MEDICAL TECHNOLOGY PROJECTMEASUREment and COMPLIANCE of HAND HYGIENEKaren quinlan k00132819Medical technology project year 3 2017RESEARCH QUESTION INTRODUCTION:”Hand hygiene is the single most important measure in preventing spread of infection. Hand hygiene refers to both hand washing with soap and water or hand rub using an alcohol gel/rub (without the use of water). There are three recommended levels of hand hygiene to ensure that the hand hygiene performed is suitable for the task being undertaken.” (Sari, 2005)Hand hygiene in the healthcare setting reduces the transmission of any types of pathogens and the occurrence of healthcare associated infections. The use of gloves does not compensate for the lack of correct hand hygiene.Are people generally aware that there is a correct method for handwashing? How effective is Hand Hygiene in LIT, example of the general public? Do people know how to wash their hands correctly and the implications of not using the correct method?LITERARY REVIEWLITERATURE REVIEW ON CONDUCTING SURVEY”The principal objectives of a survey should always be to collect reliable, valid, and unbiased data from a representative sample, in a timely manner and within resource constraints.” (McColl, 2001, p1.)However the Joint Commission (2009) advises that where hand hygiene surveys are conducted the surveyor should consider: — “Will the results accurately represent the population?— Will everyone in the survey population have an equal opportunity to respond? — What is your desired response rate?— How much follow-up is needed to obtain that response rate? — What might the differences be between survey responders and non-responders? – How readable and understandable are the survey questions, particularly to non-health care workers?” (p64)Huge emphasis is currently placed on reducing healthcare-associated infection through improving hand hygiene compliance among healthcare professionals. It is perceived by the media that there is poor hand hygiene compliance among healthcare staff. The aim was to report the outcomes of a systematic search for peer reviewed and published studies. As well as clinical trials which focused on hand hygiene compliance among healthcare professionals. Searches were done on the topic of hand hygiene from Literature published between December 2009, after publication of the World Health Organization (WHO) hand hygiene guidelines, and February 2014, which was indexed in PubMed and CINAHL on the topic. There were examinations of relevance and methodology of fifty seven publications initially and sixteen clinical trials were used. Most of the studies were conducted in the USA and Europe. The intensive care unit was the primary focus, followed by care of the elderly facilities. The Nurse was the focus of healthcare workers, followed by the healthcare assistant and then the doctor. Four studies used for analysis ‘my five moments for hand hygiene’ as set out in the WHO guidelines, the others unique multimodal designs of analysis. The conclusion was using adopting a multimodal approach to hand hygiene, whether guided by the WHO framework or by another testing framework, resulted in moderate improvements in hand hygiene compliance. Of the sixteen papers reviewed, four research designs were explicitly guided by the ‘my five moments for hand hygiene’ framework, as set out in the WHO guidelines. Locally designed multimodal approaches using various unique behavioural approaches and even though there was a lack of uniformity in these approaches, positive outcomes were achieved. Adopting a multimodal approach to hand hygiene improvement intervention strategies, whether guided by the WHO framework or another tested multimodal framework, has been shown to achieve slight to moderate improvements in hand hygiene compliance. Other areas for additional research is more knowledge, attitudes and awareness of future practitioners (e.g. medical and healthcare students, interns, healthcare facility managers, patients and carers. Also, the adoption of technology-driven solutions for both delivery of ABHRs (alcohol based hand rub) and monitoring their use. Using such data for analysis of patient and healthcare professional movements for outbreaks, may lead to enhanced compliance and understanding of the challenges involved. (Kingston, 2015)CHAPTER 3METHOLOGY Indications for hand hygieneHAND HYGIENE – DEFINED BY THE WORLD HEALTH ORGANISATIONThe 5 Moments for Hand Hygiene approach defines the key moments when health-care workers should perform hand hygiene.This evidence-based, field-tested, user-centred approach is designed to be easy to learn, logical and applicable in a wide range of settings.This approach recommends health-care workers to clean their hands1. before touching a patient,2. before clean/aseptic procedures,3. after body fluid exposure/risk,4. after touching a patient, and5. after touching patient surroundings. Clean hands according to the WHO ‘5 moments for hand hygiene’: – l immediately before each episode of direct patient contact or care (IB) l immediately before a clean/aseptic procedure (IB) l immediately after contact with body fluids or excretions, mucous membranes, non-intact skin or wound dressings (IA) l immediately after each episode of direct patient contact or care (IB) Immediately after contact with objects and equipment in the immediate patient environment (IB) Your 5 Moments for Hand Hygiene.SURVEY ON HAND HYGIENE IN LIMERICK INSTITUTE OF TECHNOLOGYIn December 2017, the Author conducted a Survey of random students of mixed age and gender. The Survey consisted of a UV machine, the property of a nearby hospital and a gel. The machine was in a public area in view of anyone passing by. There were many enquiries about the survey and how it worked. They were advised that it was totally anonymous and that they were welcome to get involved. The participants were asked if they knew there was a correct procedure for handwashing. Most were unaware of this, however, they felt quite confident of their ability to do it correctly.Everyone was shown a chart, showing a) most frequently, b) frequently and c) less frequently missed areas on the front and back of hands. There are different colours on the chart to indicate the different areas. They were shown the machine, the gel and how it all worked. They were invited to use the machine in order to obtain a result on their performance with their handwashing technique. They were given a small amount of gel which shows up the ultraviolet light on the hands below. A total of thirty five students were invited to participate in this anonymous survey. Twenty seven agreed to it and eight declined. It was quite difficult to get agreement initially as it was seen as their personal hygiene was being evaluated, but after explaining in detail the reason for the survey, they were put at ease and agreed and were quite happy afterwards for getting involved. They were also competing with friends so it was enjoyable for most.The UV machine is quite a simple apparatus, yet can give very interesting results. It is lightweight and portable. It uses normal domestic power and the light shines downwards on the object being tested. The conductor of the experiment released a small amount of UV compatible gel on the participant’s hands and they were asked to use the same motion as if they were washing with soap, making sure they covered all the areas of their hands. When they had completed doing this and were happy with their attempt, they were asked to put both hands, palms downwards into the machine. With the chart beside them, they were able to check their results especially in the most frequent areas. They then turned their hands, palms upwards to check the next results. Generally most volunteers were happy they had participated and called over friends to watch. Overall the survey was quite successful, it made students think about their handwashing techniques and how important it may be in a clinical setting to do it correctly. They could see quite clearly how areas can easily be missed and how that may impact a vulnerable person who is ill and needs basic handwashing to be done before and after dealing with each patient. The overall experience showed the positive impact that good handwashing techniques can have. In hospitals, handwashing solutions could easily be moved to entrances and exits of hospitals, clinics and GP waiting rooms. At the moment these devices are optional but should be compulsory when entering and exiting. An easy change could have a huge impact.The table below is broken down into:1. Male/Female2. Most Frequently (Purple) y/n3. Frequently (Pink) y/n4. Less Frequent (Grey) y/nMALE/FEMALE MOST FREQ Y/N PURPLE FREQ Y/N PINK LESS FREQ Y/N GREY TOTALYES TOTALNOCLIENT 1 M BACK YFRONT Y BACK NFRONT N BACK NFRONT N 2 4CLIENT 2 M BACK YFRONT Y BACK YFRONT Y BACK YFRONT N 5 1CLIENT 3 F BACK YFRONT Y BACK YFRONT N BACK NFRONT N 3 3CLIENT 4 M BACK YFRONT Y BACK YFRONT Y BACK YFRONT N 5 1CLIENT 5 M BACK YFRONT Y BACK YFRONT Y BACK NFRONT Y 5 1CLIENT 6 M BACK NFRONT Y BACK NFRONT Y BACK NFRONT Y 3 3CLIENT 7 F BACK YFRONT N BACK YFRONT N BACK YFRONT N 3 3CLIENT 8 F BACK YFRONT Y BACK NFRONT N BACK NFRONT N 4 2CLIENT 9 M BACK yFRONT N BACK YFRONT N BACK NFRONT N 2 4CLIENT 10 F BACK NFRONT Y BACK YFRONT Y BACK YFRONT Y 5 1CLIENT 11 M BACK YFRONT Y BACK YFRONT Y BACK YFRONT Y 6 0CLIENT 12 M BACK YFRONT N BACK YFRONT N BACK NFRONT N 2 4CLIENT 13 F BACK YFRONT N BACK YFRONT N BACK NFRONT N 2 4CLIENT 14 F BACK YFRONT Y BACK YFRONT Y BACK YFRONT Y 6 0CLIENT 15 M BACK YFRONT Y BACK NFRONT Y BACK NFRONT N 3 3CLIENT 16 M BACK YFRONT Y BACK YFRONT N BACK YFRONT N 4 2CLIENT 17 F BACK NFRONT Y BACK YFRONT Y BACK YFRONT Y 5 1CLIENT 18 M BACK YFRONT Y BACK YFRONT Y BACK NFRONT Y 5 1CLIENT 19 M BACK YFRONT Y BACK YFRONT Y BACK NFRONT Y 5 1CLIENT 20 M BACK YFRONT Y BACK YFRONT Y BACK N FRONT Y 5 1CLIENT 21 F BACK YFRONT N BACK YFRONT Y BACK YFRONT N 4 2 CLIENT 22 F BACK NFRONT Y BACK YFRONT Y BACK NFRONT N 3 3CLIENT 23 F BACK YFRONT Y BACK YFRONT Y BACK YFRONT Y 6 0CLIENT 24 M BACK YFRONT Y BACK YFRONT Y BACK NFRONT Y 5 1CLIENT 25 M BACK YFRONT Y BACK YFRONT Y BACK YFRONT Y 6 0CLIENT 26 M BACK NFRONT Y BACK NFRONT Y BACK NFRONT Y 3 3CLIENT 27 M BACK NFRONT Y BACK YFRONT Y BACK NFRONT Y 4 2
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