CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

 Hand hygiene is defined by WHO as a general term that applies to hand washing, antiseptic hand wash, antiseptic hand rub or surgical hand antisepsis. Hand hygiene is a basic requirement for the effective delivery of healthcare in the whole world. Good hand hygiene is an important measure to prevent the spread of healthcare-associated infections (Melhus 2019). Healthcare-associated infections hinder effective health healthcare delivery affecting hundreds of millions of individuals worldwide (Allegranzi et al.,2011).  The nurse have great role in performing effective hand hygiene and teaching fellow workers the routine practice of hand hygiene, in low and middle income countries, most of the nurses do not  practice good hand hygiene due to limited knowledge and skills ­( Ara et al., 2019). Knowledge, routine practices and necessary resources for hand hygiene are essential to healthcare workers as it reduces the rate of transmission of healthcare associated infections.Although hand hygiene is effective for preventing and reducing health care associated infections, low income/developing countries are the most affected, as most nurses in healthcare settings ignore these practices due to either  limited resources or retraining opportunities ( Ara 2019)

The WHO introduced “my five moments for hand hygiene “to minimize problems related to hand hygiene. These five moments that call for the use of hand hygiene include. The moment before touching a patient; Perform hand hygiene before touching a patient, before clean/ Aseptic procedure; Perform hand hygiene before a clean/ sterile procedure, after body fluid exposure risk; Wash your hands with soap and water immediately after exposure risk to body fluids, after touching a patient; Perform hand hygiene after touching a patient, after touching a patient surrounding Perform hand hygiene after touching any object or furniture in the patient’s immediate surroundings (Basurrah and Medani. 2006).

Hand hygiene is a basic key and component of patients’ safety and affects morbidity and mortality of clients in health care services. The use of alcohol-based hand rub solutions (ABHRSs) in health care settings has been associated with increased hand hygiene compliance and reduced rates of nosocomial infection

In developed countries, HAIs affects 5-15% of hospitalized patients and can affect 9-37% of those admitted in the intensive care units (WHO, 2009). An estimated 5million HAIs occur in acute care units in Europe contributing to 135000 deaths per year. An estimated number of 44,000-98,000 Americans died every year because of preventable hospital errors. Most errors were due to wound infection, which could have been prevented if physicians and other medical staff had washed their hands more frequently. Various reasons exist for why health care providers do not perform hand hygiene before and after each patient encounter. Health care providers might be pressed for time. Another reason could be due to the lack of accessibility to sinks and hand washing equipment, which make hand washing an inconvenient procedure for many providers. Perception deficit could also play a role (H.Ian Robins. 2006). Health care providers might think that they are performing hand hygiene regularly, but they are not doing it as often as they perceive themselves to be. Improper hand hygiene adherence is a worldwide problem. A study conducted on Intensive Care Units for 8 developing countries that are members of the International Nosocomial Infection Control Consortium found that compliance ranged from 20% to 70%. The overall rate of hand hygiene adherence was 50%, which was similar to the rates of developed countries in Europe and the United States. Noncompliance for hand hygiene is an important issue for both developed and developing countries. Increasing hand hygiene compliance is a costeffective method in infection control (H.Ian Robins. 2016). 

In developing countries, the risk of HAIs is 2 to 20 times higher than that of developed countries, with infection rate being higher than 15% and with over 4000 child deaths occurring everyday (WHO, 2009).  Bagheri et al (2011), wrote that HAIs problems are underestimated or even unknown largely because there is low surveillance in low income countries and interventions will require expertise and resources

 Therefore, HAI prevention and control measures should be implemented to ensure the safety of both patients and professionals (Graveto JM, et al. 2018). These measures are called standard precautions and include hand hygiene. Healthcare professionals’ hands are the most common transmission route of infectious agents causing HAIs, although transmission is complex and multifactorial (Graveto JM, et al.2018).  Health care workers` hands are the most usual type of vehicle for transmission of health care associated infections. Pathogenic organisms can stay for 2-60minutes on health care workers` hands. Nurses are a source of contamination in their nursing role which include getting patients out of bed, checking pulse rates, measuring arterial blood pressure and body temperature, performing various invasive procedures as well as dressing and feeding patients. (French and Friedman. 2003) Hand hygiene before and after performing these procedures is a cheap and applicable key component of the reduction and prevention of infections during patient care.  

Some challenges to effective hand hygiene are highly complex and multi-factorial influenced by elements at both organizational and individual levels. Organization levels include inadequate hand washing facilities and work place environment that do not value or emphasize hand hygiene practice. At the individual level, habits developed early in life and a lack of knowledge combined with misconceptions about hand hygiene during delivery of care produce barriers to appropriate hand hygiene practices (WHO 2015).

Other general reasons behind this low compliance could be lack of practicing hand hygiene as a behavior pattern by health professionals, decreased interest in practical application with increase educational status, heavy work load, lack of sufficient sinks for hand washing .in hospital, patients’ conditions, accessibility, type and effectiveness of microorganisms. Dermatological effects of hand washing agents and lack of knowledge of health care professionals regarding hand hygiene (Pittet D, et al. 2009).

1.2. STATEMENT OF THE PROBLEM

Hand hygiene being a preventive measure in the prevention of nosocomial infection still remains one of the major problems faced by health care workers. Over 8million of hospitalized patients acquire nosocomial infections worldwide due to poor hand hygiene practices by health care providers (WHO 2009). In the USA, serious nosocomial infections caused 99.000 patients deaths per year (WHO 2009). Research has shown that while health care workers state largely favorable attitude towards hand hygiene, observed compliance rate is below 30% (WHO 2009).In Europe, the estimated 5million hospital acquired infections(HAIs) that occur annually have an assumed attributable mortality of 50000-135000 at a cost of e13-e24 billion, in which hand hygiene among hospital personnel could prevent estimated 15%-30% of the HAIs (Wilcox M, et at. 2003). Hand washing alone   with soap and clean water deals away with 77% of staphylococcus aureus colonies on the finger tips. According to (Anderson, et al. 2016) states that in Cameroon, more than 1.7million of hospitalized patients are diagnosed of HAIs and approximately 80,000 die each year. Compliance with hand hygiene practices is an absolute need, and with increasing numbers in adherence with hand hygiene practices among nurses due to effective training and education programs, have made healthcare settings pay some attention to facilitate and support hand hygiene educational programs.

Daily observation of nurses in the Bamenda Regional Hospital during my internship period 8^th of April to 6^th of May 2022, the researcher found out that nurses were not practicing effective hand hygiene. Indeed a few of the nurses observed in the audit performed hand hygiene prior to clean and aseptic procedures and generally following my five moments of hand hygiene –a critical point in care for patient safety and prevention and control of HAIs. The result of this audit suggested that there is a lack of emphasis and challenges encountered on hand hygiene among nurses in the Bamenda Regional Hospital. Greater understanding of this phenomenon prompted the researcher to carry out this study investigating the practice and challenges faced by nurses in the implementation of hand hygiene during nursing care

1.3. RESEARCH QUESTIONS

• What are the practices of hand hygiene during patients care among nurses in Bamenda Regional Hospital?
• What are the barriers faced by these nurses in the effective implementation of hand hygiene in Bamenda Regional Hospital?

1.4. THE OBJECTIVE OF THE STUDY

1.4.1 General Objective:

To assess the practices and challenges faced by nurses in the implementation of hand hygiene during nursing care at the Bamenda Regional Hospital.

• Specific Objectives:

• To find out the practices of hand hygiene during patients care among nurses in Bamenda Regional Hospital.
• To identify the barriers faced by these nurses in the effective implementation of hand hygiene.