Preventing infection spread in hospitals

Published: 7-Dec-2016

When it comes to protecting immunocompromised patients from healthcare-associated infections, hand hygiene must be the first line of defence, says Deb Group

You need to be a subscriber to read this article.
Click here to find out more.

Hospitals bring together hundreds of patients – many of them very vulnerable due to their reduced immunity to infection. This makes hospitals highly sensitive environments where the containment of germs and bacteria needs to be assured at all times, particularly when it comes to protecting patients from healthcare-associated infections (HCAIs), which are currently believed to cost the NHS around £1bn a year.1

Research conducted by the European Centre for Disease Prevention and Control in 20112 showed that 6.4% of hospital patients – one in 16 – contracted an infection while in hospital. According to the Department of Health, 300,000 patients develop a HCAI in England every year, and 5,000 of those cases prove fatal3.

But this situation isn’t inevitable; on the contrary, it is estimated that 20-40% of all HCAIs could be avoided by communicating and applying existing hand hygiene rules and practices more effectively.4

To assure the containment of germs and bacteria in hospitals, hand hygiene is crucial. Given that 80% of all infections are transmitted by hands5, regular handwashing with soap is widely seen as one of the most effective ways to reduce the spread of infection-causing germs and bacteria. Apart from removing visible soiling, the physical action of a good handwashing technique removes high levels of bacteria and viruses that are also present on the skin.

For non-surgical procedures, applying a mild soap followed by a good handwashing technique will remove potentially harmful transient micro-organisms. For surgical procedures, antiseptic soap will be required to kill and remove micro-organisms and residents.

Electronic auditing can be considerably more reliable than direct monitoring

Electronic auditing can be considerably more reliable than direct monitoring

Hand sanitising is useful in reducing bacterial counts on visibly clean heads when access to soap and running water is inconvenient. In contrast to soap and water, alcohol-based sanitiser (the preferred choice in healthcare environments) kills a high proportion of the micro-organisms present on the hands, rather than physically removing them.

Both hand washing and hand sanitising should ideally be based on the WHO Five Moments for Hand Hygiene guideline, which identifies these key moments: before patient contact; after patient contact; before an aseptic task; after exposure to body fluids; and after touching a patient’s surroundings. If a hand hygiene programme is to be complete, it should include a third element. Skin that is exposed to regular hand-washing during the day needs to be replenished regularly. Restorative creams have been formulated to moisturise, nourish and condition the skin, improving its strength and preventing it from becoming dry or damaged. In hospitals and healthcare institutions, such products should be used as frequently as possible.

For a hand hygiene programme to work, it is important that all three types of products – soap, sanitisers and restorative creams – are available from easy-to-use dispensers. Modern equipment can be fully customised to suit an institution’s specific needs, while new technology, such as BioCote, prevents the spread of germs on the equipment thereby further increasing safety.

Electronic monitoring presents hospitals with an accurate, sophisticated means to monitor staff behaviour effectively

The provision of the right products should go hand-in-hand with proper staff education: it is crucial for staff to be educated about the importance of proper skin care in the workplace, and trained in using the right techniques. This should be an on-going conversation, rather than a one-off event. Monitoring plays a crucial role in assuring hand hygiene compliance in hospitals – and technology has made major advances in this field in recent times. Electronic monitoring presents hospitals with an accurate, sophisticated means to monitor staff behaviour effectively.

There is no escaping the fact that traditional measures for tracking hand hygiene compliance are outdated and ineffective. ‘Direct observation’ – human observers physically monitoring staff behaviour as they perform everyday duties and determining the healthcare facility’s compliance in line with the WHO’s ‘Five moments for hand hygiene’ – has many limitations. Observational programmes are typically conducted manually, with limited sophistication in the gathering or analysis of the data compiled.

Preventing infection spread in hospitals

Being under such obvious scrutiny commonly results in the ‘Hawthorne Effect’: medical staff will be aware that they are being watched and will exhibit different behaviour from that which they would normally. As a result, compliance rates are artificially high and not a true reflection of actual hand hygiene habits.

The psychological factor works the other way as well: observer bias can play a part, particularly if they are not totally impartial. Positive or negative bias can be caused, perhaps due to a sense of loyalty towards colleagues that might result in higher marks than should have been recorded, or even the opposite should they have grievances that might cause them to record results more harshly.

The statistical reliability is hampered further because, quite simply, it is impossible to gather sample sizes that reflect the entire operation. Observers cannot monitor doctors’ and nurses’ every interaction with every single patient, and it is unrealistic to think that observers can track every activated hand hygiene event that has taken place through keeping a watchful eye alone.

Finally, the resource requirements make direct observation far from perfect. Through more efficient monitoring approaches, already strained NHS bodies can make better use of healthcare workers’ time by assigning them to tasks that reflect better their medical expertise. There are several monitoring options available to hospitals, but choosing the right one has a significant impact on its success, both in terms of hand hygiene compliance and financial implications of its installation and operating costs.

With Deb’s Dashboard compliance data can be accessed via the internet with a PC or mobile

With Deb’s Dashboard compliance data can be accessed via the internet with a PC or mobile

With many technological solutions now available on the market, however, there are still drawbacks to take into account. For example, having 24/7 video surveillance might initially seem like an appropriate choice of monitoring, but having people trawl through hours of video footage from locations across a whole hospital site is costly as well as being practically impossible to keep track of effectively.

Similarly with real-time locating system (RTLS) technology, the impracticalities are apparent, because simply tracking a member of staff’s location gives no actual insight into whether they are indeed washing their hands regularly. Also, by tracking compliance on an individual basis, accountability for non-compliance becomes that much more personal.

Of course, many would say that medical professionals should welcome the individual scrutiny that non-compliance would bring, but in real terms it can be hugely damaging to staff morale, which can consequently affect their performance: feeling yourself under constant surveillance is not a desirable environment in which to work.

By this token, a group monitoring solution that promotes the spirit of collective responsibility among healthcare teams is ideal: something non-intrusive so as not to disrupt workflow, yet sophisticated enough to gather accurate data.

The answer is electronic auditing – a cost-effective method that is considerably more reliable than direct monitoring, capturing 100% of hand hygiene events which provides operators with precise, quantified data that enables them to increase compliance. And these systems can be established in a medical facility in a way that has no detrimental impact on the daily activities of medical staff.

Tracking data can be presented to operators in the form of web-based reports – giving them the insight to make informed decisions on how teams/departments can improve

State-of-the-art electronic numeration can be incorporated into the dispensers, such that a wireless signal will activate any time the dispenser is used and be sent to a tracking server. Then, by means of pre-determined algorithms on the basis of factors such as the healthcare provider to patient ratio, it is possible to measure what is happening more accurately and determine whether it falls in line with compliance standards.

After any given timeframe the tracking data can be presented to operators in the form of web-based reports – giving them the insight to make informed decisions on how teams/departments can improve.

By clearly displaying hand hygiene trends and statistics for each hospital unit, staff can collaborate on compliance improvement plans, set goals and ensure that as a team they are doing everything in their power to improve hand hygiene and thus, patient safety. If a monitoring system is combined with an integrated hand hygiene programme, hospitals can go a long way towards controlling infections and protecting the skin health of workers at the same time.

References

  1. NAO, ‘Reducing Healthcare Associated Infections in Hospitals in England’ https://www.nao.org.uk/wp-content/uploads/2009/06/0809560es.pdf
  2. http://ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf
  3. House of Commons Committee of Public Accounts – Twenty-fourth Report 2004-05: Improving patient care by reducing the risks of hospital acquired infection: A progress report.
  4. http://www.nhs.uk/news/2012/05may/Pages/mrsa-hospital-acquired-infection-rates.aspx
  5. Source: US Centers for Disease Control and Prevention

Trending Articles

You may also like