|Year : 2017 | Volume
| Issue : 2 | Page : 52-56
To know the hindrance or obstacles in hand hygiene practice among healthcare workers of Qassim province of Saudi Arabia
Sanjay Kumar Gupta, Sunitha Lorin Mathias, Ibrahim Saifi Al Harbi
Department of Infection Prevention and Control, Al Rass General Hospital, Qassim, Saudi Arabia
|Date of Web Publication||19-Jan-2018|
Dr. Sanjay Kumar Gupta
Al Rass General Hospital, P. O Box-538, Al Qassim 51921
Source of Support: None, Conflict of Interest: None
Introduction: Hand hygiene (HH) is now considered as one of the most important measure of infection control activities. In the time of the growing burden of health care associated infections (HCAIs), the increasing severity of illness and complexity of management, threatened by multi-drug resistant (MDR) pathogen infections, health care workers (HCWs) are reversing back to the basics of infection preventions by simple measures like hand hygiene.
Objectives: To find out the hindrance or obstacles in hand hygiene practice among health care workers.
Methodology: Hospital based cross sectional study.
Observation's: In the present study we asked about their opinion about hand hygiene (HH) around 21(28%) responded were fully correct, we also access their correct knowledge about WHO five moments/ indication of hand hygiene (HH) 70 (94%) had correct knowledge regarding indication of hand hygiene. We also access according to their day to day difficulties/obstacles in hand hygiene practice majority of them responded often too busy or insufficient time 18 (25%) followed by hands don't look dirty and skin irritation 17 (23%) & 17 (23%) respectively, some peoples also influenced by others behavior because they don't practice so we 13 (17.56%) also responded no difficulties in practicing hand hygiene (HH) in day to day work. We also asked their suggestions for improvement in hand hygiene compliance among health care workers majority of them suggested encourage the staff to do hand hygiene practice every now and then.
Conclusion: Most of the respondents in present study were young females, most common obstacle in hand hygiene practice was often too busy and hand don't look dirty. Common suggestion for improvement was head of unit should ask to staffs daily in morning meeting about hand hygiene compliance and those who not follow after all these efforts to be punished.
Keywords: General hospital, hand hygiene, health care workers, hindrance, obstacles
|How to cite this article:|
Gupta SK, Mathias SL, Al Harbi IS. To know the hindrance or obstacles in hand hygiene practice among healthcare workers of Qassim province of Saudi Arabia. J Patient Saf Infect Control 2017;5:52-6
|How to cite this URL:|
Gupta SK, Mathias SL, Al Harbi IS. To know the hindrance or obstacles in hand hygiene practice among healthcare workers of Qassim province of Saudi Arabia. J Patient Saf Infect Control [serial online] 2017 [cited 2018 Oct 16];5:52-6. Available from: http://www.jpsiconline.com/text.asp?2017/5/2/52/223687
| Introduction|| |
Hand hygiene (HH) is now considered as one of the most important effective measures of infection control activities. This is because enough scientific evidence suggested the observation that if properly implemented, HH alone can significantly reduce the risk of cross-transmission of infection in healthcare facilities.,,,, The importance of handwashing or HH in patient care was conceptualised in the early 19th century.,, Labarraque  provided the first evidence that hand decontamination can markedly reduce the incidence of puerperal fever and maternal mortality. Semmelweis  worked in the Great hospital in Vienna in the 1840, and he observed the difference in maternal mortality due to the puerperal fever first clinic was five-time higher than the second clinic 10% and 2%, respectively. The puzzled Semmelweis got a breakthrough in 1847, following the death of colleague Jokob Kolletschka, who had been accidentally, got a cut by a student's scalpel while performing an autopsy. His autopsy showed a pathological condition similar to that of women drying from puerperal sepsis/fever. Semmelweis concluded that some 'unknown cadaverous material' caused or responsible for puerperal fever. He instituted a policy of washing hands with chlorinated lime for those leaving the autopsy room, following which maternal mortality fall down sharply around ten times, comparable to the second clinic. Thus, he almost conducted a controlled trial, in an era when microbes were yet to be discovered, and the germ theory of disease was not defined.,, The study also done by Pittet regarding improving adherence to HH practice: A Multidisciplinary Approach, regarding non compliance and perceived barriers about HH. In another landmark study conducted by Mortimer et al. in the wake of Staphylococcal epidemics in 1950s showed that direct contact was the main mode of transmission of Staphylococcus aureus in nurseries. They also demonstrated that handwashing by patients' contacts reduced the level of S. aureus acquisition by babies. In 1975 and 1985, the CDC published guidelines on handwashing practices in hospitals, primarily advocating handwashing with non-antimicrobial soaps; washing with antimicrobial soap was advised before and after performing invasive procedures or during care for high-risk patients. Alcohol-based solutions were recommended only in situ ations where sinks were not available.,,
This initiative has, as of April 2009, seen a total of 3863 healthcare facilities registering their commitment, effectively equating to a staff of over 3.6 million people, globally. On May 5, 2009, the World Health Organisation (WHO) highlighted the importance of HH and launched guidelines and tools on HH, based on the next phase of patient safety work programme 'SAVE LIVES: Clean Your Hands'.,,,,, Time pressure is one of the biggest reported barriers to HH compliance among healthcare workers, according to a study in Infection Control and Hospital Epidemiology. Of 123 healthcare workers in a Thai hospital, compliance with the WHO's 'five moments' of HH was 23.2% by direct observation and 82.4% by self-report. In a survey, the participants identified 11 barriers to compliance: that are follows, I hurry/emergent patient conditions 45.5%, I don't see any dirt/I think it's not dirty 24.4 percent I forget 19.5%, I'm busy/too many patients 15.4%, It is inconvenient 13.8%, I don't care 8.1%, I'm lazy 5.7%, I wear gloves/no direct contact with patients 4.9%, There are adverse effects of soap/cleanser 4.9%, It wastes time 4.1%, My hands are clean 2.4%.,
The aim of this study is to find out the hindrance or obstacles in HH practice among healthcare workers.
| Methodology|| |
The present cross-sectional study was carried out in the Al Rass General Hospital by Infection Control Department from January to March 2017, that having capacity of 250 beds with workforce of around 500 healthcare workers, among all healthcare workers those who are working in direct patients care area selected for the study, all those who presented on the day of survey and willing to participate in the study were taken as a sample size. The study is planned to find out their day-to-day obstacles/difficulties, opinion and suggestions to improve compliance of HH among healthcare workers. Predesigned and pretested proforma were used for collection of data from various department, the participants were selected by random method. The total sample size of 80 were selected for study, the noncompliance rate among participants was 6(7.5%). The collected data was entered in excel sheets and analyzed using SPSS 20. The results were presented in the form of tables and graphs, and statistical test such as Chi-square test, mean and standard deviation also applied according to requirements, P < 0.05 considered to be statistically significant.
[Table 1] and [Table 2] shows that in the present study, most of the respondents under 35 years of age 59 (80%) and females were significantly higher 66 (89%), most of them have educational status up to graduate level or diploma 62 (84%), most of them working on the post of staff nurse in the hospital 62 (84%). [Graph 1] and [Graph 2] shows about their opinion about HH around 21 (28%) responded were fully correct, we also access their correct knowledge about the WHO five moments/indication of HH 70 (94%) had correct knowledge regarding indication of HH. We also access according to [Table 3], [Table 4], [Table 5] showed about their day-to-day difficulties/obstacles in HH practice, majority of them responded often too busy or insufficient time, 18 (25%) followed by hands don't look dirty and skin irritation 17 (23%) and 17 (23%), respectively, some peoples also influenced by others behaviors because they don't practice so we but difference found to be non-significant. Thirteen (17.56%) also responded no difficulties in practicing HH in day-to-day work. We also asked their suggestions for improvement in HH compliance among healthcare workers majority of them suggested encourage the staff to do HH practice every now and then and all head nurse should ask the staff about HH in the morning meeting. Some staffs suggested for monitoring by infection prevention and control department, or higher authority for good compliance, healthcare worker also suggested for punishment and put name on the display board those who have poor compliance on HH.
|Table 1: Distribution of healthcare workers according to their sociodemographic profile|
Click here to view
|Table 2: Distribution of respondents according to their present designation/post|
Click here to view
|Table 3: Distribution of study participants according to day-to-day difficulties/obstacles in hand hygiene by nursing staff|
Click here to view
|Table 4: Distribution of study participants according to day-to-day difficulties/obstacles in hand hygiene by doctors|
Click here to view
|Table 5: Suggestion for improvement in “hand hygiene” compliance among healthcare workers|
Click here to view
| Discussion|| |
The present study done to find out the obstacles in HH among healthcare workers, time pressure is one of the biggest reported barriers to HH compliance among healthcare workers, according to a study in Infection Control and Hospital Epidemiology. Of 123 healthcare workers in a Thai hospital, compliance with the WHO's 'five moments' of HH was 23.2% by direct observation and 82.4% by self-report, and in a survey, 11 barriers identified for HH compliance: That are follows I hurry/emergent patient conditions 45.5%, I don't see any dirt/I think it's not dirty 24.4% I forget 19.5%, I'm busy/too many patients 15.4%, It is inconvenient 13.8%, I don't care 8.1%, I'm lazy 5.7%, I wear gloves/no direct contact with patients 4.9%, in the present study also similar type of finding reported about obstacles in HH., The study done by Kampf and Kramer regarding epidemiologic background of HH and evaluation of the most important agents for scrubs and rub they observed the best antimicrobial efficacy can be achieved with ethanol (60%–85%), isopropanol (60%–80%) and n-propanol (60%–80%). The present study not evaluated the efficacy of scrubs and hand rub. The study conducted by Daniels IR about handwashing simple but effective they observed out of 239 patient events, which are defined as a clinician reviewing a patient to assess their treatment, a total of 88 involved an examination (37%) and of these, 41 had post-operative wounds (47%). The number of times clinicians washed their hands between examinations was 36 (41%). Between the two groups of clinicians, the consultants washed their hands 30 times in 55 examinations (55%), while the registrars washed their hands six times in 23 examinations (26%), in the present study, we try to assessed hindrance and obstacles in the HH practice and how to improve but we were not studied hand compliance. The study finding observed by Rotter in a seminal intervention study 150 years ago, Semmelweis insisted that doctors performing necropsies washed their hands before delivering babies, so reducing mortality due to streptococcal puerperal sepsis from 22% to 3%. The study done by Pittet regarding improving adherence to HH practice: A Multidisciplinary Approach, they were also observed same kind of finding like present study regarding non-compliance and perceived barriers about HH. Another study done by Smith regarding a review of handwashing techniques in primary care and community settings they observed lack of evidence for handwashing techniques being undertaken in practice today. Findings from handwashing technique studies were inconclusive and methodological issues exist resulting in sparse reliable evidence. There is an urgent need to undertake methodologically sound studies of handwashing techniques for use in the ever expanding scope of primary care practice, but the present study was conducted in tertiary care hospital.
| Conclusion|| |
This study showed for good compliance about HH among healthcare workers need repeated training, motivation, telling importance of HH, continuous monitoring with punishment those who not follow after repeated reminders.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Boyce JM, Pittet D. Healthcare Infection Control Practices Advisory Committee, HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. Recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. Society for healthcare epidemiology of America/Association for professionals in infection control/Infectious diseases society of America. MMWR Recomm Rep 2002;51:1-45.
Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004;17:863-93, table of contents.
Daniels IR, Rees BI. Hand washing: Simple, but effective. Ann R Coll Surg Engl 1999;81:117-8.
Labarraque AG. In: Porter J, editor. Instructions and Observations Regarding the use of the Chlorides of Soda and Lime. New Haven, CT: Baldwin and Tread Way; 1829.
Semmelweis I. In: Carter KC, editor. Etiology, Concept, and Prophylaxis of Childbed Fever. 1st
ed. Madison, WI: The University of Wisconsin Press; 1983.
Rotter ML. 150 years of hand disinfection-Semmelweis' heritage. Hyg Med 1997;22:332-9.
Pittet D. Improving adherence to hand hygiene practice: A multidisciplinary approach. Emerg Infect Dis 2001;7:234-40.
Mortimer EA Jr., Wolinsky E, Gonzaga AJ, Rammelkamp CH Jr. Role of airborne transmission in staphylococcal infections. Br Med J 1966;1:319-22.
Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43.
Hospital Infection Control Practices Advisory Committee (HICPAC). Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105-13.
Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW, and the epic guideline development team; Barrett S, et al
. The epic project: developing national evidence-based guidelines for preventing healthcare associated onfections. Phase 1: Guidelines for preventing hospital-acquired infections. Journal of Hospital Infection 2001; 47(Suppl):S1-82. Available from: http://www.richardwellsresearch.com Google Scholar, Crossref
. [Last accessed on 2017 June 24].
Stone SP. Hand hygiene – The case for evidence-based education. J R Soc Med 2001;94:278-81.
Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D, et al.
The first global patient safety challenge “Clean care is safer care”: From launch to current progress and achievements. J Hosp Infect 2007;65 Suppl 2:115-23.
Magiorakos AP, Suetens C, Boyd L, Costa C, Cunney R, Drouvot V, et al.
National hand hygiene campaigns in Europe, 2000-2009. Euro Surveill 2009;14. pii: 19190.
World Health Organization. WHO Guidelines for Hand Hygiene in Health Care (Advanced draft). Geneva: World Health Organization; 2006. Available from: http://www.who.int/gpsc/tools/en/
. [Last accessed on 2010 Aug 24].
Kilpatrick C, Allegranzi B, Pittet D. The global impact of hand hygiene campaigning. Euro Surveill 2009;14. pii: 19191.
Noble WC. Dispersal of skin microorganisms. Br J Dermatol 1975;93:477-85.
Eiamsitrakoon T, Apisarnthanarak A, Nuallaong W, Khawcharoenporn T. Hand Hygiene Behavior: Translating Behavioral Research into Infection Control Practice, Infection Control and Hospital Epidemiology 2013;34:1137-45.
Smith SM. A review of hand-washing techniques in primary care and community settings. J Clin Nurs 2009;18:786-90.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]