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Thesis Chapter 1 - Hand washing To Reduce Cross infection Rates In My Practice Arena (Surgical Ward)

Hand washing To Reduce Cross infection Rates In My Practice Arena (Surgical Ward)


Chapter 1



Correspondingly, hospital or medicals are places in which individual are given with various treatments to cure their diseases and to recover from any illnesses. Nevertheless, there are major concerns among hospital or medical wards about various infections which people who have acquired it become more ill. The latter happenings, it emerges, is astonishingly common among various hospital or medicals in the world.  In spite of the awareness of many individuals about the high risks of Hospital or medical Acquired Infections, there are still increasing and rising numbers of individual who are determined as victims of HAI particularly those who are working within the hospital or medical area such nurses, medical workers and doctors or those working in the surgical ward.  It is said that hospital or medicals are considered as one of the most dangerous area for many individual since this place are accountable in caring various kinds of sickness brought by various viruses, bacteria and other microorganisms (Gaunt, 1993). 

It is hazardous particularly for those health care professionals and staffs such as those working in the surgical ward because they are the individuals who have the nearest contacts with the patients and who are closer to various kinds of viruses, bacteria and other microorganisms which can bring infections to them.  Although, there are several studies which have been conducted for the awareness of the (HAI), these researches only give emphasis on the patients and do not give enough attention to the health care professionals and staffs like those working in the surgical wards.

Health-care Workers (HCWs) such as those in the surgical ward cared directly for infected patients and handled their bodily products. These individuals frequently expressed their fears about herpes soster, lice, AIDS (acquired immune deficiency syndrome) and other communicable disorders in the privacy of the utility room (Robinson, 1988).

The alarming growth of many health care workers (HCWs) who have been infected by these HAI has brought many hospital or medicals to promote awareness campaign with regards to this matter to all the members of the health care units particularly those who are working in the critical areas of the hospital or medicals such as the Intensive Care Unit (ICU) and the General Wards. Consequently the hospital or medical management also attempts to give some programmes to be able to lessen or totally prevent the risk of HAI not only for their patients but also to the health care workers (HCWs) as well (Robins, 1997).  

Most of these hospital or medicals insert catheters with alarming frequency while other hospital or medicals tend to be are more cautious. Simple hand washing remains an issue after centuries of history: an anecdotal aside in the report mentions a 19th-century clinical practice research which observed that fewer women died from puerperal fever when treated by midwives than by medical students. It transpired that the students were going straight from post mortems to delivering babies, without washing their hands.

These days, the danger comes not from doctors and nurses' ignorance of precautionary measures, but from pressures on the use of time. As the Office of the Health economics puts it, the choice of rinsing a glass rather than washing it may be of no consequence except on rare occasions when the person last using it had some infection that was easily transmittable; the time taken to wash hands between dealing with various patients may seem a luxury on a busy ward. Only after the event, when it becomes likely that person to person spread of infection has occurred as a result of a lack of washing one's hands, does the action appear to have been necessary (Robins, 1997).

It seems sensible that infection control should be written into every contract that purchasing authorities place with units providing services, some aspects of which should be spelt out in guidelines. Most essential and significant, though, is the establishment of "infection control teams" in hospital or medicals. Most hospital or medicals in Kuwait already have these, but their strength and the backing they receive from the hospital or medical administrators vary enormously.

In America hospital or medical accreditation regulations stipulate that there should be one infection control nurse for every 250 beds. A recent survey found British hospital or medicals had only one per 477 acute beds. In England a national surveillance system is only now being set up, which will allow participating hospital or medicals to compare their own infection rates with rates elsewhere - and make the system more transparent. "Consumer-power" may help if patients demand to know what infection -control measures are in place, and what the records of individual hospital or medicals are.

In some cases, various hospital or medicals consider the power of hand washing as an immediate control for preventing infectious diseases in hospital or medical settings. Primarily, the main goal of this paper is to determine how hand washing can reduce cross infections rates in a surgical ward in Saudi Arabia.

Background of the Study

Programmes Imposed by Other Nations to Prevent the Risk of HAI

            As the awareness of many people with the hospital or medical acquired infections and the risks and hazards it brings not only to the patients but also to the health care professionals and staffs, many nations have initiated various programmes which will prevent or totally terminate the risk and other problems brought by these infections. In line with this programmes and solutions to fight hospital or medical acquired infection, many hospital or medicals are establishing an Infection Control Unit which w organized the awareness campaign, prevention and other various activities that will increase the knowledge of patients, health care professionals and staffs and other authorities to be able to reduce the problems and cost brought by this infection.

            Infection prevention and control is seriously essential and significant to the efficient and policy and management of hospital or medicals particularly in the riskier environment s (Burns, 1993). Infection control programmes requires a necessary comprehension of epidemiology of the diseases which is caused by viruses, bacteria and other microorganism (Hargiss et al, 1981). Consequently, the domain of infection control needs an in-depth knowledge that no individual practitioner has. Hence, experts noted that to be able to prevent the risk and burden of HAI, multidisciplinary team is required which include hospital or medical epidemiologists, infection control practitioners, infectious diseases physician, biostatistician and microbiologists.  Such team must have an access to a molecular biology laboratory.  The efficiency of such multidisciplinary team was proven recently in a 683-bed hospital or medical in the United Stated of America. Herein, the United States had initiated an enhanced, integrated infection control programme with access to a molecular typing laboratory that resulted in a successful reduction of HAI per 1000-patients each day which is equivalent to 10%., including the prevention of HAI for the health care workers.  Consequently this program has produces an actual cost saving for the US (Horton, 1995).   Nevertheless, even with this well-planned approaches can’t really solve the issue of hospital or medical acquired infections.

Hand washing as a Preventive Measure against HAI

The management of the hospital or medicals all over the world has been working on a common goal in line with the infection control in hospital or medicals which is to reduce the nosocomial infections to the lowest p plausible as this has a positive impact on the patient care output and on the cost optimization of patient care.  Now it is a common practice in most hospital or medicals to employ full time Infection Control Team mainly Doctors and Nurses to put in place an infection control programme and ensure its implementation, aiming to limit the spread of infections and give preventive measures and safe environment for all patients and HCWs in the health setting (Health Minister Malcolm Chisholm, 2003)

The role of human hands in the transmission of infection in hospital or medical and community is not a new issue it dates back to the year 1199 as illustrated by Moses Bin Maimon:

“Never forget to wash your hands after having touched a sick person “

Oliver, Wendell Holmes wrote in his classic paper on the contagiousness of childbed fever, postulated that the physicians spread puerperal infections physically to parturient women from infected materials in autopsies they had performed or from infected women they had attended. (Caroline M De Costa- History of Hand washing).  Ignas P. Semmelewis also published his findings on puerperal fever, which showed the importance role of hands of HCWs and has showed the first statistics on reduction of infection through proper Hand washing (Gerberding, 2000)

Hand washing is a simple and efficient means of protecting patients from infections. Practitioners are well aware of this importance, nevertheless Hand washing practice remains insufficient and unacceptably ignored amongst HCWs in general and in Intensive Care settings in particular, HCWs do not wash their hands as often as they should do and compliance can be less than 50% (Pittet, 2001). Infection Control Professionals have a vital role in finding ways to reduce the infection rate and improve the practices that have an impact on the incidence rates of infection in the clinical settings and therefore are obliged to test and search the best ways of improving such practices.

The Center for Diseases Control (CDC) considers Hand washing as the single and most essential and significant method of preventing nosocomial infections. This also was evidenced by research when Cooper et al (1999) examined the spread of hand-borne nosocomial pathogen Staphylococcus aurous in a general medical ward and found that even small increases in the frequency of Hand washing bring endemic organisms under control. Similarly Conly et al (1989), in a sequential intervention clinical practice research in an Intensive Care Unit, has demonstrated that poor Hand washing practices are associated with a high nosocomial infection rate, whereas good Hand washing practices are associated with a low nosocomial infection rate. An educational and enforcement program designed to improve Hand washing procedures can significantly reduce endemic nosocomial infection rates.

Statement of the Problem

Perhaps, one of the major problems that the world is facing through the years is the hospital or medical acquired infection. In fact, every nation around the world always gives an immediate action to grow ways to be able to prevent or control the emergence of these infections.  The hospital or medical is considered as the key element in ensuring the health of the people. Thus, more and more experts in the health care units are continuously exerting efforts to improve the existing health care system for the prevention of HAI among the health care workers such as nurses, doctors, etc.

Although HCWs are well informed of the importance of Hand washing and its classification as the most simple and efficient measure for preventing nosocomial infections, and despite the various advances in infection control and hospital or medical epidemiology, Semmeleweis’ message is not consistently translated into practice. Healthcare professional’s adherence to Hand washing guidelines is poor. It is of utmost importance to discuss the obstacles that are imminent in this regard and go through the various theories and or studies to highlight the causes of the unacceptable low compliance of Hand washing practices (Larson, 2000). It is also essential and significant to understand all the known obstacles that are documented to be able to overcome the associated problems and to achieve higher rate of compliance, thus an improvement in the infection rate is ensured.

Consequently even if this behavior (Hand washing) is simple, its integration fully in the routine work and clinical practice by the HCWs is hard and complex and adherence to this procedure constitute a challenge to Infection Control Professionals and to Researchers, therefore various theories have analyzed the problem from various perspectives. For instance, while Cognitive theories suggested that poor compliance with Hand Hygiene is attributable to Doctors lack of knowledge about the results of their poor hygiene.  As mentioned by Pritchard & Raper (1996):

“It seems a terrible indictment of doctors that practices and protocols must be enhanced to take the place of something as simple… as hand washing. Perhaps an even bigger concern for current medical practice, and one, which should lead us all to do some soul searching, is that careful and caring doctors can be extraordinarily self-delusional about their behavior.”

Adult –teaching theory, considers that people need to learn from their mistakes before they are motivated to change. This will put an emphasis on the solutions and consequences of poor hand hygiene rather than preventive measures before harm is caused The emphasis on experience as a defining feature of adult learning was expressed in Lindeman (1926) frequently quoted aphorism that "experience is the adult learners living textbook". In contrary the behavioral theories believe that compliance should be performed by external stimuli or influence and change will take place as a result of feedback, modeling, incentives and other external reinforcement. It is interesting to mention that Socially, there is no norms promoting hand hygiene within the healthcare setting and there is evidence that without the support of Administrations, the chances for success in Hand hygiene programmes are minimal (Larson et al, 2000).

The low compliance rate is advocated by the organizational theories that are not an individual Doctor problem alone but a system failure caused by inadequate organized healthcare setup and care processes, and a culture that is not oriented at collaboration and improvement of care. It will be of high value to consider in the proposed research all of these theories and all other obstacles that are reported by researchers such as the amount of time needed for proper Hand washing, the convenience and user-acceptability of Hand washing & hand-drying facilities, and the condition of the skin barrier (Springthorpe & Sattar, 1998). Additionally, it is of high benefits to define the incidence rate of nosocomial infections as it may mean various measure to various organizations.

The intended formula is a well recognized scientific epidemiological equation used by Infection Control Professionals and Epidemiologists and is defined as the number of HCWs who develop any infection divided by the total number of HCWs at risk who is assigned in General Ward and Intensive Care Unit of the Hospital or medical concerned during a determined period of time. Once infected, HCWs cannot be considered at risk of infection. The incidence of infection is defined as the number of infectious episodes divided by the total number of HCWs who were hospital or medicals in the concerned ward during a determined period of time. An equal importance must exist when considering the criteria for nosocomial infection which in this proposal (Risso, 2005).  

This clinical practice research intends to give an epidemiological review of infection rates to isolate trends and possible causal factors with emphasis on hand hygiene among health care workers (HCWs) in the surgical ward in Saudi Arabia. Consequently this dissertation will be conducted to be able to understand HAI and to give an infection control programmes with emphasis in hand hygiene that can be used by surgical ward in Saudi Arabia to be able to make the health care workers (HCWs) aware of their possibility to get HAI.

Objectives of the Study

This clinical practice research will aim to achieve the following objectives:

·         To highlight the impact of HAI’s on surgical ward in Saudi Arabia in terms of length of stay, increased treatment cost and stress of Health Care Workers such as nurses, medical aids, and doctors.

·         To provide hand washing programme and clinical practice that surgical ward healthcare can use to prevent infections.

·         To determine how this hand washing programme can be implemented in surgical ward.














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