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Infection Control And Hospital Epidemiology

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Infection Control And Hospital Epidemiology

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Infection Control And Hospital Epidemiology

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Question:
Discuss about the Infection Control and Hospital Epidemiology.
 
 
Answer:

Introduction:
Nosocomial infections are the infections acquired by the patients during their stay in the health care facility, and are the major reason behind the majority of the complications that are prevalent in the health care facility. Centre for disease control and prevention have estimated that more than roughly 1.7 million incidences of hospital acquired infections occur that leads to more than 99000 deaths every year (Allegranzi et al., 2013). This ghastly scenario has undoubtedly captured the attention of the health care authorities worldwide and has become one of the public health care priorities in the last few years. Apart from the fatality rates, hospital acquired infections also are found to increase the health care costs to a sweeping 2 to 2.5 folds more and also significantly increases the stay in the hospital of the patients (Al-Tawfiq et al., 2013).
A health care complexity so prevalent and nasty could not have been neglected by the health acre authorities and governments, and it has not been. In the last 10 years there have been various infection control strategies that have been introduced in the health care industry that have seen better results with adequate effort and dedicated compliance. One such strategy that is easy, inexpensive and tremendously effective in decreasing the incidence rate of hospital acquired infection is hand hygiene policy. However studies suggest that there is a vast lack of enthusiasm and compliance to this policy which delimits the chance of the patients attaining faster and easier recovery and increases their chance of succumbing to various infections (Al-Tawfiq et al., 2013). This report will attempt to discuss the two strategies to ensure compliance of the health care staff to hand hygiene policies and discuss in details all the factors associated with the implications of these strategies.
 
Significance of hand hygiene compliance:
Studies suggest that more than 1000 different species of microorganisms inhabit the human epidermis, or our skin surface. Our hands are the most favourable breeding ground or bacteria and are home to 1500 bacteria for every square centimetre. Apart from that, it should not be overlooked that the microbiota are ubiquitous, they are everywhere, and every possible surface that our hands touch every single day are a source for thousands and thousands of different microbes, a vast majority of them can be infectious (Costers et al., 2012). As hands are the source for thousands of infectious microbes, hand hygiene inevitably is the best and most effective method to keep infection at bay, this is even more effective in the health care facility where both the patients and the health care professionals are exposed to a myriad of microbiota on a daily basis in the health care facility. Hence importance of hand hygiene in health care professionals in the field of medicine is paramount (Ellingson et al., 2014).
CDC or centre for disease control and prevention has a predetermined set of hand hygiene policies in place for all health care facilities to follow. The policy statements dictates that antimicrobial washes are to be used to clean hands that appear visibly dirty and soiled, routine hand washing should also be practiced as a daily decontamination strategy and when encountering a contaminated patient of ward (Fisher et al., 2013). The statement further specifies that in instances where the hands are not visibly dirty or soiled alcohol rubs can be opted to perform routine hygienic cleaning of the hands. This technique is to be followed when coming into direct or indirect contact with patients that pose no risk of contamination. Adhering to this hand hygiene policy can ensure decreasing the risk to infection in the patients significantly however there is a significant lack of compliance to the hand hygiene policies (Pan et al., 2013).
Considering the Australian health care legislation, the hand hygiene policy is considered to be the fifth most essential health care regimen. According to the guidelines of National Safety and Quality Health Service Standards, hand hygiene is recommended five times for the health care workers all throughout the day (Fuller et al., 2012). On a more elaborative note, the health care workers are supposed to perform hand hygiene before getting in touch with a patient, after getting in touch with patient, before an aseptic duty, after associating with body fluids and before and after entering contaminated area. The clinical risk assessment authority of Australia has recommended that each and every health care organization must practice the guidelines set forth by the National Safety and Quality Health Service in order to minimize the risk to patient due to hospital acquired infection. Moreover is has been also advised to ensure that the staff is encouraged and motivated to comply with the hand hygiene protocol, however litte efforts had been witnessed to achieve this goal (Hagel et al., 2015).
Studies suggest that the most of the infection that are acquired by the patients in the health care facility is due to the lack of compliance in the staff about hand hygiene at large. However, there is no significant initiative from the health care authorities to determine the causes behind the non compliance and act upon those reasons (Higgins & Hannan, 2013). In a exploratory study it was found that there can be more than reasons why health care profession do not comply to the hand hygiene protocol but the most vital contributing factors can be the lack of awareness and the lack of education in the health care workers that lead them to neglect the hand hygiene protocol leading to putting the health and welfare of the patients at risk (Huis et al., 2012). Such a situation will only continue to escalate if there are no strategies in place to ensure that the health care is compelled and motivated to comply to the policy.
 
Strategise to ensure compliance in health care facilities:
One of the contributing factors behind the lack for compliance that takes up the majority of blame is the lack of education and awareness in the health care about the hand hygiene and its importance. Exploratory research studies and surveys suggest that the majority of care support staff do not understand the importance of hand hygiene n clinical practice and often they neglect adhering to this protocol mostly due to lack of time, heavy workload, patient priorities, unfavourable working conditions and lack of sincerity (Ling & How, 2012). Hence it is of much importance to educate all the support staff the importance of hand hygiene and how noncompliance to it can lead to harmful consequences for both the patients and the workers themselves. Studies suggest that in most cases the health care staffs is not aware of the risks they put themselves on with neglecting proper hand hygiene and it can be expected that the staff is properly educated about the repercussions of not adhering to a standard hand hygiene program they will be more motivated to comply (Momen et al., 2012).
These education and training programs can be set up every three months or so to ensure that all the staff get the opportunity to avail this programs. Furthermore these educational programs should be free of cost for the health care professional to attend and should include bonus points in the recognition and appraisal program in place in the health care facility in the health care program to ensure that the staffs is lured to attend this seminars. Lastly the training and employee managements of the health care facility should ensure that the newly recruited staff are made aware of the educational and training programs to attend them (Morgan et al., 2012). Usage of animated and interactive graphics in the educational presentation of the hand hygiene compliance program will also intrigue the employees to attend and understand the policy, its importance and the repercussions of not adhering to it. It has also been observed that most cases the staffs forget in their heavy and exhaustive workload to adhere to the hand hygiene policies, the posters will help the staff to be reminded multiple times (Pincock et al., 2012).
On a similar note, another contributing factor that has been identified that propel the staff to not adhere to the hand hygiene guidelines is the difficult access of the sanitation agents and the irritation it causes in the hands of the health care workers. Many health acre surveys have described that a vast majority of the health care workers that refuse the usage of hand sanitation procedures, refuse it because of the lack of availability and difficult access of the sanitation products and the irritation it causes in their hands (Pan et al., 2013). The antimicrobial hand washes are generally made of harsh chemicals that strip the skin off of moisture and cause irritation reaction in the skin for the sensitive skinned population of the health care workers. In case of alcoholic rubs as well, the high concentration of alcohol present rips the natural moisture of the hands on repetitive usage and cause drying and flakiness in skin. Hence, most of the health care workers avoid coming in contact with the hand washes if they can help. The lack of strict regulations and threat to penalties adds fuel to their rebellion further (Pincock et al, 2012).
In order to combat this issue the hospital authority needs to undertake the actions to ensure that the hand sanitation products are placed at easily accessible areas all throughout the health care facility and they re replenished regularly to ensure that the inaccessibility of the products do not cause the health care staff to not comply to the hand hygiene policies (Scheithauer et al., 2012). Moreover the health care facility needs to invest in the hand hygiene strategy, so that they can purchase mild antimicrobial hand washing agents that are gentle on the hands and are more natural or organic. If the hand washing agents does not irritate the hands of the health care staff it will not cause them to abandon the policy. Lastly this strategy to ensure every healthcare worker complies to the hand hygiene policies, the staff will have to enforce stricter regulations to ensure that the staff are compelled to adhere to the rules. One way to ensure it can be heavy penalization of the staff that does not adhere to the hand hygiene policy, like monetary penalties and temporary suspension (Song et al., 2013).
Applying these well articulated and curated strategies can help in urging the staff to comply with the hand hygiene policies.
 
Implementation challenges:
Both the strategies that have been devised in the assignment above will be effective in urging the staff to comply with the hand hygiene policy. However there are some challenges to the implementation of these strategies. First and foremost, a comprehensive educational program with interactive graphics in regular intervals will cost the health care facility a pretty penny. It has to be considered that a health care facility that is large enough recruits a large number of staff regularly ensuring that the entire staffs are privy to the educational programs will cause the health care facility to conduct such interactive and comprehensive trainings very frequently, and that will be detrimental to the financial backbone of the health care facility. Moreover encouraging the staff to attend these educational programs will require the management to provide some attraction, like monetary rewards or employee recognition and appraisals, and this also will be a significant blow to the financial standing of the health care facility. An expenditure of this magnitude will be difficult for the management to overcome and will can compromise the care standards (Squires et al., 2013).
The challenges present for the implementation of the second strategy will include investing a large chunk to buying enough hand sanitation supplies that can be evenly distributed all throughout the health care facility. Moreover investing on skin friendly mild anti-microbial washes and soaps will be an expensive effort as well. However, even if we ignore the financial threat to the facility management due to storing up enough supplies of standard quality, there is more (Srigley et al., 2014). Without a set of strict rules and regulations these strategies will not bear any fruit what so ever hence, there is need for a good screening program to ensure that all the staff are complying. This represents a need for the recruiting of a screening team that will monitor and control the compliance to hand hygiene and infection control program in the facility, which will also be a financial drawback to the facility. Lastly, enforcing strict penalties like suspension and fine can initiate job dissatisfaction and irritation in the staff which can result in decreased staff retention and can hamper the care delivery in turn (Tromp et al., 2012). All these limitations can make the implementation and success of these strategies very difficult to attain.
 
Conclusion:
The rates at which the incidence of hospital acquired infection is increasing are ghastly and frightening. Every day the statistics of complication and morbidity related to these infections elevate and decrease the standard of care and the sour the experience of the patients in the health care facility. Studies suggest that the level of dissatisfaction and in the patients and their families are due to the suffering they had to go through for the infections caused under the care and surveillance of the health care facility, it is not only detrimental for the reputation of the health care facility concerned but is also morally distressing as well (Costers et al., 2012). This is the reason why the regulatory authorities in the field of heath care have invested time, resources and effort to improve the rates of hospital acquired infections by enforcing different guidelines and policies.
Hand hygiene policy is the one of the most effective policies in avoiding hospital acquired infections in the health care facility; unfortunately this policy is also the most neglected one in the health care facility. The noncompliance of the staff to this policy is due to a number o reasons as discussed above, and there are strategies that improve the level of compliance in the staff. However, these strategies like educational programs and stricter inclusion with easy access come coupled with a horde of challenges that limit the efficacy and success of these strategies. However with a little empathy and effort from both the hospital facility management and the staff, the safety and wellbeing of the patients can be prioritized above all.
 
References:
Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M. L., Moro, M. L., … & Donaldson, L. (2013). Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. The Lancet Infectious Diseases, 13(10), 843-851.
Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections. American journal of infection control, 41(6), 482-486.
Costers, M., Viseur, N., Catry, B., & Simon, A. (2012). Four multifaceted countrywide campaigns to promote hand hygiene in Belgian hospitals between 2005 and 2011: impact on compliance to hand hygiene. Euro Surveill, 17(18), 20161.
Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., … & VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand hygiene. Infection Control & Hospital Epidemiology, 35(08), 937-960.
Fisher, D. A., Seetoh, T., May-Lin, H. O., Viswanathan, S., Toh, Y., Yin, W. C., … & Peh, R. F. (2013). Automated measures of hand hygiene compliance among healthcare workers using ultrasound: validation and a randomized controlled trial. Infection Control & Hospital Epidemiology, 34(09), 919-928.
Fuller, C., Michie, S., Savage, J., McAteer, J., Besser, S., Charlett, A., … & Jeanes, A. (2012). The Feedback Intervention Trial (FIT)—improving hand-hygiene compliance in UK healthcare workers: a stepped wedge cluster randomised controlled trial. PLoS One, 7(10), e41617.
Hagel, S., Reischke, J., Kesselmeier, M., Winning, J., Gastmeier, P., Brunkhorst, F. M., … & Pletz, M. W. (2015). Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. infection control & hospital epidemiology, 36(08), 957-962.
Higgins, A., & Hannan, M. M. (2013). Improved hand hygiene technique and compliance in healthcare workers using gaming technology. Journal of Hospital Infection, 84(1), 32-37.
Huis, A., van Achterberg, T., de Bruin, M., Grol, R., Schoonhoven, L., & Hulscher, M. (2012). A systematic review of hand hygiene improvement strategies: a behavioural approach. Implementation Science, 7(1), 92.
Ling, M. L., & How, K. B. (2012). Impact of a hospital-wide hand hygiene promotion strategy on healthcare-associated infections. Antimicrobial resistance and infection control, 1(1), 13.
Momen, K. S., Fernie, G. R., Levchenko, O. I., & Hufton, G. C. (2012). U.S. Patent No. 8,237,558. Washington, DC: U.S. Patent and Trademark Office.
Morgan, D. J., Pineles, L., Shardell, M., Young, A., Ellingson, K., Jernigan, J. A., … & Perencevich, E. N. (2012). Automated hand hygiene count devices may better measure compliance than human observation. American journal of infection control, 40(10), 955-959.
Pan, S. C., Tien, K. L., Hung, I. C., Lin, Y. J., Sheng, W. H., Wang, M. J., … & Chen, Y. C. (2013). Compliance of health care workers with hand hygiene practices: independent advantages of overt and covert observers. PLoS One, 8(1), e53746.
Pincock, T., Bernstein, P., Warthman, S., & Holst, E. (2012). Bundling hand hygiene interventions and measurement to decrease health care–associated infections. American journal of infection control, 40(4), S18-S27.
Scheithauer, S., Eitner, F., Mankartz, J., Haefner, H., Nowicki, K., Floege, J., & Lemmen, S. W. (2012). Improving hand hygiene compliance rates in the haemodialysis setting: more than just more hand rubs. Nephrology Dialysis Transplantation, 27(2), 766-770.
Song, X., Stockwell, D. C., Floyd, T., Short, B. L., & Singh, N. (2013). Improving hand hygiene compliance in health care workers: strategies and impact on patient outcomes. American journal of infection control, 41(10), e101-e105.
Squires, J. E., Suh, K. N., Linklater, S., Bruce, N., Gartke, K., Graham, I. D., … & Tibbo, E. (2013). Improving physician hand hygiene compliance using behavioural theories: a study protocol. Implementation Science, 8(1), 16.
Srigley, J. A., Furness, C. D., Baker, G. R., & Gardam, M. (2014). Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study. BMJ quality & safety, 23(12), 974-980.
Tromp, M., Huis, A., de Guchteneire, I., van der Meer, J., van Achterberg, T., Hulscher, M., & Bleeker-Rovers, C. (2012). The short-term and long-term effectiveness of a multidisciplinary hand hygiene improvement program. American journal of infection control, 40(8), 732-736.

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