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The Role of Hand Hygiene in Reducing Hospital-Acquired Infections: A Literature Review
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The aim of this literature review is to assess peer-reviewed journals and articles to evaluate the question: “can hand hygiene decrease the incidence rate of hospital-acquired infection?”. In this literature review, a systematic analysis of the research question will be carried out by taking support and information from peer-reviewed journals and articles.
Hands are considered the primary source of any infection- HCWs or the hands of health care workers can be the primary cause of transmission of hospital-acquired infections or HAIs. Therefore, adherence to HH guidance and practising hand hygiene (HH) by healthcare workers can be one of the best ways to suppress the risk of transmission. This essay will aim to systematically review the published articles and journals to identify the optimal threshold for HHC and HCW rates related to the lowest degree of HAI incidence rate.
Discussion
According to the article written by (Salama et al. 2013), hospital-acquired infections are potentially preventable but common and costly events. In this article, the focus has been given to hospital-acquired infections in surgical patients during COVID-19 infection and infection prevention measures. In this article, a retrospective cohort study has been used as the method for evaluating the importance of maintaining hand hygiene as the prevention method of hospital-acquired infection. More specifically, in this article, the focus has been given to the patients who undergo the surgical procedures during the period of 1st April to 30th June 2020 (COVID-19 Pandemic), and these samples were compared to the patients who undergone through surgery before the COVId-19 pandemic situation (1st April to 30th June 2019). As per the result, among 5945 admission episodes, 224 or 6.6% of the patients were infected with hospital-acquired infection in 2020, whereas in 2019, the rate was 7.2% (Salama et al. 2013). According to the article, maintaining hand hygiene in the healthcare setup or by the healthcare workers can restrict the transmission of some HAIs like VRE or Vancomycin-resistant enterococcus and CRAB or Carbaoenem-resistant Acinetobacter baumannii. According to a study carried out at Singapore hospital on 1785 patients, proper hand hygiene can decrease the rate of hospital-acquired respiratory viral infection and MRSA transmission despite using broad-spectrum antibiotics (Mona F et al., 2013).
According to another study, a unified surveillance mechanism has been used to identify the relationship between hand hygiene and hospital-acquired infections in European paediatric wards. As per this study, hand hygiene compliance can cause a reduction in antimicrobial and nosocomial infection rates among kids in hospitals (Mona F et al., 2013). As per this study, practising hand hygiene is a simple and effective way to prevent the rate of hospital-acquired infection. According to the data, the hand hygiene compliance rate in European hospitals is high (82 per cent), but there is still a gap between the practices and habits in real-time. Thorough studies in six European countries and nine PICUs in university hospitals for over 6 months showcased the interpretation that HH or hand hygiene is single and one of the most critical measures to reduce the HCAI and intervention can improve the rate of complaints. Another study argues that HH cannot reduce the transmission of hospital-acquired infection rate to a considerable extent. Though, as per Mouajou et al. (2022), to reduce and prevent HCAI transmission, it should be necessary for healthcare sectors and practitioners to focus on HH compliance if the main routes of exposure to infection are indirect, direct or due to repeated person-to-person contact.
According to Mouajou et al. (2022), in many hospitals or healthcare sectors, patients’ and visitors’ health and hygiene practices are used to be overlooked. Though (Dhamnaskar, Chaudhari & Koranne, (2022) has argued that correct intervention can improve the HH practices of both patients and visitors and that it may reduce the incidence rate of Hospital-Acquired Infection rate or transmission of infection to a considerable extent. This is specifically relevant and important when the focus will be given to the vulnerabilities of children in the healthcare setup. Dhamnaskar, Chaudhari & Koranne, (2022) has mentioned that, in healthcare setup, children are not only treated by different healthcare workers or HCWs who travel in and out to different clinical settings and are surrounded by ill people. A thorough study at REC or the Research Ethical committee, Committee of East Midlands Research NHS and The Research and Innovation Department have proved that hand hygiene and maintaining HH compliances should be required to suppress the hospital-acquired infection rate.
Another study on hand hygiene compliance was carried out on 100 hospitalised patients, where seven patients were from developed countries, and ten patients were taken from emerging countries with HCAIs or Hospital-acquired or acquired healthcare-associated infections (Dhamnaskar, Chaudhari & Koranne, 2022). In this study, HH or hand hygiene was mentioned as a simple and cost-effective solution to reduce the incidence rate of HCAIs. This study aims to identify the compliance rate of the Hand Hygiene process among the health care workers or HCWs, specifically those who work in the ESR or emergency surgical rooms. A cross-sectional study on the residential doctors and faculties, interns and nurses was carried out for five months to check whether Hand Hygiene can reduce the incidence rate or transmission rate of hospital-acquired infection rate. 1370 HH opportunities were observed and recorded in another study where 690 resident doctors and faculties and 340 interns and nurses (Shahin, 2018). The observation shows that the HH compliance rate among every health care worker is 42 per cent, though (Tham et al. 2022) argued that the hand hygiene compliances and practices are at a poor level among the residential doctors and faculties. Kopsidas et al. (2022) has also argued that the adherence to hand hygiene guidelines among the HCWs or health care workers in ESR of tertiary care settings is at a low level. And due to this reason, the rate of transmission of hospital-acquired infections is at higher degree from residential doctors and nurses. Several studies revealed that infections generally appear in the first 48 hours or more after the hospitalisation and within 30 days of availing of health care. Hand hygiene plays an essential role in stopping the spreading of antimicrobial infection (Kopsidas et al. (2022). According to (Marques et al. (2017), hand hygiene is not only a process of “do it by yourself” but also prevents people from spreading wound infection, respiratory illness, diarrhoea or other infections. Most surveys proved that the most common type of HCAI is surgical site infection, and the risk is significantly higher in developing countries rather than in developed countries. As per the survey, the rate of transmission of surgical site infection in developing countries like paediatric hospitals in Nigeria is 31 per cent, whereas the rate in the United Republic of Tanzania is 24 per cent and 20 per cent in the maternity units in Kenya.
According to the study Mouajou et al. (2022), Nosocomial infections pose a substantial threat to the healthcare system because they are linked to high mortality rates, morbidity, and financial burden. The single most effective method of preventing nosocomial infections is hand hygiene (HH), which includes washing hands with water and detergent and/or using alcohol-based hand sanitisers. Adherence to effective HH practices is acknowledged as the most crucial strategy for reducing the transmission of pathogens in healthcare settings (Mona et al. 2013). This focus on HH is primarily the outcome of the idea that nosocomial infections will escalate into a significant healthcare issue if ignored. A hospital study states that infection used to occur within two days after admission to ICU, as it attributed to the origin of different microorganisms and caused the transmission of infection from one patient to another. This study also provides data about the fact that the transmission mostly occurs through the unwashed hands of HCWs. When an infection manifests fewer than two days after admission, it is assumed that it was already present or incubating at the time of admission to the intensive care unit and cannot be attributed to insufficient preventive hand washing (Shahin, 2018).
Conclusion
By taking into consideration of all peer-reviewed journals and articles, it can be concluded that hand hygiene plays an important role when it comes to limiting the transmission of hospital-acquired infection in healthcare setups. There are limited studies or research papers which focus solely on the question of whether hand washing or hand hygiene can be limited the hospital-acquired infection rate or whether hand hygiene is being maintained accordingly in the healthcare setup. Considering all the journals and articles, it can be concluded that the majority of the healthcare setups, both in developing and developed countries, does not adequately comply with hand hygiene. The majority of the studies provide comprehensive primary data and information to support that adherence to adequate Hand Hygiene can limit the transmission of infections at hospitals. Still, the lack of consideration of this practice can be observed among residential doctors and healthcare workers.
References
- Dhamnaskar, S. S., Chaudhari, G. M., & Koranne, M. S. (2022). Health Care Workers' Adherence to Hand Hygiene Guidelines in Emergency Surgical Room of a Tertiary Care Hospital. The Surgery Journal, 8(02), e136-e140.https://www.thieme-connect.com/products/ejournals/html/10.1055/s-0042-1749426
- Kopsidas, I., De Luca, M., Bielicki, J., Blázquez-Gamero, D., von Both, U., Ciliento, G., ... & Spyridis, N. (2022). Hand Hygiene Compliance Rates in 9 Pediatric Intensive Care Units Across Europe: Results from the Reducing Antimicrobial Use and Nosocomial Infections in Kids Network. The Pediatric Infectious Disease Journal, 10-1097.https://journals.lww.com/pidj/Fulltext/9900/Hand_Hygiene_Compliance_Rates_in_9_Pediatric.150.aspx
- Marques, R., Gregório, J., Pinheiro, F., Póvoa, P., Da Silva, M. M., & Lapão, L. V. (2017). How can information systems provide support to nurses’ hand hygiene performance? Using gamification and indoor location to improve hand hygiene awareness and reduce hospital infections. BMC medical informatics and decision making, 17(1), 1-16.https://link.springer.com/article/10.1186/s12911-017-0410-z
- Mona F, S., Wafaa Y, J., Haifa, A. M., Khaled A, A. A. G., & Vincent O, R. (2013). < The> effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital.https://pesquisa.bvsalud.org/portal/resource/pt/emr-130299
- Mouajou, V., Adams, K., DeLisle, G., & Quach, C. (2022). Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review. Journal of Hospital Infection, 119, 33-48.https://www.sciencedirect.com/science/article/pii/S0195670121003418
- Salama, M. F., Jamal, W. Y., Al Mousa, H., Al-AbdulGhani, K. A., & Rotimi, V. O. (2013). The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital. Journal of infection and public health, 6(1), 27-34.https://www.sciencedirect.com/science/article/pii/S187603411200130X
- Shahin, M. A. (2018). Compliance with hand hygiene among health care providers: Effects of a six sigma improvement project. International Journal of Public Health and Clinical Sciences, 5(3), 112-124.http://www.publichealthmy.org/ejournal/ojs2/index.php/ijphcs/article/view/623
- Tham, N., Fazio, T., Johnson, D., Skandarajah, A., & Hayes, I. P. (2022). Hospital Acquired Infections in Surgical Patients: Impact of COVID-19-Related Infection Prevention Measures. World journal of surgery, 46(6), 1249-1258.https://link.springer.com/article/10.1007/s00268-022-06539-4
