Hand hygiene is practice that nurses are expected to comply to in a hospital setting. Compliance levels need to be established so that as establishment is made against the reasons that leading to lack of compliance. Research and day-to-day observations have revealed that infections related to bacteria can be freely transmitted when contaminated hands of a physician contact patients (Stanzak, 2006, p. 154).
There is therefore great interest to establish the reasons that leads to trained nurses’ neglect or under compliance to hand hygiene practices to reduce infections to patients through contaminated hands. A point of interest in this study is related suspicions that lack of compliance could be related to workload of nurses. In addition, patients need only to battle with health conditions that led them to visit health care centers.
Lack of decontamination among health care staff escalates the risk of infections. Neglect of hand hygiene or hand washing among nurse therefore calls for setting of a standard of observing hand hygiene among nurses.
Hand hygiene non-compliance in not only observed among nurses, but is shockingly present among senior medical staff. An urgent need is required to bring down healthcare-associated infections within hospitals, with substantial attention on nurses.
Importance of the problem
Hand hygiene among nurses and other healthcare providers in a hospital center is important to the mitigation of infections. Infections are transmitted through contact with contaminated hands. According to Stanzak, (2006, p. 155.), there is a negligence of an alarming degree among nurses failure to comply with hand washing requirements.
This problem is of dire importance to the reduction of healthcare related infections among patients. It is estimated that close to 10% of patients get infections related to health-care. Medical studies show that over 30% of these infections can be curbed. In spite of the fact that control can be achieved, difficulties still present challenges to having nurses comply with the hand hygiene policies (Rickard, N.A, 2004, p. 404-410).
Nurses as health care workers need to be helped to achieve compliance with hand hygiene. The beneficiary is the patient when compliance is adhered to. This follows reduced infections.
Project objective
The main objective of the project is enhancing compliance of health care workers (nurses in particular) to hand hygiene in a healthcare environment. The achievement of high compliance levels reduces patient infections associated with negligence of hand hygiene observation by nurses.
The compliance targets the 10% infections reduction by over 90% through introduction of an education program. Infections of communicable diseases has drawn attention of people globally, leading to media such as medical and nursing joint presses to reach the public on the subject (Currie, 2005, p. 200).
Solution and description
The solution will be given a comprehensive education program targeting largely the health workers in health centers. Besides, patients too need to be included in the education program. This approach is the best since it has the capability of speeding up the awareness of the importance of hand hygiene to the prevention infection related to health care.
In addition, the education program not only targets the nurses and patients but also administration of the health facilities. Education to the administration intends to draw attention of workload and its suspected relationship to lack of compliance to hand hygiene.
The joint commission on Accreditation of Health Care Organizations (2005) found that, “…education is key- education about the relationship of hand hygiene and infections.” (p. 22).
Solution to the problem
Description of the proposed solution
The problem will be solved by creation of awareness to the nursing population and as well as the patients. Through a comprehensive education program, three groups are targeted. In the first place, nurses must take center stage in the program. It is inevitable to create awareness to the nurses because they are the most likely group to transmit infection due to their contaminated hands.
The study proposes to assess the nurses at workplace for a period of two weeks. The assessment will be succeeded an education program designed to enhance hand hygiene practice among the nursing staff (Mallik, Hall, & Howard, 2009, pp. 112). Tests will be given to nurses and results used to measure the extent of compliance.
Low compliance results will call for proposing that nurses be given refresher seminars on hand hygiene after every three months in their careers. Patients will also be given up to date material information in order to act as polite reminders to forgetful nurses about hand hygiene.
Lastly, the administration will be given education sessions pertaining to their staffing and workload as a link to lack of compliance to hand hygiene. This solution expounds on the role of patients as agents of enhancing nurses to comply with policies of hand washing in hospitals. Lack of compliance puts patients within risk reach.
Consistence with current research
Hand washing practices are critical to the reduction in infections among patients. Nurses need to be guided to an awareness of the importance of hand hygiene through comprehensive education program.
Research has shown that up-to-date infection and prevention management of infections values hand washing among nurses in a healthcare setting (Friedman & Petersen, 2004, p. 8). From the information, hand hygiene awareness through comprehensive programs remains the favorite means of compliance to hand hygiene.
Feasibility of the solution
Comprehensive education program is justified as a feasible way to the solution. It is a highly proposed means of awareness creation for nurses and patients. In the light of education about infections in a healthcare setting, Joint Commission Resources seconds education as feasible (2007, p. 13-5). In addition, the solution is executed while in contact with the two key players in the program: nurses and patients.
This enhances cost reduction to materials used to educate the nurses and patients. Consequently, comprehensive education program stands out as the most appropriate approach to instilling a compliance culture among nurses’ hand hygiene practice.
Resources and culture consistency
The study poses no threat to resources and culture to any community setting. The intention is to create awareness of infections management and control through a comprehensive education program. Consequently, ethical or cultural bottlenecks are not a major concern. Besides, the setting in which the program is conducted is friendly to both nurses and their patients. In fact, cultures and hand hygiene go hand-in-hand.
Communities have been observed to perform hand washing as a purification requirement before performance of cultural beliefs at religious functions (Lautenbach, Woeltje, & Malani, 2010, p. 249). This boosts consistency by removing any suspicions of conducting such research in diverse communities. Resource availability will not course any strains during the entire program.
References
Currie, M. (2005). Fever hospitals and fever nurses: a British social history of fever nursing: a national service. New York: Routledge.
Friedman, C. & Petersen, K.H. (2004). Infection control in ambulatory. London: Jones & Bartlett.
Joint Commission on Accreditation of Health care Organizations. (2005). Infection control issues in the environment of care. Illinois: Joint commission publications.
Joint commission Resources. (2007). Staff education tools for the national patient safety goals. New York: Joint commission Publishers.
Lautenbach, E., Woeltje, K.F., & Malani, P. N. (2010). Practical healthcare Epidemiology. Chicago: The University of Chicago Press.
Mallik, M., Hall, C., & Howard, D. (2009). Nursing knowledge and practice: foundations of decision making. London: Elsevier Health Sciences.
Rickard, N. A. (2004, April). Hand hygiene: Promoting compliance among nurses and health workers. British Journal of Nursing, 13(7), pp.404-410. Web.
Stanzak. R.K. (2006). Bottom line Medicine: a layman’s guide to evidence-based medicine. New York: Algora Publishing.
Hand hygiene has been with us for ages. This notwithstanding, its application in the medical sector has remained quite low. For the idea to be fully embraced, it is imperative to create avenues through which health care practitioners can be educated and sensitized on the importance of hand hygiene practices.
This paper examines six articles on the subject of hand hygiene and the use of alcohol-based sanitizers as a way of controlling infections. Evidently, and as revealed in this study, effective hand hygiene practices help to prevent the transmission of infections from one patient to another. In addition, hand hygiene makes it possible for health care practitioners to safeguard the lives of patients.
Introduction
An important consideration for all health care practitioners is the need to ensure the safety of all patients under their care. To a large extent, patients undergoing surgical operations are often exposed to risks that can cause them to develop serious medical conditions that can be very costly to treat (“Hand Washing: What is the Solution?,” 2014). Usually, infections find their way into a patient’s body through open wounds or other weak body points. Apparently, most nurses and doctors are aware of the risks involved and make every effort to see to it that patients are protected.
The use of surgical scrubs is thus popular among doctors and other health care practitioners who are cognizant of their importance in preventing infections during surgical operations. Three options are available for ensuring hand hygiene including the use of soap and water, antiseptic solutions, or alcohol-based hand rubs or sanitizers (“Hand Washing: What is the Solution?,” 2014). Some of these are, however, less effective and may not prevent the transmission of microorganisms into a patient’s body.
Despite efforts to ensure that patients undergoing surgical operations are not affected by acts of negligence on the part of health care practitioners, there are some instances where due diligence is not exercised, subjecting patients to serious medical risks. In order to protect patients, physicians in some countries are required to take an oath compelling them to handle all patients with care, without causing any harm (Nazarko, 2013). As a consequence, the importance of hand hygiene should be reinforced among health care practitioners.
However, this did nothing to ensure the safety of patients and some patients even refused to visit hospitals to seek treatment because of fear of being infected. They would thus look for alternative ways of treatment which, to a large extent, may be costly and less effective. According to Chen et al. (2011), infections as a result of healthcare are prioritized among the challenges faced to ensure the safety of patients. This paper presents a discussion on hand hygiene practices and the use of alcohol-based sanitizers as a way of controlling infections.
History and Importance of Hand Hygiene
According to findings by Mathai, Allegranzi, Kilpatrick and Pittet (2010), effective strategies are critical for dealing with the challenges associated with healthcare infections. Seemingly, many people have lost their lives as a result of health care associated infections. Drawing from a study by Canham (2011), the practice of hand hygiene started in the early 19th century. In the year 1961, all health care practitioners in the United States were expected to thoroughly clean their hands using soap and water before and after coming into contact with a patient.
Hand hygiene practices in the United States were later standardized by the Centers for Disease Control (CDC) in 1975 and 1985. As noted by Mathai et al. (2010), it is only recently that the association between hand hygiene and prevention of health care related infections started making sense among health care practitioners. While some people have fully taken up the idea and are making every effort to practice, some have a long way to go and probably need to be trained and sensitized.
Generally, hand hygiene is regarded as the most critical component of any strategy meant to protect infections that arise during the operation period. Evidently, hand hygiene is simple and less costly when compared with other options that may be used for a similar purpose (Chen et al., 2011). There is, however, a laxity among healthcare providers to comply with recommended guidelines.
In the study carried out by Chen et al. (2011), it emerged that clinical staff rarely washed their hands during operations. It is thus essential to ensure that health care practitioners understand the importance of hygiene when taking care of patients. Despite being helpful for improving the safety of patients, hand hygiene also lessens the burden of caring for patients and reduces the overall associated cost.
The importance of hand hygiene springs from the fact that infections are normally passed from one patient to another through the hands of health care practitioners (Nazarko, 2013). Ostensibly, this is because human hands are prone to contamination by microorganisms which can easily be transmitted from one patient to another by health care practitioners. However, they usually do not pose a big threat unless an individual has a skin that is damaged or has a weak immune system.
Evidently, effective hand washing can help to drastically lower the rate of infection. For this reason, health care practitioners should understand the benefits associated with hand hygiene practices. Ideally, recommended guidelines for hand hygiene practices should be followed keenly by all health care practitioners as they attend to patients.
Hand Hygiene Practices and the Use of Alcohol-Based Sanitizers
Citing the challenges associated with hand hygiene, alcohol-based hand rubs or sanitizers were introduced. For sometime, however, some people felt that alcohol-based sanitizers could not be used in places where sinks were lacking. Subsequent guidelines by Centers for Disease Control cleared the confusion by advocating for the use of alcohol-based hand rubs to clean hands before and after any surgical procedure.
In general, the use of alcohol-based hand rubs or sanitizer was meant to reduce instances of infections during operations as a result of health care practitioners failing to clean their hands properly. Ordinarily, alcohol-based hand rubs play an important role in preventing micro-organisms from being passed from one patient to another through the health care practitioners’ hands. In the study by Chen et al. (2011), they made use of a quasi experimental study design that involved the close monitoring of health care associated infections in order to determine the effectiveness of hand hygiene using alcohol-based hand rubs.
Based on their study, strict adherence to hand hygiene was found to be less costly. Besides, adherence to hand hygiene seemed to help with the reduction of health care associated infections. Apparently, some concerns have been raised regarding the use of alcohol based solutions. Although findings from different studies point to the fact that alcohol based solutions are more effective in dealing with microorganisms unlike the use of soap and water, they tend to have a less powerful effect on some viruses such as rotavirus as well as on some bacteria such as clostridium difficile (“Hand Washing: What is the Solution?,” 2014). As a result, the use of alcohol based solutions when dealing with patients with such infections should be encouraged.
While comparing the effectiveness of different hand hygiene solutions, Canham (2011) argued that while the use of plain soap and water is good, antimicrobial soap presents a better solution. However, the use of alcohol based hand rubs offers the best solution. It is worthwhile noting that the use of alcohol based sanitizers is inappropriate where hands are soiled or contaminated. The effectiveness of alcohol based solutions also depends on the percentage of alcohol used. Bacteria are better destroyed by alcohol based solutions that contain between 60 and 95 percent alcohol.
According to Stephen-Haynes (2014), health care practitioners can use various approaches to prevent infection. Using antimicrobial therapy, for example, it is possible for nurses and doctors to eliminate the possibility of infections being transmitted from patient to patient. The patient may also be safeguarded through immunization and personal hygiene. It is also advisable for health care practitioners to use the correct clinical equipment and protective clothing for the sake of patients.
Arguably, a patient’s personal hygiene also plays an important role in preventing the spread of microorganisms (Stephen-Haynes, 2014). Consequently, efforts should be made to ensure that patients take a bath on a regular basis. Health care practitioners should also ensure that patients do not share personal hygiene items such as toothbrushes and towels. In some cases, nurses are required to use different clothes to clean different parts of a patient’s body. In addition, it is necessary for every patient to have his or her own bowl.
The effectiveness of hand hygiene depends on proper selection of hand hygiene products. Moreover, the procedure to be undertaken and the extent of contamination also affect the success of hand hygiene to some extent. Accordingly, health care practitioners must take time to carefully choose the best products to be used for sanitization. In general, the articles reviewed indicate that alcohol-based sanitizers are more effective. While this may be true, there are concerns that alcohol based sanitizers are limited in some ways and may fail to produce the desired results in some cases.
Conclusion
Following from the discussion presented in this paper, it is obvious that hand hygiene plays a very important role in ensuring the safety of patients. Throughout the world, many people have lost their lives as a result of health care related infections and it is thus imperative for health care practitioners to be familiar with different mechanisms for dealing with such challenges. As suggested by various authors, health care practitioners should consider having guidelines for effective hand hygiene.
Although it appears like a simple problem, many people may lose their lives due to negligence and lack of knowledge among health care practitioners. However, it is possible to control the damage caused by health care related infections and stakeholders should come together and devise effective intervention strategies. As earlier explained, guidelines should be provided to ensure that health care practitioners adhere to best practices. In most cases, having guidelines in place is usually meant to ensure that all those taking care of patients get to do what is expected of them.
Arguably, the idea of hand hygiene seems to be a foreign one to some health care practitioners. As a consequence, health care practitioners should be trained and sensitized on the need for effective hand hygiene. Efforts should be made to encourage health care practitioners to embrace the concept of hand hygiene in order to improve the safety of patients. In addition, guidelines should be provided to health care practitioners to guide them on ensuring the effectiveness of hand hygiene in the medical sector. In the absence of such guidelines, there is a likelihood that health care practitioners will use their own judgment which may lead to serious problems.
References
Canham, L. (2011). The First Step in Infection Control is Hand Hygiene. Dental Assistant, 80(1), 42 – 46.
Chen, Y., Sheng, W., Wang, J., Chang, S., Tien, K., Hsu, L., Tsai, K. & Lin, H. (2011). Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections. PLoS ONE, 6(11), 1 – 9.
Hand Washing: What is the Solution? (2014). Journal of Perioperative Practice, 3(2), 8 – 10.
Mathai, E., Allegranzi, B., Kilpatrick, C. & Pittet, D. (2010). Prevention and Control of Health Care-Associated Infections through Improved Hand Hygiene. Indian Journal of Medical Microbiology, 28(2), 100 – 106.
Nazarko, L. (2013). Putting Patient Safety at the Heart of Healthcare. British Journal of Healthcare Management, 19(9), 422 – 427.
Stephen-Haynes, J. (2014). How to Ensure Better Infection Control in the Patient’s Home. Journal of Community Nursing, 28(3), 76 – 80.
Unlike in the past, people are now increasingly becoming aware about ways that they could use to keep the disease-causing germs at bay. Airtight doors and windows, anti-bacterial soaps, strong antibiotics, and vaccinations have been developed to keep these germs at bay. Majority of the people, especially in developed countries are aiming at cleanlier lifestyles. But according to Bloomfield et al. (2006), while living a germ and dirt-free life can thwart some of the life-threatening infections and diseases, leading cleanlier way of life can be related to an observed increase in allergies among the little children. In a layman’s language, this is what is referred to as the hygiene hypotheses. Before we developed all these instruments of fighting germs and dirt, our bodies had a natural mechanism of fighting the germs. This was in the name of a strong immune system. This is no longer the case. Due to the tendency to live cleanlier lifestyles, our immune systems tend to develop more allergic tendencies rather that fight infections (Liu & Murphy, 2003).
According to Norton (2008) and Singer (2008), hygiene hypothesis comes about when non-exposure to allergens, germs, and parasites weakens the human immune system and increases individuals’ vulnerability to allergic infections. According to Gibbs et al (2004), the concept that non-exposure to infections in early life leads to the development of Atopic disease has come to be referred to as hygiene hypothesis. Braun-Fahrlander (2002) has attempted to relate the lower prevalence rates of childhood asthma in Bangladesh, in relation to developed countries, to the hypothesis. According to hygiene hypothesis, western lifestyles, characterized by lower rates of infections, higher level of hygiene, and smaller family size have contributed to the high prevalence of asthma in Western countries.
Brief History of Hygiene hypothesis
According to Bloomfield et al. (2006), an article published in the British Medical Journal in 1989 by David P. Strachan first proposed the concept of hygiene hypothesis. An observation was made that some allergic infections such as eczema and hay fever were less frequent in children from big families. During this time, it was presumed that children from larger families were more exposed to infectious agents due to the size of the family, than in children from smaller families. This line of thinking brought about the hygiene hypothesis (Carpenter, 1999).
From that time onwards, hygiene hypothesis has become a vital theoretical framework in the analysis of allergic disorders as it continues to be widely investigated by epidemiologists and immunologists. This concept has time and again been used by scientists to offer explanations about the high prevalence of allergic infections especially in developed countries since the industrialization era. According to Bloomfield et al. (2006), the concept has now been enlarged to include exposure to parasites and symbiotic bacteria as “crucial modulators of immune system development, along with infectious agents.”
Mechanisms of action
To better understand the concept of hygiene hypothesis, it is only imperative to understand how it works. A TH2 mediated immune response, often brought about by inappropriate immunological responses brings about allergic reactions and infections. According to Carpenter Hypothesis (1999) and Schena (2007), a TH1 mediated immune response is often elicited by many viruses and bacteria, thus down-regulating TH2 responses. Accordingly, the first proposed mechanism of action to hygiene hypothesis stated that overactive TH2 arm, which led to allergic infections, was brought about by inadequate stimulation of the TH1 function of the immune system. But this mechanistic explanation failed to explain the rise in occurrence of several TH1 mediated autoimmune infections namely, multiple sclerosis (MS), Inflammatory Bowel Disease (IBD), and type 1 diabetes.
According to Singer (2008), alternative mechanistic explanation argues that “the developing immune system must receive stimulus from parasites, symbiotic bacteria, or infectious agents to adequately develop regulatory T cells, or otherwise become more susceptible to autoimmune diseases and allergic infections because of the insufficiently repressed TH1 and TH2 responses.”
Hygiene hypothesis and the specific nature of the immune system
As discussed above, immunological research at the time hygiene hypothesis was first proposed supported the idea that a naïve immune system was more likely to overreact to more benevolent objects found in the environment. A naïve immune system is one that has not been adequately challenged by parasitic or infectious organisms (Gelfand, 2003,). This explains the belief held during that time that people who aimed at living cleanlier lifestyles were more likely to develop allergic diseases. But subsequent researches have shown that this could be further from the truth. It is now official that parasites and bugs are not necessarily the causative agents of allergic infections. Allergic infections occur due to “lack of certain organisms that have, over the course of evolution, trained our immune system to be more tolerant” (Gelfand, 2003). This therefore shows that hygiene hypothesis must be rethought.
In trying to understand the link between allergic and infectious diseases, researchers put their focus on only one component of the immune system, namely the T-helper (TH) cells. Apart from having a role in autoimmune disease, the TH1 cells also fights viral and bacterial infections. In their roles, the TH2 cells mediate allergic reactions and deals with parasitic infections. The argument previously advanced was that decreased exposure to micro-organisms due to increased observance of hygiene failed to prime the TH1 response, therefore leading to the overcompensating of TH2 activities. This led to allergies (Gelfand, 2003).
However, a reverse hypothesis was produced by scientists working in the area of autoimmunity. In this area, diseases are often mediated by TH1 lymphocytes. Their investigations revealed that non exposure to pathogens caused inadequate TH2 activity. More TH2 activity was needed for the TH1 activity to be down-regulated. Lack of this down-regulation caused type 1 diabetes, multiple sclerosis, and Crohns disease (Gelfand, 2003; Fendt et al. 2005). This shows that hygiene hypothesis is contrary to the specific nature of the immune system basically because autoimmune diseases such as inflammatory bowel disorders and type 1 diabetes are as prevalent today as the allergic disorders such as asthma. An experiment that was carried out by Gibbs et al. (2004) found out the evidence supporting the hypothesis is inconsistent to date. In the experiment, the found out that amplified exposure to infections cannot in any way explain the reduced risk of Atopic disease.
According to Norton (2008), immunities are bestowed upon us by our mothers in the form of antibodies. These antibodies are passed through the placenta and also by breastfeeding. Depending on what we are exposed to, our immune system matures and learns how to function. The immune system fights the diseases and infections through the production of antibodies. Though the invading organisms mutate over time, exposure to them means that the immune system will produce more anti bodies. Allergic reactions come into focus when our immune system get confused and start forming antibodies against non-harmful agents by nature. To this end, the hygiene hypothesis tried to explain that allergies develop due to the immune system developing fewer antibodies due to living in a sanitized environment. According to its basic propositions, living in a serine environment may weaken the immune system, thus causing unsuitable immune reflexes exhibited in assaulting harmless substances such as pet dander, pollen, latex, and certain food proteins (Holt, 2008).
But Carpenter (1999) and Bloomfield et al (2006) uses the investigations conducted by Dr. Marc Rothenberg and associates to deny hygiene hypothesis proposition. Their experiments, conducted on mice concluded that some white blood cells named eosinophils were the likely cause of gastrointestinal inflammation and numerous food allergies. These white blood cells identify some food proteins as harmful germs in individuals suffering from food allergies. When an allergen is exposed to the intestinal lining of an allergic individual, a compound called eotaxin is discharged. This causes the white blood cells – eosinophil and other immune cells to assault them and discharge powerful proteins, thus destroying immediate tissues and causing eosinophilic irritation. This argument serves to further show that hygiene hypothesis for allergies seem contrary to the specific nature of the immune system.
To criticize the theory further, it can be argued that the popular interpretation being proposed by hygiene hypothesis, that dirt is good for us has considerably influenced the attitudes and beliefs of many people to a point of making the public lose confidence regarding home hygiene. According to Bloomfield et al. (2006), clear guidelines must provided explaining how dirt is different from germs. This will go a long way in protecting people from contracting other dangerous diseases on the premise of strengthening their immune systems.
Hygiene hypothesis seem to address the specific nature of the immune system in as far as the above is concerned. It tries to compare the rise of allergic infections, more so, in the developed world with the change in lifestyles. We no longer expose ourselves to the germs that make our immune system to function better. To this extent, our immune systems react to foreign substances it deems harmful, therefore causing allergies. Such foreign substances include dust and dust mites, pollen, mold, insect stings, animal dander, and certain types of foods. But in as far as the hygiene hypothesis may try to address the specific nature of immune system; it fails to give a definitive evidence for the reasons behind the sudden increase in some specific forms of allergic reactions such as food allergies, according to Groce (2007) and Yano et al. (2005). The main premise of hygiene hypothesis is that our immune system’s opportunity to develop standard immune responses have been severely curtailed by the decreased exposure to germs and other infection-causing organisms as a direct result of modern western lifestyles. But this proposition fails to address the fact that the immune systems of people in the third world, where people are continuously exposed to disease-causing germs seems as susceptible to allergic infections as those of people from the developed countries. To this extent, the hygiene hypothesis is contrary to the specific nature of the immune system.
According to Groce (2007), the extent to which can address the specific nature of the immune system still remains a matter of debate. The presence or absence of certain types of helpful bacteria that usually resides in the small intestines forms one of the differences in areas affected by the hygiene hypothesis. The effects of early exposure to certain infectious infections as well as exposure to parasites also bring varying trends on how hygiene hypothesis affects various individuals. According to Braun-Fahrlander (2002), though hygiene hypothesis may in part explain to explain the lower prevalence of asthma in Bangladesh compared to western countries, it fails to address why asthma prevalence in Bangladesh is still substantial enough to constitute an important health concern. Disparities in allergic infections between individuals with varying lifestyles and who resides in different parts of the world continues to exist, therefore meaning that hygiene hypothesis alone cannot be enough to explain the occurrence of allergic infections. Other factors must come into play.
Umetsu (2004) reporting in Nature Medicine said that the evidence for hygiene hypothesis remains too sparse and circumstantial for majority of the scientists to be convinced. But scientists have been working on the “assertions” that when the immune systems lacks the know-how and practice to fight viruses and bacteria, infections can occur. However, no substantial evidence has been constructed, at least according to Umetsu. This therefore proves our thesis that the hygiene hypothesis for allergies seems contrary to the specific nature of the immune system.
Conclusion
According to Carpenter (1999), “the radical notion that infrequent exposure to infectious agents contributes to autoimmune diseases has generated far more controversy than the idea that allergies and asthma stem from such deprivation.” Infact, according to most scientists, the opposite is true. Majority hold the view that autoimmune diseases are driven more by infections. To punch holes on the hygiene hypothesis, other scientists are of the view that other environmental factors, including environmental toxins most likely prompt autoimmune reactions more than the hygiene hypothesis. Ultimately, though scientists aren’t yet ready to accept the hygiene hypothesis proposition, it may be that “allergies, asthma, and other immune disorders are the price society has to pay for escaping the appallingly virulent infectious infections that have struck down children over the centuries”, at least according to Carpenter (1999).
Braun-Fahrlander. (2002). “Does the hygiene hypothesis provide an explanation for the relatively low prevalence of asthma in Bangladesh?” International Journal of Epidemiology, vol. 31, pp 488-489. Web.
Carpenter, S. (1999). “Modern hygiene dirty tricks: The clean life may throw off a delicate balance in the immune system.” Science news, vol. 156, no. 7. Web.
Fendt, J., Hamm, D.N., Banla, M., Schulz-Kay, H., Wolf, H., Helling-Giese, G., Heuschkel, C.,& Soboslay, P. (2005). “Chemokines in Onchocerciasis patients.” Clinical and Experimental Immunology, vol. 142, no. 2, pp 318-326. Web.
Gelfard, E.N. (2003). “The hygiene hypothesis revisited: Pros and cons.” Medscape Today. Web.
Research based on a previously established theory can present new findings in a structure that is shared between different spheres of interest. The versatility of some models allows them to be used for a variety of topics, For instance, the Theory of Planned Behavior (TPB) introduced as a version of the Theory of Reasoned Action (TRA) is an approach that attempts to explain people’s behavioral patterns and underlying reasons for most decisions (Polit & Beck, 2017). TPB can be used in research of different disciplines such as business and politics. In nursing and healthcare studies, this theory can be implemented to analyze patients, communities, and nurses, as its approach to people’s behavior is virtually universal (Rich, Brandes, Mullan, & Hagger, 2015). The article “Using a Theory of Planned Behaviour Framework to Explore Hand Hygiene Beliefs at the ‘5 Critical Moments’ among Australian Hospital-Based Nurses” by White et al. (2015) is an example of using the TPB for nursing research.
Article Summary
In the study, the authors explore the topic of hand hygiene and its improvement among healthcare workers. According to White et al. (2015), it is an issue that is crucial to patients’ outcomes because proper sanitation can significantly lower the rate of infections in hospitals. The authors guide their research using the TPB framework and its beliefs connected to nurses’ attitudes such as support, control, and rationalizing (Ajzen, 2015). Qualitative data used in this article included discussions with nurses about hand hygiene and related habits in the workplace. The analysis of the gathered information revealed that hand-washing could be encouraged by nurses for a variety of reasons. They may include the protection of patients and oneself and attempt to control the spreading of an infection (White et al., 2015). Nurses may engage in hygiene practices less often due to the lack of time and poor skin condition after the procedure.
The study also focused on the normative beliefs of the theory. For example, nurses were asked about supportive and unsupportive comments from their colleagues about the procedures of hand hygiene. Nurses, patients, family members, and supervisors were outlined as the most supportive of such practices. However, some patients negatively interpreted the process of hand-washing which discouraged nurses from following hand hygiene guidelines. Some control beliefs were discussed in the article as well. The authors found that barriers to adhering to the directions included the lack of time and education, skin conditions, the absence of available supplies or sinks, emergency situations, and nurses’ forgetfulness (White et al., 2015). Thus, the use of the TPB allowed researchers to locate and examine the underlying reasons for nurses’ attitudes towards hand hygiene which helped them create a foundation for developing practical solutions to encourage proper sanitary practices.
The Use of the Chosen Theory
In the article, the theory plays an essential role as it is the primary basis of the researchers’ discussion points. Thus, it is used as a guide for the study and its participants. The analysis of nurses’ opinions according to the TPB’s main ideas resulted in a detailed description of all patterns that the participants exhibited while speaking and thinking about hand washing. As a result, the scholars were able to pinpoint which issues had to be addressed to support a favorable view of hygiene. The use of TPB is versatile because of its well thought-out structure. It remains relevant in many areas of research, including nursing.
References
Ajzen, I. (2015). The theory of planned behaviour is alive and well, and not ready to retire: A commentary on Sniehotta, Presseau, and Araújo-Soares. Health Psychology Review, 9(2), 131-137.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Rich, A., Brandes, K., Mullan, B., & Hagger, M. S. (2015). Theory of planned behavior and adherence in chronic illness: A meta-analysis. Journal of behavioral Medicine, 38(4), 673-688.
Strict adherence to hand hygiene policies and procedures is one of the best ways of preventing infections and decrease infection rates at a hospital. ABC Healthcare Center offers different healthcare services to the locals. The quality of service delivery is directly influenced by hand hygiene practices that the facility embraces. According to Bowie and Green (2016), hand hygiene within a hospital setting is a requirement that should not only be met by the medical staff but also the patients and visitors who come to the facility.
Developing a plan on how different stakeholders should meet this requirement is critical in enhancing the success of this facility. Standards that should be met and the responsibility of every stakeholder should be defined in very clear terms. In this action plan, the focus is to discuss ways of improving adherence with hand hygiene policies and procedures at ABC Healthcare Facility.
Discussion
The United States Department of Health and Human Services has set clear principles and procedures relating to hand hygiene that hospitals and individual healthcare providers must meet at all times to enhance the quality of service delivery.
According to Burns, Bradley, Weiner, Shortell, and Kaluzny (2012), while the government sets these standards, it is the responsibility of every management at all healthcare centers in the country to develop their internal policies and procedures that would help improve adherence with the set standards. The management must also develop clear plans that would help ensure that patients and their visitors follow these plans to eliminate infections. In this section, the researcher will look at how the management of ABC Healthcare Center can improve adherence to hygiene policies and procedures.
Promoting a Culture of Hand Hygiene
One of the best ways of improving adherence with hand hygiene policies and procedures at the hospital is to promote a culture of hand hygiene. In this context, the management would need to create a standard practice for nurses, doctors, clinical officers, and the support staff on the one hand, and patients and their visitors on the other hand. The medical staff often understands the code of conduct expected of them, including the level of hygiene they need to maintain.
The management would need to integrate these standards into the culture that the organization embraces. For instance, doctors and nurses should strictly ensure that they wash their hands when moving from one patient to another within the wards, especially when handling those with contagious diseases. The level of hygiene in surgical rooms should be impeccable (Burns et al., 2012). Standard practice requires that every staff member understand his or her obligation in such rooms to avoid any complications caused by contamination.
Maintaining a culture of hand hygiene among patients and visitors may be a little challenging. However, it will be the responsibility of nurses to ensure that patients and their visitors adhere to the standard practices set by the hospital. Patients should be reminded constantly that they have to wash their hands every time they come from the toilet. They should also know that they have to before eating anything they have to wash their hands, including utensils such as spoons and knives.
Goldsmith (2014) explains that they should understand the fact that these standard practices are set to benefit them and their close family members. People tend to follow policies and procedures when they know that they will benefit from them. Visitors who come to the hospital should also understand the hospital’s hand hygiene policies and practices. It may not be possible to address these visitors in the same manner as patients because of the limited time they spend in this facility. Instead, strategically placed posters can be placed within the wards and paths that they follow when going to visit their patients reminding them of the need to maintain hand hygiene. The nurse in charge of specific wards can also remind them to maintain hand hygiene when getting into the wards and when leaving.
Improve the Environment within the Hospital
Maintaining hand hygiene can only be possible when the workplace environment is supportive of the practice. According to Lambert (2016), some healthcare facilities are so poorly maintained that it may not be possible to embrace the hand hygiene policies. It is the responsibility of the management, through the repairs, maintenance department, to ensure that the hospital sink and relevant suppliers are in the right condition.
Any blockage should be unclogged as soon as it is detected to make the environment sustainable. Perley (2016) explains that sometimes it is appropriate to have both the warm and cold water system running as a way of facilitating the practice. Bathrooms and toilets within the facility should be clean at all times as an assurance to the patients that the facility has high standards of hygiene.
Measure the Current Practice
The management can set guidelines that should be followed by the staff to ensure that hand hygiene policies and procedures are observed. However, it is normal to find cases where some of the staff fail to observe the standards set because of laziness or any other reason. As such, the management has the responsibility of measuring the current practice to ensure that standards set are met. One of the ways of ensuring that standards are met is to conduct direct observation, as Perley (2016) observes. A nursing superintendent should conduct physical supervision of the facility to ensure that hygiene standards are met within the wards, washrooms, waiting bays, surgical rooms, and any other area that requires such levels of cleanliness to be maintained.
Electronic monitoring is another effective way of measuring current practice. Wards and other sensitive sections of the hospital should be under CCTV surveillance. Before a patient is admitted to the ward, they should be reminded of the policy of surveillance as a way of enhancing their safety and security within the facility. The strategy may compromise their privacy but it is the ultimate way of enhancing their wellbeing at the facility (Goldsmith, 2014). The supervisor can use the video footage of the wards to determine if patients and the medical staff are observing hand hygiene. If weaknesses are noted, the supervisor can engage the relevant individuals to ensure that such challenges are addressed.
Saint Leo University Core Value of Excellence
Saint Leo University core value of excellence says, “All of us, individually and collectively, work hard to ensure that our students develop the character, learn the skills, and assimilate the knowledge essential to become morally responsible leaders,” (Saint Leo University, 2019, para. 1). The statement of excellence stipulates specific issues that should be observed by an institution of healthcare to achieve set policies and procedures.
First, it emphasizes the need to promote individual and collective effort when undertaking a given activity. Every doctor, nurse, clinical officer, patient, and any visitor should know their responsibility within this institution. They should also understand that teamwork could not be ignored when trying to achieve specific goals. It means that nurses should coordinate with cleaners, patients, and visitors to ensure that the facility remains clean at all times as a way of promoting hand hygiene policies and procedures.
The statement also focuses on the need to work hard as a way of developing a character. All stakeholders, especially patients, must maintain hand hygiene practices to limit contamination. However, it may not be easy for them to embrace the character of washing their hands every time they come from the toilet and before eating anything. However, the statement reminds nurses that they should not give up on their patients (Sui & Rui, 2016).
They should be reminded of the benefits of embracing such a practice as a way of protecting them from contamination. When they see their colleagues washing their hands regularly, they will be motivated to do the same. They will develop a character that will not only help them when at the hospital but also when they are discharged. They will understand the dangers of eating anything before washing their hands. Such patients are less likely to be readmitted because of problems arising from taking contaminated food.
The statement addresses the issue of learning new skills and assimilation of knowledge as a way of improving service delivery. According to Goldsmith (2014), bar soap was popular in the past as a detergent used in washing hands.
However, the emergence of new knowledge and technology revealed that the use of shared bar soap in health facilities can be the genesis of further contamination. When one with a contaminated soap uses the bar, the next person can easily be affected. It forced many hospitals to order small bathing soaps to be used individually by patients. Large public hospitals are currently using liquid detergents in shared sinks and toilets as a way of managing the problem of infection.
The statement concludes with the need to have morally responsible leadership. Caring for patients is one of the most demanding professions in the world. Every action that a doctor, a nurse, or even a clinical officer does would define whether a patient would live or not. Sometimes one may be called upon to work for longer than normal hours, especially in sensitive departments such as surgical rooms. Perley (2016) observes that in the industrial sector, workers can postpone what needs to be done today so that they can address it at a future date. Such luxuries do not exist in the medical sector.
A patient in critical condition cannot wait another day without getting the needed medication. As such, doctors may be required to go beyond the legal and professional requirements when undertaking their duties. They have to consider ethical concerns. They should be compassionate and able to understand their unique needs. Some of the patients may not have the capacity to adhere to hand hygiene principles and practices because of their mental or physical incapacitation (Sui & Rui, 2016). A nurse may be required to go beyond the set standard of work to help such a patient. When such nurses are encouraged and appreciated by leaders within the facility, they get the motivation to offer help even when it is not legally binding them to undertake a given activity.
Conclusion
Improving adherence to hand hygiene policies and procedures at ABC Healthcare Center will be critical in improving the quality of service that it delivers to patients. The study shows that some patients suffer from contagious diseases that can easily spread from one patient to another or even to visitors and the medical staff. To avoid such a crisis, it is important to ensure that cleanliness is maintained at all times among all stakeholders who are within this facility.
Patients should be taken through some form of awareness creation to make them understand the dangers of failing to maintain hygiene in the workplace. When they realize that hygiene is for their benefit, they would feel obliged to wash their hands every time they leave the toilet and before taking any meal.
People who come to visit their patients also need to know why they must maintain hand hygiene. They also have to wash their hands before feeding their loved ones, when leaving the toilet, and whey they are leaving the wards on their way back home. It will help avoid cases where they carry the contamination back to their houses. Doctors, nurses, clinical officers, and the support staff understand the role they need to play in maintaining hand hygiene. They only need some form of motivation from the management to ensure that they follow the set guidelines and help their patients maintain high levels of cleanliness.
References
Bowie, M. J., & Green, M. A. (2016). Essentials of health information management: Principles and practices. Clinton Park, NY: Delmar Cengage Learning.
Burns, L. R., Bradley, E. H., Weiner, B. J., Shortell, S. M., & Kaluzny, A. D. (2012). Shortell and Kaluzny’s healthcare management (6th ed.). Clifton Park, N.Y: Delmar.
Goldsmith, S. B. (2014). Understanding health care management: A case study approach. Burlington, MA: Jones & Bartlett Learning.
Lambert, P. D. (Ed.). (2016). Managing arts programs in healthcare. New York, NY: Routledge.
Perley, R. (Ed.). (2016). Managing the long-term care facility: Practical approaches to providing quality care. San Francisco, CA: Jossey-Bass.
Saint Leo University. (2019). History, values, & catholic roots. Web.
Sui, P. L., & Rui, Z. (2016). Service quality for facilities management in hospitals. Singapore, Singapore: Springer Singapore.
The study under analysis uses inferential statistics. The statistical tool applied to analyze the intervention was a segmented log-linear regression analysis of interrupted time-series data. It implies the division of time series into pretest and posttest components. SPSS 15 version and R version 2.7.1 were used to perform the analysis (Helder, Brug, Looman, van Goudoever, & Kornelisse, 2010). The article does not provide the value of inferential statistics or the degrees of freedom. The statistical significance of p-Values for multiple testing on the completeness of hand rubbing was estimated at the point of less than.01. For the other tests, the statistical significance of p-Values was defined as less than.05. Multilevel analysis was not appropriate for this study since healthcare professionals involved in the experiment were observed more than once, and their characteristics were not included in the dataset.
Since ANOVA was used to analyze the differences in observation after log-transformation, it can be concluded that the tests applied in this study were parametric. This type of measure is suitable for research tasks. Moreover, they allow the measurement of variables relevant to the number of groups involved in the experiment and the sample size. The article does not state the hypothesis of this research. Thus, there is no opportunity to evaluate the representation of inferential statistics in connection with the hypothesis. Nevertheless, inferential statistics correspond with the aim of the study, which is “to assess the impact of an educational program on compliance with hand hygiene and its influence on the incidence of nosocomial bloodstream infections in VLBW infants” (Helder et al., 2010, p. 1246).
The results of inferential tests are discussed in detail. The discussion is logical and clearly set. It is divided into parts to address every research problem. Pretest and posttest results are compared, and the conclusion about the statistical significance is provided. Moreover, the presentation of results in tables and figures in addition to text contributes to a better understanding of inferential statistics. Thus, the figures provide a detailed presentation of the sample and time series used for the analysis. The tables depict the results of tests, for example, technique and compliance with hand hygiene or clinical characteristics of infants in the pretest and posttest periods (Helder et al., 2010).
Data Interpretation and Conclusion
Data interpretation is detailed and well-structured. Every aspect of research, such as compliance with and completeness of hand rubbing, hand hygiene during high-risk and low-risk procedures, nosocomial bloodstream infections, etc., provided an understanding of research findings. Data used in the analysis were obtained during two pretest and two posttest stages. After the pretest period, the educational program promoting hand hygiene was applied for healthcare professionals involved in the care of infants with very low birth weight. The analysis revealed a significant increase in hand hygiene compliance both before and after patient contact (p-value 0.001) (Helder et al., 2010).
Comparing hand hygiene during high-risk and low-risk interventions, it can be concluded that it was higher during high-risk procedures and increased after the educational program (an increase from 64.4% to 85.8% during low-risk procedures and from 73.6% to 89.4% during high-risk procedures). Drying time and usage of hand alcohol also demonstrated a significant increase in the posttest period. Nevertheless, they did not achieve the recommended level. Major clinical characteristics of the VLBW infants also changed as a result of the improvement of healthcare professional hand hygiene. Thus, the frequency of nosocomial bloodstream infection significantly decreased from 44.5% to 36.1% after implementing the suggested educational program resulting in a p-value of 0.03 (Helder et al., 2010, p. 1249). On the whole, the risk of infants developing a nosocomial bloodstream infection was reduced by 18.9%. Also, the general incidence of nosocomial infections was reduced. With a 95% confidence interval, the rate of infections was 17.3 before the educational program. After the program and evident improvements of health professional hand hygiene, the infection rate decreased to 13.5 (Helder et al., 2010, p, 1450).
The article does not have a conclusion as a separate section. There is a brief concluding paragraph as a part of a discussion section. However, this discussion summarizes and generalizes the research findings and compares them to the results of previous investigations on the problem, thus concluding the presentation of the research. Thus, the final section of the research presentation provides an overview of the whole study, its limitations, applicability to practice, and implications for further research.
Implications for Further Research
The study provides several implications for further research. First of all, the findings suggest an opportunity of using alternative techniques to collect the research data. Thus, hand alcohol dispensers with the functions of time, date, and frequency of application recording can be used to reduce the Hawthorn effect. Moreover, it empowers the collection of data for a longer period of time compared to the method used in this study. Another implication is the introduction of social cognitive models into research, which will allow a better understanding of the participants’ behavior and provide a possibility of influencing healthcare professionals.
References
Helder, O., Brug, J., Looman, C., van Goudoever, J., & Kornelisse, R. (2010). The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison. International Journal of Nursing Studies, 47(10), 1245-1252. Web.
Tools used to transfer essential and succinct information about nursing standards, instructions, and crucial regulations are critical for the well-being of the target demographic. Therefore, providing visual support for this purpose becomes increasingly important (Booth et al., 2017). As the example of Carter, Cohen, Murray, Saiman, & Larson (2016) shows, the incorporation of a simple 5-step workflow diagram for hand hygiene in the context of pediatric care creates additional opportunities for caregivers of infant children to acquire the necessary abilities. By focusing on simplicity and clarity of instructions, as well as the goal of educating patients, one can create a simple and understandable yet informative and educational guide for maintaining hygiene.
Figure 1. Workflow Diagram: FO Feeding.
Explanation of the Flowchart
As shown in Figure 1, the current workflow of maintaining the hand hygiene in the pediatric care setting requires the placement of a patient in a specific location and the preparation of the tray with the necessary items. Putting on gloves in order to administer the next steps, which include feeding a child in the specified guideline, is the next step that has to be accomplished while wearing gloves. Afterward, the tray has to be removed from the area, followed by the child being removed from the chair, and transferring it to the stroller. The specified steps have to be repeated for each child under a nurse’s care.
Each of the steps in the diagram can be described as value-added since they are succinct and provide an immediate instruction for a specific action. For instance, the first step instructs a nurse about the preparation for the feeding process, which helps to address possible hygiene-related issues. The next stage also adds an important value by stressing the need to refer to the sanitation standards for donning gloves and keeping them on while feeding. The third step of the instructions has the greatest value as it mentions the actual feeding process. The fourth and the fifth stages, in turn, add crucial value since they instruct a nurse about finishing the feeding process properly.
The Metric
The diagram in question uses a rather basic metrics of ml of food administered to children. While this information is not specified in the diagram, the amount of food provided to infants depends on their weight and health-specific requirements. Although general recommendations exist, a patient-specific approach is strongly recommended in the instance (Hanin, Nuthakki, Malkar, & Jadcherla, 2015).
Areas of Improvement
The current workflow describing the process of managing the feeding of infants is rather simple and easy to use, yet it needs improvements concerning the details of feeding. For instance, additional information concerning the strategies for keeping the gloves and the feeding tools clean will have to be provided (Jadcherla et al., 2017). In addition, the existing instructions lack the description of the instances of mismanaging the feeding process and the information about handling the specified concerns. Therefore, adding extra information about common difficulties that nurses may face during the process of infant feeding is highly required.
Conclusion
By creating a simple workflow chart with basic instructions about managing the process of feeding infants, one can address a range of health-related issues in the nursing care environment, which is critical for the further well-being of the target patients. Due to the incorporation of the guidelines that represent a workflow diagram, one can outline the essential instructions to patients. Simultaneously, the suggested approach encourages nurses to build a knowledge system that will allow them to improve their knowledge and understand the principles based on which the guidelines are built. As a result, the levels of patients’ well-being will rise systematically, and the quality of care will improve exponentially.
References
Booth, R. G., Sinclair, B., Strudwick, G., Brennan, L., Morgan, L., Collings, S.,… & Singh, C. (2017). Deconstructing clinical workflow: Identifying teaching-learning principles for barcode electronic medication administration with nursing students. Nurse Educator, 42(5), 267-271. Web.
Carter, E. J., Cohen, B., Murray, M. T., Saiman, L., & Larson, E. L. (2015). Using workflow diagrams to address hand hygiene in pediatric long-term care facilities. Journal of Pediatric Nursing, 30(4), 17-21. Web.
Hanin, M., Nuthakki, S., Malkar, M. B., & Jadcherla, S. R. (2015). Safety and efficacy of oral feeding in infants with BPD on nasal CPAP. Dysphagia, 30(2), 121-127. Web.
Jadcherla, S. R., Khot, T., Moore, R., Malkar, M., Gulati, I. K., & Slaughter, J. L. (2017). Feeding methods at discharge predict long-term feeding and neurodevelopmental outcomes in preterm infants referred for gastrostomy evaluation. The Journal of Pediatrics, 181, 125-130. Web.
Compare industrial hygiene and occupational hygiene
The terms refer to the same concept; nonetheless, their use may be dependent on a person’s geography. In Australia and UK, occupational hygiene is preferred while in Latin America and The US the term industrial hygiene is more common. However, a minor difference exists between occupational and industrial hygiene. Occupational hygiene covers a wide range of work places; conversely, industrial hygiene is limited to industrial settings.
Name the professional associations for occupational/ Industrial hygiene
The associations are: IOHA which stands for International Occupational Hygiene Association, AIHA-American Industrial Hygiene Association, ACGIH-American Conference of Governmental Industrial Hygienists, BOHS-British Occupational Hygiene Society and ultimately AIOH – Australian Institute of Occupational Hygienists.
Describe the qualifications required for an occupational hygienist in Australia
Occupational hygienists must be capable of handling challenges adequately in their profession. One must have worked for five years or more. The occupational hygienist needs to have the proper academic qualifications.
Outline the ethical obligations of the occupational hygiene profession
All occupational hygienists are obligated to practice in accordance with their fields of competence. No one should give information freely; only legal and health reasons can impose an exception. Professionals should follow the code of conduct. They need to offer help concerning probable risks in occupations. Workers may sometimes put themselves at risk; occupational hygienists need to warn them about taking precautions. Members of this profession are expected to act with integrity. They need to abide by scientific principles within the profession; these govern workers’ safety and well being.
You have prepared a report on a hazardous exposure that includes high monitoring results. Your client or manager asks you to retain the results but delete any other comments. Outline your response.
In response to the situation, I would first try talking to the manager in order to sensitise him about the importance of the recorded comments. I would let him know that very serious dangers could emanate from hazardous exposure of the workers. It would probably be a good idea to have proof that such a conversation existed between the client or manager and me. This would ensure legal protection. If the client insists on deletion, I would stop working for him. (Bluff, 2004)
Summarise the development of occupational hygiene since 1901
Occupational hygiene started in South Africa specifically because dust exposure was found to be a health concern. Consequently, the profession established a level of dust that would not put people at risk by analysing the air around those areas. In subsequent years, it was established that people’s exposure to dust could be monitored medically through the use of x-rays. In the next decade; up to and including the First World War, a lot of industries started emerging. Industrial hygiene became a major concern. It was at that time that Industrial Hygiene and Sanitation (Changed to Division of Industrial hygiene of the Nation in 1937) was created within the United States; this occurred in 1914. Later on, the Air Hygiene Foundation (Changed to Industrial hygiene foundation in 1941) was established in 1935 after the public voiced concerns about a tunnel project in West Virginia. In 1937, an association for industrial hygiene practices was created. In 1960, the American Board of Industrial Hygiene was formed to certify hygienists all around the country.
What lessons does the historical silica experience have for contemporary occupational hygiene?
The silica issue revealed that this profession still needs to work on evaluative techniques for prevention of such occurrences in the future. Nonetheless, some lessons have been learnt from it. The silica issue was a platform against which certain specialities could emerge in the profession. A number of new entities were formed in order to respond to these respective issues. It also led members of the profession to become aware of the importance of reproducibility of results. Measurement methods have improved dramatically in this profession owing to the experience. These can be carried forward in the detection of other substances. Manufacturers need to realise they can minimise risks that their staff are exposed to by utilising medical findings on prevalence of a certain substance. They need to ensure that these are synchronised with engineering controls that operate within the institution. Additionally, industrial operating procedures should be aligned with scientific findings so as to protect workers.
How does the occupational hygiene approach of anticipation, recognition, evaluation and control compare with the risk management approach of identify, assess and control?
The anticipation, recognition, evaluation and control approach differ from the-identify-assess-and-control approach because in the latter strategy, major focus is on prevention rather than mitigation. Here, risks are usually detected before they take place and suitable measures are put in place in order to tackle them. A lot of speciality is involved in such a process because some hazards maybe obvious while others maybe hidden, but just as risky. Conversely, the identify-assess-and-control plan dwells on the quantifiable risks that exist in a certain workplace. Once assessments have been made, then actions are taken in order to mitigate those risks. It should be noted that comparisons to prevailing industry standards are normally done in the first strategy compared to the second. In addition, the second approach dwells on physical information while the first approach depends upon experience and data or information. Lastly, the second method puts an organisation at a greater risk than the first approach because it will only focus on those extreme situations that maybe out of control already.
Unit 2
How are TWA exposure standards used in the working environment?
Time weight average exposure standards are a method of assessing the level of exposure of airborne contaminants. TWA exposure standards are used in the work environment through an assessment of exposure levels during a specified period of time. Usually, this occurs over a period of 5 days in the week and eight hours of exposure per day. TWAs are compared with exposure standards and if the former are found to be higher than the latter than the health of the respective worker is said to be at risk. However, exceptions can be made if workers do not remain inside the work premises (under exposure) all day long; precautions should be taken. (Mayhew & Peterson, 1999)
What is the difference between STEL value and peak/ ceiling values?
STEL encompasses only short term exposure levels. The term refers to the amount of airborne concentration that is permissible within a period of 15 minutes in a normal working day (normal refers to an eight hour working day). No one should exceed the STEL concentration for more than 15 minutes, 4 times in a day. The interval between exposure times ought to be 1 hour. STEL values are more appropriate when substances under consideration are likely to lead to adverse health effects if short term exposures occur. Conversely, peak values do not involve concentration averages. They are appropriate for substances (Like irritants) that can cause certain health effects even at the slightest exposure times. However, their concentration is what peak values are used to measure. Although both measures can be used as guidelines that determine how much of a particular substance one can be exposed to, one of the values –STEL- is time bound while the other –peak value- is defined by concentration levels.
What proportion of workers should “nearly all workers” cover?
“Nearly all workers” should encompass close to all the workers who do not show any intense health effects after continuous and increased exposure to threshold values of the substances in their workplace. Minor exceptions are permissible for workers who react to lower concentrations of the concerned substances by illustrating slight uneasiness. Exceptions also exist for those workers who are regarded as extremely sensitive to the exposure of the substances as they may get sick.
TWA exposure standards normally cover eight hour shifts. What should be done about variable length shifts?
Workers that are exposed to longer durations of work shifts may be at a greater risk, so the TWA exposure standards ought to be adjusted. Specific emphasis should be given to the half life of the substance. If substances have half lives of less than three hours then the TWA values should remain as they are. This is because workers are not exposed to the substances long enough for them to have an adverse effect on their health or safety. However, if half life lies between three to four hundred hours, then the substance can stay in the atmosphere long enough to cause damage to workers. The TWA exposure standards need to be reduced using the following formula:
Exposure standard reduction = (8/h)*(24-h)/(16)
H=duration of work shift
For substances with half lives that exceed four hundred hours, daily limits of exposure should be found through average values found from the forty hour week specification.
Workers whose shift is less than 8 hours should use the standard as it is.
What are the limitations of exposure standards?
Exposure standards are limited by the nature of a worker’s health and biology. Some workers are more sensitive than others and may be affected at concentrations that fall below the exposure standards or even at levels above them. The standards are based on certain time assumptions such as eight-hour working days. Unless calculations are done in order to adjust these standards, then workers may not be safe. The standards are valuable for products that have no carcinogenic effects. It is also problematic to apply these exposure standards to workplaces that contain a mixture of substances. The combination of all of substances increases the health risks involved because they create a synergistic effect. Exposure standards are based on substances that are inhaled into the body. If a substance can seep in through the skin, this exposes workers to greater concentrations of the substance in their bodies. The values are often absolute and make it difficult to compare them with other substances in double exposure.
How do exposure standards for eight hour shifts apply when a worker works for longer than eight hour shifts?
The formula for exposure standard reduction will be useful in such instances. The value obtained from that calculation should be subtracted from the stated exposure standards so as to protect workers from these excessive dangers. The reason is that most workers are exposed to such situations even without having knowledge about them. It may sometimes be necessary to look at whether the exposures standards cover long term and short-term effects. The latter situation does not warrant any changes but the former does. Intensity of the workload also has an effect on the exposure levels so it should be considered. Industries / workplaces should use expert advice in order to modify their exposure values.
How do you assess acceptable exposures for materials that do not have exposure standards?
Exposure standards come in handy because they allow industries to monitor exposure levels. If they do not exist, then this function should not be carried out. Managers and other administrators need to try and determine exposure levels through mechanisms available to them. One method is the chemical abstract service registry number. Another approach would be name association. The establishment can look for certain chemicals that have exposure standards and are synonymous to the ones being used. However, if all strategies fall short and the company fails to find clues, then exposure levels should be kept at a minimum. (Perkins, 1996)
Are exposure standards useful in the control of biological hazards?
Biological hazards are different from typical hazards because they are complex in nature. Sometimes they may spring from physical objects while in other instances they may actually come from people. Assessment of these probabilities is close to impossible. Biohazards are difficult to quantify because they tend to increase in the body through replication. In these cases, concentration levels are not useful in assessments since a worker’s health may be at risk even at the slightest exposure levels. Classification procedures for biohazards depend upon the type of risk imposed by that category; exposure standards have no place in this area and should be left out.
Unit 3
Why are occupational hygiene samples collected?
Workers can be put at risk when exposed to excessive contaminants. Sample collection allows firms to assess the level of hazards that their workers are exposed to in order to minimise it. Industries need to have evidence that they abided by occupational safety requirements. This is because the government requires them to comply and so do health insurance providers. The samples can also be quite applicable if a company faces compensation claims from a certain worker. These can be used as evidence that the firm is abiding by regulations. In other words, they are a form of record keeping. Quality system procedures can also be duly maintained through this procedure. Besides, companies with safety programs in place often require such data.
Which workers should be asked to participate in a sampling program?
The workers that can participate in a sampling program are those ones that represent the largest proportion of employees in the industry. Their exposure levels need to be sufficient enough to warrant consideration. Their jobs need to reflect the ones carried out by majority of employees in that place of work. Alternatively, it could be that their job takes place in a central area where most of the staff are also found. Companies should stick to the employees who possess the above mentioned traits (Erickson, 1996).
What is a homogenous exposure groups (exposure zone)
A homogenous exposure group is one that possesses similar exposure levels. This consists of workers who are stationed in the same working zone or area and are thus exposed to similar concentration levels. It can encompass those employees who have identical job types and hence similar risk levels. Industrialists should take caution when working with these groups. They need to be aware of other factors that may affect exposure groups as these dynamics may alter their level of homogeneity. For instance, if workers keep moving between work stations, then they may no longer belong to the same homogenous exposure group. Distant locations from highly concentrated substances are not safe because of movement of air.
Most occupational exposure data is log normally distributed. What does this mean in practice?
Log normally distributed data refer to those values that have a straight line when a graph of the log of cumulative values versus the log of the actual values is plotted. The graph is said to be normally distributed because when the absolute values are plotted, a normally distributed curve will emanate. The median of these values is greater than the mode, while the mean is the greatest of the three. In practice, occupational exposure data is utilised because it ensures that chemical and physical properties are assessed objectively. Absolute concentrations tend to vary from time to time so using log normally distributed data overcomes this challenge. Once the graph has been created, a straight line will emerge for the values. However, those values that fall away from this line can be easily detected and corrected. They can be used as warning signs that certain regions are not alright. Usually, this line indicates the permissible exposure limit for workers.
How many samples should be collected?
First, the total number of workers that carry out specific tasks should be established as this serves as a crucial starting point for the rest of the process. Thereafter, the square root of this number should be calculated. Samples collected should then respond to the latter value. For example, if the staff members working on a given task are 64, then number of samples to be collected from that work group should be eight.
Contrast personal and area samples
Personal samples differ from area samples because they focus on inhalation areas or breathing zones while area samples dwell on open areas. The exposure levels for area samples are normally collected through placement of a fixed device in a certain working station or a person may move with the instrument as he or she collects samples around a definite location. Exposure amounts for personal samples are collected by placement of a device on a worker’s collar; this is about 3cm from the nose and the mouth. Samples can then be used to estimate the inhalation levels of exposure to contaminants by the workers. Personal samples are more accurate than area samples when focusing on individual values. On the other hand, area samples are more appropriate if an organisation needs to establish the level of contamination at ambient levels. It is also more effective than personal samples when sources of the contaminants need to be traced during indoor investigation and for instatement of engineering controls. Area sampling can complement personal sampling. (Tillman, 2007)
Describe the uses and abuses of markers
Markers are used to minimise exposure to toxic mixtures that may be prevalent within a work area. In other words, they are used during regulations. They can also be applied in epidemiological analyses. Upon suspecting a toxic agent, markers can help in reducing analytical costs. The same benefits apply even to known agents. Abuses usually come in the form of using the marker for analyses of exposure levels to a myriad of mixtures. This usually results in qualitative inaccuracies. Markers can also be misused when dealing with complex mixtures that contain unknown agents. Eventually, this will lead to confusion as the marker may sometimes be assumed to be the active agent.
Describe the data required to be collected in a good occupational hygiene record?
One should collect data about worker exposure levels. Sometimes this can be done for statistical purposes, research purposes and epidemiological purposes. Data should also be collected on exposure related illnesses such that working conditions can be checked for safety. Recordings for the data collection and analysis methods need to be done. Here, calibrations and naming of the samples should be provided. In the analytical process, one should record information about evaluation and monitoring of exposure levels. Work schedules should also be provided. Additional employee data needs to be recorded as well; these include medical records. Pictures can also be used. It will be necessary for the respective hygienists to record any environmental audits that may have been done and these should be linked to individual staff records. Any other information that can affect exposure levels should be recorded in a comprehensive, detailed and well structured manner.
Unit 4
What do you understand by the term aerosol?
Aerosols are solids that cause adverse health effects when inhaled into the body via the respiratory system. The solids must be suspended in gases or liquids and should have stayed there for a long time. Their sizes should also be quite small. However, as a rule most aerosols have varied densities, chemical compositions, sizes and shapes. They may come from various industrial and mining processes. They can be found in smoke as a mixture of fumes, particulates, vapours and gases. Such smoke may be released during combustion of carbon based products. Aerosols can also come from smelting and welding processes; they can also be released from food industries in the form of bio aerosols and droplets. Dust, pesticide sprays, aerosol sprays and asbestos or fibrous particles are also other well known types of aerosols. (Quinlan & Bohle, 2000)
Describe the three main particle size fractions
Particles can be small, medium or large. The aerodynamic diameter of the middle sized particles is about 10-100μM. They are classified as dust that is inhalable in nature. subdivisions include coarse and thoracic particles. They can get into the respiratory system thus leading to mucous production, irritation and cancer too. Once these particles get into the body, they settle in the bronchi of the lungs or the bronchioles and other nasopharyngeal areas. Large particles have an aerodynamic diameter of 10-20μm; they do not pose substantial danger to workers because they cannot be inhaled. Lastly, particles can be small sized; they are quite hazardous because they settle in the lungs in specific tissues such as the alveoli. As a result, the particles can lead to cancerous cells, fibrosis of the lungs as well as alveolitis, which are all dangerous conditions that can be fatal. Sometimes the relative small sizes of the particles may cause them to come out of the body through exhalation, but others can still be retained.
There are several methods for sampling inspirable dusts. How do the methods differ?
Personal sampling is preferable for inspirable dusts. It can be done through 3 types of sampling devices, i.e., the single-hole sampler, 7-Hole sampler and the IOM sampler. The latter kind is the most superior because it meets inhalable deposition curves and all materials that have been collected are analysed through the use of an internal cassette. It functions by pump connection. Conversely, the single-hole sampler does not have much use as its performance is comparable to the total dust sampler. It is only appropriate for lead sampling. The 7Hole sampler lacks a cassette and does not allow weighing of samples through the filter. Wind easily affects it and the device also tends to undersample large particles.
What are the desirable features of an air sampling pump for occupational hygiene monitoring?
The pump needs to have a battery with prolonged life so as to accommodate full shift sampling. Furthermore, it should possess a timer and a setting for programming so as to increase handiness. The tool needs to be as light as possible in order to allow mobility during the sampling process; this is especially true for personal sampling. Lastly, when dust load increases, a sampling pump needs to regulate changes in filter back pressure or it should adjust flow.
What are some of the uses and limitations of instantaneous particulate monitors?
Instantaneous particulate monitors are greatly useful in the process of reading exposed hazardous substances directly. No time needs to be wasted in sending the sample for laboratory analysis. Control measures in commissioning, prior to and after monitoring and test controls can be tested through the machines. The monitors are very effective in identification of high exposure materials thus minimising possible health hazards. One of the limitations of this machine is that it requires calibration of its devices. Consequently, use of the monitors can become a very cumbersome and inconvenient experience. It is quite expensive to buy and maintain. Additionally, every category of dust needs to have its own calibration. As a result, one cannot use it for legally based compliance testing. The monitors lack a mechanism for differentiating fibres and dusts that may be prevalent at work.
How is dust sampling equipment calibrated?
Calibration devices can either measure volume or flow. Flowmeters include critical orifices, rotameters, and velocity meters which are designed to measure the velocity of air. Volume measurement calibrators include wet test meters, bubble burettes, dry and wet gas test meters. In the calibration process, enough values ought to be represented in order to accommodate any scale variations. Furthermore, there should be ample room to include all the flow rates that will need to be measured. In the calibration process, one should start by selecting standards, which maybe primary or secondary, and then proceed with the calibration. Primary standards are selected because of minimal instances of error. Secondary standards are selected for backup purposes.
What are some of the factors that can cause errors in particulate monitoring?
Sampling equipment can be a serious source of error especially if the hose or the pump is faulty. Specific issues that can arise include battery failure, disconnection of the hose or incorrect connection, a mechanically damaged hose, hose kinks that lead to pump stoppage or minimal air pumping within the system and an underpowered pump. If flawed sampling strategies have been selected, then one is also likely to record an error in performance. Examples here include: choosing the right flow rates or the right size fractions. Filters can also lead to poor particulate monitoring. In such cases, the wrong type of filter may have been selected. The filter may also have one or more tears or sheds. Personal challenges such as employee or employer interference through lost pumps, addition of dust to the sample head, switching of the pump and altered work schedules can lead to monitoring errors. (Gardiner & Harrington, 2005)
Describe some of the problems of sampling and analysis of fibres
Fibre analysis is based on fibre numbers rather than masses of the fibres themselves. Because of this, it may be complicated to carry out the procedure. First the sample must be single layered, and in order to ascertain that this is so, its morphology must be scrutinised using moderate type of magnification. Any samples that have clumps cannot be used. A lot of attention also needs to be given to the size of the fibres for asbestos. Diameter and length of the fibre determines how respirable it is. As such, only fibres with a width of 3μm or less; length 5μm or more and length and width ratio of one to three can be analysed. Fibres are also challenging to analyse because they require only samples from graticule locations. Any other sources will be regarded as useless in the analysis. Lastly, handling of the fibres may also be another big challenge in the analysis. If transportation is done poorly such that some vibrations are created, then this could mess it all up. Mishandling of the sample also dislodges the fibre from the filter.
Unit 5
What is a gas, what is vapour?
A vapour is a type of gas that exists as a liquid when pressure and temperature of its surrounding is at room temperature. Vapours may include: organic vapours, which come from solvents, and water vapour. In industrial hygiene, focus is given to organic vapours mostly; they also come from volatile liquids. Examples of such substances include toluene and benzene. In a few of the cases, vapours may also emanate from inorganic substances like mercury.
Gases are substances which are fluids at room pressure and temperature, and will expand to fill up the volume they are occupying. One cannot condense gases at room temperature. Common examples include carbon monoxide, oxygen and nitrogen. Industrial hygiene often focuses on inorganic compounds and elements. Examples are hydrogen cyanide, chlorine and ammonia. (Confer & Confer, 1999)
How are gases and vapour samples collected?
Gases and vapour samples can be collected through passive or active sampling depending on whether area or personal sampling has been chosen. Passive sampling entails a gas detector that uses a passive bubbler in liquid sorbent or an electrochemical cell. The mechanism behind its operation is diffusion of the gases or vapours. In certain instances, one can get a direct reading while in others, it may be necessary to take the sample to the lab for analysis. If whole air methods are in use, gas bags, aerosol cans, glass tubes and passivated canisters may be of use. Some can offer direct readings while others require lab analysis. In personal active sampling, one needs to use a vacuum or a pump to bring the sample into a medium. Sometimes the detecting device may be the one that contains the pump and a battery. On the other hand, the pump can be connected manually. However, if other methods are not available for personal sampling, then the bag method can be used.
What are the constraints in passive sampling that are not relevant to active sampling?
No back up section exists for samplers in passive sampling, yet this exists in active sampling; users may refrain from using it. Passive sampling requires minimum air movement and this means that it is so restrictive. The method necessitates heavy recurring costs.
Discuss the criteria that should be used in the selection of a direct reading instrument
Direct reading instruments need to give instant results when in use. No radio frequency interference should affect the instrument. It should be able to yield results in a short period of time. When contaminants can lead to acute effects, then the instrument should be able to read high short term exposures. The instrument should be capable of estimating long term exposure using correct sampling procedures. Alarm functions should also be prevalent.
Describe a method of gas or vapour calibration
In calibration, one has the option of using a primary standard (like a bubble tube or a soap film flowmeter) versus a secondary standard (such as an electronic flow rate meter or a rotameter). Direct reading of gas detectors can be done at standard atmospheres for aerosols, gases and vapours. However, most persons use a small cylinder of the sampled vapour or gas at a specific concentration as the method of calibration. Alternatively, a polymer bag may also be applicable. One should carry out a field check (or a bump test) prior to and after completion of monitoring. Full calibrations need to be taken to the lab.
What are some of the problems of using detector tubes?
If different contaminants are being assessed, then different detector tubes will need to be used, each detector will vary in terms of the time needed for colour development, strokes to be used, effects of atmospheric pressure, humidity requirements and temperature requirements. A lot of time will be wasted in trying to set up the valves in every tube so that they can all measure volume accurately. If contaminants are prevalent in low levels in the atmosphere, the detector tubes may not be the best since they are not sensitive enough. Some factors can mess up the possibility of getting accurate readings; for instance: the sampling rate, the actual air volume, the granular packing, airflow patterns and other interferences. Types of manufacturing, the age of the tube and storage will determine accuracy and reproducibility. (Australian Council of trade Unions, 2003)
Describe the methods for the identification of asbestos in buildings
In order to identify asbestos in a building, competent people should engage in this endeavour. They must consider almost every aspect of a building if suspicions of asbestos are prevalent. The product may be found in several types of locations within the building. Nonetheless, it is likely that most of the products will be found in materials that are friable or materials that have been proven to contain asbestos. Additionally, those materials that are susceptible to damage should also be considered. Examples of such building materials include: insulation pipes in furnaces or insulation for fire retardant products, cement products with asbestos, roofs, and acoustics especially in false ceilings.
How are asbestos hazards controlled in buildings?
Once identification of asbestos has been done then the best remedy should be to remove it from the building; this may prove to be quite costly. One could instate measures that would cut the amount of contact between the materials and workers, or materials and the environment. Companies can achieve this aim by placing a barrier on top of the material. One may find appropriate coatings that can cover it up. Employers can seal the asbestos based products as well. It is possible to find asbestos residues in the workplace. To avoid harmful effects, residues should be eradicated. Frequent inspections will assist greatly in the minimising exposure.
Unit 6
What is biological monitoring?
Biological monitoring is the process of assessing exposure to hazardous products through analysis of the body fluids and measurement of reversible biological changes. The procedure is done in order to quantify the level of exposure within a subject. Only occupational hygienists can carry this out; although they may get help from health-care experts. Sometimes, air sampling may not yield representative or accurate results. Consequently, businesses can use biological monitoring to get dependable results. Air sampling can fail because it focuses on inhalation, yet contaminants may get into the body through the skin or the mouth.
What media are used to make biological monitoring measurements? Which are the most common?
Body fluids are the main media that provide exposure information in biological monitoring. Some of them include urine, breadth, hair and blood. However, urine and blood are the most commonly used; with urine as the first then blood. Some subjects may consider blood samples as invasive because they must be drawn out of the body. In such circumstances, urine samples are preferred. (Tranter, 2004)
What are the advantages and disadvantages of biological monitoring?
The main advantages of biological monitoring include: ability to determine contaminant exposure using different pathways, ability to reconstruct past exposure, ability to detect exposures that may not be work related, ability to give extra information about individual risks and the ability to test control measure effectiveness.
Major disadvantages include the invasive nature of the method. If blood samples are being collected, then the method may be objectionable to some people because it is invasive. Personal factors like health status and diet can interfere with the results. Before anyone can participate in the procedure, he or she needs to give informed consent to the person carrying it out. When results have been found, result confidentiality needs to be maintained by the industrial hygienist, yet those same employers need to protect their workers from overexposure. Exposure standards for this method are not easily available.
How can wipe tests be used to produce improvements in workplace conditions?
Wipe tests complement other measures of exposure levels in the workplace because they focus on the dermatological aspect of the issue. It should be noted that workers can be exposed to hazardous products through ingestion, skin absorption and inhalation. Most methods facilitate monitoring through inhalation but wipe tests allow exposure detection through dermal exposure. Besides, it has been shown that wipe tests are directly related to the amount of surface contaminant concentration, air concentration and dermal potential of absorption. Wipe tests therefore assist in the workplace because they contribute towards finding the total level of exposure that a substance has caused in the concerned industry or company. By measuring skin exposure, employers may be able to reduce prevalence of the substance at work. Nonetheless, the method can be highly variable.
Describe some of the sources of variability in biological monitoring
Variability in biological monitoring can be caused by worker’s personal habits such as their hobbies or the kind of drugs they take. Employees with preference for fishing may be exposed to lead, which is used to make sinkers. Secondly, diets can also lead to variability. Workers who take plenty of alcohol tend to report greater toxication. It may be the food that workers consume; those who take a lot of fish may expose themselves to arsen and this may change results. Chemicals found outside the workplace can also lead to variability. Fourth, it could be personal medication; as the person excretes, remains from that medicine can be found in the urine and this changes results. Fifth, the personal characteristics affect results since one’s hygiene practices, gender, body metabolism, age and body build are unique. Sixth, work related factors may be another source. Those who have a higher work rate will usually breathe at a faster rate and alter results. Workers may be exposed to different contaminants. (Benson & Benson, 1996)
How do biological monitoring results compare with air sampling results?
Biological monitoring tends to be more accurate than air sampling since it identifies exposure from all possible routes of entry. Air sampling on the other hand is restricted to the kind of exposure that only gets in through inhalation; hence such a method focuses on what could get into the body rather than what is already in the body. On the other hand, since biological monitoring measures exposure in the body, it may be possible to measure exposure that occurred outside the workplace. In other words, it is not limited to exposure at the job only. Biological monitoring reveals significantly high amounts of substances than air sampling so it should be considered for this purpose.
Describe the main dermal exposure assessment techniques
The chemical removal technique removes the product from the through the use of solvents like water-alcohol or water-surfactant mixers. Generally, washing applies to hands only. For the rest of the skin, one may want to consider wiping. Significant amount of hazards can be lost during the washing process, so only what is removed from the skin is measured and not the actual exposure level. One’s wiping or washing efficiency can alter the results. In the surrogate skin technique, a chemical collection medium is placed on the skin using a garment sampler or a patch. It is assumed that the collector will contain the same composition of chemicals as the worker’s skin then the collector is taken for analysis although overestimation of chemical exposure can occur. Sampling media have different absorption properties, so results differ. In the fluorescent tracer technique, video imaging is used in order to detect the presence of fluorescent materials on the skin. The method is non invasive, but one needs to use chemical tracers. Quality assurance is needed and protective clothing can interfere with the work.
What is the role of the occupational hygienist in biological monitoring?
In biological monitoring, the occupational hygienist is only interested in analysis of exposure levels i.e. assessment of reversible processes in the workers. Non reversible changes should be directed to a medical practitioner for analysis. In the biological monitoring process, one should be aware of sample collection procedures. One should also know about all the chemicals that can be identified through biological monitoring and the ones that cannot. The industrial hygienist needs to know how to carry out certain procedures that are done in biological monitoring; one example is venipuncture.
References
Benson, E. & Benson, S. (1996). Health and hygiene. London: ARISE foundation.
Bluff, E. (2004). OHS regulation for a changing world of work. Melbourne: Federation press.
Confer, R. & Confer, T. (1999). Occupational health and safety: terms, definitions and abbreviations. Sydney: Lewis publishers.
Erickson, P. (1996). Practical guide to occupational health and safety. Melbourne: Elsevier.
Gardiner, K. & Harrington, J. (2005). Occupational hygiene. NY: Wiley-Blackwell.
Mayhew, C. & Peterson, C. (1999). Occupational health and safety in Australia: industry, public sector and small business. NSW: Allen and Unwin.
Mayhew. C. & Peterson, C. (2005). Occupational health and safety: international influences and the new epidemics. Sydney: Baywood publishers.
Perkins, J. (1996). Modern industrial hygiene: Recognition and evaluation of chemical agents. NY: Van Nostrand Reinhold.
Quinlan, M. & Bohle, P. (2000). Managing occupational health and safety: a multidisciplinary approach. Melbourne: Palgrave McMillan.
Tillman, C. (2007). Principles of occupational health and hygiene. St. Leonards, NSW: Allen and Unwin.
Tranter, M. (2004). Occupational hygiene and risk management. NSW: Allen and Unwin.
Australian Council of trade Unions. (2003). ACTU occupational health and safety priorities. ACTU report, 32437269.
The field of occupational hygiene grew out of the need to protect workers from physical, chemical, biological and ergonomic hazards at the workplace. The International Labor Organization (ILO) estimates that 440,000 workers worldwide die each year from exposure to hazardous substances (Zaracostas 2005, p.656). The major goals of occupational hygiene encompass anticipation, detection, assessment, and control of a hazard (Vincent 2005, p. 649). At the workplace, the most common hazards originate from the use and handling of chemicals and chemical products (Steve & Rampal 1999, p.79). This paper gives an overview of the occupational aspects of chemical hazards and exposure. The first part discusses the nature of chemical hazards at the workplace. Next, the regulatory measures adopted in Australia are examined. The details of the limits of these regulations are explored followed by practical aspects of sampling, quality control, control measures and the interpretation of sampling results. A specific case on respirable crystalline silica is also presented.
Chemical hazards
Chemicals represent the most significant hazard to health in a workplace setting. The major forms of chemical forms at the workplace are dust (e.g. silica, coal, lead and asbestos), mist (e.g. acid mists, chrome plating etc), gases (e.g. Chlorine, Sulphur dioxide, Ozone), fumes (smoke metal fumes) and vapours (e.g. chlorinated solvents, amines, alcohols etc). Entry into the body may occur by inhalation, absorption through the skin or rarely, by ingestion/swallowing. The effects of chemical exposure range from acute to chronic. These effects may be exhibited by corrosion of tissue such as skin or lung, irritation of the skin or lung tissue, asphyxiation among others. Long term effects may include cancers due to gene mutations, liver failure, brain damage, reduced birth weight, miscarriage, Asthma etc (Creely et a. 2005, p. 106).
Applicable control legislation
In Australia, the regulatory frameworks for occupational hygiene regarding chemical hazards and exposure are contained in several legislations. The primary regulation is the National Model Regulations for the Control of Workplace Hazardous Substances [NOHSC: 1005 (1994) (EBSCO chemical Controls Watch 2010). This regulation is aimed at protecting workers from potentially harmful chemicals to health. It requires that employers provide employees engaged in a chemical-handling activity with Material Safety Data Sheet (MSDS). The MSDS should provide details of the nature of the chemical(s) in use that have been categorized into three groups: Type I, Type II and Type III. Type I chemical category is made up of chemicals likely to cause adverse health effects ranging from carcinogens, mutagens, teratogens to various corrosives. Employers are also obligated to ensure correct labelling, registration and risk assessment of hazardous substances.
According to an EBSCO Chemical Controls Watch report (2010), a chemical inclusion in this group is based on exposure standards listed in the Adopted National Exposure Standards for Atmospheric Contaminants in the Occupational Environment [NOHSC:1003 (1995). Additionally, its listing warrants workplace exposure limits exceeding the “exposure limits” specified in another regulation by the NOHSC- Approved Criteria for Classifying Hazardous Substance [NOHSC:1008(2004). In addition to these broad regulations, there are also other control standards specially developed for some specific chemicals. These are the National Standard for Control of Inorganic Lead at work, the National Code of Practice for the Safe Use of Vinyl Chloride and the National Standard for Synthetic Mineral Fibers. The national regulations for hazardous substances developed by the National Occupational Health Commission (NOHSC), now SafeWork Australia, only lays the necessary frameworks for the regulations of such substances. Territorial regions can set up their regulations in line with these frameworks. For example, Victoria regulates hazardous chemicals under its own enacted Occupational Health and Safety Regulations, 2007 (Victorian Trades Hall Council’s (VTHC) 2011).
Exposure standards for chemicals
The Australian Adopted National Exposure Standards for Atmospheric Contaminants in the Occupational Environment (Hereafter NOHSC:1003(1995) defines exposure standard as “an airborne concentration of a particular substance in the worker’s breathing zone, exposure to which, according to the current knowledge, should not cause adverse health effects nor course undue discomfort to nearly all workers” (p.70). These limits, based on dose-response studies are believed to be safe to workers even with repeated exposures (Sauleau et al. 2002, p.101). The limits of exposures applicable in Australian regulations are: “time-weighted average (TWA), peak limitation and short-term exposure (STEL)” (NOHSC:1003-1995, p.70). TWA is interpreted as “the average airborne concentration of a particular substance when calculated over a normal eight-hour working day, for a five-day working week” while STEL is defined as “a 15 minutes TWA exposure which should not be exceeded at any time during a working day even if the eight-hour TWA average is within the TWA exposure standard” (p.70). Peak limitation is explained as the “maximum, or peak concentration of a particular substance determined over the shortest analytically practicable period which does not exceed 15 minutes”(p. 70). These limits are expressed in numerical values, namely: parts per million(ppm), milligrams per meter cubed (mg/m3) and fibres per millilitre (for fibre measurement by membrane filter method) (NOHSC:1003(1995), p.71). NOHSC:1003 (1995) lists TWA, STEL and peak limits for hundreds of workplace chemicals together with these exposure levels.
Assembling a complete list of exposure limits for chemicals is an involving process that involves a series of steps that involve hazard identification, risk assessment and risk evaluation (Oldershaw and Fairhurst 2001, p. 291). Significantly, acceptability and compliance mostly rely on a consensus reached on such limits by various stakeholders such as employers, trade unions health professionals and the government. In recent times there has been a cost-benefit approach to such processes whereby the benefits of standards are compared to the cost of implementation (Sandra and Rampal 1999, p. 118).
Sampling methodology and limitations
Sampling is an important step in the assessment of chemical exposure at the workplace. It mainly involves collecting samples of gases, vapour, dust, mists and fumes on the body of workers (mainly in the breathing zone) and the workplace air to determine the amount of contaminating agents. Samples gathered may provide immediate inference or may require further laboratory analysis depending on the sampling device used. The method employed may involve grab sampling or continuous sampling (Boss and Day 2001, p.118). In grab sampling samples are gathered over short durations throughout an equally short period that may range from a few seconds to a minute (Brown and Monteith 1995, p. 371). This means this method is not suitable for contaminants with fluctuating concentration or in the determination of a time-weighted limit. On the other hand, continuous sampling may involve collecting samples over a much longer period and interval using either a single sample or multiple samples (Boss and Day 2001, p.118).
The type of sample required will determine the choice of method to be applied. In sample gases and vapours, direct-reading instruments have gained widespread applicability. These instruments include Detector tubes, Whole air sampler, Bubblers (liquid sorbents) and solid sorbent samplers
Both direct-reading methods and integrated methods may be applied in sampling procedures. In an integrated method, chemical samples of the workplace air are collected and later analysed in the laboratory. Direct-reading methods involve the use of Direct Reading Devices (DRDs) and are primarily used to monitor airborne pollutants in form of gases, vapours, and aerosols (BOHS 2001). Commercial DRDs operate on chemical and physical principles such as mass spectrophotometry, para-magnetism, chemiluminescence, catalysis, semi-conductivity, flame ionization, infrared, electrochemistry, etc. Modern direct-reading devices have further been enhanced by the integration of sounds alarms and the ability to record data for peak, STEL and TWA. Their major limitation is that they are prone to interferences (chemical or physical) resulting in inaccuracies in measurements (BOHS 2001).
Sampling may also be active or passive. Inactive sampling, the air is drawn through a sampling medium such as a sorbent by use of a pump or vacuum. On the other hand, passive sampling is based on the diffusion of air particles from high to low region of concentration and do not require the usage of pumps. Both passive and active samplings possess several limitations. Active air sampling requires the use of expensive devices that require complex calibrations for the airflow rate (Bohlin, Jones and Strandberg 2007,). Air-sampling pumps are also heavy, bulky prone to break down and require frequent calibration for accuracy (Harper 2004, p. 407). The limitations for passive sampling include higher recurring costs, post interference due to residues and the fact that most passive samplers lack a backup section (Harper 2004, p. 411). Another drawback is that most passive samplers have a fixed uptake rate and thus are limited in measuring extremes of concentrations (Harper 2004, p. 407). They have also suffered poor acceptance in the market partly influenced by lack of endorsement by standard bodies and occupational health agencies (Harper 2004, p. 407).
Quality control and Operator safety
Quality control is an important aspect of occupational hazard assessment. Concerning chemical hazards, this will involve adhering to the basic requirement such as following the correct strategy and methods, documentation of all procedures and the use of representative samples.
Validation of sampling and test methods is important to ensure the accuracy of the result. Validation should provide for estimation, with acceptable accuracy, of extremes of concentration of the hazardous material.
Record keeping is central in the quality control of any laboratory. Field information such as temperature, sampling location and possible interfering compounds should be well stored (NIOSH Manual of Analytical Methods 2003). Field blanks, which are used to estimate pre-sampling and post-sampling contamination require a quality control strategy that should be formulated before the actual sampling.
Measurement procedures are perhaps the most important aspect of occupational hygiene quality control. There should be written guidelines for any measurement method. These procedures should also be evaluated periodically to confirm their performance. Standard solutions and other reagents should be of correct purity to avoid errors in the quantitation of results. All blanks (e.g., reagent, media and field blanks) should of correct measurement to minimize errors in analysing field samples. The use of blind samples should be such that they will offer the right degree of confidence in any independent analysis and not be any source of confusion or errors. Recovery studies are important in cases where there is a need for the separation of the contaminating agent from its media. They can be useful as analytical accuracy enhancing checks. Sampling instruments require calibration whenever a deviation is detected. Calibration is central to ensuring accurate results.
Some of the instruments that require calibration include bubble tubes and sampling pumps. For credible results, it is also important to select accredited laboratories. In the course of sampling, it is important to maintain communication with the project’s laboratory. All laboratory results should be thoroughly scrutinized. In case of any discovered flaws, a retest or resampling should be considered. The occupational hygienist should also observe his/her safety during sampling activity. Broken glass from sorbent or calorimetric tubes should be handled with care. This also applies to toxic and inflammable substances such as impinge solutions. For confined spaces, any test or sample gathering should be conducted from the outside. Apart from adhering to control limits, employers are also required to undertake another measure to limit workers exposure to chemicals. They are required to provide workers handling chemicals with personal protective equipment. Their establishment structures are also required to have an efficient ventilation system for letting out contaminants. Other measures to be observed include maintenance of equipment, medical examination and testing of workers, training and supervision.
Interpretation of monitoring results
After laboratory analyses of the samples have been completed, the interpretation of the results can be made. The NOHSC requires that interpretation of exposure standards be undertaken by qualified and experienced personnel. In most cases based on the mandatory Australian regulation laws, compliance can be deduced by comparing the results with permissible Exposure Limits contained in the Adopted National Exposure Standards for Atmospheric Contaminants in the Occupational Environment [NOHSC:1003 (1995). However, as a policy, the National Occupational Health and Safety Commission requires the use of the Guidance Note on the interpretation of Exposure Standards for Atmospheric Contaminants in the Occupational Environment in interpreting exposure limits contained in the National Exposure Standards for Atmospheric Contaminants in the Occupational Environment (Australia. National Occupational Health and Safety Commission 1995). The current publication is the Guidance Note on the Interpretation of Exposure Standards for Atmospheric Contaminants in the Occupational Environment NOHSC 3008(1995) 3rd Edition. This document puts it clearly under its policy statement that “exposure standards are guides to be used in the control of occupational health hazards [and] should not be used as fine dividing lines between safe and dangerous concentrations of chemicals”.
Case study: Respirable Crystalline Silica
Crystalline silica is a type of silicon dioxide whose main forms are quartz, cristobalite and tridymite. The occupational hazardous silica, respirable crystalline silica (RSC) refers to very fine crystalline silica dust less than 10µm in diameter capable of infiltrating into the non-ciliated airways of the lungs through inhalation (AIOH 2009, p.7). RSC is known to occur in workplaces such as mining, quarrying, exploration, stonemasonry, construction, ceramics, foundries, brick manufacture and heavy clay, industrial mineral and the production and the use of silica sand and flour (Cherrie 2009, p. 98). A considerable number of Australian workers are employed in these sectors (NOHSC 1993). Workers exposed to RSC have the potential to develop silicosis, a disease characterized by fibrosis of the lungs (AIOH 2009, p.9).
RSC has also been linked to the development of lung cancer, autoimmune disorders and chronic renal disease (Key-Schwartz 2003, p. 260).
Cyclone with a cassette has been used to sample airborne silica (Key-Schwartz 2003, p. 260). A sampling of dust containing silica is a highly complex process that requires strict adherence to standardized methodologies. In Australia, AS 2985(2004) based on ISO 7708: 1995 is used (AIOH 2009, p.8). Further analysis for the major major forms of RSC can be carried out by X-ray diffraction spectrophotometry (XRD), infrared absorption spectrometry (IR) and colourimetric spectrophotometry (Key-Schwartz et al. 2003, p.268). The colourimetric method is the least precise of the three (Key-Schwartz 2003, p.272). Only XRD and IR are common in Australia (AIOH 2009, p.8). The AIOH recommends long-hour sampling for RSC typically 8-hour or 12-hour time-weighted average exposure and analysis by an accredited laboratory. RSC concentration of 0.05 mg/m3 for an 8-hour sampling period is considered to offer an acceptable level of uncertainty while a similar concentration for 4 hours is considered below legal standards (AIOH 2009, p.8). The current exposure standard for RSC in Australia is 0.1 mg/m3 (AIOH 2009, p.14).
The “Guidelines for Health Surveillance” (NOHSC 1995) offers the criterion for carrying out health surveillance for adverse health effects in workers at high risk. It requires surveillance for workers with potential for long term exposure at concentrations exceeding 50% of the legal exposure limits (AIOH 2009, p. 8).
Control principles advocated by AIOH involve cutting down on a mechanical generation of dust through the use of wet processes and adequate ventilation. Others are dust education, medical monitoring, compliance with regulatory limits and proper PPE (P1 or P2 efficiency half-face respirators).
Mining is a significant economic activity in Australia. This means workers in this industry still face greater exposure to respirable crystalline silica. Studies have linked RSC to adverse health effects such as lung cancer.Though debate still rages on the exact health effects of this mineral, authorities need to strictly enforce compliance with the exposure limits and other control measures so that exposures are reduced to as low as reasonably practical
Conclusion
Exposure to particles and matters of chemicals in form of gases, vapours, mists and aerosols represent the most serious of hazards at the workplace. These components may enter the body system through inhalation, absorption or ingestion and may result in adverse health effects or even death. Regulations set up by governments are aimed at reducing exposure to dangerous levels of such chemicals. Assessment of exposure is undertaken through various sampling techniques. The sampling results are central to exposure assessment and high standards of quality control should be observed throughout the exercise. The results of sampling will determine the level of exposure and more so the compliance with regulatory laws. Chemical exposure at “safe limits” cannot be relied on. Therefore, other control measures are required at the workplace. These include setting up efficient aerations systems such as ventilation and the proper use of Personal Protective Equipment.
References
Adopted National Exposure Standards for Atmospheric Contaminants in the Occupational Environment [NOHSC: 1003 (1995) (Australia).
Australian Institute of Occupational Hygienists (AIOH) 2009, Respirable crystalline Silica and occupational health issues, AIOH Inc, Tullamarine Victoria.
Australia. National Occupational Health and Safety Commission 1995 Guidance Note on the Interpretation of Exposure Standards for Atmospheric Contaminants in the Occupational Environment 3rd Edition [NOHSC: 3008 (1995)].
Bohlin, P, Jones, KC & Strandberg, B 2007, ‘Occupational and indoor air exposure to persistent organic pollutants: a review of passive sampling techniques’ Journal of Environmental Monitoring, vol. 9, pp. 501-509, Web.
Boss, JM & Day, DW 2001, Air sampling and Industrial hygiene engineering, Lewis Publishers, New York, Washington D.C.
British Occupational Hygiene Society (BOHS) 2001, Direct reading devices for airborne chemical contaminants, Technical guide series No.15, Web.
Brown, R.H & Monteith, L.E 1995, ‘Gas and vapor sample collectors’ Chapter 17 In: Air Sampling Instruments for evaluation of atmospheric contaminants, 8th edn, ACGIH, Cincinnati, pp. 371-382.
Cherrie, JW 2009, ‘Reducing occupational exposure to chemical carcinogens’, Occupational Medicine, no.59, pp.96-100, Web.
Creely, KS, Hughson, GW, Cocker, J & Jones, K 2006, ‘Assessing Isocyanate exposure in polyurethane industry sectors using biological and air monitoring methods’, Annals of Occupational Hygiene, vol.50, no. 6, pp. 609-621, Web.
Harper, M 2004, ‘Assessing workplace chemical exposures: the role of exposure monitoring’ Journal of Environmental Monitoring, vol.6, pp. 404-412. Web.
Key-Schwartz RJ, Baron, PA, Bartley DL, Rice FL & Schlecht PC 2003, ‘Determination of airborne crystalline silica’ in NIOSH Manual of Analytical Methods (3rd Supplement) 2003, NIOSH, chapter r.
NIOSH Manual of Analytical Methods (3rd Supplement) 2003, NIOSH, Web.
NOHSC (1993). Draft Technical Report on Crystalline Silica, (Australia).
Sandra, SS & Rampal, KG 1999, Occupational health risk assessment and management, Wiley-Blackwell, New York.
Sauleau, EA, Wild, P, Hours, M, Leplay, A & Bergeret, A 2003, ‘Comparison of Measurement Strategies for Prospective Occupational Epidemiology’, Annals of Occupational Hygiene, vol. 47, no. 2, pp. 101-110, Web.
Victorian Trades Hall Council’s (VTHC), ‘Hazardous substances- an introduction to legislation’, Web.
Vincent, JH 2005, ‘Graduate education in occupational hygiene: a rational framework’, Annals of Occupational Hygiene, vol. 49, no.8, pp. 649-659, Web.
Zarocostas J 2005, ‘International Labour Organisation tackles work related injuries’, British Medical Journal, vol 331, no.7518, pp:656. Web.
Nosocomial infections (NCI) are the leading cause of sepsis in the acute care setting. According to the Centers for Disease Control and Prevention (CDC), the highest rates of infection occurred in the Burn Intensive Care Unit (ICU), neonatal ICU, and pediatric ICU. The CDC strives to understand how healthcare-associated infections happen and develop appropriate interventions.
A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. The most reportable NCI in the acute care setting are related to; urinary tract infections (32%), 22 % are from surgical site infections, 15 % are pneumonia (lung infections) and, 14 % are from bloodstream infections (CDC, 2002). The purpose of this literature review is to collect data on evidence-based practice (EBP) protocols that have been used or are in a testing phase to determine successful parameters that will help decrease nosocomial infections in the acute care setting.
Nosocomial infections
In order to understand the significance of evidence-based parameters to decrease the incidence of NCI in the acute care setting, the author would elaborate on an important aspect of the pathophysiology of NCI. Nosocomial infections result due to improper interventions or procedures in a hospital (acute care facility) or a healthcare service unit. The microbial flora especially bacteria of patients tend to attain the unique features of the bacterial pool in the vicinity. Infections are better regarded as hospital-acquired if clinical signs manifest early or after 48 hours of hospitalization.
Infections are better regarded to have a nosocomial origin if organisms invade the body during the hospital stay and cause infections after the patient’s discharge from the hospital.
NCI can be classified as iatrogenic, organizational, and patient-related based on risk factors.
Pathogenic agents on the hands of medical personnel, invasive procedures (eg, intubation and extended ventilation, indwelling vascular lines, urine catheterization), antibiotic use, and prophylaxis are iatrogenic risk factors (Mayoclinic, 2008). Contaminated air-conditioning systems, contaminated water systems, and staffing and physical layout of the facility (eg, nurse-to-patient ratio, open beds closed together) are organizational risk factors include (Mayoclinic, 2008). The severity of illness, underlying immunocompromised state, and length of stay are patient risk factors include the (Mayoclinic,2008).
The incidence of Nosocomial infections has increased at an alarming rate in the 21st century. The main reasons could be; mass admitting of sick people when their body loses the potential to mount an immune attack, proliferation of pathogens when medical staff members move frequently between the patients, escaping of the body’s natural protective barriers by the medical procedures. Another significant and the most important reason is the sanitation protocol regarding uniforms, equipment sterilization, washing, and other preventative measures that may be either overlooked by the hospital staff or too lax to sufficiently isolate patients from the infectious agents.
Review of Literature
There is a growing body of evidence on the spectrum of risk contributing agents. There may be a further need to gain insights on the development and better management of nosocomial infections. Earlier it was found that Candida albicans has potential for possible cross-transmission (Bischoff et al., 2000). This was revealed when a large study on 194 patients was undertaken to determine the colonization and possible transmission of yeasts among patients and healthcare workers in adult intensive care units. The overall contribution of Yeats was 67% where 19 % of Candida albicans was found in the oropharynx and 8% Candida parapsilosis was recovered from hands (Hedderwick et al., 2000).
This has strengthened an earlier report on the role of yeasts with regard to their frequency and distribution on the hands of hospital personnel working in an intensive care units (ICUs). Here, the techniques used for isolating C. parapsilosis were genotyping by electrophoretic karyotyping using contour-clamped homogenous electric-field gel electrophoresis (Huang et al., 1998). Hence, these reports may indicate the pathogenic role of Candida SPS. during the episode des of nosocomial infections. In addition, there are reports on outbreaks of hepatitis A in the burn treatment center of a referral hospital.
This was attributed to poor hand-washing and oral contamination accompanied by frequent eating on the wards on the hospital wards (Doebbeling, Li & Wenzel, 1993). These reports may indicate an urgent need to prevent the colonization and spread of multidrug-resistant bacteria. The intervention of hand hygiene strategies/protocols has revolutionized the management of nosocomial infections to a maximum amount. Over the years there has been much interest in the good practice of handwashing. Many learning programs were proposed to NHS for ward-based –learning. This has become a more adaptable strategy for nurses to take responsibility, a process known as Post-registration education and practice (PREP) (Gould, 1996).
Pittet (2001) described that hand hygiene that involves alcohol-based hand rubs rather than traditional hand washing could easily reduce hospital-acquired cross-infection in hospitals, provided there is a good adherence to guidelines by the healthcare workers’. This could facilitate great skin protection and improve overall hygienic behavior (Pittet, 2001).Further, nosocomial infections are reported to pass through blood stream which could lead to morbidity and mortality (Gura, 2004). This has caused nearly 8% of all nosocomial infections in the United States (Gura, 2004). The suspected reason was the administration of contaminated infusate through a central venous catheter without properly following asceptic techniques and poor hand washing (Gura, 2004). Therefore, there is a need for educational awareness regarding the nosocomial bloodstream infections (Gura, 2004).
Recent reports have emphasized that most cases of morbidity and mortality result from healthcare-associated infections. However, hand hygiene was better considered as the reliable and cost effective method for minimizing the incidence. Although there are certain indifferences shown by the health care workers (HCW) in following this method, a well planned study to investigate the effectiveness of interventions to improve hand hygiene practices were recommended like focusing on the inclusion criteria employed by the Cochrane Effective Practice and Organisation of Care Group (Gould et al., 2008).
As the incidence of yeast carriage on the HCWs’ hands is increasing, there is a need for the usage of gloves for minimizing the hand grown pathogenic yeast.(Brunetti et al., 2008) To this end a study was conducted in three departments like Surgery, Intensive Care Unit, Obstetrics and Gynaecology (Brunetti et al., 2008).It was revealed that the carriage of yeast and Candida species in the Surgery department was 50% and 49%, Intensive Care Unit was 61% and 57% and Obstetrics and Gynaecology was 65% and 59%.Hence, there is a need to monitor the colonization of these pathogenic strains in the recent developing hospital atmospheres.(Brunetti et al., 2008).
Integrated summary of the literature reviewed
From the above scientific documentation, it can be summarized that nosocomial infections have emerged as the major hospital acquired infections. Yeasts especially Candida sps. have become primary concern in the episodes of NI due to increased chances of cross transmission and invasion. The timely interference of prevention strategies especially, hand hygiene methodologies have provided immense relief to the health care professionals as they are easy accessible and cost effective. Aqueous alcoholic solution could offer great protection during hand-rubbing. Hence, approaching for risky chemicals or solutions could be avoided.
Apart from ICU’s, surgery and obstetrics departments may also carry great risk. Hence, a thorough clinical evaluation of aseptic techniques and hand hygiene strategies/protocols was suggested for these departments. Health care workers like nurses have shown an increased affinity in the maintenance of hand hygiene protocols. This could be widely appreciated and needs a consistent implementation.
Implications for nursing (patient care)
Nosocomial infections have become problematic in the major departments of Hospitals. There is a need to monitor the growth or colonization of yeasts. The implementation of molecular Biology techniques to investigate the colonization of microbial pathogens could be better considered as evidence based approach and has bright future implications. Maintaining the registry of morbidity and mortality may help to assess the rising prevalence rates of nosocomial infections. The utility of infectious or inflammatory markers like Adenosine deaminase (ADA) and C-reactive protein (CRP) could help in assessing the health status of severely ill patients.
Nosocomial infections may be more thoroughly controlled by the modifications of existing hand hygiene protocols with safer and cost effective agents,. Routine educational intervention programs for all the healthcare workers may have good implications for the rapid eradication of hospital acquired infections. There is a great need of proper implementation of guidelines recommended for the management of nosocomial infections by the medical professionals.
Remaining gaps in the literature identified
The literature cited here is more probably confined to few microbial populations like yeasts. There is also a need of understanding the role of other infectious agents like mycoplasma. Technical aspects involving molecular biology were not well covered. Much information would help to understand the pathways of bacterial colonization as there may be an emergence of good number of drug resistant bacteria. Apart from the prior mentioned departments, respiratory, cardiovascular, nephrology may also serve as hosts for transmitting infections. An upto date information on the methods of assessing the efficacy of hand hygiene strategies/protocols was more suggestive.
Conclusion
The management of all kinds of nosocomial infections could be possible with the collaboration of medical professional and researchers. As, the incidence rates may contribute to the mortality, hand hygiene protocols are the safest approaches to control. Educational awareness and intervention strategies like DNA typing may greatly influence prevalence indices registered across various hospitals.
Maintenance of databases regarding the history of incidence and therapy provided through hand hygiene protocols could help to streamline the evidence based approach.This could probably eliminate all possible chances of hospital acquired or other opportunistic infections. Therefore, nosocomial infections could be totally eradiated in the society.
References
National Nosocomial Infections Surveillance System. (NNIS). 2006. Web.
National Nosocomial Infections Surveillance (NNIS) System Report. (2002).Am J Infect Control, 30,458-75.
Quoc V Nguyen. (2009). Hospital Acquired Infections. Web.
Mayo Clinic. Hand washing: An easy way to prevent infection. Web.
FAQ. Web.
Hedderwick, S., Lyon, M., Liu, M., Vazquez, J., Kauffman, C. (2000). Epidemiology of yeast colonization in the intensive care unit. European Journal of Clinical Microbiology & Infectious Diseases, 19, 663-70.
Huang, J., Lin, T., Leu, S., Wu, H. (1998).Yeast carriage on hands of hospital personnel working in intensive care units. Journal of Hospital Infection, 39(1), 47-51.
Doebbeling, B., Li. N, Wenzel, R., (1993). An outbreak of hepatitis A among healthcare workers: risk factors for transmission. American Journal of Public Health, 83(12), 1679-84.
Gould, D. (1996). Hand-washing: Can Ward-based learning improve infection control? Nursing Times, 92(24), 42-3.
Gura, K. (2004). Incidence and nature of epidemic nosocomial infections. Journal of Infusion Nursing, 27(3), 175-80.
Gould, J., Drey, N.S., Moralejo, D., Grimshaw, J., Chudleigh, J. (2008).Interventions to improve hand hygiene compliance in patient care. Journal of Hospital Infection, 68(3), 193-202.
Brunetti, L., De Caro, F., Boccia, G., Cavallo, P., Capunzo, M. (2008). Surveillance of nosocomial infections: a preliminary study on yeast carriage on hands of healthcare workers. Journal of Preventive Medicine Hygiene, 49(2), 63-8.