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Hand washing is the removal of micro-organisms from hands using running water or alcohol rub or gel (Brooker and Waugh, 2007). It is the most effective way of controlling the spread of infectious diseases in hospitals and populated areas. The skin is a vital part of the body that acts as a demarcation between internal and external environment and hence should be kept clean all the time to prevent harmful micro-organisms from entering our bodies (Merchant, 2001). These micro-organisms on the skin can either be resident or transient. Resident micro-organisms also called normal flora are harmless and provide protection against colonization by transient organisms and are not transferred from one person to the other, however they may cause problems if the skin is damaged or if the immune system is weak (Carroll, 2001). Transient micro-organisms are transferred from one person to the other and therefore are capable of spreading infections (Carroll, 2001). Hands can appear as if they are clean yet they are contaminated with bacteria, therefore it is always good practice to wash hands regularly. Staff members can pass infectious diseases to patients and patients can also pass diseases to staff members or other patients. Since this is a major issue the author will review hand washing as a means of reducing the spread of infections. The review looks at why hand washing is still an important matter; its historical perspectives, proper hand washing techniques, and the benefits it can bring to patients if practiced properly.
The historical background of hand washing explains clearly that most health professionals are found to be the most usual transporters of the bacteria to patients, even though they know that the secret of controlling infections is proper hand hygiene. The production of hand washing liquids dates back from as early as the 19th century when in 1822, Labarraque, a French pharmacist carried out experiments to demonstrate that liquid chloride solutions could successfully eradicate the smell coming from human dead bodies (Safe Care Campaign, 2007). In 1825, Labarraque then recommended the use of these chemicals in hospitals by doctors handling people with contagious diseases in order to moisten their hands but no one followed the instructions (Safe Care Campaign, 2007). In 1846, Dr Ignaz Semmelweis did research on why the ward where medical students were working had a high rate of deaths in comparison to the ward were qualified midwives were working. The results showed that medical students who were having their lectures were rushing to the ward without washing their hands. Instead of washing their hands they were going straight to the patient in the ward. As soon as the error was fixed the death rate started to decline (Advanced Scientific Health, 2010). Recently a report was published by Pfizer limited which showed an increase in MRSA infections. It is believed that “9% of patients in hospitals in England (About 100,000 people per year) have healthcare associated Infections, many of which are due to MRSA. There are between 6,000 and 7,000 MRSA bloods stream Infections each year in patients in NHS hospitals in England. In 2005 in England and Wales, 1,629 deaths Certificates mentioned MRSA as a contributory factor; and MRSA was cited as the main cause of death in 467 of these cases” (Pfizer limited, 2009). With this high rate of current MRSA cases in hospitals it is imperative that patients in hospitals, their families and their carers have the correct information available to them so that they know the risks of not adhering to proper hand washing techniques when they are in hospitals.
Hand washing Technique
The NHS is encouraging all health professionals to practice proper techniques of washing hands. It is argued that the more emphasis stressed on this message, the more effective it becomes. The technique of proper hand washing is very essential in any health care setting. The routine or social hand washing technique mainly emphasizes on thorough washing of hands using liquid soap and running water for 15 to 20 seconds without missing any part. It is recommended to use liquid soap delivered from a dispenser as compared to bar soap as the latter may be contaminated by the previous user or the surrounding atmosphere (Carroll, 2001). The diagram in figure 1 in apprentices’ section below shows most parts of the hands that are frequently missed during hand washing (Nazarko, n.d). These areas that are missed during hand washing may harbor micro-organisms that will then spread to other patients. There is no specific time that is recommended to wash hands. Hands are washed depending on a specific task. Health workers are advised to wash their hands when starting or finishing their shift. Several activities such as wound dressing are prone to bringing bacteria to patients and therefore, hand washing should be practiced regularly. Nurses must make sure that they wash their hands before and after they attend another patient and also whenever there is any contact of blood and body fluids or after removal of gloves. It is also advised to wash hands before and after eating and drinking and also after visiting the toilet (Wilson, 2006). Micro-organisms are very tiny such that they cannot be seen with a naked eye. Therefore, it is encouraged to maintain have short nails as longer ones easily accommodate micro-organisms that may be difficult to remove during hand washing. The areas under the watches, rings and bracelets also harbor millions of bacteria; therefore it is also advised not to wear these in hospitals (Gould, 2009). Nurses are also encouraged to wear short- sleeved clothes.
Technological developments have also led to the introduction of next generation ultraviolet light based training kits which are being manufactured by a company called Glowtec. These kits are used to check if the hands have been properly washed before attending to a patient (Glowtec, n.d). This form of hand washing technique is used to see a microscopic dirty surface that cannot be seen by a naked eye therefore improving the control of the infections.
Hygienic Hand disinfection is another technique that is used to remove or destroy transient organisms from the skin by washing hands with an antiseptic such as chlorhexidine gluconate, iodine or triclosan for 15-30 seconds and should be carried out before aseptic procedures or during a pandemic situation (Carroll, 2001). The diagram in figure 2 of the appendices section below shows how to wash all areas of the hands to remove any visible contamination of the hands and also to effectively remove transient organisms (Nazarko, n.d)
Surgical hand wash is also another technique that is used during surgery which involves the scraping or brushing of the nails with a sterile nail brush, washing hands and forearms with an antiseptic for a minimum of 2 minutes and then drying with a sterile towel (Carroll, 2001). This technique therefore removes transient organisms and reduces the levels of resident organisms.
Hand drying is also another vital technique that involves using paper towels, the warm air dryer or sterile towels. This procedure is very important because micro-organisms are spread from one person to the other easily in wet conditions than in dry conditions and drying also reduces the risk of developing sore dry skin (Gould, 2009).
Benefits to Patients
Patients are the most vulnerable people who are supposed to be taken good care of in a health setting they benefit a lot from hand washing program. It prevents them from cross infection disease among themselves and those who are in care of them (BMJ, 2010). Hand washing is a process that brings hope and assurance to a patient. The patient is likely to recover better. But if a patient is in pain he or she is likely to develop physical or mental problems. If the patient is affected mentally he or she is prone to depression therefore it means the patient would develop infection due to stress environment. Another benefit of hand washing is short stay in hospital, which will enhance the social and economic (no loss of wages) part of a patient’s life. Eventually this would improve the quality life of a patient. Hand Hygiene Policy (2010)
According to Hillingdon Annual Public Health Report 2004 a lot of death can be avoided by hand hygiene, especially those disease caused by MRSA and again a patient is also able to escape isolation in hospitals. Since patients with serious MRSA are sometimes isolated from other patients because of fear of infecting others. Therefore hand washing scheme enhances the well being of a patient.
Finally the best way of decreasing infectious diseases to patients is hand wash hygiene. According to one of the pioneers of hand wash Dr Semmelweis death rates in hospitals can be lessened if all health professionals follow the idea of handwash. Pathogens and bacteria that are found on hands are said to be the most dangerous causes of infectious diseases unless they are decontaminated by using proper hand technique patients would still suffer the same fate of olden days. According to my opinion hand washing has been discovered long time ago as a main factor of causing infectious diseases but up to now it is still not practiced in a proper way. If each nurse as an individual and those in care underpin the scheme of hand technique in an appropriate manner, they can be a massive change that can bring safety and trust to patients, their families, and friends and even to nurses themselves. Therefore children must be educated on how and when to wash their hands starting from the toddlers so that they can get used to the principle as they grow up. More education training is needed to all health professional on regular basis. If every step of hand washing is followed according to rules and regulations there can be a drastic change in all health care settings.