|
Hand hygiene is still the
No. 1 concern that lacks compliance regardless of the education provided or the education level of the healthcare worker.
Compliance is difficult, as there is a lot of opportunity to not perform hand hygiene even with the availability of products and technology to track
performance.”— Linda Goss, DNP, BS, APRN-
BC, CIC, COHN-S,
FAPIC
|
external factors – such as inadequate time, lack of convenience, supplies, etc. – may impede compliance. An example of a knowledge and practice gap is the implementation of Enhanced Barrier Precautions in nursing homes. The message of why this is important is not well understood by many staff members, and compliance was variable due to conditional steps that continue to be ignored by some who interact with residents and their environment.”
Aaron Woodall, chief of infection prevention and control for the U. S. Department of Veterans Affairs in Tampa, Fla., says It’ s a little bit of both.“ If we say otherwise, we would be letting everyone off the hook. Some healthcare workers really just don’ t know because onboarding, education, competency, etc. are inconsistent, outdated, rushed or worse, a check-the-box based. This is a leadership issue. Others who know the standard and still choose not to follow it, that is not a knowledge gap, it’ s a behavioral issue. Unfortunately, both stem from weak accountability systems. We train for tasks, not for risk thinking. We assume knowing equals doing. If the culture doesn’ t support practice, knowledge sits unused.”
IP & C consultant Ericka Kalp, PhD, MPH, CIC, FAPIC, founder and CEO of IPC Launch, says that she doesn’ t believe that issues such as hand hygiene compliance result from a knowledge or practice gap.“ I think it is fair that most people, including healthcare workers, understand that washing their hands rids their hands of dirt and other visible debris,” she says.“ The challenge is convincing healthcare workers that what they can’ t see on their hands may pose a significant infection risk to themselves and others. Staff must understand the importance of hand hygiene. For example, as an IP, I have conducted hundreds of hand hygiene observations and found that hand hygiene compliance improves when staff know they are being watched. This is known as the Hawthorne effect, a phenomenon where individuals change their behavior because they know they are being watched. This shows that behavior modification is possible with the correct motivator.”
Alhumaid, et al.( 2021) identified several associations between healthcare personnel’ s knowledge and
|
other variables such as experience, training, working abroad, availability of IP & C guidelines, participation in an IP & C committee, and receiving information through scientific journals. Healthcare personnel who engaged in IP & C education and training, had significant work experience, were familiar with IP & C guidelines, received information through medical journals, and participated in an IP & C committee were more likely to be knowledgeable on IP & C overall.
Alhumaid, et al.( 2021) also found several factors that may affect healthcare personnel’ s compliance and noncompliance with IP & C measures. Three of the major factors prompting HCWs to comply with the IP & C measures were knowledge, education and training, and experience.“ For instance, more awareness of the IP & C benefits and procedures and the perception of risk associated with not following IP & C recommendations motivated HCWs to be more compliant. HCWs who reported receiving enough training and education on IP & C were much more compliant. Also, HCWs who cared longer for patients with a history of infective diseases or participated in IPC committees were more adherent to IPC practices. Being a doctor rather than a nurse was associated with lower compliance with hand hygiene guidelines, PPE use and IP & C practices. Compliance was the lowest in ICUs compared with non-ICU wards or surgical wards, and higher when HCWs were working at public, secondary and tertiary healthcare facilities and during performing procedures that carried more exposure to blood products and body fluid or when HCWs were fearful of acquiring BBDs. Compliance of HCWs with IP & C in the urban hospitals was better than in the rural ones.”
Predictors of HCWs’ noncompliance included high workload and time constraints, more beds and / or higher patient-to-nurse ratio. Glove overuse seemed to reduce hand hygiene compliance. Noncompliance of HCWs to occupational vaccinations recommendations was due to lack of fear of contracting the infection( e. g. influenza A / H1N1), doubts about vaccine efficacy, belief that vaccine is useless or dangerous, and fear of vaccine side effects. Reported barriers for HCWs to adhere
|
with standard precautions included nonavailability of equipment( alcohol hand rub, nearby sink, soap or paper towels) and intolerable or difficult to use hand hygiene agents. Lack of implemented IP & C protocols; HCWs belief that patients pose no health risk on them or patients cannot be a source of infection as if they were asymptomatic or unaware that they are infected; or following IP & C recommendations interferes with providing good patient care resulted in less IP & C adherence.
The Hardest of the Hard Tasks
When it comes to the infection prevention principles and practices that are the hardest to achieve compliance among healthcare personnel, opinions varied.
“ Hand hygiene is still the No. 1 concern that lacks compliance regardless of the education provided or the education level of the healthcare worker,” says Goss.“ Compliance is difficult, as there is a lot of opportunity to not perform hand hygiene even with the availability of products and technology to track performance.”
Kalp also points to hand hygiene as a tough recurring compliance challenge, noting,“ In my experience, hand hygiene compliance can be challenging due to the fast pace of the care environment, simple forgetfulness, or logistical reasons, such as inconvenient access to soap, sinks, and hand sanitizer.”
St. John says he thinks the hardest tasks in which to achieve compliance are repetitive tasks, whether simple or complex.“ What I mean by compliance is not just performing the simple task such as hand hygiene or‘ scrub the hub,’ but performing all the necessary process steps required to complete the task effectively 100 percent of the time. An example of a complex task is cleaning and high-level disinfection of an endoscope after use on a patient. Numerous steps are involved, and each one is important. Why this gap in full compliance occurs is multi-factorial and often requires a human-factors engineering analysis to identify opportunities for improvement.”
“ There really isn’ t one that is harder than the other,” says Woodall.“ It’ s an accountability culture issue. It can be anything-- hand hygiene, transmission-based precautions, environmental cleaning
|