Educating and training of HCW on hand hygiene

Introduction

One of the major causes of mortality and morbidity among hospitalized workers is healthcare associated infections, particularly resulting from health cares workers (HCW) noncompliance with hand washing protocols. It has been identified that infections resulting from noncompliance with hand washing standards affect nearly two million people annually in the Unite States alone and are responsible for around 90,000 deaths each year (Alemagno et al, 2010). The infections results from transmission of health-care-associated pathogens during healthcare operations via contaminated hands of HCW. Research conducted in healthcare institutions has shown that compliance with the recommended hand hygiene procedures is below the set benchmark of 100%. In fact, Alemagno et al (2010) noted that adherence to hand hygiene guidelines in United States ranges between 30% and 60% and hardly exceed 50%.

Various reasons have contributed to this lack of 100% compliance with hand washing among HCW including lack of knowledge regarding the significance of hand hygiene in reducing the spread of infections to patients. It has been identified that some HCW lack adequate understanding of how hands become contaminated and the correct hand hygienic techniques (Souza, 2010). To overcome this barrier, it has become increasingly important for healthcare organizations to enhance educational and training strategies which will help to increase hand hygiene compliance. This can be achieved in various ways as explained in the following section.

Educating and training of HCW on hand hygiene

There are various education and training opportunities available for HCW, which can significantly help to promote compliance with hand washing protocols. One of these opportunities described by Alemagno et al (2010) is through online learning. Alemagno et al (2010) explains that the emergence and development of online learning opportunities over the last decade has raised new opportunities for providing education and training among HCW regarding compliance with hand hygiene standards. Alemagno et al (2010) conducted a study investigating the effectiveness of an online continuous education and training program in increasing knowledge among HCW of hygienic procedures and practices. The study also assessed the effectiveness of the program in promoting behavioral change among HCW and the extent to which such a program can promote adherence to hand hygiene guidelines. This study involved 256 HCW selected from two health care institutions in Ohio, United States.

All the participants were taken through three sessions of online education program. All the participants involved in this study recorded significant improvement in hand washing knowledge and reported improved adherence to hand washing guidelines. Precisely, 97% of the participants reported that this online education program was highly influential and thus, helped to improve clinical compliance behaviors. Generally, the results of this research indicate that online education program available for HCW can help to update their knowledge, thereby promote compliance with hand hygiene standards.

The results of the above study were consistent with suggestions made by researchers at the University of Geneva in Switzerland. They suggested that focusing on behavioral, normative and control beliefs can greatly help to improve enhance adherence of HCW to hand hygienic guidelines. In a study conducted by these researchers, they found that compliance with hand washing guidelines was highly associated with the belief that hand hygiene helps to prevent infections and adherence requires little effort (Waltman et al, 2011). The researchers associated lack of knowledge with noncompliance with hand washing guidelines. According to Alemagno et al (2010), these beliefs are often influenced through education and training programs.

Another education strategy which can help to increase compliance with hand hygiene guidelines is the inclusion of a work-based training program, especially for new employees. An observational study conducted in four hospitals in United States indicated that inclusion of work-based hand washing education programs and the availability of an effective sanitizer significantly helped to reduce infections resulting from antimicrobial- resistant bacteria (Holyoake, 2010). It was found that adherence of HCW to hand hygiene guidelines remained high in healthcare institutions where the program was included.

In addition to regular work-based teaching, HCW can learn more about hand hygiene through attending face-to-face education seminars discussing the importance and the correct procedures of hand washing. Various studies conducted in clinical organizations have showed incorporating regular learning programs in form of seminars highly increase adherence to hand hygienic standards. A study under this topic was carried out by Lam (2006) in one health institution in United States, which included this program for the first time. The researcher found after HCWs in the institution attended 10 seminars discussing matters related to hygiene, compliance increased from 40% to 59% before and after patient contact. For high risk procedures, hygienic compliance increased from 35% to 60% (Lam et al, 2006). Number of patient contacts in the institution decreased from 2.8 % to 1.8% per hour. As well, there was a remarkable improvement in various aspects of hand washing technique after the intervention. Importantly, health care-associated infection rate in the institution decreased from 11.3% to 6.2% per 1000 patient-days.

Display of reading materials in strategic positions can also help to improve adherence to hand washing guidelines (Alemagno et al, 2010). Materials such as posters placed on notice board can help to constantly remind HCW about the need for hand hygiene. Analysis done in several healthcare institutions in United States indicated that after frequent exposure to hand hygiene guidelines, approximately 75% of the HCW believed that it is possible to improve their hand hygiene practices and to meet the 100% benchmark (Alemagno et al, 2010). Around 75% of the workers involved in the study indicate that half of hospital infections occur as a result of poor hand hygienic practices.

Alemagno et al (2010) noted that HCW can also learn indirectly from their superiors in healthcare organizations. For this to occur, management personnel in these organizations need to completely adhere to clinical guidelines, hence act as role models to workers. An analysis done in United States indicated that HCW adherence to hand hygienic guidelines increased when superiors within healthcare organizations acted as role models for hand hygiene. These findings were consistent with another study involving 60 nursing students. It was found that found that the greatest predictors of compliance with hand hygiene guidelines were the tutor’s positive example of hygiene and positive attitude towards compliance (Alemagno et al, 2010). This view is also supported by the findings of a study that involved new versus old healthcare organizations in United States. It was found that though new healthcare organizations had more sinks, there was lower compliance with usage. The lower compliance with hand hygiene in the new healthcare organizations was linked to the behavious or senior staff. The senior staff in the new organizations cleaned their hands less frequently compared to senior staff in old organizations.

Summary

In conclusion, healthcare associated infections resulting from poor

References

Alemagno, S., Guten, S., Warthman, S., Young, E., & Mackay, D. (2010). Online Learning to Improve Hand Hygiene Knowledge and Compliance Among HealthCare Workers. Journal Of Continuing Education In Nursing, 41(10), 463-471. doi:10.3928/00220124-20100610-06

Holyoake, D. (2010). The Awkward Feeling campaign: confronting poor hand hygiene to improve hand washing. Nursing Times, 106(35), 18-20.

Lam, B. C. C., (2006). Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection. Rediatrics 114(5), 565-571

Souza, M. (2010). Adhesion to the practice of hand hygiene by professionals in the health area in a university hospital [sic] [Portuguese]. Revista Eletrônica De Enfermagem, 12(2), 266-271.

Waltman, P. A., Schenk, L. K., Martin, T. M., & Walker, J. (2011). Effects of Student Participation in Hand Hygiene Monitoring on Knowledge and Perception of Infection Control Practices. Journal Of Nursing Education, 50(4), 216-221. doi:10.3928/01484834-20110228-06