Hand Hygiene, Clinical Protocols and Evidence-Based Practice Research for UNM Hospitals

The current work policy at The University of New Mexico (UNM) institutes Hand Hygiene as an active clinical procedure in the guidelines for employment and general practice (University of New Mexico, 2014). The procedure of hand hygiene is an exercise that decreases the transmission of nosocomial infections to patients, hygiene related infections, and illness in UNMH employees (UNM, 2014). This research paper serves to reinforce the pre-existing policy used by UNM Hospitals, and supports the current guidelines regarding hand hygiene practice with evidence-based research found in three peer-reviewed articles. The goal of this research paper is to further stabilize the current UNM Hospital’s hand hygiene policy using evidence-based practice research from three corresponding studies in the same category of hand hygiene.

Literature Review

Hand hygiene in Kapil, Bhavsar and Madan’s (2015) article summary, is recognized for being the most effective intervention for control of hospital acquired infections. The article provides data from a clinical study testing the effectiveness of proper hand hygiene using hand sanitizer. Bucher, Donovan, McCoy, and Ohman-Strickland (2015) conducted a study on several Emergency Medical Services (EMS) companies throughout the United States by volunteer surveys regarding the hand hygiene of EMS providers between patient contacts. Bissett (2010) posits that studies regarding healthcare provider skin care sounds awkward, and proper hand hygiene is expressed using the same resources found UNM’s policy including evidence-based practice from the World Health Organization (WHO).

Methods

Methods in Kapil et al. (2015) article summary, involved a tertiary care hospital setting involving 60 clinicians of various disciplines fields that participated in a clinical study after receiving informed consent. The clinicians were asked to place all ten of their unwashed fingers on a sheep’s blood agar that was cultured for twenty-four hours, and participants were asked to do it again after using hand sanitizer. In Bucher et al. (2015) article, a survey was the devised method to obtain data about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail where the participants surveyed provided demographics and answered questions regarding the use of decontaminating products in different day to day situations using a 1-5 Likeart scale (1- Never and 5- Always.) According to Bissett (2010) article, methods of evidence-based practice acquired research and resources are referenced along with information regarding skin care and prevention measures.

Results/Findings

Using hand sanitizer, hygiene related nosocomial infections could be decreased drastically in hospital settings. The percentage reduction of bacterial presence with use of alcohol based hand sanitizer was 95-99% in all except attendants where it was 70-90% for lab attendant and only 50% in sanitary attendants (Kapil et al., 2015). The risk of contracting nosocomial infections isn’t isolated to just the hospital, EMS personnel also increase the percentage of patient developed nosocomial infections due to poor hand hygiene (Bucher, 2015). With poor results in EMS hand hygiene, healthcare providers of all ranks should strictly adhere to the standards of good hand hygiene to decrease nosocomial infections. Additionally, it is essential that providers practice good skin care on themselves in prevention of acquiring work related infections (Bissett, 2010). Skin is a barrier for the body that also serves as a tabletop for bacteria that is in constant contact with the environment. Emphasis must be made placed on continuing skin care with moisturizers and skin protective agents to maintain optimal skin integrity. It is just as important for a provider to take care of their skin, as it is to have proper hand hygiene when working due to the possible routes of exposure (Bissett, 2010). The barrier to percutaneous absorption lies within the stratum corneum that has constant interaction with the environment. Consequently, the healthy maintenance of this layer is critical, as quoted by Kaiser and Newman, 2006, as cited by (Bissett, 2010).

Conclusion/ Discussion

The UNM Hospital’s hand hygiene policy document includes: Areas of responsibility where procedure (ref. 1.1-1.5) entails that hand hygiene is to be performed in the same situational categories defined by WHO guidelines. The same WHO guidelines are referenced in the three peer reviewed articles. This supports UNMH’s policy with clinically significant and experimentally sound evidence to continue implementing the current guidelines of situational hand hygiene in clinical practice. UNM Hospital’s Hand Hygiene policy document (ref. 2.1.-2.1.4) provides clinical procedure for use of alcohol-based hand sanitizer as a means for accomplishing the organizational hand hygiene requirement. Review of Kapil et als article (experimental results regarding effectiveness in clinical use of alcohol-based hand sanitizer) provided evidence in support of UNMH’s policy regarding sanitizer as an acceptable and effective hand hygiene procedure. This is not to demonstrate that sanitizer is a better or more preferred method than antibacterial soap and water, but its appropriate use under the prescribed guidelines is proven effective. The articles provide further justification and validation in the current UNM Hospital policy regarding hand hygiene through evidence-based practice research.