Hand hygiene.pdf

quantified in observational studies 454,504,507,537,539-541 . Table I.14.3 lists the most frequently
reported reasons that are possibly, or effectively, associated with poor adherence. Some
of these barriers are discussed in Part I, Section 13 (i.e. skin irritation, easy access to hand
hygiene supplies), and in Part I, Section 20.1 (i.e. impact of use of gloves on hand hygiene
practices).
Lack of knowledge of guidelines for hand hygiene, lack of recognition of hand hygiene
opportunities during patient care, and lack of awareness of the risk of cross-transmission of
pathogens are barriers to good hand hygiene practices. Furthermore, some HCWs believed
that they washed their hands when necessary even when observations indicated that they
did not 153,155,507,508,518,545 .
Additional perceived barriers to hand hygiene behaviour are listed in Table I.14.3. These
are relevant not only to the institution but also to the HCW’s own particular group. Therefore,
both institutional and small group dynamics need to be considered when implementing a
system change to secure an improvement in HCWs’ hand hygiene practices.
15. RELIGIOUS AND CULTURAL ASPECTS OF HAND HYGIENE
There are several reasons why religious and cultural issues should be considered when
dealing with the topic of hand hygiene and planning a strategy to promote it in health-care
settings. The most important reason is that these guidelines, as a WHO document, are
intended to be disseminated all over the world and in settings where very different cultural
and religious beliefs may strongly influence their implementation. Well-known examples
already exist of health interventions where the religious point of view had a critical impact
on, if not interfered with, their implementation. The topic is so vast that this section cannot
be considered exhaustive. This is also the reason why, intentionally, only the main religions
have been considered. These include Christianity, which counts almost 2.2 billion followers
in 238 countries around the world, Islam with almost 1.3 billion followers in 232 countries,
Hinduism with 851 million in 166 countries and Buddhism with 375 million in 130
countries. Ethno-religion, which is made up of the followers of local, tribal, animistic or shamanistic
religions, with members restricted to one ethnic group, has 253 million adherents
worldwide spread over 144 countries. Other religions considered include Sikhism which
has almost 25 million adherents worldwide in 34 countries, and Judaism with 15 million
adherents in 134 countries 546 .
These reflections should be considered to be very much as a work in progress, particularly
since they will undoubtedly be revisited during the implementation phase of the guidelines
at country level. The aim of this section is to explore and propose comments on this innovative
topic, in order to suggest considerations and possible solutions to health-care providers
dealing with hand hygiene in settings where the practice may be strongly influenced by
religious and cultural factors. As regards hand hygiene in health care, this is an entirely
unexplored speculative area; it has been difficult to find information about cultures in which
hand hygiene has a particular meaning or impact, whereas the investigation has been more
fruitful concerning religious aspects.
Philanthropy, generally inherent in any faith, has often been the motivation for establishing
a relationship between the mystery of life and death, medicine and health care. This
predisposition has often led to the establishment of health-care institutions under religious
affiliations. Faith and medicine have always been integrated into the healing process as many