The Health And Social Care Act Nursing Essay
Due to the fact that each local National Health Service (NHS) trust may well differ, local NHS trusts are allowed to create their own infection prevention and control hand hygiene policy by using Health and Social Care Act 2008 as framework. The NICE guideline 2003 stated that local health communities should review their existing practice for healthcare-associated infections (HAIs) prevention as they develop their Local Delivery Plans.
Patients on a neurological ward are more susceptible to developing infections due to poor body immunity or being immobile after a stroke episode. Healthcare settings are more susceptible to harbor microbes, hence it is important for us, as a healthcare provider, to keep patients and ourselves free from infections (Macnair, 2010). According to a publication entitled "The Management and Control of Hospital Acquired Infection" by the National Audit Office (2000), there are approximately 5000 deaths out of 100000 cases of hospital acquired infections in England each year.
Smyth et al, 2008, carried out a survey involving 75694 adult patients in acute hospitals across England, Wales, Northern Ireland and the Republic of Ireland to estimate the prevalence of HCAIs; they found 5743 patients acquired HCAI while hospitalized. In an article by Bagnall (2008), according to Office National Statistics between 2002-2006, a total of 79 MRSA related death were recorded at Wrexham Maelor.
One of the most effective ways of preventing the spread of germs to others is keeping our hands clean through improving hand hygiene. Our hands carry million of microbes every day; we pick up microbes by touching another person or items that are contaminated.
The Health and Social Care Act 2008 stated that the NHS body must ensure sufficient supply of suitable hand washing facilities and antibacterial hand rub in hospitals to provide a clean and appropriate environment for healthcare. Besides that, it is important to provide information regarding HCAIs to encourage compliance by visitors and to implement visiting restrictions to patients and the public.
Hand hygiene policy is highlighted in the acute stroke inpatient department; the staff implemented the policy by following the hand hygiene guideline provided by the trust. Hand hygienic signs and posters are hung up on the wall around the wards, especially on the main door of the department. Signs with brightly colored wordings are hung on the main entrance of the department to urge staff and visitors to clean their hands before entering or leaving the department. Alcohol hand rubs are placed next to the department’s main entrance and at patient’s bedside to prompt visitors and healthcare staffs on the importance of maintaining hand hygiene at all times. Alcohol hand rubs are placed in locations for use when access to hand washing facilities is not convenient. Changing the way a massage is delivered by using signs and poster could encourage the compliance and remind hospital workers about hand hygiene (Grant, 2011). According to a study done by Adam Grant and Hofmann David, which was published in Psychological Science, it was found that healthcare workers were more aware of hand hygiene when it comes to their patient’s health rather than their personal health risks when they were reminded by signs.
Each ward on the department has its own sink situated close to where clinical procedures are carried out to allow ease of access for staffs and visitors to clean their hands immediately, before or after direct or indirect contact with a patient (National Health Service, 2003). This is to protect the healthcare staff and visitors from harmful microbes carried by the patient. One sink is provided between six patients in acute and low-dependency bay as recommended by the NHS Estates 2002. Besides that, elbow or foot taps are available to prevent re-contamination of hand following hand hygiene routine at sink (Betsi Cadwaladr University Heath Board, 2011). Clean disposable paper towels are mounted on the wall above the sink for easy access after hand washing. Hand cleaning techniques are printed on an A4 paper and mounted above the sink on each bay and side rooms.
All staff are responsible for soap and sterilizing gel, and stock checking to make sure there are adequate stocks to prevent shortage of stock when needed. Besides that, infection prevention and control leaflets are available on the ward, to provide patients and their relatives with hand hygiene awareness. According to Anglian Community Enterprise (2011), hand hygiene awareness to patients and visitors is promoted by offering infection prevention and control information leaflets around ward areas.
The following report is based on my personal observations while on a 6-week placement with the Trust. During the placement, staff members on the ward adopted most of the procedures stated in their local infection prevention and control hand hygiene policy. I noticed that they always cleaned their hands using the alcohol hand rub which was mounted on wall next to the main door. This would be the first thing they do upon entering the ward. They would also use the alcohol hand rub situated at the foot of the patient’s bed before and after patient contact and treatment.
Whenever there is a suspected outbreak, alcohol hand rubs will be temporarily removed from patient’s bedside. This is to prompt staff to clean their hands with liquid soap because the use of alcohol-based hand rub is not effective against spore-forming organisms or noroviruses (Betsi Cadwaladr University Health Board, 2011).
I observed that some of the staff performed the proper hand washing technique using liquid soap while others did not implement any hand washing techniques especially during morning ward rounds by the multi-disciplinary team members. In my opinion, the main reasons why members of staff do not wash their hands after patient contact is because of poor knowledge of guidelines and the lack of time to perform hand hygiene regimes(Doebbeling et al, 1988). In addition, forgetfulness is another reason for hand hygiene negligence. A survey done by Pyne (2010), stated that "a high workload or feeling too rushed as physicians" is the main barrier to compliance with hand hygiene procedures. According to Pratt et al, 2001; Boyce and Pittet, 2002, frequent hand washing causes hands to become dry and irritated, and could be yet another reason why healthcare providers fail to adhere to hand hygiene guidelines. Supplying hand moisturisers will encourage healthcare providers in the trust to adhere to good hand washing practice, as hand moisturizers helps maintain skin integrity (Boyce and Pittet, 2002).
Disposable gloves are worn by staff when having direct patient contact, since there is a risk of exposure to body fluids and secretions. Hands are supposed to be washed after the use of disposable gloves, however, I observed a few doctors who did not perform hand hygiene after the use of gloves. This is because they assumed that gloves provide sufficient protection against infections, making hand washing after the use of gloves unnecessary (Pittet et al, 1999).
The worst practice I noticed was nursing staff who wore false long nails. In a study done during an outbreak of Klebsiella pneumonia in a neonatal intensive care unit, the nurse with false nails carried hand cultures for the outbreak strain (Gupta et al, 2004).
People have a tendency to follow each other’s footsteps. During one specific incident, a nursing student washed her hands with liquid soap and water after having direct contact with a patient which is what her supervisor normally does. My clinical educator has been a role model to me when it came to complying with the policy. For example, he prompted me to clean my hands at the wards’ sink even though I was just observing the patient. Infection control procedures were briefed during induction on the first day of the placement.
During the period of my placement I observed that good Infection Prevention Control signage strategically placed around the Trust encouraged good hand hygiene policy and procedure's to be observed and implemented. The process was not only carried out by the Trust staff but also by contractors, visitors and the patients themselves. It was clear from my personal practice and observations that both National and local procedure's were being implemented and observed well within the guidelines. However, hand hygiene could be improved by supplying more hand moisturizer on ward, so that there is no excuse for any healthcare provider to not perform the hand hygiene protocol.