Teaching Experience on Handwashing Practice

Introduction

The World Health Organization provided guidelines on hand hygiene in health care. It is noted that healthcare-associated infections affect many patients all over the world. These infections cause serious illnesses, extended hospital stays, cause long-term disability, increased hospital costs, thereby leading to overburdening of the health-care system. Most of these infections are preventable. Hand hygiene is one of the measures that have been identified and can be used to reduce infections. However, although the action might appear simple, there has been noted to be a prevalent of lack of compliance by healthcare providers. This prompted the WHO to create a Global Patient Safety Challenge dubbed, “Clean Care is Safer Care” (Challenge, 2009). This campaign was focused on improving hand hygiene standards and practices in healthcare. The WHO has prescribed an evidence-based measure to be used to enhance hand hygiene referred to as the five moments of hand hygiene. This requires the washing of hands before touching a patient, before carrying out an aseptic or clean procedure, after possible exposure to body fluids, after getting in contact with a patient, and after touching the patient surroundings (Challenge, 2009). This paper is focused on a discussion on teaching experience on hand washing amongst healthcare providers in a transitional care facility. 

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Summary of the Teaching Plan

The mode of presentation was mainly through a pamphlet presentation. This presentation summarizes major issues in hand washing practice including hand washing procedures, when to wash your hands, benefits of hand washing, diseases to be prevented through hand washing, and barriers of hand washing. The steps provided in the presentation include wet hands with water and apply enough soap to cover all hand surfaces. Rub hands palm to palm, right palm over the left dorsum with interlaced fingers and vice versa, palm to palm with fingers interlaced, back of fingers to opposing palms with fingers interlocked. Then rotational rubbing of left thumb clasped in right palm and vice versa, rotational rubbing, backward and forwards with fingers clasped fingers of right hand, rinse hands with water, dry thoroughly with a single-use towel, and use a towel to turn off the faucet.

The teaching plan on handwashing was comprised of three main behavioral objectives and domain. These included having healthcare practitioners identify the clinical situations that require handwashing, having the nurse and other medical practitioners explain the appropriate hand washing procedures and identification by the practitioners of the infections that can be prevented through handwashing. The content covered in the first objective includes the general situations where the handwashing is required and clinical situations that require washing hands before and after. The strategies used to achieve this objective were the use of pamphlet presentation. The content discussed for the second objective was the step-by-step handwashing procedure. The strategy used to achieve this objective was the use of the diagram on the pamphlet presentation and practical demonstration of the handwashing procedures by the teachers and participants. The third objective involved an explanation that infections that can be prevented through handwashing. The strategy used to achieve this was the use of a focus group that brought out a discussion among the participants.

Delivering this lesson on handwashing required the application of creativity in the whole process. This was applied in the development of the pamphlet presentation to ensure it captured the interest of the participants. Creativity was also critical in ensuring that the discussion was both seamless and informative. The methods of outcome evaluation described in the teaching plan include self-reporting of the participants, practical demonstration of the handwashing procedure, assessment of the behavioral change on adherence to handwashing requirement, and reduction in the associated infections. To evaluate the overall goal, the teaching plan indicated the need for measuring the adherence level to handwashing requirements among the healthcare practitioners, following the rights steps in the handwashing process, and reduction of healthcare infection. This evaluation would be carried out a month after the completion of the training. The teaching plan identified some barriers that needed to be overcome for the training to be successful. These included a negative attitude among the participants and lack of adequate resources to sustain the process.  

Epidemiological Rationale

Among the issues addressed by the National Health Service include the reduction of hospital-acquired infection and antimicrobial resistance. The most common method is the strengthening of the basic infection procedure of handwashing. It is indicated that hospital-acquired infections affected approximately 1 in every 11 patients, has a mortality rate of about 13%, and period of hospital stay by a factor of 2.5 (Stone, 2001). It is noted that about 15-30% of all hospital-acquired infections can be prevented (Stone, 2001). 

It is estimated that in the United States, about 2 million people are infected by the healthcare-associated infections annually, leading to over 80,000 associated deaths per year (Abdulsalam, Ibrahim, Michael, Mijinyawa, 2015). The transmission of healthcare-associated infections is mainly spread through contaminated hands of the healthcare practitioners. Handwashing through its forms including handwashing with soap and water or waterless alcohol-based rub has been for a long time been recommended as an ideal and effective method for preventing such infections. It has however been indicated that the compliance among the healthcare workers with the recommended hand washing practices has been very low with levels recorded being under 50% (Abdulsalam et al. 2015). Healthcare workers’ compliance with handwashing is indicated to be very poor and considered to be the worst among the doctors (Mathur, 2011). This trend of low compliance is related to issues such as lack of time, poor availability of sinks and soaps, skin sensitivity, and lack of evidence. A study by Chavali, Menon, and Shukla (2014) revealed that the compliance rate among the nurses was 69%. The nurses were the most compliant on handwashing after body fluid exposure risk and patient contact and least compliant before an aseptic procedure. The allied staff had the best compliance rates of 86.9%. The average level of compliance with hand-washing techniques among healthcare workers was 78%, which is below the benchmark of 90% (Chavali, Menon, Shukla, 2014).

Another study revealed that the adherence level to hand hygiene ranged between 3%-100% (Musu et al., 2017). This study noted that the compliance rate was 28% for the physicians and 86% for the nurse aides. Hand hygiene before direct contact with the patient was noted to be 38.4% while adherence to hand hygiene after contact with the patient was found to be 55.1% (Musu et al. 2017). The compliance rate for hand washing with an alcoholic solution was noted to be 53.5-70.2% while the rate for hand washing with water and soap was found to be 59.3-84.6% (Musu et al. 2017). 

It has been revealed that liquid soap and water works best in the decontamination of hands. However, 70% alcohol-based antiseptic hand rub offers the most effective means of decontamination for a variety of organisms. Use of liquid soap and water is expected to take about 90 seconds if the recommended approach is to be adhered to. Alcohol rubs, on the other hand, are expected to take about 10-20 seconds and hence have more compliance rates among the medical practitioners (Mathur, 2011).

Evaluation of Teaching Experience

The teaching on handwashing among the healthcare practitioners was informed by two major learning theories – Kolb’s Experiential Learning Theory and Stages of Change Theory. The Kolb’s Experiential Theory required that the appropriate that learner have an initial experience and then reflect on the experience. Through the application of this theory, the learning experience was more fruitful since the healthcare practitioners have prior knowledge on handwashing but had just failed to be compliant. The application of this theory formed a basis of the focus group discussions where the participants reflected on the handwashing practices and the experiences with it. The stages of change theory offered an important framework that educators and participants use to identify the exact stage where the participants are and facilitate their transition to the anticipated behavior. Using this theory, the learning experience was more meaningful because it allowed the understanding of the current prepositions on handwashing held by the healthcare practitioners. This helped in understanding the current situation characterized by high rates of non-compliance, thereby establishing a basis for the learning process.  

Community Response to Teaching

The healthcare practitioners undertaking the training all agreed that the healthcare-associated infections are amongst the important cause of morbidity and mortality. There was no doubt among the participants that adhering to hand hygiene was effective in preventing these infections. The participants agreed on the commitment call to adhere to the set guidelines. Most of the practitioners undertaking the training were enthusiastic about improving their practice of appropriate technique and analyzing the right moments of doing. This matched with results from a study by Silva, Andrade, & Silva (2014) who revealed that while most healthcare practitioners knew about the handwashing model by WHO, only 34% had previously attended a specific training on handwashing. There was a general motivation among the practitioners to carry out a hand hygiene and get an evaluation, to determine whether their practice would be considered as adequate, very adequate, or in need of improvement. However, the healthcare practitioners expressed their concerns about the effects of work pressure on adherence level of the hand washing practice as well as the quality of the practice. 

Areas of Strengths and Areas of Improvement

The presentation for the teaching process was a key area of strength. This was evident from the interest the presentation sparkled amongst the participants. The mode of presentation allowed for the participants to engage actively in the learning process, through discussion and practicing the handwashing techniques. It was clear that good plans were in place to facilitate the learning process.

A key area that may need to be improved is the application of creativity in the learning process. Creativity allows the delivery of the objectives in a manner that best stimulates the interest of the participants and keeps them engaged. The main intended outcome of the teaching process is to have the health care practitioners practice the handwashing techniques in the course of carrying out their normal duties in the facility. Thus, creativity is essential to ensure that the learning process has a long effect on the adherence to handwashing practices by the practitioners. 

References

Abdulsalam, M., Ibrahim, A., Michael, G., & Mijinyawa, A. (2015). Hand washing practices and techniques among health professionals in a tertiary hospital in Kano. Journal of Medical Investigations and Practice10(1), 8.

Challenge, F. G. P. S. (2009). WHO Guidelines on Hand Hygiene in Health Care: a Summary. World Health Organization, Geneva, Switzerland. Retrieved from http://www.who.int/gpsc/information_centre/hand-hygiene-summary/en/

Chavali, S., Menon, V., & Shukla, U. (2014). Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine18(10), 689.

Mathur, P. (2011). Hand hygiene: back to the basics of infection control. The Indian journal of medical research134(5), 611.

Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., … & Mura, P. (2017). Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. Journal of preventive medicine and hygiene58(3), E231.

Silva, D., Andrade, O., & Silva, E. (2014). Perspective of health professionals on hand hygiene. Atencion primaria46, 135-139.Stone, S. P. (2001). Hand hygiene—the case for evidence-based education. Journal of the Royal Society of Medicine94(6), 278-281.

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