Alcohol Based Hand Sanitizers Vs Hand Washing

Introduction

Hand hygiene has been emphasized upon realizing that most of nosocomial infections were transmitted through soiled hands. Therefore, to keep the hands clean, various modalities were put in place to ensure effective cleaning and maintaining germs free hands. The hands may be carriers of bugs that can cause infection in other patients in the process of providing care. Some of the bugs include bacteria and viruses. To prevent the cross transfer, there has been increased use of both hand washing with soap and water and the use of hand sanitizers as the major means for cleaning hands. The paper provides recommendations on the best method of keeping hands clean and gives a comparison of alcohol hands sanitizers and hand washing with soap and water. The information on effectiveness of the two methods will be taken from the literature (Turner, Fuls, & Rodgers, 2010).

Literature review

Traditionally, hand washing with soap and water was the routine way of keeping hands clean. The reason of mitigating cross infection in the wards, still remains the driving force towards hand washing. According to (Bloomfield, Aiello, Cookson, O’Boyle, & Larson, 2007), the advent of alcohol-based hand sanitizers, has seen hand washing  as the method of controlling infections reduce among health care providers. Following the announcement made by the center of disease control in the 2002 to utilize hand sanitizers, most facilities shifted to the use of alcohol hand sanitizers. The center for disease control advocated for their use so as to prevent cross infection. Observations had been made that continuous washing of hands was the limiting factor to ensuring a cross infection free environment in the hospitals. It became to be the limiting factor because of the tedious procedures involved in it. Thus, hand sanitizers are more preferred for the fact that they are easy to use more so when handling patients in the ward or in an outpatient clinic (Petty, 2009). Hand sanitizers will save more time that could be spent doing the hand washing which needs more minutes to eliminate the bugs.

Despite the fact that alcohol content of the sanitizers is 60 percent, the studies conducted on effectiveness of hand sanitizers show that some bugs are removed with the alcohol (Ejemot-Nwadiaro, Ehiri, Meremikwu, & Critchley, 2012). Among the bugs are the C. difficill and the novovirus. They, therefore, require more thorough hand washing with soap and water. For example, the C. difficill is quite dangerous since it colonizes the gut in the large intestines. Therefore, there should be much more attention given to hand disinfection for it is the most common way of cross infection.

Undoubtedly, hand washing is vital in provision of health care and welfare of the general population at large. Microorganisms are found in and on any object in the world around, therefore, disinfection of hands is the primary means of maintaining health especially in into a highly contaminated area. The issue of hand washing can be promoted with the support from the stakeholders in health care provision institutions. Among the key stakeholders are the management of the institutions and health care providers. In case of any change in the institution policy in line with hand washing, both stakeholders are crucial in ensuring the change is applied. The increased use of hand sanitizers, presupposes increased harboring of microorganisms found on the hands, hence, ability to transfer them to the next client is high. That is for a fact that sanitizers have been proven inactive on novovirus and the C. difficill. Hence, to keep the cross infection rate low, nursing practice should be changed from the immediate use of hand sanitizers to embracing traditional methods of hand washing with soap and water. However, hand washing should be coupled with the use of hand sanitizers containing about 60 percent alcohol.

Activities to Achieve the Intended Change

Change in utilization of hand washing with soap and water is inevitable. Hence, there is a need to employ plans and strategies in order to have the society and namely, healthcare workers, follow the recommendations. Therefore, people have to be convinced that there is a need to utilize the evidence-based practice. With that as a guide, the nurses have to embrace developed modalities of change for the fact that they are drawn from the experiences of other nurses. However, to attain commitment of the nurses, six steps defining the quality of the work done are to be implemented (Allende, Selma, López-Gálvez, Villaescusa, & Gil, 2008).

Step 1: Assess Needs for Change

Hand washing has been the single most utilized way of deterring nosocomial infections. Therefore, compromising the whole process of infection prevention by improper hand washing will pose a challenge to health care providers and may lead to an outbreak of communicable diseases. According to numerous studies on the issue, hand sanitizers are not one hundred percent effective. Some microorganisms that like bacteria and viruses have proven resistant to this mode of infection prevention. Among these are C. difficile leading the pack and novovirus. The only sure way of clearing the two microorganisms is by use of soap and water.

Step 2: Link the Problem, Interventions and Outcomes

In the recent past proper hand washing has been shown as one of the biggest strides to infection prevention in hospitals or when rendering patient care at the premises of the patient (Raze & Matthews, 2011). Therefore, to curb the poor practice in hand washing, there should be guidelines on the patient’s walls to ensure that each nurse follows the steps necessary for comprehensive hand washing. With that put in place, there are likely more improved practices in hand washing and eventual drop in the number of nosocomial infections reported in health care facilities. Nurses should look beyond convenience when using hand sanitizers and focus on the effect to the patient in cases disinfection process is not up to standards.

Step 3: Synthesize the Best Evidence

According to Patnayak, Prasad, Malik, Ramakrishnan and Goyal (2008), efficacy in hand washing is directly proportional to the patient outcome. However, there is a difference in sensitivity to microorganisms on either of the methods used in hand washing. Use of alcohol hand sanitizers has seen the continued growth of some microorganisms including novovirus and C. difficile bacteria. Therefore, there is an obvious need to utilize the most effective methods of prevention.

Step 4: Design Practice Change

To maintain proper hand washing and utilization of the sanitizers, various aspects need to consider. Firstly, it is of the essence to find out the reason for poor utilization of facilities in place for hand washing. After assessment of the hindering factors, it will be easy to develop a clear plan on the way to deal with the issue. To prevent cross infection from the fact that health workers are deficient of knowledge, hospital management will have to organize relevant training and provide the guidelines in each ward. By so doing, the nurses will always be reminded to do a proper hand washing. Their activities will be self driven on the fact that they have the knowledge on the importance of the above procedure.

Step 5: Implement and Evaluate the Change in Practice

After implementation of the program, which includes conducting seminars on the same and providing guidelines, it is important for the management to find out the effect of modalities and the view of health care providers. The evaluation process will involve determination on reduction in cross infection. At the same time, there are routine evaluations done on daily basis so as to ascertain that health care providers are practicing the set standards of hand hygiene. At the same time, care providers should keep record of reduction of the initial costs of managing the actual cases from the one used in infection prevention (Petty, 2009). The parameter for the effectiveness of the change, are the changes in the morbidity and mortality rate. To determine the effect on the above parameter, the clinical epidemiologist is important in providing the information on the causative agents of a disease and the mortality. The health records in the hospital are funder mental in determining this.

Step 6: Integrate and Maintain the Change in Practice

Maintenance of the acquired practice is one of the very important areas of focus by the management. People will tend to go back to the routine and hence pull back the steps made forwards in the implementation phase. keeping in mind that to keep the level of cross infection low, there is a need to maintain the changes that were made on this issue (Montville, Chen, & Schaffner, 2002), will go a long way in maintaining the acquired practices. Therefore, it will be important to have guidelines and reminder in the workplaces by placing stickers on the walls so as to always remind the workers. And eventually, there will be a routine in the way people operate. Therefore, all the stakeholders have to be kept as part of the program with continuous education on the process and the essence of it. There should be a routine check on the level of implementations of the set strategies as well.

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Summary

For quite some time now, the use of hands sanitizers has taken over the routine traditional hand washing. Therefore, increasing the risk of cross infection in the wards. Ideally, the hand sanitizers are not there to replace the traditional hand washing but synergies the efforts put in