Hand hygiene.pdf

More documents

Recommendations

Info

tion precautions 580 . There are also reports on the effective use of education for hand hygiene promotion strategies outside the acute hospital care setting 581,582 . It is important, therefore, to continue to use the formal education programme for the implementation of hand hygiene in the hospital. It is noteworthy that good hand hygiene guidelines are now available for infection control teams around the world 7,583 . This is a distinct advantage because studies have shown that guidelines are in themselves an effective means of influencing behaviour regarding infection control 584 . If a formal education programme is organized to introduce the guidelines, the effects should be even further enhanced. In this section, guidance is given on the planning process of the education programme, together with a guideline review scheme that could help in developing an effective strategy for implementation. 17.1 IMPLEMENTATION PROCESS The usual implementation process is depicted in Figure I.17.1. As shown, after a guideline is finalized, the infection control team will usually adopt a two-pronged implementation process. One of these prongs consists of submitting the guideline to the infection control committee for approval, and circulating it down the chain of command with instructions for implementation. The other prong would be the education programme, conducted by the infection control team and given directly to front-line staff. It is important to realize that HCWs’ compliance can be extremely low when guidelines are simply circulated down the hospital hierarchy: research indicates that the compliance rate can be as low as 20% 557 . When monitored, compliance with MRSA precautions was only 28% in a teaching hospital 585 ; compliance was as low as 8% during the evening shift, and 3% during the night shift. This underlines the importance of the education programme: the success of the implementation process depends on the effectiveness of this programme, and careful planning is essential. 17.2 REVIEWING THE GUIDELINE FOR IMPLEMENTATION The central part of this scheme is a method for reviewing guidelines before implementation 586,587 . After this review, the infection control team will obtain essential information for formulating the education programme (Figure I.17.2). An infection control guideline generally consists of a list of recommendations on appropriate patient-care practices. In the education programme, instead of covering all the recommendations in a similar fashion for all categories of HCWs, a better strategy is to focus on the patient-care practices that require alterations, particularly those that would meet resistance from HCWs. The review scheme seeks to anticipate the educational needs so that the infection control team can plan accordingly. All recommendations in the guideline are categorized as follows:
A policy for the practice is already present in the institution or is already standard practice. An example is the washing of hands that are visibly dirty or contaminated with proteinaceous material, or are visibly soiled with blood or other body fluids. Even without an official guideline for hand hygiene, many health-care facilities will usually already have such a practice in place. It is expected that HCWs would agree with the rationale of the recommendation and also that resources for implementation, if needed, are already in place. Therefore the practice should be easily implemented by the usual educational programme of inservice lectures or posters. An example is hand antisepsis before inserting peripheral vascular catheters or other invasive devices, as most HCWs will not object to such a reasonable practice. For this category, it is anticipated that implementation would be difficult mainly because of the lack of resources. An example is the need to provide a sufficient supply of alcoholbased handrub for use in areas of high workload and high intensity patient care, so that it is available at the entrance to the patient’s room or at the bedside and other convenient locations. Implementation is difficult in this category because HCW resistance is expected to be high. An example is the recommendation for hand antisepsis after glove removal, as many HCWs may consider their hands to be clean, having been protected by the wearing of gloves. It is recommended that a senior infection control professional in the hospital conducts the initial review 586 . Other senior nurses in the institution should also be coopted for this exercise. Using this scheme, studies have shown that front-line senior nurses in the hospital are accurate in predicting actual practices on the wards. A survey comparing their predictions with practices reported on the wards showed a significant correlation 586 . Figure I.17.2 shows the different educational methods that can be used for each category of recommendations. Implementation of established practices simply requires adequate communication and a formal announcement because HCWs are already putting these recommendations into practice. Non-established practices (easy implementation) are recommendations for which a high level of agreement is expected. When there is agreement, the intent for practice is already present and attitude change is usually not required. Azjen & Fishbein have shown that, under such circumstances, the desired behaviour will often
Page 2 and 3:
The WHO Guidelines on Hand Hygiene
Page 5 and 6:
CONTENTS INTRODUCTION . ...........
Page 7 and 8:
17. Organizing an education program
Page 11:
INTRODUCTION The WHO Advanced Draft
Page 14 and 15:
Handwashing. Washing hands with pla
Page 16 and 17:
still considered the standard of ca
Page 18 and 19:
treatment selectively removes glyce
Page 20 and 21:
of the organism on their hands. Mak
Page 22 and 23:
6. MODELS OF HAND TRANSMISSION 6.1
Page 24 and 25:
In the 1960s, a prospective, contro
Page 26 and 27:
for its ability to reduce the relea
Page 28 and 29:
8.2 SHORTCOMINGS OF TRADITIONAL TES
Page 30 and 31: tions of short-chain aliphatic alco
Page 32 and 33: 9.1.3 WATER QUALITY The physical, c
Page 34 and 35: Case study: experience of Egypt The
Page 36 and 37: and both reduced viral counts on ha
Page 38 and 39: activity of chlorhexidine is not se
Page 40 and 41: protein synthesis and alteration of
Page 42 and 43: in micelle structures formed by sur
Page 44 and 45: In all the studies that included pl
Page 46 and 47: isopropyl alcohol) were applied to
Page 48 and 49: 3) Glycerol is added using a measur
Page 50 and 51: in 2005 the costs of an alcohol-bas
Page 52 and 53: infection, risk factors that are la
Page 54 and 55: 11.4.4 SIDE-EFFECTS OF THE SURGICAL
Page 56 and 57: • Repeat the process on the other
Page 58 and 59: 12.2 ALLERGIC CONTACT DERMATITIS RE
Page 60 and 61: particularly when resources are lim
Page 62 and 63: Handrubs are available as gels, sol
Page 64 and 65: 14. HAND HYGIENE PRACTICES AMONG HE
Page 66 and 67: quantified in observational studies
Page 68 and 69: According to behavioural theories (
Page 70 and 71: of water with special leaves) outsi
Page 72 and 73: Furthermore, according to Phra Depv
Page 74 and 75: 16. BEHAVIOURAL CONSIDERATIONS 16.1
Page 76 and 77: and community factors must be consi
Page 78 and 79: i. ii. iii. iv. v. vi. a) b) Educat
Page 82 and 83: follow the intent 588 . Studies hav
Page 84 and 85: 18. FORMULATING STRATEGIES FOR HAND
Page 86 and 87: 18.2 DEVELOPING A STRATEGY FOR GUID
Page 88 and 89: 1998 (P
Page 90 and 91: HCWs routinely to wear vinyl gloves
Page 92 and 93: quality gloves, reuse, shortage of
Page 94 and 95: • To test for holes, gloves shoul
Page 96 and 97: Figure l.20.2: Blood safety: crucia
Page 98 and 99: Consensus recommendations are that
Page 100 and 101: D. Wash hands with either plain or
Page 102 and 103: 5. SKIN CARE A. B. C. Include infor
Page 107 and 108: PART III. OUTCOME MEASUREMENTS 1. M
Page 109 and 110: 2. HAND HYGIENE AS A QUALITY INDICA
Page 111 and 112: can be seen during routine work. Da
Page 113 and 114: Case study: United Kingdom national
Page 115 and 116: PART IV. PROMOTING HAND HYGIENE ON
Page 117 and 118: ated to reinforce its principles (t
Page 119: 6. PRINCIPLES OF COUNTRYWIDE HAND H
Page 122 and 123: As many international and national
Page 124: debate that resulted in increasing
Page 128 and 129: 23. Lee YL et al. Colonization by S
Page 130 and 131:
Interscience Conference on Antimicr
Page 132 and 133:
122. Vicca AF. Nursing staff worklo
Page 134 and 135:
171. Kauppinen J et al. Hospital wa
Page 136 and 137:
224. Krilov LR et al. Inactivation
Page 138 and 139:
276. Thomas L et al. Development of
Page 140 and 141:
326. Johnson S et al. Prospective,
Page 142 and 143:
34th Interscience Conference on Ant
Page 144 and 145:
423. Kampf G, et al. Influence of a
Page 146 and 147:
474. West DP et al. Evaluation of a
Page 148 and 149:
524. Muto C et al. Hand hygiene rat
Page 150 and 151:
578. Babcock HM et al. An education
Page 152 and 153:
Interscience Conference on Antimicr
Page 154 and 155:
679. Hirschmann H et al. The influe
Page 156:
729. Martin LS, McDougal JS, Loskos
Page 161 and 162:
Table I.8.1: Basic experimental des
Page 163 and 164:
Table I.9.1: Waterborne pathogens a
Page 165 and 166:
Table I.9.3: Virucidal activity of
Page 167 and 168:
Table I.9.4: Studies comparing the
Page 169 and 170:
Table I.9.6: Studies comparing the
Page 171 and 172:
Table I.14.1: Hand hygiene frequenc
Page 173 and 174:
Table I.14.2: Hand hygiene adherenc
Page 175 and 176:
Table I.15.1: Hand hygiene indicati
Page 177 and 178:
Table I.18.1: Strategies for succes
Page 179 and 180:
Table l.20.1: Possible problems and
Page 181 and 182:
Table I.21.1. Hand hygiene research
Page 183 and 184:
Table I.21.1: Hand hygiene research
Page 185 and 186:
Table I.21.2: Unsolved issues for r
Page 187 and 188:
Table III.2.1: Quality indicators r
Page 189 and 190:
Table V.3.1: Examples of public inf
Page 191 and 192:
Table V.4.1: Examples of national p
Page 193:
Table V.5.1: The public information
Page 197 and 198:
APPENDIX 1. DEFINITIONS OF HEALTH-C
Page 199:
APPENDIX 2. HAND AND SKIN SELF-ASSE
Page 202:
Data in coloured cells can be chang
Page 206:
NHS NICU n-P NPSA NA NS OPD PACU PA
Page 211 and 212:
AUTHORS: John Boyce Saint Raphael H
Page 213 and 214:
Garance Upham People’s Health Mov
show all

Hand hygiene.pdf

Create successful ePaper yourself

Delete template?

Save as template?