Improving hand hygiene in community healthcare settings: the impact of research and clinical collaboration

A review of applications of operational research in healthcare coordination in disaster management

Many disasters that have happened in the last decades, including the latest COVID-19 pandemic, have caused a shortage of healthcare resources and change in healthcare operations. Given these impacts, the Operational Research (OR) community has applied various approaches to improve the emergency medical responses. Coordination of healthcare facilities is one of the emergency medical response strategies to ensure the continued provision of medical services during disasters. Although the existing literature reviews of OR approaches have included the perspective of healthcare management, they focused mostly on the application of OR in disaster operations and logistics management. The importance of coordination in healthcare systems during disasters is well recognised in the literature, but to the best of our knowledge there has been no review of the published research in this area. This study provides a focused literature review of the OR contributions in the coordination in healthcare systems during disasters. Definitions of the terms in use in this field are provided. An overall descriptive statistics of the reviewed articles is given, followed by the review of the presented research problems, disaster types, and developed methodologies. The main characteristics of models for the coordination in the healthcare system are described. Measures of coordination effectiveness that denote healthcare resilience are discussed. Based on our findings, we suggest future research directions in the context of existing models extension, and application and development of other methodologies with the aim to provide a solid basis for OR research in the healthcare disaster management.

Exploring infection prevention practices in home-based nursing care: A qualitative observational study

BACKGROUND

Home-based nursing care continues to expand, delivering care to increasingly older clients with multiple, chronic and complex conditions that require the use of additional and more numerous invasive medical devices. Therefore, the prevention of infections poses a challenge for nurses, professional caregivers and clients.

OBJECTIVE

This article explores infection prevention practices and related behavioural factors in both nurses and clients to identify barriers and facilitators of infection prevention practices in home-based nursing care.

DESIGN

A qualitative, exploratory design.

SETTING

Four healthcare organisations providing home-based nursing care in the Netherlands.

METHODS

Participant observations were used as the main source of data collection complemented with focus group discussions and semi-structured interviews.

PARTICIPANTS

Participant observations: 16 nurses, three professional caregivers and 80 clients. Semi-structured interviews: 11 clients. Focus group discussions: 15 nurses and four professional caregivers.

RESULTS

A total of 87 unique care delivery situations were observed for 55 h, complemented with three focus group discussions and 11 individual semi-structured client interviews. Infection prevention practices in home-based nursing care appeared to be challenged by 1. The specific context or environment in which the care occurred, which is more autonomous, less structured, less controlled and less predictable than other care settings; 2. Suboptimal and considerable variation in professional performance concerning the application of hand hygiene and the proper use of personal protective equipment such as face masks, barrier gowns and disposable gloves; 3. Extensive use in and outside the client's surroundings of communication devices that are irregularly cleaned and tend to interrupt nursing procedures; and 4. Inadequate organisational support in the implementation and evaluation of new information or policy changes and fragmentation, variation and conflicting information regarding professional guidelines and protocols.

CONCLUSIONS

From a first-hand observational viewpoint, this study showed that the daily practice of infection prevention in home-based nursing care appears to be suboptimal. Furthermore, this research revealed considerable variation in the work environment, the application of hand hygiene, the proper use of personal protective equipment, the handling of communication devices and organisational policies, procedures and support. Finally, the study identified a number of important barriers and facilitators of infection prevention practices in the work environment, professional and team performance, clients and organisations.

The fall and rise of cleanliness in British healthcare and the nursing contribution

This paper discusses the term ‘cleanliness’ and applies it to healthcare. Ways of achieving cleanliness in premises where healthcare is delivered are explored. It is concluded that although once a world-leader in infection control practice and research, the United Kingdom is now lagging behind other countries. Traditionally hands have been regarded as the main vectors of healthcare-associated infection. However, hands can never be rendered entirely free of micro-organisms, so it is inevitable that healthcare-associated infection will always be a challenge. Decontamination of the healthcare environment, its fixtures, fittings and clinical equipment are also of pivotal importance in maintaining cleanliness, controlling infection and regaining consumer confidence in healthcare. Nurses play a major role in ensuring that appropriate decontamination processes and procedures are in place to meet required standards. To do so they must receive the appropriate education and training.

Hand hygiene improvement in the community: a systems approach

Hand hygiene compliance, which is influenced in part by human behaviour, is central to infection prevention in all care settings. This article focuses specifically on the importance of a multimodal strategy for continued hand hygiene improvement, and its relevance to community nursing. Additionally, the article addresses the challenges and opportunities of infection prevention and control in a community context, and highlights current national and international guidelines that offer a framework and set of principles for implementation and sustainability with a specific focus on the multimodal strategy associated with the WHO Guidelines on Hand Hygiene in Health Care (2009). The authors conclude with some considerations for community nurses when addressing translation of these principles into their everyday working context.

Hepatitis C virus in primary care: survey of nurses' attitudes to caring

AIM

This paper is a report of a study measuring attitudes of primary care nurses towards caring for people with hepatitis C.

BACKGROUND

Hepatitis C is a major public health problem. Attitudes to caring for people with hepatitis C vary and can have an impact on nursing care practices. International literature has identified discriminating practices amongst healthcare professionals including nurses. There is limited research examining primary care nurses' attitudes to caring for people with hepatitis C.

METHODS

A cross-sectional postal census survey of 981 nurses working in one health board region in the Republic of Ireland was conducted during the period March 2006 to June 2006.

RESULTS

A response rate of 57.1% (n=560) was achieved. Exploratory factor analysis of an attitude scale identified three latent variables: 'infection control behaviour', 'caring' and 'fear'. Attitudes were generally positive towards caring for persons with hepatitis C; however, 51.7% of respondents would use additional infection control precautions if caring for someone with known hepatitis C. Younger nurses and those educated to degree level and above held significantly more positive attitudes to caring. Nurses agreed that they have a central role in managing and treating people with hepatitis C; however, many agreed that they lack the knowledge and skills to care for persons with hepatitis C.

CONCLUSIONS

Negative attitudes can result in discriminatory experiences for persons with hepatitis C or at risk. Nurses require ongoing education on hepatitis C to improve knowledge, to limit concerns and ensure adherence to infection control guidelines.

Potential pitfalls in adherence to hand washing in the community

Infection control is vitally important in community settings. Community nurses care for people with complex care needs who are extremely vulnerable to infection. The most important thing a nurse can do to prevent the spread of infection is to maintain good hand hygiene. Nurses can face barriers in their efforts to practice good hand hygiene, including lack of education, lack of time, poor facilities and inappropriate clothing and hand adornments. This article outlines evidence-based practice on how to overcome barriers to good hand hygiene and stresses the important role of the community nurse in working with her team to ensure best practice, cut infection rates and save lives.

Review of personal protection equipment used in practice

Standard precautions offer a consistent approach to infection control that does not rely on knowledge or suspicion of infection, and contributes to staff and patient safety by reducing the risk of exposure to potentially infectious material. One of the cornerstones of standard precautions is the appropriate use of personal protective equipment (PPE) whenever contact with blood or body fluids is anticipated. However, evidence suggests that compliance with standard precautions including correct use of PPE is inadequate. Demographic and epidemiological changes in the U.K., and the drive to provide more complex patient care outside acute hospitals may lead to increased infection risks for both patients and community healthcare workers. This review examines the importance and use of PPE by community nurses and discusses the implications for practice of poor compliance with standard precautions. Recommendations for practice will be made aimed at improving compliance with this important element of standard precautions.

Hand hygiene among nurses in Turkey: opinions and practices

AIMS AND OBJECTIVES

This study aims to identify nurses' practices and opinions of handwashing during routine patient care.

BACKGROUND

Transmission of microorganisms from the hands of healthcare workers is the main source of cross-infection in hospitals and can be prevented by handwashing.

DESIGN AND METHODS

A questionnaire survey was used for this study. A total of 129 clinical nurses at University of Ege Faculty of Medicine Application and Investigation Hospital at Internal Medicine Clinics was surveyed with a response rate of 100%. Data analysis was carried out using SPSS version 10.

RESULTS

The study revealed that nurses have a poor level of knowledge concerning quality of hand washing. All nursing actions related to 'clean' and 'dirty' activities were evaluated using the Fulkerson scale. The majority of nurses reported that they always wash hands after contact with contaminated and non-contaminated patients, equipment and environment. It was found that they did need to wash their hands often but that they were not able to do this because of dense working conditions, insufficiency of necessary materials and drying and sore of hands after frequent washing.

CONCLUSION

To improve hand hygiene and quality of handwashing compliance, additional factors must be considered. These factors include improving healthcare workers--especially nurses'--skin conditions, hand hygiene techniques and disinfections substantially.

RELEVANCE TO CLINICAL PRACTICE

Hospitals need to develop and implement innovative educational and motivational programmes tailored to specific groups of health personnel.

Occupational Therapists' Knowledge and Practice of Infection Control Procedures: A Preliminary Study

Occupational therapists often meet clients with infections in the course of their work, but research into such therapists' knowledge and practice of infection control procedures is limited. This small postal survey explored the deficit, gathering data from 63/93 (68%) occupational therapists working in 12 randomly selected English health care trusts. The results showed evidence of a discrepancy between respondents' knowledge and practice of infection control procedures. The respondents acknowledged the importance of infection control but did not always take the necessary precautions, reporting some difficulty in judging the latter. The reasons for the study findings and their potential implications for occupational therapy practice, research and education are considered.

Hand-washing and methicillin-resistant Staphylococcus aureus

Effective hand-washing, including drying to decrease skin surface microbial counts, is recognized as a critical factor in infection control policies. It is also recognized that hand-washing is not always undertaken as it should be. Spending large amounts of time with the hands in water is not enough to control infection as the technique of washing hands is more important than merely the length of time under water. Therefore, ways of promoting hand hygiene must be found, as well as finding ways of ensuring that healthcare workers follow hygiene guidelines.

Hand hygiene: simple and complex

This review gives an overview of hand hygiene in healthcare and in the community, including some aspects which have attracted little attention, such as hand drying and cultural issues determining hand hygiene behaviour. Hand hygiene is the most effective measure for interrupting the transmission of microorganisms which cause infection both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors which determine hand hygiene behaviour makes the study of hand hygiene complex. It is now recognised that improving compliance with hand hygiene recommendations depends on altering human behaviour. Input from behavioural and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs. New strategies to promote hand hygiene worldwide include the formation of public-private partnerships.

Universal precautions: a survey of community nurses' experience and practice

BACKGROUND

Universal precautions are a set of guidelines which aim to protect health care workers from blood-borne infections. Community nurses often have to deliver care to people in less than ideal home conditions, their ability to comply with all universal precautions may therefore be compromised.

AIMS AND OBJECTIVES

This paper presents the findings of a questionnaire survey which aimed to explore community nurses' experience and practices of using universal precautions.

DESIGN AND METHODS

A questionnaire survey was used for this study. All community learning disability nurses, community mental health nurses and generic community nurses from one Welsh Health Authority were surveyed (n = 543) with a response rate of 70%.

RESULTS

The majority of community nurses reported compliance with universal precautions, although a small number of nurses stated that they re-sheathed needles, inappropriately stored sharps containers, inadequately wore gloves and experienced difficulties in handwashing.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

Community nurses work in a unique and unpredictable environment, which may result in nurses being unable to comply with existing universal precautions guidelines. The production of new infection control guidelines for the community by the National Institute of Clinical Excellence in June 2003, has addressed some of the difficulties faced by community nurses.

Innovations in hand hygiene: Manugel from SSL International

Hand hygiene is the single most effective method of preventing cross-infection. Barriers to performing effective hand hygiene include lack of time and the poor cosmetic acceptability of many of the available hand decontaminants. These problems are exacerbated in domiciliary nursing care where conditions in some homes may prevent adequate decontamination, especially when drying hands. Damp hands transfer bacteria more effectively than dry ones. The availability of newer alcoholic hand gels is helping to overcome these problems and the introduction of single-use sachets is of particular benefit in domiciliary care.