Stretch The Horizon – Holding Hands For Better Hygiene
The practice of hand hygiene has long been known as the most effective way to reduce the transmission of pathogens in healthcare settings. Hand hygiene is important and the single most important tool in preventing the spread of healthcare-associated infections between patients. Adherence to proper hand hygiene practices among hospital staff is one of the easiest ways to help keep patients as safe and healthy as possible. In view of Healthcare-associated infections drawing increasing attention from patients, insurers, governments and regulatory bodies hand hygiene has now come to be regarded as one of the most important elements of infection control activities.
In the wake of the growing burden of healthcare-associated infections (HCAIs), preventing the spread of contagious infections in hospitals and healthcare facilities requires the focus of every healthcare worker. All major agencies agree that proper hand hygiene is the cornerstone of infection control as there is undisputed evidence to suggest that strict adherence to hand hygiene reduces the risk of cross-transmission of infections. In order to mitigate the challenges that HAIs present, WHO has laid down guidelines to promote improved hand hygiene practices in healthcare institutions and reduce transmission of microorganisms and the associated infections, which lead to increased morbidity, mortality, lengths of stay, and costs. The guidelines consist of specific recommendations that are based on scientific evidence and the consensus of leading experts in the field. But the guidelines need to be practiced at a high level of compliance for it to be effective as even the most advanced healthcare will not work if clinicians neglect basic practices such as hand hygiene or adequately disinfect their hands. Measuring adherence to hand hygiene practice is the primary concept to demonstrate improvements and the quality of health care being provided in that healthcare setting and the core concept of Hospital Infection Control system. However, measuring health care worker adherence to hand hygiene guidelines is not a simple matter.
At Apollo Hospitals, Bhubaneswar (AHB), we have implemented a series of activities involving Hand hygiene practices to ensure its enforcement, adherence, and sustainability. What is observed is despite monitoring or quality assessment protocols for hand hygiene in hospitals, compliance rates for appropriate hand hygiene are far from where they should be. This could be attributed to the target (pathogens) not being visible on the hands or cost of time as proper hand washing is very time-consuming and the time lapse in the transmission of pathogens from their contaminated hands to patients and the resultant infection that may happen days or even months later. So there is a need to emphasize patients’ welfare or consequences rather than their own as altruism is a better motivator than self-interest. As it’s difficult to create that habit or enforce it among hospital staff there is a need to need to integrate hand hygiene into routine procedures so that they do it without even thinking about it as second nature. This needs to be backed up by having in place strong systems to support, monitor, and promote the correct behavior.
As part of the hand hygiene practices implementation process, we created a major awareness initiative named “See and Remember”
This involved displaying hand hygiene and hand washing posters at various strategic locations. standardized WHO Hand hygiene guidelines. Continuous education is needed to inform and remind healthcare workers of the indications for hand hygiene,
so educational sessions by externals and knowledge updating sessions were held.
To educate on the proper hand washing techniques Hospital hand Hygiene and hand washing guidelines have been provided in the Unit Binder for all Nursing Stations and in all the Department Operating Manuals for other administrative departments.
Regular training sessions for the nursing team and refresher courses for the trainers help them stay abreast of the new developments in the field of hand hygiene
To adopt WHO guidelines mean to change behaviour that is already ingrained. So to inculcate good hand hygiene practices and to affect a culture where good hand hygiene is the expectation requires long and sustained efforts. For that purpose, we have established a dedicated Infection control Team and a functional Infection Control Committee where the team member conducts various monitoring and surveillance activities to observe and quantify the improvement in infection control and hand hygiene practices in Consultants, Nursing staffs, Housekeeping staffs and PCA staffs.
Frequent audits by Hospital Quality team and by Infection control Team are carried out to ch6eck hand hygiene guidelines adherence rates. Under the “Inspect the Aspect” activity Hand hygiene facilities measurement audit tool and the checklist was prepared and given to the auditors and all aspects under hospital inspection control was inspected.
The Audits are supplemented by surveillance which is carried out at all the patient care areas and areas like, Canteen, OPDs, CSSD frequently and timely manner and the reports are being studied by Infection Control Chairperson and adequate measures on the same to prevent reoccurrence are being conducted as per the Hospital protocol.
Educational curricular do not go far in forming a habit. There needs to be a culture of reinforcement in which the caregivers and staff wash their hands. Monitoring hand hygiene is only the first step, motivations in terms of awards and recognition helps in compliance and cleaning hands frequently. To make it comprehensive, under “Stretch the Horizon” initiative Patients and patient attendants were educated and made part of the infection control measures
A culture needs occasions of fun and games to create that happy fostering spirit. Role plays, dance and quiz competitions, poster making competitions made the process of imbibing hand hygiene practice enjoyable, as knowledge transfer and learning happen better and faster in a relaxed atmosphere.
To raise awareness an outreach program was undertaken in an Engineering College and a local slum to addresses topics related to the importance of hand hygiene in an effort to improve public health and decrease the spread of infections in the community
Safeguarding the health of the community is important so an infection safe community preserves the health of the community.
Good hand hygiene saves lives. So an HCO should pull out all stops to ensure compliance as anything that boosts compliance even a little bit might save a few of those numerous lives that are now lost to infection each year.
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Ms. Swetapadma Dash
Apollo Hospitals Bhubaneswar