Y
FRONT    
Y

BACK     
  Y
FRONT    
Y

BACK      
N
FRONT   
Y

       5

      1

CLIENT 25    
M

BACK    
Y
FRONT  
Y

BACK     
Y
FRONT  
Y

BACK    
Y
FRONT  Y

     6

     0

CLIENT 26    
M

BACK    
N
FRONT  Y

BACK     
N
FRONT  
Y

BACK    
N
FRONT  
Y

     3

     3

CLIENT 27     M

BACK    
N
FRONT  Y

BACK     
Y
FRONT  
Y

BACK    
N
FRONT  
Y

     4

     2