Lyndsay Madru

ENGL 301
Dr. Bruce
April 15, 2014
Team and leaders-directed monitoring program is more effective
Florence Nightingale once said, It may seem a strange principle to enunciate as the very
first requirement in a hospital that it should do the sick no harm, (BrainyQuote). Hospitals
should not be an area of concern for anyone in terms of acquiring diseases and infections.
People are admitted to a hospital in order to get better, not to get sick or potentially worse. With
that being said, more and more studies are revealing that simple hand hygiene practices are not
being adhered to by hospital staff (Aziz, 2013, 458). Unfortunately, hand hygiene compliance is
not a priority among healthcare workers in the hospitals. It seems like a simple practice to the
general society, but hand hygiene tends to be overlooked quite often on several different
occasions within hospitals. By increasing hand washing compliance, the intended result will be
lower rates of hospital acquired infections among the patients. The argument towards hand
hygiene compliance among hospital staff and visitors is whether or not there is a need to
implement a monitoring program or hire staff members to audit the hospitals on a regular basis.
Unnecessary high infection rates are preventable just by proper hand hygiene with either an
alcohol-based sanitizer or with soap and water. Although it may seem effective to have a
monitoring program that is run by the staff, a team and leaders-directed approach seems more
effective in making sure hospital acquired infections would remain low and close to none.
Basic hand hygiene practices should be self-explanatory and easy to comply with right?
Unfortunately, studies in the literature have repeatedly documented that the importance of this
Figure 1 My 5 Moments for Hand Hygiene
simple procedure is not sufficiently recognized by healthcare workers (HCWs), and compliance
with recommended hand-hygiene practices is unacceptably low, (Pittet, 2000, 381). Therefore,
the World Health Organization has created a list of moments to engage in proper hand hygiene in
the hospital environment called
the My 5 Moments for Hand
Hygiene, (About SAVE
LIVES, para. 1). As shown in
Figure 1, this image is meant to
be easy to comprehend and
applicable in a multitude of
settings for healthcare workers.
They should be able to realize
when to wash their hands as a result. Even though this image is placed in hospitals as a reminder
for the healthcare workers, the Centers for Disease Control and Prevention (CDC) reported that
in the United States alone in 2011, an estimated 722,000 patients acquired hospital infections,
and of those, 75,000 patients died (HAI Prevalence Survey, para. 1). These healthcare-
associated infections (HAIs) are not a result of lack of knowledge or information provided to the
hospital staff, but rather a compliance issue. According to the CDC, HAIs include central line-
associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-
associated pneumonia, (Types of Healthcare-associated Infections, para. 2). Regardless of
where the patients contracted the healthcare-associated infections, compliance with hand hygiene
practices will ensure that the rates will decrease as hospital staff and visitors work together to
make sure everyone is complying.
Physicians and nurses have been properly trained throughout their many years of
schooling about the importance of hand hygiene practices, along with how to prevent and treat
infections, but yet it continues to be a struggle and challenge to keep up with. It can be
challenging for hospital staff to keep up with compliance because they may work in departments
that have a lot of inpatient and outpatient traffic. For example, trauma or emergency
departments are very fast paced, so hand hygiene practices tend to be overlooked in order to
serve the patient in that specific moment. However, high volume traffic in the departments
should not be the factor influencing skyrocketed hospital acquired infection rates. In a study
conducted by Pittet and colleagues (2000), they observed 2,834 hand hygiene opportunities and
found an average compliance rate of 48% and nurses had the lowest noncompliance rate (383).
Even though the researchers acknowledged that full compliance may be unrealistic, they did
emphasize that improved compliance could result with more readily accessible hand-hygiene
supplies. According to Aziz (2013), appropriate hand hygiene behavior is possible through
accessibility and availability of either skincare lotion or alcohol hand-rubs within the department
wards (458). In addition to having readily accessible materials, they also conducted audits that
displayed the results along with praising the staff members for positive results in each ward. By
encouraging the healthcare workers with hand hygiene compliance, it resulted in lower
healthcare-associated infections, which in turn, helped each member to work as a team to
continue delivering great results. While displaying audit results and having materials handy
seemed to work for some department wards in hospitals, other approaches such as having a
leadership team come in and keep everyone in check might work for other hospitals.
In any implementation program, it is not effective to have one kind of approach to obtain
results. Therefore, some department wards have chosen to apply a team and leaders-directed
strategy in order to improve hand hygiene adherence. A study conducted by Huis et al. (2013)
revealed that having alternative activities for hand hygiene improvements will allow them to
target the specific subpopulations that they are working with. These subpopulations consist of
doctors, nurses, allied healthcare professionals, ancillary and other staff, children or visitors,
(Randle, Firth & Vaughan, 2012, 2587). Huis and colleagues (2013) also found that by having a
team and leader-directed strategy is very valuable in the hospital environment because most of
the healthcare workers already work in teams when assessing patients (465). Managers in that
department would hold meetings to check in with the staff to verify if they were complying with
hand hygiene. Once they assessed the results, they would reconvene in follow up meetings to
make sure they were continuously improving as a team. Therefore, by introducing a strategy that
is based off of their work environment already will potentially lead to positive compliance
results. From this study, the researchers found that compliance increased drastically in the
leaders-directed group versus the state-of-the-art group with over 10,785 hand washing
opportunities among 2,733 nurses within three hospitals in the Netherlands. As far as the state-
of-the-art group, there were only educational pamphlets passed out along with reminders.
However, there were no leaders to make sure the communication efforts had positive results.
The state-of-the-art group improved from 23% to 42% in the short term and to 46% in the long
run. The compliance in the team and leaders-directed group increased from 20% to 53% (short
term) and remained 53% on long term, (Huis et. al., 2013, 469). Based off their findings, they
concluded that the most effective approach is including the healthcare professionals, teams,
leaders, and the organization as a whole in terms of improving hand hygiene compliance. Most
importantly, they also found that by having the participating ward managers on board with that
strategy and believing that it is possible will help keep the motivation with hand hygiene
compliance possible.
After reviewing the different approaches to tackle hand hygiene compliance, the
important take away message is to create a target specific program that fits with the particular
group of healthcare workers you are working with. However, the results from the different
studies did reflect that having a team-leader based strategy was more effective than a state-of-
the-art program or even a program that was conducted among the staff in their department wards.
It is crucial to have everyone on board in order to make sure hand hygiene compliance does not
become an individualistic approach but rather a teamwork effort. In order to provide positive
adherence results and ensure that healthcare-associated infection rates decrease, it is best to serve
the entire ward and implement a team approach on that floor. Instead of actually implementing a
program that targets the hospital as a whole, it is better to take each floor and create the team
leaders-directed approach in that department. In doing so, it will help eliminate the stigma that
healthcare workers do not engage in safe hand hygiene practices. It is one thing to blame
compliance on the environment and the fact that each ward tends to get busy at times, but it still
doesnt answer why it cant be done. When you think about it, washing hands with soap and
water or using an alcohol-based rub should take no more than 15 seconds. If healthcare workers
began to apply this practice while greeting patients or just having it become an automatic
practice before entering a patients room, it would become second nature and it would never be a
compliance issue anymore. But unfortunately, problems wont get solved unless there is a
solution to fix it. Therefore, healthcare workers and the hospital as a whole needs to conduct
better reviews and make sure that hand hygiene results are visible to everyone in the hospital.
Knowing that you are being accounted for will help bring awareness to anyone entering the
hospital. Overall, I think there needs to be further research done to examine hand hygiene
results, and more importantly, there needs to be more team-leader implementation programs
established to ensure that hospital-acquired infection rates remain low and close to none. Like
previously mentioned, hospitals are not a place of concern to potentially get sick, but rather it is a
safe-haven that patients should depend on each staff member to help them get better. However,
if healthcare workers continue to not adhere with hand hygiene standards, patients run the risk of
acquiring a hospital infection and ultimately dying. Patients do not want to be thinking about
this being an issue, let alone a possibility. In conclusion, hospitals need to do a better job by
implementing a monitoring program to enforce hand hygiene practices by having teams and
creating leaders to actually ensure that high compliance rates are being adhered to.
Works Cited
About SAVE LIVES: Clean Your Hands. World Health Organization. Retrieved April 16, 2014,
from http://www.who.int/gpsc/5may/background/5moments/en/
Aziz, A. (2013). How better availability of materials improved hand-hygiene compliance. British
Journal of Nursing (Mark Allen Publishing), 22(8), 458, 460.
Florence Nightingale Quotes. BrainyQuote. Retrieved April 16, 2014, from
http://www.brainyquote.com/quotes/authors/f/florence_nightingale.html
Healthcare-associated Infections (HAIs): HAI Prevalence Survey. Centers for Disease Control
and Prevention. Retrieved April 16, 2014, from
http://www.cdc.gov/HAI/surveillance/index.html
Healthcare-associated Infections (HAIs): Types of Healthcare-associated Infections. Centers for
Disease Control and Prevention. Retrieved April 16, 2014, from
http://www.cdc.gov/HAI/infectionTypes.html
Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., et al. (2013). Impact of a team
and leaders-directed strategy to improve nurses' adherence to hand hygiene guidelines: A
cluster randomised trial. International Journal of Nursing Studies, 50(4), 464-474.
Pittet, D. (2000). Improving compliance with hand hygiene in hospitals. Infection Control and
Hospital Epidemiology, 21(6), 381-386.
Randle, J., Firth, J., and Vaughan, N. (2012). An observational study of hand hygiene
compliance in paediatric wards. Journal of Clinical Nursing, 22, 2586-2592.