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    Hand Hygiene


    Nursing requires professionals to work in clinical and non-clinical areas to adhere to some fundamental key practices which include Hand hygiene or hand washing. A lack of appropriate hand washing techniques was found to increase the spread in number of infectious diseases and resistant bacteria infections such as MRSA, VRE and some respiratory infection like adenovirus and hand foot mouth disease (Preventing Health Care-Associated Infections, 2019). The aim of this essay is to critically evaluate some of the professional issues that underpin hand washing within the health care settings. 

    Hand hygiene plays a significant role in providing high quality care to patients. As in providing care services diseases are directly and quickly spread from hand to hand (Kingston, O’Connell and Dunne, 2016). Therefore, it is very important to practice this skill properly so that hand hygiene is maintained. To practice this skill, there are various methods and techniques available to professionals. For instance, there are two methods for hand cleansing including antiseptic hand-rub and surgical antisepsis like water and antimicrobial soap (Pelat and et.al., 2016). It enables them to learn and gain knowledge about different methods that can be followed for undertaking hand washing. Hand hygiene should be undertaken so that infectious disease is not transmitted. Also, it will help in maintaining cleanliness and hygiene in hospitals by adhering to evidence based practice. It will also evaluate potential influence of psychological, social and cultural factors that impact in maintaining hand hygiene.


    Critical understanding of professional issues for Hand Hygiene

    The main issue is theory practice gap that exists within nursing care especially into hand washing. Hagel et al (2015) found a theory-practice gap that existed amongst health care practitioners because of the inability to fulfil their duties and advocate for patients. Non-compliance exists in hand hygiene among practitioners, which may increase patient mortality and morbidity rates, and raise healthcare costs. Hand hygiene practices have been failing and research has found that care workers and equipped with a lot of theoretical knowledge but were still not meeting the hand washing standards set out by local hospital guidelines and policies (Wetzker and et.al., 2016). This clearly illustrates that the knowledge provided is not adhered to and practically implemented. Hence, it has contributed to the increase in the theory – practice gap that currently exists. Further showing that the available strategies are not adequately implemented. This strengthens the need to effectively address the problem of hand hygiene to reduce the number of infections.

    Pelland et al (2015) reported that guidelines and hand hygiene strategies worldwide are not adapted in nursing care irrespective of the resources available. He particularly felt that there was a lack of awareness of hand hygiene practices especially in care homes. The nurses were not aware proper methods to maintain hand hygiene. Also, the guidelines are not properly implemented or followed.

    There are some other issues as well such as improper training and knowledge of nursing staff regarding hand hygiene (Kingston, O’Connell and Dunne, 2016). When there is no awareness then no practice is followed in washing hands. Whereby healthcare workers do not wash hands before providing care services. Thus, this issue is impacting in maintaining effective hand hygiene.

    Luangasanatip and et.al., 2015, the hand washing issue generally occurs when there is no proper or systematic practice followed in it. Furthermore, it has been analysed that many care worker resists in washing hands due to their thinking.

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    Discussion of the evidence that relates to hand hygiene

    Hand Hygiene is an essential practice of nursing and is very crucial to be adopted by healthcare staff in order to achieve complete sanitation and better provision of healthcare to their patients. It is imperative for this skill to be used adequately to encourage and promote health practices (Tejada and Bearman, 2015). There are various aspects, resources and methods accessible to healthcare organisation which should be utilised to undertake and amplify the scope of adoption of hand hygiene (Mahida, 2016).

    Some of the tools and equipment available with professionals include sanitation solutions dispensers. In addition, with enhancements in technologies, a strategy to combat ineffective hand hygiene practices would be to use technical solutions such as touchless technologies. While there is a scope of error in traditional methods such as carelessness in implementation or monitoring, these solutions would be productive as well as would provide maximum comfort to service users. Facilities like automatic faucets, self-flushing toilets, automatic paper towel dispensers, etc. must be utilised against the traditional methods as long-term strategies for hand hygiene (Going Touchless is a High-Tech Solution to Hand Hygiene Compliance, 2019).

     Wetzker and et. al., 2016  state that hand hygiene strategies organised by WHO are best ways to improve medical and hygiene practice. However, Farhoudi and et. al., 2016 have witnessed the overall impact of Hand Hygiene Improvement Program Implementation. This program revolved around various elements like changes in systems of hand hygiene. Implementation of the program would have assured access of alcohol hand-rubs to healthcare professionals and evaluation of practices of hand hygiene along with regular feedback. It was quite effective, however, its evaluation was based on direct observation which was time consuming. Thus, healthcare organisation should choose more effective methods like regular external monitoring to keep a track on implementation of these practices.

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    There are various guidelines which are set by WHO and are imperative to be critically discussed to determine the best method to be followed for appropriate hand hygiene. These guidelines emphasise on inclusion of various methods like use of towels to turn off faucets. Another prominent guidance provided by the organisation was using alcohol based hand-rubs to enhance the scope of improvement in hand hygiene. Moreover, the guidelines emphasise on using gloves to accomplish daily operations appropriately, thus, keeping hand hygiene consistent (WHO Guidelines on Hand Hygiene in Health Care, 2019). All of these techniques are pretty effective to be utilised, however, it would be more productive to choose best alternatives. Out of the guidelines provided by WHO, gloves and hand-rubs should be provided to healthcare professionals and should be treated as a regular practice. On the other hand, where towels are considered to be used for using faucets and other equipments, it should be replaced with enhanced technological inputs. Blindly following of guidelines might restrict organisations to analyse better strategies.

    Applying all these tactics would assist organisation in creating a culture where hand hygiene would be treated as a priority. With minimal efforts, it would be easy to convert them into habit. Consequently, as per the view of Pelat et. al., 2016, this will also eliminate the professional issue and theory practice gap. This gap is evident due to lack of proper knowledge provided to healthcare professionals and nurses about hand hygiene and availability of techniques led out by theories which could guide professionals in practices of hand hygiene. Adopting these practices as well as innovating processes within the healthcare organisation is necessary for an appropriate implementation of hand hygiene skill (Bridging the Theory–Practice Gap With Evidence-Based Practice, 2019).

    However, after determination of key methods, healthcare professions should be taught about adopting these practices. Education and training play effective roles in healthcare. WHO has laid different tools for healthcare organisations for educating their professionals and nurses regarding hand hygiene (Tools for training and education, 2019). These tools require them to utilise guidance related to its Multimodal Hand Hygiene Improvement Strategy. Moreover, a more interactive approach through films and documentaries is suggested by WHO to help organisations enhancing this skill in their professionals. However, sticking up to certain guidelines might not provide long-term benefits to these organisations. Hence, more robust and effective research should be adopted by healthcare association to identify more appropriate prospects in attaining health hygiene standards. Nurses could be trained by using different learning styles suitable to them. Moreover, computer-based training modules should be used as a strategy. Another method of training staff in developing hand hygiene skills is to evaluate current hygiene patterns adopted by employees and develop tactics to ensure better outcomes (7 Best Practices for Hospitals' Training and Development Programs, 2018). Thus, all these techniques are necessary for healthcare institutions to apply, as it would determine how adequately these organisation could establish hand hygiene functions. However, it should be a regular practice within healthcare organisations, that their training methods are replaced with all those techniques that fulfil the technological demand.  This would engage employees even further with hand hygiene practices and the same would be appropriately established amongst healthcare professionals.

    Critical evaluation of potential influence of psychological, social and cultural factors

    In nursing care, there are various factors which influence maintenance of hand hygiene. These change the perspective of nurses and restricts them to follow practice. Along with this, according to Chassin, Mayer and Nether, 2015,  these factors result in protecting patients in spreading bacteria and diseases in patients. They basically relate to social, cultural and psychological which are as follows:

    Social –

    This factor includes ethics, values, beliefs, etc. which are inherited or adopted by staff. Here, employees may not have proper knowledge or information about hand hygiene. Various parameters influence practices of hand hygiene such as attitude, intention, social norms, perceived risks, etc. (Improving Adherence to Hand Hygiene Practice: A Multidisciplinary Approach, 2019). These factors influence healthcare professionals in giving importance to adopt hand hygiene practices. However, staff may not undertake these practices as there might be communication barriers within the workplace, such as, English might not necessarily be the first language used by employees which could restrain them from accurately understanding the instructions. This restricts them to implement practice. Moreover, they might not be habitual of washing hands frequently as they belong to a social environment which are careless in hand hygiene. Their social environment might be under this perception that their hands are neat and clean even after using tools and equipment

    Cultural –

    In nursing, various people belonging to different backgrounds work together and provide care to people. Here, culture plays a vital role. There are some cultural beliefs and values that influence workers' mindset.  According to Tanner and et.al., 2016, these values are inherited from their parents. There might be cases where these values don't consider hand hygiene as an important element while providing care services to patients. While providing health services to such people, it could be difficult for the nurses to convince them of maintaining hand hygiene to protect themselves of getting infected. Also, staff may think that they should not wash hands after treating patients. In addition, culture plays a big role in the way hand hygiene is adopted within individual. For instance, while countries adopting western culture emphasize more on usage of soaps, some countries in Asian cultures use mud and ash to clean their hands (Religious and cultural aspects of hand hygiene, 2019). Thus, this factor must be effectively evaluated to help analyse and communicate clinically approved methods of hand hygiene within healthcare organisations. 


    It highly influences an individual in following the practice of hand hygiene as it is directly related to behaviour of professionals. Staff members might develop perception that  tools or equipments used to provide healthcare have been sterilised effectively before use. Also, they might perceive that it is not necessary to wear gloves while providing care. Hence, change in behaviour is the result of psychological factor which might influence staff in not undertaking these measures (The influence of knowledge, perceptions, and beliefs, on hand hygiene practices in nursing homes, 2019). Secondly, staff may reuse tools after treating patients because it might not be considered vital by them to sterilise these equipments which could end up spreading infections/


    Thus, from the above mentioned report, it could be concluded that hand hygiene plays a crucial role in nursing practice currently as well as in the future. It is useful in preventing spreading of infection through physical contact (Smiddy, O'Connell and Creedon, 2015). Moreover, it allows nurses and medical professionals to maintain a systematic and proper procedure of certain methods that is followed in washing hands time to time. There are two major professional issues like theory-practice gap and guidelines as well as hand hygiene strategy which is not been adapted into practice in nursing care irrespective of resources. Furthermore, the methods through which practices can be implemented includes hand washing practices and providing effective knowledge and training to staff. This will enable them to execute appropriate and hygiene practices (Kingston, O'Connell and Dunne, 2016). Also, it has been summarised that hand washing enables in properly effective care services to patients. Besides this, a clean and hygienic environment must be maintained in hospitals and other centres (Ejemot‐Nwadiaro and et. al., 2015). Further, there are some skills which indicates that development is required in medical practice like communication, using tools and equipment’s, etc. It will help in adoption of hand hygiene practices within healthcare. Lastly, There are several factors such as social, cultural which impacts in providing care to patients within hospitals and other healthcare centres.

    Hand hygiene is very crucial in nursing care. The implementation of practice supports in maintaining hygiene and cleanliness. Moreover, it helps in reducing the transfer of infectious diseases from one person to another (Chun, Kim and Park, 2015).


    • Chun, H.K., Kim, K.M. and Park, H.R., 2015. Effects of hand hygiene education and individual feedback on hand hygiene behaviour, MRSA acquisition rate and MRSA colonization pressure among intensive care unit nurses. International journal of nursing practice. 21(6). pp.709-715.
    • Ejemot‐Nwadiaro, R.I., and et. al., 2015. Hand washing promotion for preventing diarrhoea. Cochrane Database of Systematic Reviews, (9).
    • Farhoudi, F., and et. al., 2016. Impact of WHO hand hygiene improvement program implementation: a quasi-experimental trial. BioMed research international, 2016.
    • Gould, D.J and et.al., 2017. Interventions to improve hand hygiene compliance in patient care. Cochrane database of systematic reviews, (9).
    • Hagel, S and et.al., 2015. Quantifying the Hawthorne effect in hand hygiene compliance through comparing direct observation with automated hand hygiene monitoring. infection control & hospital epidemiology. 36(8). pp.957-962.
    • Kingston, L., O'Connell, N.H. and Dunne, C.P., 2016. Hand hygiene-related clinical trials reported since 2010: a systematic review. Journal of Hospital Infection. 92(4). pp.309-320.
    • Kingston, L., O'Connell, N.H. and Dunne, C.P., 2016. Hand hygiene-related clinical trials reported since 2010: a systematic review. Journal of Hospital Infection. 92(4). pp.309-320.
    • Luangasanatip, N and et.al., 2015. Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis. Bmj. 351. p.h3728.
    • Mahida, N., 2016. Hand hygiene compliance: are we kidding ourselves?. Journal of Hospital Infection. 92(4). pp.307-308.
    • Pelat, C and et.al., 2016. Hand hygiene, cohorting, or antibiotic restriction to control outbreaks of multidrug-resistant Enterobacteriaceae. infection control & hospital epidemiology. 37(3). pp.272-280.
    • Pelland, M.J and et.al., 2015. Hand hygiene compliance system. U.S. Patent 9,000,930.

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