Category: Hand Washing

Cleanliness is the basic part of our religion. Every religion in the world gives the message of cleanliness. It could be cleanliness of our body or environment but most importantly it is cleanliness of our body. A person’s personality is judged by his physical look and attitude.

According to a medical research 80 percent of the infections are transmitted through hands, why? Because when we greet someone, we shake hands, hugs each other and to show affection even tap on face which are the cause of transfer of germs. People do not understand the importance of hand washing, and do not give a concern to it but it is not a good habit. Some infectious diseases that transfer through contact of dirty hands are described below:

• Dysentery;
• Cholera;
• Typhoid fever;
• Salmonellosis;
• Influenza.

Norovirus is the cause of vial gastroenteritis in humans, people of all ages can be affected through it. This disease transfer from one person to other when people do not clean their hands or they don’t wash them thoroughly. This disease can transfer very rapidly among group of peoples living in a same area. To avoid transmission of this disease is to wash hands before preparing food and after toilet and should not touch mouth and nose frequently.

Airborne diseases are those infections transfer through droplet which are taken out during breathing, sneezing and coughing by the people who ae suffering from these diseases. Poor hand washing is also a big reason as during sneezing people keep their hands on mouth and do not wash them and when they come in contact with other people they transfer germs to them. Common cold, influenza, chicken pox are diseases which transfer through poor hand washing.

Nosocomial infections are those infections which transfer from patients and staff of hospital to other people and this happens because people do not was their hands completely. In hospitals germs are present everywhere if staff do not wash hands they can easily transfer those diseases to general public. MRSA and E.coli are those bacteria which can transfer from one person to other.

Hepatitis A is disease whose symptoms are problems in liver, jaundice, severe pain in abdomen, fever and weakness. It is a viral infection which transfer by eating contaminated food prepared by people who do not wash their hands after toilet.

When it is necessary to wash hands:

• Before and after taking a meal;
• After touching pets, their wastes, and their foods;
• After sneezing, coughing, blowing nose;
• Baby diapers also contains many germs so after changing them there is a need to wash hands;
• Before dealing a wound and after touching it;
• After touching a garbage can.

How to wash hands Hand washing:

• Place your hands under clean water;
• Apply hand washer or soap and rub your hands for 20-25 minutes;
• Rub your hands across all surfaces of hands;
• Rub your hands properly; between fingers, back of hands, and wrists of both hands and beneath nails;
• It is important to remove rings, watches or other accessories before washing hands because germs can adhere to them;
• Now rinse soap in running water;
• Now dry your hands with a clean towel and paper towel.

Best way to clean the hand is to wash them but if water is not available, it is effective to use hand sanitizer which should contain at least 60% alcohol which is a good antimicrobial agent.

Alcohol wipes: These are alcohol soaked wipes which are placed in plastic wrapper and are easy to carry, one can keep them in bags and can use them if water is not available.

Strategies to raise awareness regarding hand washing:

• Kids should be given instruction to wash hand after and before taking meal and after playing in parks with mud and toys;
• Seminars should be arranged in schools and colleges in which proper hand washing techniques are taught to the students and awareness should be given regarding diseases which transmit through dirty hands;
• Hand washing steps should be paste near water sinks so that people can follow them;
• In schools, teachers should tell students to wash their hands before eating;
• In schools there should be a sink and soap in dining room so that students can wash hand before eating;
• Mothers should wash their hands after changing diapers of the baby;
• People should wash their hands before touching new born because new born babies are more susceptible to infections as their immunity is weak;
• Hand sanitizer and alcohol based wipes should be kept everywhere so that where water is unavailable these things will help.

It is very important to develop the habit of hand washing from early age. Usually people do not wash their hands after contact with contaminations. According to a recent survey only 19% people wash their hands completely but most of the people don’t know how to wash hands.

In this essay, I will talk about my experience with the skill of hand hygiene in clinical practice. First I will explain how I perform the technique and my reasons for doing so using official guidelines such as the World Health Organisation (WHO), and research into hand hygiene to explain and support my method for hand hygiene. As well as supporting my own practice, I will use research to show the importance of hand hygiene in preventing the spread of disease in the clinical setting. Following this, I will explain how my experience with this skill has impacted my knowledge and use of hand hygiene, as well as how it will inform my practice in future clinical placements. Finally, I will conclude my essay by summarising the points I have made about my use of the skill and my continuing use of it in practice.

I perform hand hygiene before and after every interaction with patients or patient areas. Prior to the interaction, I apply alcohol-based gel to my hands. If the interaction involves bodily fluids such as feces, or the patient are in isolation, would perform post-interaction hand hygiene using water and soap or cleansing gel. The procedure I follow for handwashing contains seven steps. Firstly I dampen my hands with water before applying soap to the palm of my hands. I rub my palms together, then rub the back of my hands, followed by rubbing my palms together with my fingers interlaced. Next, I interlock my fingers and rub the back of my fingers with my palms. Following this, I use my palms to rub the thumb of the opposing hand, and finally, I rub my palms with the fingers of the opposing hand.

After following these steps, I will rinse my hands with water and dry them with a paper towel from a dispenser next to the sink. To turn the tap off I would use the towel to avoid re-contaminating my hands.

Hand hygiene is one of the most frequently used skills in nursing and also one of the most important. This is because the nurse’s hands are frequently in contact with patients or patient areas, and any pathogenic organisms that may be present. This means a nurse’s hands are frequently contaminated and, if not properly cleaned, can easily spread these organisms through the clinical environment (Mehta et al., 2014)

An important factor in proper hand hygiene is knowing when it must occur. To this end, I base my decisions on when to use hand hygiene on Sax. H., et al (2007)’s ‘My five moments for hand hygiene’ which has since become an important part of the WHO guidelines for hand hygiene (WHO., 2009). These guidelines highlight the importance of hand hygiene for preventing infection and identifies five moments in which it should be used. These moments are; before patient contact, before aseptic task, after body fluid exposure, after patient contact, and after contact with patients’ surroundings. Following this guideline prevents a number of negative outcomes, these being; patient cross-contamination & infection, healthcare worker infection & cross-contamination, and environmental contamination (Sax. H et al., 2007).

As well as performing hand hygiene at the right time, it is important to carry out hand hygiene with the proper technique. This is because the improper technique can result in missing areas of the hands, leaving them contaminated and increasing the risk of transferring pathogenic organisms. Areas commonly missed in hand hygiene include the backs of the hands and the thumbs (RCNI., 2016) as well as the tips of and spaces in-between the fingers (WHO., 2006).

To ensure that my hands are thoroughly cleaned, and that easily missed areas are not left contaminated, I follow the hand hygiene techniques outlined in the ‘WHO Guidelines on Hand Hygiene in Health Care’ (WHO., 2009). My reason for using the WHO technique is that it ensures the entirety of my hands are decontaminated and can be used with both soap and water as well as hand gel, the only difference being wetting and drying hands. Furthermore, this hand hygiene technique is endorsed by the NHS (NHS., 2016) making it the standard method for hand hygiene in health trusts within the UK. This has the benefit of soap dispensers on hospital wards displaying instructions on how to perform the technique, making it easy for me to remember.

Another important part of hand hygiene in the clinical setting is whether to use Alcohol-based hand sanitizers (ABHS) or soap and water. After interactions with patients such as basic vital observation or assisting a patient in feeding I will use ABHS rather than soap water. This is because, while soap and water are more effective, ABHS is easier and quicker to use while still very capable of cleansing hands of contaminates as long as they are not visibly soiled (NHS., 2016).

Another reason I use ABHS rather than soap and water unless necessary is to prevent eczema/dermatitis. Hamnerius. N et al., 2018 found that handwashing with soap was associated with the development of dermatitis among healthcare workers, while hand disinfectant was not. Furthermore, WHO states that frequent hand washing leads to lipid depletion which in turn causes skin dryness and cracking, damaging the skin and possibly increasing susceptibility to infection (WHO 2009). Based on this evidence I only use soap and water when necessary in order to protect my own health while ensuring I comply with infection prevention standards.

However, sometimes hand sanitizer is not appropriate for hand hygiene. To this extent, I always use soap and water after interacting with patients in situations that expose me to bodily fluids such as cleaning feces or when my hands are visibly soiled. Another occasion in which I will use soap and water is after interacting with a patient in isolation, such as contact or respiratory isolation. Soap and water must be used after possible body fluid contact or when hands are visibly soiled because, while ABHS is effective at killing pathogens, they are not capable of properly removing traces of contaminants such as feces from the skin (Mathur. P., 2011). Soap and water must be used to clean hands after contact with patients in isolation as pathogens such as norovirus have shown resistance to ABHS (Vogel. L., 2011) and reliance on hand sanitizer over soap and water has been shown to increase risks of outbreaks (Blaney et al., 2011).

Prior to placement, I was not fully aware of the full extent of hand hygiene importance in healthcare. Now that my placement is over, whenever I wash my hands I instinctively use the technique promoted by WHO and the NHS even outside of placement and intent to continue to do so. Another important aspect of hand hygiene I have learned is when to carry it out. After my placement and research for this essay, I base my decisions for when to clean my hands on the hospital guidelines as well as Sax. H., ‘My five moments for hand hygiene, these being before and after any contact with the patient or patient area. In future placement, in clinical practice, I intend to continue to follow this guideline on when hand hygiene should occur.

Another way this has affected my future practice is deciding whether to use soap and water or hand gel during hand hygiene. In the future, whenever I interact with a patient who is in any sort of isolation, if the interaction involved contact with bodily fluids such as feces or urine, or if my hands are visibly soiled, then I will use soap and water to reduce the risk of my hands remaining contaminated. However, after viewing evidence such as Hamnerius. N et al., 2018, which suggests that overuse of soap and water can lead to dermatitis, I will use ABHS unless the previously mentioned criteria are met in order to protect my own well-being.

In conclusion. Hand hygiene is one of the simplest and most commonly used skills in nursing while also being one of the most important in preventing the spread of pathogenic organisms and infections. To this extent, I follow the WHO promoted technique for hand hygiene to ensure that the entirety of my hands is cleaned when performing the skill. Likewise, by following ‘My five moments of hand hygiene’ I reduce the risk of spreading contaminates between patients and other patients or staff. My last development of this skill is only to use soap and water when necessary to reduce the risk of developing dermatitis, which will reduce the risk of infection to myself and others. Finally, I will continue to use the approach I have developed to performing hand hygiene based on my experience with it in practice and the supporting knowledge I have obtained while writing this essay.

Hand washing (or handwashing), additionally called hand hygiene, is the act of cleansing fingers for the motive of removing soil, dust, and microorganisms. If water and soap are not to be had, arms may be wiped clean with ash. Medical hand hygiene refers to hygiene practices associated with medical approaches. Hand washing earlier than administering medication or hospital treatment can save you or limit the spread of disease. The predominant medical reason for washing fingers is to cleanse the palms of pathogens (like microorganisms or viruses) and chemical compounds that could reason damage or disease. This is especially essential for those who handle meals or paintings in the clinical area, but also critical exercise for the general public.

Handwashing with soap consistently at vital moments during the day prevents the spread of illnesses like diarrhea and cholera which can be transmitted through fecal-oral routes. People can emerge as infected with respiratory illnesses consisting of influenza or the not unusual cold, as an instance, in the event that they do no longer wash their fingers before touching their eyes, nose, or mouth.

Hand washing has the subsequent health blessings:

• Minimizes the unfold of influenza;
• Prevents infectious reasons of diarrhea;
• Decrease respiratory infections;
• Decrease toddler mortality rate at domestic delivery deliveries.

A 2013 study showed that stepped forward handwashing practices may also cause small upgrades within the length growth in children underneath 5 years of age

In developing nations, adolescent mortality costs related to respiration and diarrheal illnesses may be decreased by introducing easy behavioral adjustments, which include handwashing with soap. This easy action can lessen the charge of mortality from these sicknesses with the aid of nearly 50 percent.

Interventions that promote handwashing can reduce diarrhea episodes by using about a third, and this is comparable to offering easy water in low-profit regions forty eight% of discounts in diarrhea episodes may be associated with handwashing with soap.

Handwashing with cleaning soap is the single handiest and cheaper manner to save you diarrhea and acute respiratory infections (ARI), as computerized conduct is executed in homes, faculties, and communities internationally. Pneumonia, a major ARI, is the number one purpose of mortality among youngsters underneath 5 years antique, taking the life of a predicted. Eight million kids in line with year. Diarrhea and pneumonia together account for almost three.5 million baby deaths yearly. According to UNICEF, turning handwashing with soap earlier than ingesting and after the usage of the toilet into an ingrained addiction can shop greater lives than any single vaccine or medical intervention, slicing deaths from diarrhea via almost 1/2 and deaths from acute respiratory infections through one region. Hand washing is usually integrated together with different sanitation interventions as a part of water, sanitation, and hygiene (WASH) programs.

Hand washing also protects against impetigo that’s transmitted through direct physical contact. A possible small adverse impact of hand washing is that common handwashing can cause pores and skin harm because of drying of the pores and skin. Excessive hand washing is typically visible as a symptom of obsessive-compulsive disorder (OCD). There are 5 critical times at some stage in the day where washing arms with cleaning soap is crucial to reduce fecal-oral transmission of disorder: after defecation, after cleaning a child’s backside, earlier than feeding a baby, before ingesting, and earlier than making ready food or dealing with raw meat, fish, or fowl

In many nations, there’s a low occurrence of handwashing with cleaning soap. A have a look at handwashing in 54 countries in 2015 located that on average, 38.7% of families practiced handwashing with cleaning soap. Several Behaviour alternate methodologies now exist to increase uptake of the behavior of handwashing with cleaning soap at the essential times.

Group handwashing for college kids at set instances of the day is one choice in developing countries to engrain handwashing in children’s behaviors. The ‘Essential Health Care Program’ carried out by the Department of Education within the Philippines is an instance of at scale motion to sell youngsters’ health and education. Deworming twice a 12 months, supplemented with washing fingers daily with soap, brushing teeth day by day with fluoride, is at the center of this national software. It has also been efficiently implemented in Indonesia. As a preferred rule, hand washing protects human beings poorly or in no way from droplet and airborne illnesses, which include measles, chickenpox, influenza, and tuberculosis.

Removal of microorganisms from pores and skin is greater through the addition of soaps or detergents to water. The essential motion of soaps and detergents is to reduce barriers to answer, and increase solubility. Water is an inefficient pore and skin purifier due to the fact fat and proteins, which can be components of organic soil, are not easily dissolved in water. Cleansing is, however, aided by means of a reasonable drift of water.

Solid soap, due to its reusable nature, might also maintain bacteria received from preceding uses. A small number of research that has checked out the bacterial switch from infected stable soap have concluded transfer is not likely because the bacteria are rinsed off with the froth. The CDC nonetheless states ‘liquid soap with palms-unfastened controls for dispensing is superior’.

Hand washing has been a central pillar of personal hygiene among communities, cultures, and religions. This has since created a link between handwashing and health thereby introducing new methods of handwashing. In recent years, handwashing with soap and other forms of hand hygiene has been gaining recognition as a cost-effective, essential tool for achieving good health and nutrition globally.

Furthermore substantial level of control from diseases caused by foodborne outbreaks and healthcare-associated infections as a result of checks and balances aimed at promoting hand hygiene, some of these include implementation and support of hand hygiene programs that are consistent with the National Hand Hygiene Initiative (NHHI). (Clinical Excellence Commission., 2019).

In addition, there are various means of performing hand hygiene such as Applying an alcohol-based hand rub to the surface of hands (including liquids, gels, and foams) or washing hands with the use of water and soap or a soap solution, either non-antimicrobial or antimicrobial.

According to the aforementioned scenario, the family has the option of either using hand soap or alcohol hand sanitizer in ensuring effective infection control relative to healthcare standards. In recent years, increased research on hand hygiene suggests that effectiveness has been achieved through a collection of data or information on the positive aspects of the practice as well as the recommended methods between hand soap and an alcohol-based sanitizer, hence highlighting the advantages and disadvantages respectively(Vermeil et al., 2019).

Subsequently, it provides an opportunity to identify and improve on flaws affiliated with hand hygiene practices, by understanding their general outcomes in healthcare. Further studies also highly advocate for either practice as they have both proved to be the most effective means of hand hygiene over the years. However, the standard recommended practice remains to be the use of hand soap as opposed to the use of alcohol sanitizer; through understanding the nature of both means it is deemed that alcohol-based hand rub is not as effective for hand hygiene against hand soap because of its inability to break down tough germs and bacteria. Moreover, alcohol hand sanitizer is only limited to use in clinical situations where the hands are visibly clean whereas the use of hand soap is highly recommended whenever possible and mainly when an individual’s hands are visibly soiled. This, therefore, creates a perception that the family risk cross-infecting their loved one (Hand Hygiene Australia, 2019)

This research can assist with giving education and awareness on the different forms of hand hygiene and their importance. This further informs the healthcare approaches towards reducing the rate of preventable infections affecting patients, their carers, and their loved ones in healthcare settings and the community (Fox et al., 2015).

The study findings acknowledge that when performed correctly, both hand soap and alcohol-based sanitizers hygiene result in a reduction of germs and microorganisms on the hands which in turn reduces the spread of infections. However, there are limited resources that support the use of alcoholic sanitizers as efficient in reducing the microbial flora on the hands, unlike hand soap. Researchers note that the use of alcohol sanitizers is preferred in healthcare settings given its beneficial attributes such as; being mild and maintaining skin integrity, easy and quick access when required compared to hand washing where you require a sink and running water.

Never the fewer studies continue to advocate for handwashing as the leading most effective means of reducing cross-infection of germs, bacteria, and prevention of nosocomial infections; however, the use of alcohol sanitizers is only used to supplement hand hygiene and therefore should not be considered a primary means of infection control.

Substantial studies and findings support the aforementioned by relating the preference of hand sanitizers against limitations of time and the use of soap and water. Although handwashing may be time-consuming and rigorous; it is highly recommended due to its anti-microbial properties that help kill germs and bacteria effectively. In order to curb the shortcomings of handwashing, it is a requirement that health care facilities provide

Another beneficial aspect of handwashing with soap is that involves the use of neutral soap hence reduces the chances of allergic reactions to alcohol-based hand rubs (Vermeil et al., 2019). Moreover, soap is considered cost-effective as it is less expensive, efficient, and has few side effects. However, alcohol sanitizers seem effective in terms of saving time and improving the overall compliance with hand hygiene recommendations in healthcare settings. Besides, alcohol hand sanitizer ensures fast drying thus serves as the most preferred hand hygiene method in most healthcare settings. In terms of reliability, hand soap is more reliable owing to its chances of reducing infections. On the other hand, in terms of validity and currency of the information selected, alcohol sanitizers seem to be preferred owing to their efficiency and ability to promote hand hygiene. However, the effectiveness level is limited compared to the use of hand soap (Mathur, 2011).

Based on the research findings, alcohol sanitizers are commonly used in most healthcare settings because of their ability to promote a level of hand hygiene that is fast, easy, and reliable. However, it is highly recommended to use hand soap since it is much more effective in reducing bacteria, germs, and cross infections unlike hand sanitizers are limited. (Kirkland et al., 2012)

There are a few potential areas of change that can be addressed towards promoting hand hygiene in healthcare settings and the community at large. Besides encouraging the practice of proper hand hygiene, education and public awareness need to be emphasized so that people are able to understand the benefits of handwashing compared to the preferred method of hand sanitizers. Other areas of change include sensitizing the community and healthcare providers on new means of hand washing hygiene as well as how to deal with infectious diseases, some of the techniques that can be instrumental include:

• Use of informative awareness charts in health care settings
• Use of different languages so as to accommodate minority groups like the blind and people from non-English speaking backgrounds
• More signage and pictorials on the appropriate way of undertaking hand hygiene for easier understanding

This approach endeavors to encourage the use of traditional hand washing as opposed to sanitizers in healthcare settings (Marimuthu, Pittet, and Harbarth, 2014).

Further research is necessary to concretely address the potential side effects associated with the use of different hand hygiene methods like hand washing or alcohol sanitizers. Apart from studies conducted to promote hand hygiene, Investigators advocate for the use of different methods to study the in vivo efficacy of handwashing, antiseptic handwash, and surgical hand antisepsis protocols, in contrast to the nature of germs and bacteria. (Centers for Disease Control and Prevention, 2019)

Other actions that can be adopted based on the research involve communicating with the patient’s family members on the use of hand soap and its core benefits. Besides, the actions will also be based on demonstrating the effectiveness of the method in reducing possible infections (NCBI, 2013). Other key actions that can be employed involve the provision of handwashing amenities and resources like water, soap, and alcohol hand rub within the healthcare setting and information materials such as posters to improve the level of compliance with handwashing hygiene. Moreover, it is important to consider the patient’s and relatives’ views towards the use of both methods. On the other hand, involving other healthcare professionals can also help in better understanding why hand soap should be preferred compared to alcohol sanitizers, hence promoting confidence in the healthcare system (Vermeil et al., 2019).

It seems evident that we are not aware of the importance of maintaining good hand hygiene. Otherwise, the fact that only two thirds of adults use the toilet after going to the toilet would not be explained. However, it has been shown that the hands are one of the main routes of entry of infections to the rest of the body, since they are in constant contact with the nose, eyes and mouth.

Let’s be responsible for our health and that of those around us , and pay attention to the warnings and recommendations of the experts, who do nothing but repeat what we should already know: the hygiene of our hands depends, to a large extent, on our maintaining ourselves. healthy as individuals and as a society. And not only against the coronavirus , which is currently the major concern worldwide, but also against many other diseases that find their gateway through our hands.

Celina Llanos Jorge , intensivist at the Quirónsalud Tenerife HospitalThis link will open in a new window , emphasizes the importance of hand hygiene, both in everyday life and, of course, in the healthcare field. And to make us aware of it, she has provided us with the following information.Hand hygiene

A hygiene right hand is the easiest and most effective way that we all have to prevent the spread of infections transmitted through contact. More than 150 different species of bacteria live in our hands . In addition, women’s hands generally contain more germs than men’s. This is because the male skin is more acidic and this hinders its growth.

The microbes responsible for causing colds that spread quickly through the hands by sneezing, coughing, or rubbing the eyes can also remain hidden under the nails . For this reason, by shaking someone’s hand they can spread to another person. Handling food without proper hand cleaning (before and after cooking) is one of the most frequent causes of the spread of digestive diseases. It is especially important to wash after coming into contact with raw foods such as chicken, which can transmit salmonella.

According to a study, up to 20% of workers have caught an infectious disease in their workplace. The places where most of the germs have been found are:

• Door : up to 38% of its surfaces are colonized by germs
• Elevator buttons: 20%
• Railings: 14.5%

Mobile phones and computer keyboards have up to 10 times more bacteria than a public toilet seat. The surfaces of our mobiles are the ideal place for bacteria to reproduce and up to 30% of them are transmitted to their owners. Therefore, it is very important to wash your hands after talking on the phone and avoid using them during meals.

6 steps to wash your hands

These days, more than ever, we are seeing that, in addition to maintaining hand hygiene, it must be done correctly, lasting more than 20 seconds, following six phases. Before you start, cover the palm of your hand with soap, preferably liquid, or a hydroalcoholic substance.

These are the six steps for proper hand hygiene:

• Palms of the hands. Rub palm to palm
• Back. With the palm of the right hand we rub the back of the left hand and repeat the same with the opposite hand
• Between the fingers. Palm to palm with interlaced fingers we rub them so there are no gaps
• Tight fingers. Rubbing the back of the fingers of one hand against the opposite palm as if holding your fingers
• Thumbs Friction by rotation of the fingers on the left hand closed around the right thumb and vice versa
• Use the yolks. Rotational friction of the fingertips of the right hand against the left palm and vice versa

Abstract

With increasing urban migration there is a need of improving facilities available in the public restrooms to ensure a safe contamination-free environment. This project attempts to design and develop an Automatic Sanitization system for public restrooms using an integrated circuit with a pre-defined control algorithm (555NE). This system comprises a hand washing and hand drying system built in a solitary unit. For standard application, the system is designed to ensure it is user-friendly and interactive with ease of installation in regular water supply and electrical power supply.

This project utilizes an IR proximity sensor to detect the presence of hands that would automatically trigger the required unit on and off thus avoiding doses due to dirty hands because sensory technology enables touchless control, unlike the traditional technology that required human touch for its operation.

Introduction

As the world’s population is increasing, more of public washrooms have been used. This makes it necessary to ensure that adequate and sustainable sanitary systems can still be made available for this and future generations. This project exactly is about the automatic sanitization system. It means that –“as if in conventional sanitization systems, the user presses a top of water orifice, which opens a water valve allowing water to flow into the wash basin, or sometimes the user turns the tap to allow and/or disallow were to flow”, but in public toilets (washrooms) we found that; lot number of peoples uses toilets facilities for their use, but only one percent out of them clean up effectively to maintain his/her hygiene after visiting the toilets. The mindset of people is that, if we touch the water taps/ faucets and soap faucet/tap our hands will get infected or will become dirty or most of the people ignore using soap during the hand washing process or ignore the whole process of cleaning. Due to this mindset, a lot of dirty waste is kept /carried on, and slowly from this dirty various virus and bacteria get released in the nearby area which generates various types of diseases

As a solution of this problem, an automated sanitization system is idealized. In this system when a user places hands in closer proximity to the hand washing system and hand drying system an infrared sensor gets activated and when a person moves away, the sensor sends some signals to shut the system down automatically

The sanitization system is made up in a solitary unit with two separate segments each operating automatically to ensure safe and clean operating conditions on the public washrooms. It generally includes the following segments

I. Hand washing segment

This section is made up of an automatic water faucet which is integrated with the soap faucet to ensure that soap becomes a must-use component during the action of hand washing. Washing hands with soap is compulsory. Although it is not necessarily an antibacterial soap, regular soap is required since the surfactants in soap could lift soil and microbes from the skin. Using antibacterial soap might even lead to the development of bacteria that are resistant to the product’s antimicrobial agents. Due to the low percentage of users that use soap in their hand-washing routine, hence the automatic faucet must be designed to force the users to use soap with no exception

II. Air drying segment

This section is automated to dry the hands of the customers/users after being washed. In this project, it will be placed just beside the hand washing segment.

• Problem statement

As a result of an increasing number of people in urban areas such as Mlimani City mall In the Dar es Salaam region, there is an increasing rate of contamination on the public restroom due to manual operation of water faucets and negligence of many users to use all basic components for effective cleaning have exposed users to bacterial contamination and poor water management.

• Objectives of the project

Basically, the objectives of this project can be categorized into two sub-categories

1. Main objective
2. Specific objective

• Main objective

The main objective of this project is to design a sanitization system that can provide touchless automatic control for maintaining user hygiene in public washrooms.

• Specific objective

1. Designing automatic valves control for hand washing sinks
2. Design of toilet flashing system
3. Development of an automatic valve control system for hand washing sinks
4. Development of an automatic toilet flushing system

• Significance of the project

The main significance of this project is to ensure a contamination-free handwashing process as it will capable of forcing users to use soap and scrub their hands for less than 30 seconds during cleaning and with its touchless control of the entire system the problem of the increased rate of contamination can be reduced to a greater extent.

The end product of this project will enable better water management Since Water will only be allowed to flow at times when required thus with this system more water will be preserved as compared to the conventional mechanism used in these days on controlling water faucets in public restrooms.

Also, this project will Improve the reliability of the system Since each unit will be fully complete with all basic components, for the hand washing and hand drying process

Literature review

• Related Works

The recent trend of automatic water faucet available in the market have tried to eliminate the need of the user to operate the faucet lever. These faucets require a user to initiate their operation but it will mechanically stop after the recoil has regained its original position. These types are widely used in public areas as they are trying to tackle the problem of contamination (huge, n.d.).

In the market, automatic air dryers that do not necessitate users are very common. It uses a proximity sensor that is mostly based on infrared (IR) light to detect the presence or absence of hands (Anon., 1993).

Semi-automatic soap dispensers are very common but they do not completely offer a user touchless control and others have applied similar usage of the proximity sensor in detecting hands and free users from touching the soap dispenser (Anon., 2019).

World Toilet Day Celebrations at the national level is part of the Clean Toilet Campaign activities carried out by the Ministry of Housing and Local Government through the Department of the local. This response is intended to remind people about the practice of good care and clean toilets and thereby improving the image cleanliness of public toilets in the country (Sadhguru, 2019)

Methodology

Development of the automatic sanitization system uses an interactive design process to carefully consider the usability of the final product that meets the standard hand-wash procedures.

Proposed system

In order to overcome the shortcoming of the existing system, I recommend this project as it attempts to design and develop an Automatic Sanitization system for public restrooms using an integrated circuit with predefined controls. This system comprises hand washing and hand drying sections built in a solitary unit. For standard application, the system is designed to ensure it is user-friendly and interactive with ease of installation in regular water supply and electrical power supply.

• Indicator-led lamps
• Sensor
• Soap pump
• Ely
• Fan
• Elay
• Buzzer
• Miro controller
• Solenoid valve
• Regulated power supply

Figure 3.1: Block diagram of the proposed sanitization system for public washroom

References

1. Anon., 1993. Wikipedia. [Online] Available at: http://www.wikipedia.org/wiki/hand_dryer [Accessed 12 2019].
2. Anon., 2019. medicines. [Online] Available at: http://www.mediclinics.com/en/soap-dispensers [Accessed 12 2019].
3. Haque, Z. u., n.d. Automatic Washbasin Tap Controller. Mohammad Ali Jinnah University, Islamabad, p. 4.
4. Sadhguru, 2019. world toilet day. [Online] Available at: http://worldtoiletday.info [Accessed 12 2019].

Abstract

The purpose of this experiment was to determine which water temperature was most successful in the removal of pathogenic growth from handwashing. The experiment consisted of three participants which include: Taylor Pumo, Rebekah George, and Lexi Vendl. There were two procedures involved in this experiment. The first procedure was washing the left hand with bar soap in warm water. The second procedure was washing the right hand, with the same bar of soap, but with cold water instead. The hands were both washed for a duration of twenty seconds each. Every person has a preferred temperature they like to wash their hands in. However, this experiment showed which temperature was most effective in inhibiting bacterial growth. The results showed that washing hands in warm water vs cold water were very similar. The Petri plates for both hands were very close in the number of bacteria that had grown. The main reason for these results is due to rigorous handwashing. Intense scrubbing while washing hands can actually remove the body’s natural flora. However, the results concluded that the most effective hand washing temperature was when the hands were washed in warm water.

Introduction

The significance of handwashing is constantly being drilled into a child’s head throughout their whole childhood. However, most people don’t truly realize its importance of it. Handwashing plays an essential role in decreasing the transmission of microorganisms, including pathogenic microorganisms, which result from contact, like handshaking. One of the first people to truly realize the importance of handwashing was, Ignaz Semmelweis. Ignaz discovered that puerperal fever resulted from the lack of handwashing. He realized that the medical students would come from performing autopsies and then straight to help deliver a newborn child. After realizing this, he made it mandatory for staff to wash their hands with a substance called chlorine. This resulted in a decreased spread of bacteria and a drop in the mortality rate. Furthermore, a few years after Semmelweis tried advocating the importance of hand washing, a nurse in Italy named, Florence Nightingale, tried to do the same thing. During this time, most people believed that infections were transmitted by odors in the air called miasmas (GHP). Nightingale introduced the technique of handwashing into the war hospitals she worked in. The results ended up showing a decline in the spread of infections. Although handwashing was still being used, it took over a century for people to truly realize its importance of it. People started to realize this when a foodborne outbreak started to become abundant. These food outbreaks started to occur during the 1980s. The public started to spark fear from these outbreaks that were happening. The United States Centers for Disease Control and Prevention realized that proper handwashing would be the only way to stop these pathogenic microorganisms. Since the public was so concerned about these outbreaks, The United States Centers for Disease Control and Prevention released the first national guideline for hand hygiene (GHP).

The purpose of this experiment was to figure out the optimal hand washing temperature that would inhibit the most growth of pathogenic microorganisms. Most people were raised to believe that washing your hands with hot water would be the most effective. However, there has been a lot of controversies on which temperature works the best. The main purpose of hand washing is to get rid of transient microorganisms and to inhibit bacterial growth from growing on the skin (Gardner, 2019)​.​An article called “Impact of hand hygiene knowledge on hand hygiene compliance”, states that, “ 32.9% of the students did not perform hygienic hand washing properly”(Novak, 2019). These results showed that almost have of the experiment’s population admitted to not having proper hand washing skills. Hand washing with hot water is believed to kill more bacteria rather than if you had washed your hands with cold water. The Food and Drug Administration (FDA) believes that washing hands in hot water and soap is the most effective way of removing pathogens. The FDA conducted a study to see which temperature was most optimal. Their results showed that temperature had no effect on the removal of bacteria (Sandoiu, 2017). On the contrary, a study published by the​Journal of Food Protection​had a different opinion. The data concluded from their experiment showed that washing hands in cold water worked at inhibiting the growth of bacteria just as well as hot water did (MacMillan).

The initial hypothesis before completing the experiment was that the warm water would inhibit the most growth of pathogenic bacteria. However, many experiments and analyses over the years have shown that all the optimal temperature for inhibiting the most growth was when hands were washed in warm water. The experiment conducted will visually show which temperature inhibited the most growth due to how much growth is on each individual petri dish. The hands were washed with Irish Spring bar soap for twenty seconds each to insure that the results would be more accurate. According to the Centers for Disease Control and Prevention, the optimal way for a person to wash their hands is to apply soap and lather all parts of the hands. The correct amount of time a person should lather for is around twenty seconds. This specific amount of time insures to get rid of most of the bacteria residing on the hands. A potential setback for this experiment that could potentially affect the data would be to much removal of the body’s resident flora. Resident flora is the body’s natural microorganisms that reside on the skin and are not harmful. If the scrubbing is to harsh and removes a lot of the resident flora, it could result in more bacterial growth rather than less. This experiment is definitely a reminder on the importance of great hand hygiene.

Materials and Methods

Figure 1​: Irish Springs Original deodorant bar soap

The Imperative materials for this assignment included the lab manual, six blood agar Petri plates, a sharpie marker, Irish spring original deodorant bar soap (Figures 1), three participants, three pairs of latex gloves, a sink that has warm and cold water, paper towels, a timer, and an incubator set at 37 degrees Celsius. The experiment took place at Florida Gulf Coast University in Whitaker Hall, room 268, on Wednesday, September 18th, 2019, and the results were collected on Monday, September 23rd, 2019, in the same location. Before starting the experiment, make sure to check that the incubator is set to 37 degrees celsius for accurate results. The first major step in starting this experiment is to discuss and develop a research plan to find out which specific method is going to be used. There should only be one variable changed in this experiment to get accurate results. The participants had to decide which variables they were gonna use to find their results. The experimenters decided on using the Irish Springs bar soap has the handwashing material. Furthermore, the group decided that the left hand would be washed in warm water and the right hand would be washed in cold water. The participants then took about paper and pencil and recorded what was discussed and everything else that had taken place in the experiment. Each member was assigned two blood-infused agar Petri plates. The participants were in charge of labeling their own petri dish. The first petri dish was for the left hand. A line was drawn down the middle to separate both sides. The left side was indicated before treatment and the right side was indicated after treatment. This petri dish symbolized that the member’s left hand was washed with warm water. The second Petris dish was labeled the same way. However, this petri dish symbolized the right hand. The right hand was to be washed in cold water. After differentiating which plate was which, each member put their initials and row numbers to ensure they knew which plates were theirs. The next step was to figure out the placement of the hands on the blood-infused petri dish. The members decided on using three fingers to collect data. The three fingers included the index phalange, middle phalange, and ring phalange. The members picked these specific fingers because it would be the easiest to place on the petri dish without touching the opposing side. The experiments then took the lid off the Petri dishes and pressed down the three fingers on the before-treatment side. The fingers were pressed onto the petri dish for 5 seconds. This was timed with a timer. This ensured that the before-treatment side of the right and left hand would have similar results.

Finally, after all the setup steps are done and recorded it was time for the next part of the experiment. This part of the experiment was the handwashing section. The participants discussed what techniques were going to be used to actually wash their hands. After discussing, the members agreed on washing each hand for twenty seconds each. The seconds would be timed with a timer to insure accuracy. The group also decided on doing the left hand first. A latex glove was placed over the right hand to ensure that it wouldn’t get splashed with soap and water and inhibit the chance of any bacteria from leaving the hand. The members walked over to the sink, turned on the water, and let it run for a minute to ensure that the water would get warm. After the water was at optimal temperature, each experimenter wet the ungloved hand with the running water and started lathering the hand with the Irish Spring bar soap. This was trimmed for twenty seconds each. After the twenty seconds were up, each experimenter grabbed two paper towels to dry their hands. Next, they went back to their left-handed Petri dishes, opened them with the covered hand, and placed their three fingers on the after side. Finally, they closed the lid of the petri dish and disposed of the right-handed glove.

Similarly, the experimenters put a glove on the left hand and began the steps for the right hand. The right hand represented cold water. The members turned off the hot water using their gloved hands and changed the temperature to cold. They waited approximately one minute to ensure that the temperature was cold enough and began the same procedures as the left hand. After each member washed their hand for twenty seconds they dried their hand with two paper towels and pressed their fingers into the after side of the petri dish labeled right hand. After placing the fingers for three seconds, they closed the lid and recorded the steps they took.

When the experimenters finally completed all the steps, they carried their Petri dishes to the front of the classroom. They placed the dishes onto racks which would be sent to be incubated at 37 degrees Celsius. The Petri dishes will be incubated for five days to ensure accurate results. After the five days had passed, the members collected the dishes corresponding to them and inspected their results. As they observed their results, they counted and recorded the amount of bacterial growth on each plate. They then discussed all the possible factors that could have affected their results and wrote them down. The members then took pictures of their results on each petri dish for their lab report. Lastly, the Petri dishes were safely discarded into the hazardous bin in the back of the classroom.

Results

Figure 1​: Experimenter one’s left hand before ​Figure 2​: results from experimenter & after washing. one’s right hand before and after.

The plates above show the before and after growth of bacteria from experimenter one.

The left-handed petri dish shows that there was a slight increase in bacterial growth on the after side compared to before treatment. Figure one had 10 colonies before treatment and only around 27 colonies after bacteria. Most of these colonies probably represent resident flora. However, Figure 2 shows a considerably larger increase in bacterial growth compared to before treatment. As depicted in figure 2, their were approximately 31 colonies before treatment. After washing the hand, there were around 70 colonies of growth that were produced.

Figure 3: ​Illustrates Experimenter two’s Figure 4: Illustrates Experimenter two’s left-handed results. right-handed results.

The figures above both illustrate the before and after treatment in the result of hand washing. Figure 3 had only 11 colonies grow from the before-treatment side of the petri dish. In addition, the after-treatment side definitely had a greater increase in bacterial growth than the experimenter one. The left-handed side ended up with around 80 colonies after treatment. However, the right-handed petri dish, which was washed with cold water, initially had 20 colonies of growth before treatment and ended up with around 120 after treatment.

Figure 5​: Represents Experimenter three’s Figure 6​: Represents Experimenter three’s results of the left hand washed with warm water. results of the right hand were washed with cold water. As you can see, Figure 6 had significantly more growth in after treatment rather than figure five, which was washed in warm water. Figure five had approximately 22 colonies before treatment and only a slight increase of 40 after treatment. In comparison to Figure six which resulted in 24 colonies of growth before treatment and ended up with around 50 colonies of growth after treatment.

Graph 1: The amount of bacterial colony growth from each hand before and after treatment.

The bar graph depicted above represents the results from each participant. Each participant is labeled with a specific color. The results are categorized by a specific hand and if it was before treatment or after. The bar graph shows that the right hand after had the highest overall number in bacterial growth. The right had was washed with cold water. The left hand had the lowest average number in both bacterial growths before treatment and after treatment. These numbers help support that washing hands in warm water inhibited the most amount of growth.

Discussion

Once the experiment was fully conducted and the results were analyzed and recorded, it was clear to see which temperature inhibited the most bacterial growth. After carefully analyzing all of the results, it is believed that the optimal temperature of inhibiting the growth of bacteria would be when hands are washed with warm water. The hypothesis that was articulated during the start of the experiment was that washing hands in warmer water will have a greater impact in the inhibition of bacterial growth. The participants carefully reviewed the results and came to a conclusive decision that there were significantly lower colony numbers from the hand that was washed in warm water compared to the hand that was washed with cold water ( Graph 1). Although the numbers for the before treatment were higher than expected, our hypothesis is still supported by the data collected.

The members discussed possible factors that could have potentially affected the results of the experiment. For example, like mentioned earlier, the human body houses natural bacteria all over the skin. This bacteria is called resident flora. This resident flora can potentially help protect us from harmful pathogenic bacteria. The group concluded that harshly scrubbing the hands while washing them could potentially remove resident flora from the skin, leaving the hands vulnerable to harmful bacteria. This could have been a factor in having a higher amount of bacterial growth in our results. Furthermore, bacteria is lying on everyday objects that people use. Another factor that could have affected the accuracy of the results is if there was any bacteria on the paper towels used to dry the hands after being washed. The paper towels were placed in a rack, which makes them susceptible to any microorganisms floating around. To conclude, the members of the group used their best effort in order to minimize the factors that would affect the accuracy of the results.

Overall, the experiment was very eye-opening to how much bacteria we have on our skin before washing our hands and even after. Many people don’t realize the importance of good hand hygiene. The practice of healthy hand hygiene is crucial in the process of inhibiting and decreasing the spread of pathogenic bacteria. If the topic of proper hand hygiene was talked about more, people realized how much bacteria lives on the human body, and how it can grow even if someone washed their hands, then more people would start developing better hand washing skills.

References

1. Cdc.gov. (2019). When​ and How to Wash Your Hands | Handwashing | CDC​.[online] Available at: https://www.cdc.gov/handwashing/when-how-handwashing.html [Accessed 12 Oct. 2019].
2. Gardner, D. (2019). How​ To Perform Surgical Hand Scrubs​.[online] Infection Control Today. Available at: https://www.infectioncontroltoday.com/hand-hygiene/how-perform-surgical-hand-scrubs [Accessed 13 Oct. 2019].
3. MacMillan, A. (n.d.). Why You Should Wash Your Hands in Cold Water. Retrieved from https://time.com/4800412/wash-hands-cold-water/.
4. Novak, M. (2019). [online] Ljkzedo.ba. Available at: http://ljkzedo.ba/mgpdf/mg32/11_Novak_1051_A.pdf [Accessed 12 Oct. 2019].
5. Sandoiu, A. (2017, May 31). Handwashing with cold water just as good as hot water for killing bacteria. Retrieved from https://www​.medicalnewstoday.com/articles/317712.php.​

Evidence-based practice may be defined as a problem-solving approach that requires nurses to be conscientious in their clinical practice. Therefore, the practice is emphasized on the incorporation of best evidence in making decisions with regard to patient care, from well-designed studies, and the preference and values of the patient (Vaidotas et al., 2015). The use of feedback by health care professionals is a way of creating opportunities for learning and reflection which will consequently lead to improved practice (Smiddy et al., 2015). The Nursing and midwifery council’s (2015) code of conduct requires all healthcare professionals to make clinical and rational decisions using best practices.

This assignment will mainly focus on a research article on hand hygiene among healthcare professionals in a specific healthcare institution and the effect on patient care. Research indicates that most of healthcare workers around the world have been neglecting proper hand hygiene practices (Sadule-Rios et al., 2017). The neglect is also witnessed among the visitors that usually come to visit their patients in hospitals. As a result, many healthcare workers and visitors are at risk of being infected with other diseases because of neglecting hand hygiene practices (Kingston et al., 2016). According to research, the lack of hand hygiene practices remains at a low level in most medical institutions around the world. Many doctors and nurses have been reported to routinely forget to wash their hands before meeting their patients (Chassin et al., 2015). The WHO came up with guidelines on hand hygiene in health care, in 2005 as a way of improving hand hygiene among the health care workers in their facilities.

The assignment will discuss the formulation of an answerable question that relates to how hand washing can be improved in health care facilities among the clinical staff and visitors. The assignment will use a systematic search using a database to identify a relevant research paper on handwashing practice that will be further discussed. To formulate the question, PICO is used, specified in the PICO table 1. The question formulated is “Does maintaining proper hand hygiene in health care reduce the spread of infections to patients?”. However, the formulated question does not allow for any comparison as the paper used for answering the question only includes a controlled group that quantifies whether hand hygiene reduces the spread of infections to patients which will provide a comparison by default.

Table 1. PICO

• Population
• Health care workers
• Intervention
• Maintaining hand hygiene through proper washing of hands
• Comparison
• Not applicable
• Outcome
• Reduce the spread of infections.

The Cumulative Index of Nursing and Allied Health Literature (CINAHL) was the chosen database as it covers a range of nursing and health journals. Each section of the PICO was populated with key terms with the primary purpose of focusing the search of the database once the question was chosen. During the search of the article, putting the quote marks around the phrase helped in returning materials that contain a full sentence. Also, during the search of the database, truncation was applied for searching for words with different endings using a database-specific symbol. However, it is usually advisable for researchers to use the truncation cautiously to avoid getting irrelevant hits. The wildcard is also another useful search tool that can be used in instances where a word has a variety of spellings. The Boolean operators ‘not’, ‘or’, and ‘and’ were used as a way of combining various aspects, shown in Table A. Each of the Boolean operator terms usually has a specific role for instance, ‘or’ serves the purpose of increasing the number of hits that include one or more of the key terms. On the other hand, the Booleans; ‘not’ reduces the number of hits while ‘and’ gives a list of hits that contain combined key terms. ‘Not’ also removes any hits that contain a certain key term, thus helping to prevent irrelevant hits from surfacing. Table 2 displays the number of hits that were returned after the inclusion and exclusion criteria were applied. The total number of hits found in the database was 33, including duplicates. Of the 33 hits, 23 were discarded, due to the irrelevant titles to the PICO question; the other 10 articles had good abstracts, using Table B. However, 5 of them were of poor quality; therefore, only 5 articles were read in full. The article on ‘Handwashing practices and techniques among health professionals in a tertiary hospital in Kano’ was found on the database and chosen for critical appraisal. The article was relevant in answering the PICO question and the search criteria.

Table 2. Database Search Results

• Database
• Number of Hits
• Number of Abstracts Read
• Number of Full Papers Read
• Cinahl

1. 33
2. 10
3. 5

Critical appraisal allows researchers to evaluate the research relevance and credibility of the findings to nursing practice. Various analytical tools of the appraisal can be applied to help in the evaluation of the quality of research. However, some of the critical appraisal tools may tend to be specific to the type of research while some others may take a generalized approach during the critical analysis of the study. Critical appraisal tools are essential in that; they act as guides to emphasize thorough appraisal being conducted on specific research. The tools usually consider the many aspects of a piece of research. For this research article, the critical appraisal tool chosen was the CASP Case-Control Study specified in Table C as the study will look at the relationship between hand hygiene among health professionals and the reduced spread of infections.

In terms of validity, Abdulsalam et al.’s (2015) research paper presented its main focus. The authors broke down their presentation into primary and secondary outcomes. The primary outcomes of the research were the effect of proper hand hygiene on reducing the spread of the impact. The type of study in the research was a descriptive cross-sectional one. It was mainly conducted among the nurses and doctors of the AKTH between August 2014 and February 2015. Upon getting permission from the Ethics Committee of AKTH, Kano, and consent from the nurses and doctors, the authors proceeded with the research.

The research applied the use of questionnaires as a way of obtaining the required information from the participants to know about their daily clinic sessions and ward rounds. The main contents in the questionnaire were; years of experience, washing hands before wearing and after removing hand gloves, age, having seen a poster on hand washing technique, profession, whether or not taught on hand washing technique, five moments in hand washing and ability to list them, adherence to the principle of hand washing, agents used in hand washing, washing hands before and after touching patients or handling secretions or body fluids of patients, steps in hand washing, and washing hands after using toilets (Kapil et al., 2015).

After obtaining the required data, the authors entered and subsequently analyzed it using the Statistical Package for Social Sciences version 16 by Microsoft Corporation 2007. A summary of the quantitative variables was also done using medians and means. On the other hand, percentages and frequencies were used for summarising the qualitative variables. The Chi-square test of significance was used for comparing the categorical variables. The authors considered P less than 0.05 as statistically significant for the research. The study recruited 140 health professionals as participants. Of the total participants, 30% of them were doctors while 70% of them were nurses. There were 71 females who accounted for 50.7% and 69 men which accounted for 49.3% (Abdulsalam et al., 2015). Therefore, the ratio of males to female was 1:1.03. The recruitment of the participants was acceptable as it encompassed both the doctors and nurses without any biases. The ages of participants involved in the study ranged between 20 to 60 years with a mean of 36.95+-6.59 years.

From the study, 90 (64.3%) of the health professionals are aware of the WHO global hand washing day. However, only 21 (15%) of these professionals were able to accurately state the date of the WHO global hand washing day while another 50 (37.7%) of these professionals were not even aware of the WHO global hand washing day, and consequently, none of them could even state the exact date. According to the authors, this (χ2 = 21.21, df = 2, P = 0.000) is statistically significant (Abdulsalam et al., 2015). However, 139 of these professionals strongly believe that the risk of infections can be reduced if hand washing is correctly done. Twenty-five of the health professionals (17.9%) failed to wash their hands before meeting patients. Over one hundred and thirty-one of the health professionals (93.6%) attended a hand washing lesson. Sixty-six of the members (47.1%) were well are of the five moments in hand washing while 65 of them (46.4%) did not have an idea of the five moments in hand washing. Nine professionals never attended lessons on hand washing (6.4%) while 4 of the professionals said they are aware of the five moments of hand washing (2.9%). These results were not statistically significant (Chi-square = 0.119, df = 1, P = 0.73).

The results from this study can be applied to address the challenges facing hand hygiene in healthcare both in the African continent and the world at large. Important and critical findings on hand hygiene in health care were revealed after the investigation by the authors. The study revealed the moderate knowledge that health professionals have about the WHO global hand washing day. The study validates the importance and benefits of hand washing with regard to reducing infections. The health professionals also have knowledge about the importance of using soap and water or other agents when washing their hands. The main limitation of the study is that research was only concentrated at one institution with a controlled group of participants while its main strength was the ability of the authors to get as much information as possible from the participants.

The authors attribute to the awareness of the health professionals on the importance of hand washing to the recent Ebola awareness and personal protection seminar that was conducted by hospital staff. The health professionals also have knowledge about the importance of using soap and water or other agents when washing their hands. Adherence to hand hygiene among health care professionals is still low, despite the evidence of benefits.

Overall, the intervention measures that aim to encourage health care professionals to adhere to hand hygiene are limited. Therefore, there is a need for intervention techniques to promote the need for hand hygiene among health professionals (Gould et al., 2017). The findings of this research can be significant especially in health care to improve on hand washing campaigns. Change theory can also be used as a strategy of changing the perception of doctors and nurses toward hand washing. The application will have a huge impact on changing the behavior of health professionals.

In conclusion, hand washing should be enhanced in all health care facilities to reduce the rate of infections that are being largely contributed by health care professionals. More training should be included in hospitals to encourage nurses and doctors on the importance of hand hygiene when handling patients.

References

1. Abdulsalam, M., Ibrahim, A., Michael, G., & Mijinyawa, A., 2015. Hand washing practices and techniques among health professionals in a tertiary hospital in Kano. Journal of Medical Investigations and Practice, 10(1), 8.
2. Banach, D.B., Bearman, G.M., Morgan, D.J. and Munoz-Price, L.S., 2015. Infection control precautions for visitors to healthcare facilitiesBolon, M.K., 2016. Hand Hygiene: an update. Infectious Disease Clinics, 30(3),
3. CASP Randomised Controlled Trial Checklist. (2017).
4. Chassin, M.R., Mayer, C. and Nether, K., 2015. Improving hand hygiene at eight hospitals in the United States by targeting specific causes of non-compliance. The Joint Commission Journal on Quality and Patient Safety, 41(1), pp.4-12.
5. Gould, D.J., Creedon, S., Jeanes, A., Drey, N.S., Chudleigh, J., and Moralejo, D., 2017. Impact of observing hand hygiene in practice and research: a methodological reconsideration. Journal of hospital infection, 95(2), pp.169-174.
6. Kapil, R., Bhavsar, H.K. and Madan, M., 2015. Hand hygiene in reducing transient flora on the hands of healthcare workers: an educational intervention. Indian journal of medical microbiology, 33(1), p.125.
7. Kingston, L., O’Connell, N.H. and Dunne, C.P., 2016. Hand hygiene-related clinical trials reported since 2010: a systematic review. Journal of Hospital Infection, 92(4), pp.309-320. pp.591-
8. Nursing & Midwifery Council. (2015). The code: Professional standards of practice and behavior for nurses and midwives. London: NMC.607.
9. Sadule-Rios, N. and Aguilera, G., 2017. Nurses’ perceptions of reasons for persistent low rates in hand hygiene compliance. Intensive and Critical Care Nursing, 42, pp.17-21.
10. Smiddy, M.P., O’Connell, R. and Creedon, S.A., 2015. Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. American journal of infection control, 43(3), pp.269-274.
11. Staats, B.R., Dai, H., Hofmann, D. and Milkman, K.L., 2016. Motivating process compliance through individual electronic monitoring: An empirical examination of hand hygiene in healthcare. Management Science, 63(5), pp.1563-1585.
12. Vaidotas, M., Yokota, P.K.O., Marra, A.R., Camargo, T.Z.S., da Silva Victor, E., Gysi, D.M., Leal, F., dos Santos, O.F.P. and Edmond, M.B., 2015. Measuring hand hygiene compliance rates at hospital entrances. American journal of infection control, 43(7), pp.694-696.

Abstract

My inspiration for this essay is from a critical incident that occurred in my practice. Mrs. O. was admitted to the ward with complaints of Shortness of breath, chest pains, and syncopal episodes. A diagnosis of NSTEMI (Non-ST-elevation myocardial infarction) was given after an ECG (Electrocardiogram) and blood cardiac protein levels were checked. she was then swabbed for coronavirus disease-2019 (COVID-19) and as well as methicillin-resistant staphylococcus aureus (MRSA) which is an admission pre-requisite for all patients coming into the ward (this is to better inform care, precaution, prevention, and isolation). Her swabs came back negative, and she was put in a bay of 4 patients. It is also compulsory for patients in the hospital to be swabbed for COVID-19 on their day1, day3, and day5 of admission. Mrs. O had all these swabs taken and they were negative as well as those in her bay. By day 10 of admission, Mrs. O. spiked temperatures and was noticed to be coughing as well as having symptoms of Shortness of Breath. As required by hospital policy, she was swabbed for COVID-19 but this time it came back positive.

This left us pondering on how she got infected knowing that she was the last to be admitted into that bay and visitors are not allowed into the ward but the only people she could have encountered were staff and other fellow patients. An investigation ensued into the mode of transmission for this infection as all precaution was followed. All members of staff of the ward were swabbed for COVID-19 as well as patients to find out the cause of the outbreak. It is possible that someone who is a reservoir of the infection (although maybe asymptomatic) may have carried it through either by direct contact or indirect contact. Mrs. O was then isolated in a bay as she was symptomatic of the infection. Drawing from the chain of infection framework, the most applicable link of the chain is the mode of transmission (this is because she was infected either through direct or indirect contact)

There are several infection prevention and control (IPC) guidelines and protocols already in place to help guide and guard our daily activities in healthcare settings. In order to critically appraise IPC protocols in this essay, I will be considering contemporary issues and debates in this field. I will emphasize on the washing of hands as well as the control of infection in a clinical setting and even the community at large.

Introduction

The impact of an infection outbreak is enormous. An outbreak of MRSA for example in a bay can lead to the closure of that bay or unit entirely until a deep clean has occurred leading to delay in care and admission as well. An outbreak also predisposes patients and staff caring for them to sickness. A simple technique such as handwashing is proven to lessen the risk of infection spread (Pratt et al, 2007). The Health Act (2006) required lawfully mandatory obligations on the National Health Service (NHS) trust including providing ample hand washing resources as well as hand rub points and directing a rolling appraisal and auditing of hand hygiene which was also implanted into the framework for local clinical governance.

Discussion

Hospital-acquired infections (HAIs) can be very harmful in any health and social care setting because of patients who are highly vulnerable to disease. These infections are those that a patient gets after or during when healthcare was received which is dangerous as developing an infection while getting health care from an unconnected problem could pose a worsening effect on the patient when compared to the reaction on a healthy individual.

Patients in health care settings and hospitals have heightened susceptibility so are subsequently receptive to ill-causing germs due to cases like diminished immunity or a portal of entry like an open wound. Therefore, proper procedures and precautions need to be in place to make sure the occurrence of cross-infections is prevented. It is therefore essential for health workers to understand the way infections spread in order to act on and consider the major consequences that can ensue when proper preventive measures are not adhered to hence the essence of having the knowledge of the chain of infection.

Health care providers place the control of infection high because of its importance as it protects patients, the public as well as staff providing care. It also promotes safe practice and environment as well as indicating the quality of health care provided. It is essential to emphasize on regulation that applies to the NHS like the NMC (Nursing and Midwifery Council) code of conduct as well as the Constitution of the. Care, competence, and Communication are part of the 6Cs of care factors in how controlling infection is being managed in the NHS.

Hand washing is arguably the most common practice that can be applied to reduce the risk of cross-infection in hospitals (Bennett, Brachman, and Jarvis, 2007). Understanding the chain of infection framework is important as well as applying the proper infection prevention technique at every link. The framework streamlines how germs spread and cause infection. germs are referred to as infectious agents because of their ability to infect the body as they appear to be clustered in some parts called reservoirs (Pittel et al, 2000).

A Reservoir for an infectious agent can be people or the environment and can also be transported from one place or area to another. Germs can be transmitted from a person by exhaling and are described as a portal of exit; these germs can then be transmitted to a patient through the air, food, contact, or even blood. A portal of entry depicts the receptive area in which these germs are then launched into a patient, these can be through an aperture in the skin, urinary tract, and mouth. (Nicol and Brooker, 2011)

Between the exit portal and the entry portal there is a possibility for cross-infection, hence the necessity for proper hand hygiene. Damani (2011) recommended that Unclean hands easily transfer these germs but washing hands properly in hospitals can avert harm to patients to some extent. This increases the significance of health workers learning the technique that will clean their hands both physically and invisibly to get rid of germs. (Clayton-kent and Storr, 2004)

There are several papers and guidelines on hand washing techniques and when to carry out the technique an example is the WHO (World Health Organisation) five moments of hand washing (2006). WHO endorses that hands are to be washed prior to coming in contact with a patient and also before any aseptic procedure as well as instantly after exposure to bodily fluids, after coming in contact with a patient or their environs to shield yourself from pathogens when carrying out healthcare activity. This also complies with the NMC`s code of professional conduct (2004) which states that a nurse must act to identify and minimize risk to patients and clients.

The hand washing technique that was first outlined by Ayliffe et al (1978) has been modified by many bodies to serve different procedures. Hands are to be wet by running water and antiseptic soap. The technique consists of forwarding and backward strokes in a motion of; palm to palm, each palm over the other`s back, palm to palm interlocked, each palm over the other hand`s back interlocked, and then a rotational scrubbing of all fingers into each palm completed by the rubbing of the wrists for a 30-second duration. The hands are then to be rinsed with running water for over 15-seconds and made dry with paper towels (Ayliffe et all, 1978).

Although this practice has a stringent timeframe the WHO opts for the time it takes to sing a Happy Birthday song twice. This has raised worries over the estimate of time as it differs individually. The technique indicated the use of running water without specifying the temperature. Hand Washing for Life (2015) recommends that the temperature of the water should not exceed 43̊c as a rise can cause delicate tissues of the hands to be damaged. This can cause pain to the caregiver as well as aiding bacteria to trapped, thereby making it hard to remove. More so, health workers are required legally to ensure they protect themselves first, this includes protecting their hands by taking care of it. (Health and Safety at Work Act, 1974)

Dougherty and Lister (2010) gave a thorough guide to carrying out hand washing effectively, stating that the least time to scrub soapy hands is about 15 seconds. It suggested that interest should be placed on areas that can be easily missed like the thumbs, tips of fingers, and between the fingers. Damani (2011) advises that single-use towels should be used to dry hands as well as in turning off taps where hands-free control is not obtainable.

It is the responsibility of everyone to take proper consideration to the control and prevention of infection; this includes patients, their visitors, and every healthcare worker (Randle, Coffey, and Bradbury, 2009). Understanding when to wash as suggested by the WHO`s handwashing five moments makes it a norm for nurses to know when to wash their hands. It also allows the nurse to be aware of the necessity to keep clean hands. National Patient Safety Alert from 2008 states that hazards to patients are significantly lessened if health workers disinfected or washed hands whenever they need to carry out patient contact.

Cummins and Bennett, (2012) state that a nurse`s main responsibility is to care (which is part of the 6Cs), this means keeping clear of possibly preventable HAIs that can have a substantial effect to the patient`s psychological and physical state. This could further exacerbate their illness, increase stress and worry, increase suffering and pain and consequently lead to an increase in the length of hospital stay. These cause a huge impact to the economy as HAIs cost the NHS an estimate of about 1 billion pounds. (NAO, 2009)

The understanding of appropriate hand hygiene will also show competence, another of the 6Cs, as nurses can control the spread of infection confidently by applying what they have learned. Handwashing also requires commitment; a nurse can wash their hands but needs the commitment to wash them to the appropriate standard. Communication is crucial in infection control as it is everyone`s responsibility. (Randle, Coffey, and Bradbury, 2009). In every aspect of infection control communication is at the heart of the process in order to take the right precautions. Researchers and health workers must communicate with each other in order to maintain an up-to-date level of knowledge on hand hygiene. It is also essential for staff to communicate with patients to teach them on how to improve their own hygiene and to ensure the safety of themselves and those around them. Communicating with patients’ relatives for them to carry out regular hygiene which is germane in infection control. Public awareness should be done to with an emphasis on its ability to reduce general illness if done adequately, thereby lessening the burden on the NHS.

The 6Cs would influence a nurse in hand hygiene as a nurse would think about caring for the patient, giving a commitment to safe care as well as being competent in this task. Electing the most effective hand washing technique must be done to successfully remove pathogens so as not to transmit it from one patient to another or one area to another. The techniques discussed vaguely circle around the same routine with differences in times, in clinical practice these would all influence the nurse whilst performing hand hygiene, but the standard practice would be used as it is the technique enforced by the NPSA adapted from the WHO.

The most recently updated hand hygiene method by the NPSA includes the use of alcohol gels, these should not be used as a constant alternative as they would lead to build-up and therefore not effective for removing harmful microbes and are not suitable in some cases as they would not remove dirt or organic materials, cause a risk of ignition when handling medical gas cylinders and would not be effective against Clostridium difficile and Norovirus. (Brekle and Macqueen, 2012) Therefore this would influence workers in clinical practice as alcohol gels should only be used in these circumstances.

This demonstrates that there will always be constant reviews of infection control, so it is important to keep up to date on the latest information on practice available and to comply with the NMC code of conduct. A nurse must take part in additional learning or training to develop competence in hand hygiene practice and to constantly review on their development in order to assess what they could do to improve (Department of Health, 2019).

Randle, Coffey, and Bradbury (2019) suggest that ongoing training will always be required in this area of practice. This personal and professional development relates to the NMC Code, developing and understanding the appropriate hand hygiene procedures for personal and professional practice is important to comprehend so that the nurse can continue to care of the patient as their first concern. Caring for a patient means to not worsening their health by transmitting infection which could be preventable as by washing hands.

It is immensely important for nurses to act within their competencies which includes being able to competently hand wash appropriately to control infection as it is vital in performing any act of physical care to patients. (Dougherty and Lister 2011). Another section of the NMC code specifies that a nurse should administer care based on the best available evidence or best practice. All nurses must strive and aspire to remain on top of the developing and constantly modifying information and research on infection control.

This also relates significantly to the NMC code which represents that all nurses must maintain and improve their knowledge and skills based on the most up-to-date information throughout their working lives. Providing high-quality infection control always applies to the NMC code because it means that the nurse is complying with always providing a high standard of practice and care. The NHS constitution also states the rights and commitments to patients, the public, and the staff. (Department of Health, 2013). The constitution is the integral law to which the NHS strives to stand by and infection control is constantly high on the agenda for the NHS to improve upon. The constitution expresses that the NHS aims to provide the highest standards of excellence and professionalism and provide a high caliber of care that is safe, effective, and focused on the patient. The terms safe and effective relationships to hand hygiene as nurses must follow hand hygiene procedures so that the care given is not hindered by the possibility of passing infection.

The constitution also gives the values of the NHS, which include the value to improve lives. The NHS commits to improving lives and not decreasing the health of the patient due to HAIs and so it is paramount that infection control procedures are followed to lessen the risk of infections occurring whilst receiving healthcare. More so it is the right of the patient to be treated with a professional standard of care which is to be administered by a qualified professional. Service users of the NHS also have the right to expect the quality of healthcare to be monitored and improved continuously, which includes safety, so the hand hygiene of workers should be continuously reviewed to make sure it is up to the standard that will ensure safety. The NHS Constitution commits to establishing a safe and hygienic setting that is fit for purpose which directly involves the matter of hand hygiene because of its importance in infection control which promotes a safe and clean environment. (Department of Health, 2013)

Conclusion

Transmitting infectious diseases can be reduced if staff, visitors, and patients wash their hands prior to and subsequently after any task, a routine hand hygiene technique cannot be stressed enough as it is paramount for all staff to adhere to so that the spread of infection can be kept at bay. It is now valued that hand washing is not only important when hands are visibly contaminated but is also vital that they are washed when it is not visible that they are contaminated due to the microscopic pathogens hidden on the skin. More so, hand hygiene techniques influence all nurses because of the strong link to many of the 6Cs and the vast importance to the health of all patients.

This knowledge is essential to be passed on to all those who flow through a healthcare setting so that education can be continued on infection control. With this given, it is key that communication skills are overly efficient at voicing and helping in infection control with caring for the patients at the heart the education. With continued education and observations in this area, more people would be able to show acceptable handwashing and therefore reduce the risk of infection.

Handwashing as an intervention is everyone’s responsibility, but for us as nurses, the NMC Code requires us to ‘promote professionalism and trust’ as one of our main standards, this includes nurses and professionals acting as a role models for other colleagues and patients, including children (NMC, 2021b). This demonstrates the importance of working as a collaborative team to provide the best care for children and their families.

A collaborative framework is known as different professionals working together to deliver the best care, it is argued to be one of the missing 6 C’s because of its importance (Wiltjer, 2017). The nursing 6 C’s are a key value in practice and lie at the core of everything, including handwashing, the 6 C’s are care, compassion, competence, communication, courage, and commitment (Nursing Notes, 2015).

In children’s nursing, a collaborative framework can improve the care provided by working on communication, and working relationships, saving a lot of time and reducing the effort used in repeating information (NHS, 2019). Handwashing as an intervention is a collaborative effort, because if all healthcare professionals do not keep up with the same standards, then bacteria can form and cause harm, even from just one individual.

There are many values involved in a handwashing intervention, all of which influence the containment of infection. Under the NMC standards of proficiency (2018), all nurses must prevent ill health and promote infection prevention and control throughout their practice. This means keeping our standards of hand hygiene high and not allowing it to slip, as this can cause harm to our patients. The NMC code is embedded into us from the start of working in healthcare, allowing it to become our core values to always be working off and holding ourselves accountable to. The NMC guides nurses and midwives, helping to produce a collaborative approach to effective practice, providing everyone with values which they can spread.

The NMC Code (2021c) requires us to prioritize people, people being our patients, and our patients being children. Children require a lot more attention regarding washing their hands and it is our responsibility to give that when they are in our care (Jess et al, 2019). Watson et al (2018), discuss the importance of child’s play and using different interventions and techniques to encourage children to wash their hands. They conducted a study with children who wash their hands with plain soap and children who wash their hands with a modified bar that has a toy inside. The results showed significant uptake in the modified bar, compared to the standard, confirming that with encouragement and fun, children do comply with the intervention. This needs to be a collaborative effort that can be mirrored in all healthcare and home settings.

The National Institute for Care Excellence (NICE) (2014b) published a document of guidance regarding infection prevention and control, which handwashing falls under. NICE guidance is for every professional in the health and social care sector, and handwashing is so important that it has its own guidance. NICE states that effective handwashing means significantly fewer HCAIs and breaks the chain of infection. They have guidance for every profession, and they state that healthcare workers are trained in effective techniques and perform the intervention at every contact.

It is important that we have sufficient knowledge of disease and infection when talking about handwashing intervention, such as the different forms of transmission, for example, the cholera outbreak was linked to drinking the contaminated water carrying the disease, this was discovered by John Snow in 1856 (Shore and Caldwell, 2019). We know that diseases can spread at different levels, outbreaks in a particular area, epidemics in communities, and pandemics worldwide (Anon, 2020). There are different professionals involved in infection control, but it is everyone’s responsibility to follow all advice and guidance given whilst specialists tackle the disease (Sotomayor-Castillo et al, 2021).

It is taught to everyone that washing your hands is the most simple and effective way of preventing illness and containing the spread of diseases (Al-Wutayd et al, 2021). As a collaborative team, we must ensure that we know the importance of washing our hands regularly with soap and water, sanitizing in between, and encouraging others around us, to protect our patients from HCAIs, because currently, all healthcare workers wash their hands around half as much as is advised, which is putting patients at risk (Centres for Disease Control and Prevention, 2020). It’s important for health and social care workers to keep up to date with relevant policies and guidance surrounding handwashing, as it is always being updated so that HCAIs are kept as low as possible (NMC, 2019).

One skill that is important when working collaboratively to ensure efficient hand hygiene is being able to collaborate with our patients, in this instance children and their families. Bridger and Allen (2019) discussed the importance of hygiene with immunocompromised children and the consequences of infections. They offer guidance for healthcare workers involved in the care of unwell children and how to manage the risks involved, this is a team effort and all bodies involved in the care must be complying and practice effectively and demonstrate to the child the importance of this skill.

Another important skill in working collaboratively to deliver the handwashing intervention is being aware and mindful of yourself and others around you. As part of the NMC Code (2021d), we are told to work within our own competence and limits, and everyone’s limits are different. Whilst we must respect people’s competency and abilities, we must not forget that if we are seeing bad practice, causing potential harm to patients, there is the opportunity to perform whistleblowing, raising concerns to those in charge which can be anonymous, to protect individuals from harm (NMC, 2021).

To summarise this discussion, we can confirm that handwashing is an essential skill in Children’s Nursing that protects from disease and further harm in the healthcare setting. It is evident that performing this skill cuts deaths and transmission of disease, saving lives and reducing HCAI’S. All professionals in health care settings are involved in this intervention, ensuring that they act as role models in the workplace, influencing others to act as efficiently. Bacteria is all around us, but it is our responsibility that in the workplace we minimize the spread and protect our Children.