MEDICAL that response rate? — What might the differences

MEDICAL TECHNOLOGY PROJECT  MEASUREmentand COMPLIANCE of HAND HYGIENE Karen quinlan k00132819 Medical technology project year 3 2017   RESEARCHQUESTION INTRODUCTION:”Hand hygiene is the single most importantmeasure in preventing spread of infection.

Hand hygiene refers to both handwashing with soap and water or hand rub using an alcohol gel/rub (without theuse of water). There are three recommended levels of hand hygiene to ensurethat the hand hygiene performed is suitable for the task being undertaken.”(Sari, 2005)Hand hygiene in the healthcare setting reduces thetransmission of any types of pathogens and the occurrence of healthcare associatedinfections. The use of gloves does not compensate for the lack of correct handhygiene.  Are peoplegenerally aware that there is a correct method for handwashing? Howeffective is Hand Hygiene in LIT, example of the general public? Do peopleknow how to wash their hands correctly and the implications of not using thecorrect method?LITERARYREVIEW LITERATUREREVIEW ON CONDUCTING SURVEY”The principal objectives of a surveyshould always be to collect reliable, valid, and unbiased data from arepresentative sample, in a timely manner and within resource constraints.”(McColl, 2001, p1.)However theJoint Commission (2009) advises that where hand hygiene surveys are conductedthe surveyor should consider:  —    “Will theresults accurately represent the population?—    Willeveryone in the survey population have an equal opportunity to respond? — Whatis your desired response rate?—    How muchfollow-up is needed to obtain that response rate? —    What mightthe differences be between survey responders and non-responders? –         Howreadable and understandable are the survey questions, particularly tonon-health care workers?” (p64)      Huge emphasisis currently placed on reducing healthcare-associated infection throughimproving hand hygiene complianceamong healthcare professionals. It is perceived by the media that there is poorhand hygiene compliance among healthcare staff.

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The aim was to report theoutcomes of a systematic search for peer reviewed and published studies. As wellas clinical trials which focused on hand hygiene compliance among healthcareprofessionals. Searches were done on the topic of hand hygiene from Literaturepublished between December 2009, after publication of the World HealthOrganization (WHO) hand hygiene guidelines, and February 2014, which wasindexed in PubMed and CINAHL on the topic.

There wereexaminations of relevance and methodology of fifty seven publications initiallyand sixteen clinical trials were used.  Most of the studies were conducted in the USAand Europe. The intensive care unit was the primary focus, followed by care ofthe elderly facilities.   The Nurse wasthe focus of healthcare workers, followed by the healthcare assistant and thenthe doctor. Four studies used for analysis ‘my five moments for hand hygiene’ asset 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, resultedin moderate improvements in hand hygiene compliance. Of the sixteen papers reviewed, four researchdesigns were explicitly guided by the ‘my five moments for hand hygiene’framework, as set out in the WHO guidelines. Locally designed multimodal approaches usingvarious unique behavioural approaches and even though there was a lack ofuniformity in these approaches, positive outcomes were achieved.  Adopting a multimodal approach to handhygiene improvement intervention strategies, whether guided by the WHOframework or another tested multimodal framework, has been shown to achieveslight to moderate improvements in hand hygiene compliance. Other areas for additional research is moreknowledge, attitudes and awareness of future practitioners (e.g. medical andhealthcare students, interns, healthcare facility managers, patients and carers.

  Also, the adoption of technology-drivensolutions for both delivery of ABHRs (alcohol based hand rub) and monitoring theiruse.  Using such data for analysis ofpatient and healthcare professional movements for outbreaks, may lead toenhanced compliance and understanding of the challenges involved. (Kingston, 2015) CHAPTER 3 METHOLOGY Indications for handhygieneHAND HYGIENE – DEFINED BY THE WORLD HEALTH ORGANISATIONThe 5 Moments for Hand Hygiene approach defines the keymoments when health-care workers should perform hand hygiene.This evidence-based, field-tested, user-centred approach isdesigned to be easy to learn, logical and applicable in a wide range ofsettings.This approach recommends health-care workers to clean theirhands before touching a patient, before clean/aseptic procedures, after body fluid exposure/risk, after touching a patient, and after touching patient surroundings.  Clean handsaccording to the WHO ‘5 moments for hand hygiene’: – l immediately before eachepisode of direct patient contact or care (IB) l immediately before aclean/aseptic procedure (IB) l immediately after contact with body fluids orexcretions, mucous membranes, non-intact skin or wound dressings (IA) limmediately after each episode of direct patient contact or care (IB) Immediatelyafter contact with objects and equipment in the immediate patient environment(IB) Your 5 Moments for Hand Hygiene.        SURVEY ONHAND HYGIENE IN LIMERICK INSTITUTE OF TECHNOLOGYIn December 2017, the Author conducted a Survey ofrandom students of mixed age and gender.

 The Survey consisted of a UV machine, the property of a nearby hospitaland a gel. The machine was in a public area in view of anyone passing by.  There were many enquiries about the surveyand how it worked.  They were advisedthat it was totally anonymous and that they were welcome to get involved.

Theparticipants were asked if they knew there was a correct procedure forhandwashing.  Most were unaware of this,however, they felt quite confident of their ability to do it correctly.Everyone was shown a chart, showing a) mostfrequently, b) frequently and c) less frequently missed areas on the front andback of hands. There are different colours on the chart to indicate thedifferent areas.

They were shown the machine, the gel and how it allworked.  They were invited to use themachine in order to obtain a result on their performance with their handwashingtechnique.  They were given a smallamount of gel which shows up the ultraviolet light on the hands below. A total of thirty five students were invited toparticipate in this anonymous survey. Twenty seven agreed to it and eight declined.  It was quite difficult to get agreement initiallyas it was seen as their personal hygiene was being evaluated, but afterexplaining in detail the reason for the survey, they were put at ease andagreed and were quite happy afterwards for getting involved.  They were also competing with friends so itwas enjoyable for most.The UV machine is quite a simple apparatus, yet cangive very interesting results.

  It islightweight and portable.  It uses normaldomestic power and the light shines downwards on the object being tested.  The conductor of the experiment released asmall amount of UV compatible gel on the participant’s hands and they wereasked to use the same motion as if they were washing with soap, making surethey 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 tocheck their results especially in the most frequent areas.  They then turned their hands, palms upwardsto check the next results. Generally most volunteers were happy they hadparticipated and called over friends to watch.

 Overall the survey was quite successful, it made students think abouttheir handwashing techniques and how important it may be in a clinical settingto do it correctly.  They could see quiteclearly how areas can easily be missed and how that may impact a vulnerableperson who is ill and needs basic handwashing to be done before and afterdealing with each patient.  The overallexperience showed the positive impact that good handwashing techniques canhave.  In hospitals, handwashingsolutions could easily be moved to entrances and exits of hospitals, clinicsand GP waiting rooms.  At the momentthese devices are optional but should be compulsory when entering andexiting.  An easy change could have ahuge impact.  The table below is broken down into:1.     Male/Female2.

     Most Frequently  (Purple) y/n3.     Frequently (Pink) y/n4.     Less Frequent (Grey) y/n MALE/FEMALE              MOST FREQ  Y/N PURPLE FREQ Y/N PINK LESS FREQ Y/N GREY TOTAL YES TOTAL NO CLIENT  1       M BACK         Y FRONT      Y BACK       N FRONT    N BACK       N FRONT    N        2       4 CLIENT  2       M BACK         Y FRONT      Y BACK       Y FRONT     Y BACK       Y FRONT    N        5       1 CLIENT  3       F BACK         Y FRONT      Y BACK        Y FRONT     N BACK       N FRONT    N        3       3 CLIENT  4       M BACK         Y FRONT      Y BACK        Y FRONT      Y BACK       Y FRONT    N        5       1 CLIENT  5       M BACK         Y FRONT      Y BACK        Y FRONT     Y BACK       N FRONT    Y        5       1 CLIENT  6       M BACK         N FRONT      Y BACK        N FRONT     Y BACK       N FRONT     Y        3       3 CLIENT  7       F BACK         Y FRONT      N BACK        Y FRONT     N BACK       Y FRONT    N        3       3 CLIENT  8       F BACK         Y FRONT      Y BACK        N FRONT     N BACK       N FRONT    N        4       2 CLIENT  9       M BACK         y FRONT      N BACK        Y FRONT     N BACK       N FRONT    N        2       4 CLIENT 10      F BACK         N FRONT      Y BACK        Y FRONT     Y BACK       Y FRONT    Y        5       1 CLIENT 11      M BACK         Y FRONT      Y BACK        Y FRONT     Y BACK       Y FRONT    Y          6       0 CLIENT 12      M BACK         Y FRONT      N BACK        Y FRONT     N BACK       N FRONT    N        2       4 CLIENT 13      F BACK         Y FRONT      N BACK        Y FRONT     N BACK       N FRONT    N        2       4 CLIENT 14      F BACK         Y FRONT      Y BACK        Y FRONT     Y BACK       Y FRONT    Y        6       0 CLIENT 15      M BACK         Y FRONT      Y BACK        N FRONT     Y BACK       N FRONT    N        3       3 CLIENT 16      M BACK         Y FRONT      Y BACK        Y FRONT     N BACK       Y FRONT    N        4       2 CLIENT 17      F BACK         N FRONT      Y                            BACK        Y FRONT     Y BACK       Y FRONT    Y        5       1 CLIENT 18      M BACK         Y FRONT      Y BACK        Y FRONT     Y BACK      N FRONT    Y        5       1 CLIENT 19      M BACK        Y FRONT     Y BACK        Y FRONT     Y BACK      N FRONT    Y        5       1 CLIENT 20      M BACK        Y FRONT     Y                          BACK        Y FRONT     Y BACK      N FRONT    Y        5       1 CLIENT 21      F BACK        Y FRONT     N BACK        Y FRONT     Y BACK       Y FRONT    N        4       2   CLIENT 22      F BACK        N FRONT     Y BACK        Y FRONT     Y BACK       N FRONT    N        3       3 CLIENT 23      F BACK        Y FRONT     Y              BACK        Y FRONT     Y    BACK       Y FRONT    Y        6       0 CLIENT 24     M BACK        Y FRONT     Y BACK        Y FRONT     Y BACK       N FRONT    Y        5       1 CLIENT 25     M BACK     Y FRONT   Y BACK      Y FRONT   Y BACK     Y FRONT  Y      6      0 CLIENT 26     M BACK     N FRONT  Y BACK      N FRONT   Y BACK     N FRONT   Y      3      3 CLIENT 27     M BACK     N FRONT  Y BACK      Y FRONT   Y BACK     N FRONT   Y      4      2