Study On Hand Hygiene In Optometry Nursing Essay

Study On business deal hygienics In Optometry Nursing Essay grant hygienics is a term spend to describe any act of die purifysing. There ar various methods of decontamination each with their own level of efficacy (Lucet et al., 2002 Kampf, Lffler and Gastmeier, 2009). It is an essential work pop out among wellness c atomic fleck 18 workers (HCWs) to pr stock-stillt the transmission system of microorganisms and spread of nosocomial infections in a clinical setting. Despite this knowledge, residence among HCWs remains low averaging 40% which increases the pretend of long-sufferings contracting hospital acquired infections (Boyce and Pittet, 2002). The World Health Organisation (2005) recognise hospital acquired infections as being a major cause of death and mortality in hospital bound patient roles, averaging 5000 deaths a year in England. up(a) pile hygienics practice among HCWs is the cornerstone in reducing nosocomial infections such(prenominal) as methicillin- resistant Staphylococcis aureus (MRSA) and clostridium difficile (C. diff.). However, implementing this change in conduct is complex and difficult to achieve. An integral factor for better happen hygiene compliance relies on HCWs educational training and the introduction of motivational programmes designed proper(postnominal) completely in ally to influence behaviour. supervise and encouragement go forth be necessary for these uses to be successful (Boyce, 2008 Saint et al., 2009).1.2 fall out hygiene in OptometryThere is an app argonnt lack of research into spate hygiene practice in a special and union c be setting optometric practice included. Currently thither are no evidence found studies directly linked with Optometry to support the recommended guidelines set out by The College of Optometrists. Instead these guidelines are ground on expert opinion with little conclusive evidence of efficacy in primary care. The importance of trenchant baseball mitt hygiene in the prevention and control of infection is stressed. They hire adopted recommendations set by The National ground for Health and Clinical Excellence (NICE 2003), which are for the use of professionals in primary and community care. A minimum archetype of trade hygiene practice would be to decontaminate work force originally each and every fact of patient play and after(prenominal) any procedure or contact that would cause bowl overs to become contaminated. The College of Optometrists (2009) expand upon this stipulating that there is no set regularity in hand swooshing instalments and that instead it should be adhered to in circumstances such as contact lens founding and removal, after going to the toilet, when hands appear visibly unclean, before and after contact with ocular surfaces or the adnexa, before and after administering topical ointments or drops, after any possible microbial contamination, after treatment soiled or contaminated materials and before stand fir ming and after removing gloves. Furthermore, an instruction of take into account hand hygiene technique in clinical practice is suggestedWet hands under running water supply.Dispense scoopful/antiseptic into cupped hand (N.B. bar welt should non be used).Rub hands vigorously and well for 10-15 seconds without adding more water.Ensure all surfaces of the hands are covered.Rinse hands thoroughly under lovesome running water.Dry hands with a disposable paper pass over. The use of non disposable towels is non approximate practice.Advisory recommendations for ophthalmologists regarding hand hygiene in the community setting remains at a big-boned level. To improve standards, further research must be conducted as it is widely regarded that sound clinical practice requires conclusive clinical evidence (Smith, 2009). Optometrists in a primary care setting could benefit from adopting high standards of hygiene expected in hospital environments.1.3 Hand hygiene guidelines and tech niqueDue to the clinical and sparing implications of wellness-care associated infection the World Health Organisation (WHO) and the US Centers for Disease Control and Prevention (CDC) wipe out develop guidelines to promote improved hand hygiene adherence among health care workers (Boyce and Pittet, 2002 Pittet, Allegranzi and Boyce, 2009 Sax et al., 2009). These guidelines include particular proposition indications for hand clean and hand antisepsis episodes. A detailed description of tolerate hand hygiene technique is too included. The recommendations are categorised on the basis of published scientific data, theoretical knowledge, pertinency in a clinical setting and economic involvement. The CDC/HICPAC created a system for categorising hand hygiene recommendations. These categories are shown in parry 1 display panel 1 screening the CDC/ HICPAC categorisation of guidelines (Boyce and Pittet, 2002)CategoryCriteriaIAStrongly recommended for executing and strongly back up by well-designed experimental, clinical or epidemiologic studiesIBStrongly recommended for implementation and strongly back up by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale.ICRequired for implementation, as mandated by federal or state regulation or standardIISuggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or a consensus by a panel of experts.No recommendationUnresolved uncover. Practices for which insufficient evidence or no concensus regarding efficicacy exist.Sections 1, 2 and 6 of the CDC/HICPAC recommendations advise specifically on handwashing and hand antisepsis indications, hand-hygiene technique and early(a) aspects of hand hygiene. Each guideline is given a classification category relevant to Table 1. These recommendations are as follows1. Indications for handwashing and hand antisepsisA. When hands are visibly dirty or contaminated with proteinaceou s material or are visibly soiled with blood or other body fluids, wash hands with either a non germicide soap and water or an antimicrobial soap and water (IA).B. If hands are non visibly soiled, use an alcohol-based hand grave for routinely decontaminating hands in all other clinical situations expound in items 1C-J (IA). Alternatively, wash hands with an antimicrobial soap and water in all clinical situations described in items1C-J (IB).C. cleanse hands before having direct contact with patients (IB).D. Decontaminate hands before donning sterile gloves when inserting a central intravascular catheter (IB).E. Decontaminate hands before inserting urinary catheters, computer peripheral vascular catheters, or other invasive devices that do not require a surgical procedure (IB).F. Decontaminate hands after contact with a patients intact clamber (e.g., when taking a impetus or blood pressure, and lifting a patient) (IB).G. Decontaminate hands after contact with body fluids or excr etions, mucous membranes, nonintact tegument, and wound dressings if hands are not visibly soiled (IA).H. Decontaminate hands if moving from a contaminated-body commit to a clean-body site during patient care (II.I. Decontaminate hands after contact with dyspneal objects (including medical equipment) in the immediate vicinity of the patient (II).J. Decontaminate hands after removing gloves (IB).K. Before eating and after use a restroom, wash hands with a non-antimicrobial soap and water or with an antimicrobial soap and water (IB).L. Antimicrobial-impregnated wipes (i.e., towelettes) may be considered as an alternative to washing hands with non-antimicrobial soap and water. Because they are not as effective as alcohol-based hand rubs or washing hands with an antimicrobial soap and waterfor reducing bacterial counts on the hands of HCWs, they are not a substitute for using an alcohol-based hand rub or antimicrobial soap (IB).M. Wash hands with non-antimicrobial soap and water or with antimicrobial soap and water if exposure to Bacillus anthracis is suspected or proven. The physical action of washing and rinsing hands under such circumstances is recommended because alcohols,chlorhexidine, iodophors, and other antiseptic agents have misfortunate exercise against spores (II).N. No recommendation can be made regarding the routine use of nonalcohol-based hand rubs for hand hygiene in health-care settings.(Unresolved issue).2. Hand-hygiene techniqueA. When decontaminating hands with an alcohol-based hand rub, apply ware to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry (IB).Follow the manufacturers recommendations regarding the volume of product to use.B. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse h ands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet (IB). Avoid using hot water, because repeated exposure to hot water may increase the risk of dermatitis (IB).C. Liquid, bar, leaflet or powdered forms of plain soap are unexceptionable when washing hands with a nonantimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage and flyspeck bars ofsoap should be used (II).D. Multiple-use cloth towels of the hanging or roll type are not recommended for use in health-care settings (II).6. Other Aspects of Hand HygieneA. Do not wear bleached fingernails or extenders when having direct contact with patients at high risk (e.g., those in intensive-care units or operating rooms) (IA).B. find natural nails tips less than 1/4-inch long (II).C. Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and nonintact skin could get along (IC).D. Remove gloves after caring for a patient. Do not wear the same pair of gloves for the care of more than one patient, and do not was gloves between uses with contrastive patients (IB).E. Change gloves during patient care if moving from a contaminated body site to a clean body site (II).F. No recommendation can be made regarding wearing rings in health-care settings. Unresolved issue.These guidelines were developed for the use of health care professionals in a clinical setting and were not specifically designed with optometric practice in mind. However, umteen of these recommendations remain highly relevant when adopted to an optometric environment and are strongly supported by The College of Optometrists. The World Health Organisation have extended the recommendations on hand-hygiene technique and produced a visual publication poster detailing the hand hygiene technique for use with alcohol-based formulations and the handwashing technique for use with soap and water. These are shown in digits 1 and 2 respectively. plan 1 showing recommended hand hygiene technique with an alcohol-based formulation (World Health Organisation 2006) ***online access book of facts2Figure 2 showing recommended handwashing technique using soap and water (World Health Organisation 2006) **online access reference1.4 Hand hygiene practices among health care workersHand hygiene practice among health care workers is poor with many observational studies reporting low compliance rates in a number of declarative areas. Hence, understanding underway trends among health care workers is critical in planning and implementing the necessary modification in behaviour (Allegranzi and Pittet, 2009). Hand hygiene adherence can be investigated over a range of parameters such as duration spent cleansing or scrubing, frequency of hand washing episodes over a given time and observing the variations in performance with regard to clinical setting, physician status and sexual urge (Boyce and Pittet, 2002). Employing the appropriate hand hygi ene technique is essential. Consider the situation in which hand hygiene episodes per mo compliance is high. If insufficient hand hygiene technique is being performed e.g. inadequate coverage of hand surfaces and a short cleansing time, then the overall standard of compliance will decrease. This confirms that hand hygiene practices among health care practitioners involves both multimodal strategies and multidisciplinary approaches to improve adherence (Pittet, 2001 Dierssen-Sotos et al., 2009).Multiple factors are associated with the suboptimal hand hygiene performance among health care practitioners and they vary in relation to resources available and the setting involved. For example, the lack of appropriate infrastructure, equipment and materials will occlude good hand hygiene practice, the cultural background and perhaps even religious beliefs can also affect performance (Ahmed et al., 2006 Allegranzi et al., 2009). The most commonly reported causes of poor hand hygiene compli ance are (i) physician or nursing status, (ii) clinical care setting e.g. ICU, AE, surgery units (iii) understaffing and overcrowding (iv) male (rather than female) gender and (v) un-get-at-able hand hygiene supplies (Pittet, 2000).(Erasmus et al., 2010) conducted a systematic literature review of studies based on observed or self-reported hand hygiene compliance rates in hospital practice, mainly intensive care units. The normal compliance rate was low at 40%. Physician status was found to be a factor affecting adherence, lower among doctors (32%) than nurses (48%). In general, a lower compliance rate was found in physicians reporting a high level of activity in clinical practice. Compliance rates improved in situations whereby physicians or nurses associated the task as being visibly dirty or unhygienic, alcohol-based hand rubs or gels were available, feedback performance was introduced and when materials and facilities were easily accessible.Hand hygiene compliance among optom etric practitioners is an area yet to be investigated. opticians are further to follow the recommended guidelines set by organisational bodies such as the World Health Organisation and The College of Optometrists.1.5 Hand hygiene behaviourHand hygiene behaviour can be investigated in relation to factors such as cordial cognitive determinants. A number of situations trigger a hand cleansing episode to occur and therefore affect compliance e.g. knowledge and perception of the risks associated with cross contamination, social expectations for adequate hygiene, self valuation of the perceived advantages against the existing hindrances and the initial motivation to perform the hand hygiene action (Pittet, 2004 Whitby et al., 2007). This cognitive behavioural reaction falls into two categories (Whitby, McLaws and Ross, 2006). Inherent hand hygiene behaviour arises in circumstances when individuals cast hands to be visibly soiled, s tagy or gritty. This type of intrinsic hand washing behaviour is initiated when a task is recognised as being unhygienic or has a potential risk factor involved to the individual concerned. The other component of hand hygiene behaviour is denoted as elective course hand hygiene behaviour. This type of behaviour is represented in situations such as tactile social contact e.g. shaking hands to greet someone. This will not induce a reception for many individuals to wash their hands and instead it becomes an elective response. Similarly, health care workers may partake in non-invasive electroneutral contact with patients when taking pulses or touching inanimate objects in their surroundings. This type of social contact is not perceived to be a danger and does not drive a hand cleansing episode to take lieu. Instead an elective response has to be made. However, hand cleansing or disinfection after such contact in a hospital setting is crucial, because failure to do so may exact to microbial hand contamination, with the increased risk of cross-infection.1.6 Relation of hand hygiene with the acquisition of nosocomial infectionsHand hygiene reduces the transmission of microbial contamination and the spread of health-care associated pathogens from one patient to another via the hands of health care workers (Pessoa-Silva et al., 2007 Pittet et al., 2007 Allegranzi et al., 2010). Hand hygiene is the cornerstone in securing adequate patient safety. Failure to comply with this standard prolongs duration of hospitalisation, causes unnecessary suffering, increases costs as well as mortality rates (World Health Organisation, 2009). Thus, to spring up awareness and combat the problem of health care associated infections, (Sax et al., 2007) produced an evidence-based, user-centred design to promote improved hand hygiene adherence termed My Five Moments for Hand Hygiene, shown in Fig.3. This highlights the five most common routes of transmission which HCWs are subject to in daily clinical practice. The model is based on th e World Health Organisations hand hygiene guidelines. It recommends hand washing episodes to occur before touching a patient, before clean/aseptic procedures, after a body fluid exposure risk, after patient contact and after touching patient surroundings. Although designed specifically for HCWs in a clinical setting, this model could be adopted for use in community practice to include an optometric environment. Optometrists should be aware of the risks of cross contamination and demonstrate an understanding of appropriate infection control methods (Lakkis et al., 2007).Figure 3- My 5 moments for hand hygiene model1.7 Infection control in optometryModern optometric practitioners are offering an expanding area of services and care with regards to the treatment and management of gist diseases and eye injuries. Therefore, more specialised procedures and techniques are being carried out in the primary care setting which have the potential to spread infection and disease via blood borne and air borne transmission. Hence, practitioners have an obligation to carry out adequate infection control measures to ensure a high standard of patient safety and rampart (Tyhurst and Hettler, 2009). The majority of optometric procedures are considered low risk for the spread of disease and infection. However, in a few cause the risk increases e.g. when instruments come in direct contact with an infected patient and when blood, cuts or abrasions are unresolved (AOA Primary Care and Ocular Disease Committee, (1993). Other procedures which have the potential for infection include the aggregation of eye culture samples, foreign body removal, contact lens fitting, lacrimal lavage and the treatment of patients exhibiting ocular trauma.1.7.1 Hand hygiene and preventative barriers to infectionA basic measure of infection control begins with effective hand hygiene. Many eye diseases and infections are spread manually, and it is the responsibility of the optometrist to minimise this t ransmission to patients by adhering to appropriate hand washing techniques before and after examinations and procedures. Appropriate hand hygiene technique refers to the standard described in section 1.2. In addition, the use of protective barriers such as disposable medical gloves, gowns, masks and protective eyewear has been suggested in specialised circumstances as a precautionary control to minimise the transmission of microorganisms (Lakkis et al., 2007).1.7.2 HIV, Hepatitis B and Hepatitis CDiseases can be spread by direct contact between individuals, via blood or other bodily fluids and as a result of airborne transmission. Considerable awareness has been directed towards the transmission of the humans immunodeficiency virus (HIV) and the Hepatitis B and C viruses, (HBV) and (HBC). HIV has been isolated from tears, contact lenses and ocular tissues, but there is no evidence to support transmission of the disease through these medians (Cantrill et al., 1988 Tillman, Klotz and Maino, 1992). Studies have reported the detection of the hepatitis B surface antigen in tears and aqueous humour, suggesting that optometrists must take all necessary precautions in clinical practice (Temel, Seber and Gunay, 1990 Tsai et al., 2009). Although these are areas of concern, the risk of transmission in an optometric setting is remote.1.7.3 Influenza A (H1N1) virusIn 2009, the emergence of the influenza A (H1N1) virus in humans has led to the first global epidemic in 41 years. It is more commonly referred to as swine flu and is made up of porcine, avian and human genes. Although a potentially fatal disease, the mortality rate is expected to be less than previously cognize influenza pandemics and is more likely to cause harm to young people and individuals with compromised health (CDC 2009). In decree to contain the spread of this infection, health care personnel were advised to heighten infection control measures. (Kiely et al., 2009) discussed specific infection contr ol guidelines applicable in an optometric environment. A basic measure of infection control begins with ghost handwashing. Due to the close proximity to patients throughout the eye examination, in a more extreme guideline, it was recommended that optometrists should wear personal protective equipment such as surgical masks, goggles, gowns and gloves when treating a suspected infectious individual. It was indicated that influenza A (H1N1) should be treated like any other form of influenza.1.7.4 Creutzfeldt Jacob DiseaseThe theoretical transmission of prions, regard in Creutzfeldt Jacob Disease (CJD) and variant Creutzfeldt Jacob Disease (vCJD) is an area of concern in optometric practice (Lakkis et al., 2007). These diseases are chronic neurological conditions that are incurable and invariably fatal. Reusing ophthalmic devices such as RGP trial lenses and contact tonometer heads has been place as a possible risk factor in spreading this disease from one patient to another but has been described as highly improbable (Armstrong, 2006).1.7.5 Summary of infection control in optometric practiceDue to the potential risk factors in an optometric environment, practitioners must abide by the recommended guidelines in sound out to control the spread of infection and disease. Lack of motivation and insufficient knowledge of expected protocol will lead to non-compliance among optometrists. Hence eye care personnel are advised to develop and implement a suitable infection control policy within practice (Seewoodhary and Stevens, 1999 Stevens, 2008).2.0 AimThe purpose of this survey was to construe the typical hand hygiene practice among optometrists in a primary care setting. It investigates the level of compliance among practitioners to include the type of hand products used, hand hygiene technique and the hand hygiene facilities available in various optometric environments.3. 0 Method3.1 Survey designIn order to determine the role of hand hygiene in optometric practi ce, a questionnaire was designed to gain an insight into hand hygiene product use, hand hygiene technique, facilities and general compliance among practitioners. The questionnaire was split up into three sections, All About You, Facilities and Hand Hygiene Technique. It consisted of 28 questions, the majority being mandatory to rejoinder. The format of questions was either on a yes-no basis, multiple choice, tick box and rating of answers using a scale based response. Questions were designed on the basis of external guidelines regarding hand hygiene. A detailed literature review was conducted to ascertain appropriate hand hygiene technique, hand hygiene facilities and reported barriers to hand washing. The questions from the survey are shown in the Appendix.3.2 Survey circulationThe questionnaire was launched using Bristol Online Surveys. This is a site used by over 200 UK organisations in order to develop, distribute and analyse web-based surveys. It was sent to volunteers via el ectronic mail using a webpage link.3.3 VolunteersA total of 124 individuals responded to the survey which included optometrists workings in university, hospital, multiple, franchise and free-lance optometric practice around the UK. If an individual worked in a combination of practices, they were instructed to answer questions based on the place they worked most of the time. All participants were asked to answer honestly as the survey would remain anonymous.3.3 Survey analysisResults were preserve online within the Bristol Online Surveys (BOS) site. Key features of the BOS results section included the option of statistical investigation, cross tabulation of answers, feel at individual responses and the export of data to a spreadsheet document on Microsoft Excel. The data was analysed and arranged into a variety of tables, graphs and pie charts for easier interpretation of results.4.0 Results4.1 All about youA total of 124 optometric practitioners took part in the study. An almost even distribution of gender was found totalling 61 males and 63 females, with an average age SD of 41.4 15.5.The majority of individuals who responded to the questionnaire were Cardiff University graduates totalling 26%, followed by City University, Aston University , The University of Bradford , The University of Manchester and Glasgow Caledonian. The remaining sector of individuals were grouped in the category other and included graduates from Auckland University, Bradford College, Dublin Institute of Technology, Northampton Polytechnic, Rand Afrikaans University, Southern College of Optometry, University of Durban and the University of Ulster. This is shown in Figure 4.Figure 4. University attended by each participantThe number of years qualified as an optometrist was investigated and is shown in Fig. 5. Most respondents have been qualified for 21-30 years, followed by participants who have been practicing for less than 5 years. A small minority of individuals have been qualif ied for more than 40 years.Figure 5. Years qualified as an optometristOver half of respondents work in independent practice, with a smaller proportion working in a variety of practices such as multiples, hospital based settings, a combination of practices and franchises. The minority fall into the category named other e.g. domiciliary practitioners, retired optometrists and University based optometrists who no overnight practice. This is shown in Fig. 6.Figure 6. Type of practice participants work inFigure 7. Gender related response regarding hand washing or disinfection between each patient episodeFig. 7 illustrates that more females than males wash or disinfect hands between each patient episode. 71.1% of the male and female optometrists who wash or disinfect hands between each patient episode, do so in front of the client.Table 2. Reasons for not washing or disinfecting hands between each patient episodeReasonsMale response as a %Female response as a %Busy clinic2457 inter2043U nnecessary4876Lack of facilities45Sore skin819Other1214Practitioners who do not wash or disinfect hands between each patient episode (25 males and 21 females) were asked their reasons for not doing so. More than one answer could be selected and is shown in table 2. The majority of these individuals deemed hand washing or disinfection an unnecessary practise. Twice as many females compared to males report that the busy clinic prevents such behaviour occurring, they forget or blame sore skin as reasons for not washing hand between each patient episode. Refer to Table 3 for Other responses.Table 3. Other reasons for not washing or disinfecting between each patient episodeOther responses from optometric practitionersNever been part of routineWas never stressed during University or Pre-regOnly recently became an issueWash hands for each contact lens patient, but not all refraction patientsHand wash during the appointment and not betweenFigure 8. Practitioner response as a destiny regard ing patient greeting with a handshakeFig. 8 illustrates that just under half of respondents do not greet patients with a handshake. The remaining individuals answered yes or sometimes to this form of patient contact. 39.5% of male optometrists and 44% of female optometrists who greet patients with a handshake, wash or disinfect their hands after this contact.Figure 9. Satisfaction of hand hygiene practisesThe vast majority of individuals have a high level of satisfaction with the hand hygiene practices currently employed at the practice where they work. Collectively, 8.9% of individuals are fairly unsatisfied or unsatisfied with current hand hygiene practises. Results are illustrated in Fig. 9.4.2 Practice facilities and structureThe questionnaire investigated the number of staff members in each individual practice to include optometrists, locum optometrists, dispensing opticians, optical assistants and receptionists. These results were calculated as a median agency to include the range and are shown in Table 4. The frequency of patient appointments in an average working day were investigated and appointment duration. Practice facilities were reported upon such as number of consulting rooms and number of bathrooms. Results were averaged or calculated as a median function to include the range and are illustrated in Table 5.Table 4. Number of staff members in practicePosition held(Median, range)Optometrist(1, 1-20)Locum Optometrist(0, 0-5)Dispensing Optician(1, 0-6)Optical assistant(1, 0-35)Receptionist(2, 0-8)Table 5. General practice statistics and available facilitiesAverageSD(Median, range)Number of patients seen per day per optometrist13.83.74(14, 10-25)Appointment length (in minutes)30.76.21(25, 15-60)Number of consulting rooms(2, 1-12)Number of bathrooms(1,1-5)In regard to practice facilities, greater than half of all participants are assigned to their own personal consulting room and report that the hand washing knack is separate from the toilet Three quarters of individuals said that there is at least one wash basin in each consulting room. Fig. 10 illustrates these findings.A large proportion of individuals reported that the practice they worked in did not display a poster detailing official recommendations on the hand washing and hand grinding technique. Just under half of participants were aware of the poster being displayed in practice. The minority were faint-hearted and this is shown in Fig. 11.Figure 10. Practice facilitiesFigure 11. Guidance poster detailing the advised handwashing and hand rubbing technique3.3 Hand hygiene productsFigure 12 The gender related practitioner response as a function of hand hygiene product use.A variety of hand hygiene products were listed. Participants rated how a great deal they used each product in relation to the scale provided (always, most of the time, occasionally, very rarely or never). Results were plotted as a function of gender. Fig. 12(a) illustrates that the majority of male