Two common methods used to prevent the spread of infectious agents are hand washing and the use of personal protective equipment (PPE). This paper will discuss different research studies that were performed on these two methods to compare the effectiveness’ of each and to determine if one is more useful than the other for infection prevention.
Stowell et al. (2014) conducted a study on how effective hand washing works against Cytomegalovirus (CMV) on human hands and different surfaces. This study also examined the use of applying five different hand-cleansing methods to remove CMV or to make it nonviable (Stowel et al., 2014). Three study groups with 10 participants each (equal to 20 hands) were performed in a 2 week observation. Group 1) CMV survival on hands up to 15 minutes with no hand cleansing, group 2) CMV transferability from hands to other surfaces, group 3) CMV survival on hands up to 10 minutes after hand cleansing using five different cleaning agents (plain water, plain soap and water, antibacterial soap and water, hand sanitizer, diaper wipes) (Stowel et al., 2014). Each participant’s hands within the 3 different groups were swabbed and collected after CMV saliva solution was placed on their fingers for 15 minutes. After the sample was completed participants washed their hands with disinfectant (softCIDE).
Group 1) showed viable CMV persisted on hands for at least 15 minutes with no hand washing, and group 2 ) indicated CMV survived on environmental surfaces and were more viable on surfaces before contact with hands as oppose to after hands due to increased acidic levels on hands compared to environmental surfaces. Group 3) had CMV survival decline after 15 minutes using plain water, plain soap and water, and antibacterial soap and water. However, hand sanitizer and diaper wipes retained high levels of viable CMV after 15 minutes (Stowel et al., 2014). Based on the research results group 3 was the most effective method to wash hands with soap and water that has reduced the number of CMV.
Catheter associated urinary tract infection (CAUTI) contribute to 45-50 percent of noso-comial infections in healthcare facilities which is an ongoing problem for infection control to be maintained (Peter, Devine, Naya, 2018). Most of these nosocomial infections are profound within patient care actives when patients are hospitalized with a urinary catheter and the catheter is not being monitored and cleaned properly along with poor hand hygiene when the patient or healthcare workers start to manipulate the catheter site.
Peter, Devine, and Naya did a study on infection prevention for CAUTI with the effectiveness of hand hygiene and PPE (2018). This was a quasi-experimental study contained 70 inpatient participants divided into two groups of 35 participants in each group. Each group were hospitalized with indwelling catheters and they were being observed and monitored by the infection control nurses (ICN) for seven days. They observe all the staff nurses for 7 days to see how effective nurses practice good hand hygiene in infection control when taking care of patients.
Prior to patient contact, each health care worker had to perform hand hygiene before, during and after catheter insertion as well as use antiseptic and sterile technique (Peter, Devine, & Naya, 2018). A group of 30 female nurses between the ages of 31 to 35 were being evaluated on how effective their clinical practice infection control when inserting a catheter. By doing so, a urine culture was collected for a pre and post test to evaluate the number of microbes that were found after an indwelling catheter placement. They were able to find signs of nosocomial infections has occurred (2018) and found that 10 female nurses needed to be re-educated on how to perform effective infection control to avoid CAUTI. The other 20 nurses had effective clinical practice in prevention of CAUTI (2018). This study has proven that re-educating or reminding healthcare workers to always wash hands based on the evidence that was found in the urine collection.
Munoz concluded that hand washing with soap and water is still more effective compared to alcohol-based hand rub (ABHR) (2018). Munoz found that the amount of Healthcare associated infections (HCAIs) has increased because most healthcare workers only apply alcohol-based hand rub and did not wash their hands with soap and water after removing dirty gloves (2018). The reason hospitals have ABHR located in the patient’s room and outside the patient’s room is for everyone to perform hand hygiene in front of patient’s and patient’s families to promote infection control at the beside. Evidently, the amount of evidenced-based practice is showing that HCAIs are still on the rise due to the fact healthcare workers (HCWs) and non-healthcare workers still don’t perform effective hand hygiene with washing their hands with soap and water.
Hand hygiene with soap and water has been proven to be the most effective to help reduce gastrointestinal distress with episodes of diarrhea, nausea, vomiting, and even respiratory infections in the community settings by over 31% (Munoz, 2018). Munoz mentioned in his article that HCWs should apply alcohol based sanitizers in between patient care but to always perform effective hand hygiene, because alcohol based sanitizer application is only temporary during patient care. Most HCWs neglect to perform hand hygiene after patient care due to being extremely occupied in trying to complete all other nursing duties.
Based on Munoz conclusion, everyone still needs to wash their hands with soap and water in between patient care, not just using alcohol based hand rub. Carter argued that hand sanitizer and hand washing are not the same effectiveness. His studies found that the use of alcohol-based hand sanitizers (ABHSs) in healthcare settings are not effective against Noroviruses and Clostridium difficile (C. diff) (2013). Carter mentioned that the number of C.diff diseases increased by 94% which was accounted from healthcare facilities related to nosocomial infections. Carter mentioned in his article that many patients die from C.diff which were linked from medical care with poor ineffective infection control. That is why C.diff patients need to be on contact precautions by applying PPE, washing hands with soap and water for effective infection control and to reduce the nosocomial infections that patients can acquire from the healthcare setting (2013).
Carter continues to mention that long-term care facilities (LTC) had multiple outbreaks of C.diff and Norovirus since 2006 from using only ABHS and lack proper hand hygiene. Additional to patients taking antibiotics, the patient’s become more resistant to the antibiotics along with ineffective hand hygiene which increases HAIs, and ongoing poor infection control. The study provided why PPE and hand washing with soap and water are the most effective approaches to reduce the number of nosocomial infections in the healthcare setting.
Farotimi, Ajao, Nwozichi, & Ademuyiwa (2018) did a quasi-experimental design on 80 participants divided into two groups of nurses and patients in Nigeria Hospital to answer a questionnaire on infection control. They found that over 50% of these participants in both groups who answered the questionnaire did not know the definition of infection control and how to prevent infections. They found that both groups are unaware that hand hygiene means to wash hands with soap and water for at least 20 seconds or apply antiseptic on hands. They were not trained on infection and how to prevent the spread of infections during patient care (2018).
Approximately 35 million healthcare workers worldwide have an increase of infections from poor hand hygiene and not using PPE including gloves (Farotumi et al., 2018). Healthcare workers in developing countries either lack resources to improve infection control or lack the knowledge on what it means to wash hands effectively (2018). This study displays how poor hand hygiene is effected by deficient knowledge from healthcare workers.
Based on the results of these studies, healthcare workers need to vigorously wash hands with antibacterial soap or regular soap and warm water for at least 20 seconds or more to reduce the risk of spreading infection before, during, and after patient care activities. It is required and essential for all healthcare workers to always perform hand hygiene with soap and water. It was determined that HCWs should not depend on hand sanitizer due to the evidence that hand sanitizer is not effective (Stowell et al. 2014). Studies show supporting evidence to be applied in practice to always wash hands before and after wearing gloves when touching patients, patient’s room, surface areas, equipments, and anything else relevant.
References
- Stowell, J. D., Forlin-Passoni, D., Radford, K., Bate, S. L., Dollard, S. C., Bialek, S. R., … Schmid, D. S. (2014). Cytomegalovirus Survival and Transferability and the Effectiveness of Common Hand-Washing Agents against Cytomegalovirus on Live Human Hands. Applied and Environmental Microbiology, 80(2), 455–461. http://doi.org/10.1128/AEM. 03262-13
- Peter, S., Devi, E. S., & Nayak, S. G. (2018). Effectiveness of Clinical Practice Guidelines on Prevention of Catheter-associated Urinary Tract Infections in Selected Hospitals. Journal of Krishna Institute of Medical Sciences (JKIMSU), 7(1), 55–66. Retrieved from http:// prox.miracosta.edu/login?url=http://search.ebscohost.com.prox.miracosta.edu/login.aspx? direct=true&db=asn&AN=127612749&site=ehost-live
- Munoz-Figueroa, G. P., & Ojo, O. (2018). The effectiveness of alcohol-based gel for hand sanitising in infection control. British Journal Of Nursing, 27(7), 382-388. http://doi: 10.12968/bjon.2018.27.7.382
- Carter, D. (2013). The Right Balance Between Hand Sanitizers and Handwashing. AJN American Journal Of Nursing, 113(7), 13.
- Farotimi, A. A., Ajao, E. O., Nwozichi, C. U., & Ademuyiwa, I. Y. (2018). Effect of Training on Knowledge, Perception and Risk Reduction Regarding Infection Control among Nurses in Selected Teaching Hospitals in Nigeria. Iranian Journal of Nursing & Midwifery Re-search, 23(6), 471–477. https://doi-org.prox.miracosta.edu/10.4103/ijnmr.IJNMRpass: [_]208_17
- Bouwer, M., Labuschagne, S., Spamer, S., Vermaak, C., Zietsman, L.-M., Steyn, D., & Joubert, G. (2018). Knowledge of final-year medical students at the University of the Free State of hand hygiene as a basic infection control measure. South African Family Practice, 60(3), 74–78. https://doi-org.prox.miracosta.edu/10.1080/20786190.2017.1396789
- Mitchell, K. F., Barker, A. K., Abad, C. L., & Safdar, N. (2017). Infection control at an urban hospital in Manila, Philippines: a systems engineering assessment of barriers and facilitators. Antimicrobial Resistance & Infection Control, 6(1), 1–9. https://doi-org.prox.miracosta.edu/10.1186/s13756-017-0248-2
- Tao Wang, Lina Zhuang, Wei Guo, & Yishu Zhang. (2017). Therapeutics evaluation on whole range dynamic management for infection control in cardiac surgery patients during rehabilitation. Biomedical Research (0970-938X), 28(17), 7389–7392. Retrieved from http:// prox.miracosta.edu/login?url=http://search.ebscohost.com.prox.miracosta.edu/login.aspx? direct=true&db=asn&AN=125798253&site=ehost-live