In by healthcare workers such as checking

 In healthcare, good hygiene is important as itprevents many diseases and infections (Malliarou, 2017). The issue of handhygiene is important because approximately 10 percent of patients admittedworldwide will acquire healthcare associated infection (HAI) while in hospital(Jowitt et al., 2016). Healthcareworker’s hand are the primary medium for the transmission of pathogens frompatient to patient in healthcare facilities. The skin of patients may becolonized with pathogens, and when they shed this skin, it covers the surfacesof their environment (Allegranzi & Pittet.

, 2009).  The transmission of pathogens usually occurswhen a health worker touches a patient’s environment. Despite no direct contactbetween the healthcare worker and the patient, transmission still occurs(Allegranzi & Pittet.

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, 2009). In many health facilities, workers weargloves to prevent HAI, but this is ineffective due to their improper use byhealth care workers and the fact that microorganisms can survive for severalminutes which is sufficient for an individual to contaminate a large area(Pronovost, 2015 A lot of resources are devoted to maintaininghigh levels of hygiene in healthcare facilities. However, hand hygiene isusually overlooked despite its role in the spread of diseases (Mathur, 2011).Poor hand hygiene in a health facility exposes patients, visitors and healthworkers and their families to diseases and infections. Simple tasks performedby healthcare workers such as checking the temperature of patients and changingtheir gowns can expose both the patient and the healthcare worker to harmfulmicroorganisms (Shabot et al.

, 2016). Toensure good hand hygiene, it is essentialfor healthcare workers to scrub their hands vigorously using soap and water toensure all microorganisms are destroyed (Widmer, 2013).The scope of the problem ofhygiene in healthcare can be analysed by looking at HAI that patients sufferfrom when undergoing treatment in healthcare facilities (Al-Tawfiqa &Tambyahc, 2014). In England there are approximately 100 000 cases of HAI whichresult in close to 5000 deaths annually (World Health Organization, 2007). HAIcosts the National Health Service approximately 1 billion pounds a year and inthe United States, there are 2 million cases of HAI annually at the cost ofapproximately 5 billion dollars.

Also, 90 000 deaths are as a result of HAI (Fox et al., 2015).  Evidence from studies shows that poor handhygiene is the primary cause of HAI and to reduce infections and increasepatient safety health facilities will have to encourage and maintain hand hygiene(World Health Organization, 2007). The introduction ofalcohol-based hand sanitizers has had a positive impact as it has allowedhealthcare staff to frequently and conveniently sanitize their hands. Despitethe introduction of alcohol-based hand sanitizers adherence to hand hygienestandards remain as low as forty percent and this includes large well-resourcedfacilities (Longtin et al.

, 2011). Inmany health facilities around the world understaffing is a major problem andplaces a heavy workload and pressure on existing staff, leaving them littletime to focus on maintaining required hand hygiene standards (Ellingson et al., 2014). In some healthfacilities, sinks are placed in inconvenient locations which results in theirlimited use (Kendall et al., 2016). Also,cultural issues play a part in hand hygiene standards such as the case ofMuslims who shun the use of alcohol-based hand sanitizers as alcohol is tabooin their religion (Van de Mortel et al.

,2017).Management or senior staff in health facilities play a vital role in handhygiene as they must be role models and must set an example to other staffmembers otherwise they will pay little attention to hygiene rules andguidelines. Health facilities have workers from differentprofessions such as nurses, physiotherapists, radiographers, sonographer anddoctors and this has a direct impact on the level of hand hygiene of eachworker (Allegranzi & Pittet, 2009). This implies that individuals fromdifferent professions are trained differently with each profession placing adifferent emphasis on the importance of hand hygiene (Allegranzi & Pittet, 2009).The area in a health facility that individual works also influences their levelof hand hygiene (Allegranzi & Pittet, 2009). Health workers who work in theintensive care unit and surgery rooms demonstrate  high levels of hand hygiene due to the policiesplaced by their units because of the sensitive condition of patients in theseareas (Allegranzi & Pittet, 2009).

However, this approach is not entirely successfulas HAI still occurs as health workers from less hygienic parts of the facilityvisit these areas. For instance, sonographers usually go to the intensivetherapy units to perform bedside scans. As a result, it is essential for healthfacilities to ensure that all departments are subject to the same highstandards of hygiene.  An important aspect of handhygiene is the attitude and perceptions of healthcare workers towards thisissue. A research conducted on the perception of healthcare workers in Malaysiaraised the importance of this issue (Birkset al.

, 2011). The research indicated that despite extensive training andefforts by healthcare facilities to highlight the importance of hygiene to itsworkers, their perception of the importance of hygiene determined their levelof hand hygiene (Birks et al., 2011). Itis impossible to monitor every health worker at a health facility so toovercome this issue it is important for staff to be highly motivated andreceive mentorship from senior staff members to ensure they continue learningand developing professionally. The attitude of health workers plays a role in theirlevel of hygiene in a healthcare facility (Dreidiet al.

, 2016). A health worker with bad attitudes often careless when it comesto their duties and is more likely not to maintain the required levels ofhygiene (Dreidi et al., 2016).

The causeof negative attitudes of healthcare workers is mainly due to displeasure causedby their working environments such as long working hours or an unreasonableworkload. Negative attitudes can be prevented by management and senior staffmembers communicating with workers to gain knowledge of the challenges theyface and to find solutions to this challenge. Health facilities have fewprivate rooms for patients and open ward designs, and semi-private rooms makereducing HAI and improving hygiene difficult (Stichler 2013). Poor hand hygienecan be prevented through tools and methods such as automated observation,volume-based observation and direct observations (Ellingson et al. 2014).

However, throughout the world, there are nonational standards, rules or laws for hand hygiene in health facilities. Agovernment program that includes measurement and feedback from patients will bean effective method improving the national level hand hygiene (Bhat et al. 2015).

 .The caseA patient complained throughPatient Advised and Liaison Service (PALS) of the trust about her experience inthe ultrasound department. She was experiencing post-menopausal bleeding andwas referred to the ultrasound department by her general practitioner (GP). Priorto the scan the sonographer informed her that the scan would be performed both trans-abdominallyand trans-vaginally to evaluate the lining of the uterus and the ovaries in greaterdetail.

She gave her consent to the procedures. However, according to thepatient, the sonographer did not carry out hand hygiene before performing thetransvaginal scan. While she could not challenge this at the time of the scan,this made her uncomfortable throughout the scan which resulted in her loss ofconfidence in the sonographer and the system at large. She also mentioned shehad both trans-abdominal and transvaginal scans in the past in this trust andother trusts during which the sonographers observed all the necessary hygienein each of the scans and wondered why things had changed. She was concernedthat health service users would potentially be exposed to infection if theinfection control policy of the trust is not adhered to by the staff.

Thedepartment however, has not been able to verify if the information in thiscomplaint is entirely true.  DiscussionAcritical evaluation of the case will require an in-depth analysis of theprocedures and methodology used by the sonographer. The patient was sufferingpost-menopausal bleeding and determining the cause the sonographer decided toperform both trans-abdominally and transvaginal scan as recommended bydepartmental and BMUS guidelines.

The complainant did not mention if thesonographer observed hand hygiene before the initial trans-abdominal scan. Themajor issue in this case arises from the lack of hand hygiene before thetransvaginal scan. Understandably, with transvaginal ultrasonography, there is higherpossibility of cross-contamination involving microorganisms which increases therisk of disease or infection to the patient (Buescheret al., 2016). So it is not surprising that the patient was more concernedabout the hand hygiene prior to the transvaginal scan.  To prevent the spread of disease andinfection in a medical facility, it is essential for medical staff to wash andcover themselves and to use sterilized or disinfected equipment (Allegranzi& Pittet, 2009).

The sonographer may have displayed negligence and adisregard for the safety of the patient by providing the least amount ofprotection or safety. In this case, hand sanitization was vital as thesonographer could have easily transferred bacteria or a virus to the outerlayer of the gloves which would have come into direct contact with the patient.The vagina is a sensitive organ which is extremely susceptible to diseases andinfection, and the sonographer should have taken extra care when performing atransvaginal scan. The low hygiene standards expose the sonographer to the riskof disease and infection which can quickly spread throughout the healthfacility as the sonographer is exposed to sick individuals with weak immunesystems (Mathur, 2011).

The event had negativepsychological and emotional impact on the patient. The patient was alreadysuffering from post-menopausal bleeding which is a serious condition which puther in distress. She gave her consent and placed her trust in the sonographerbecause the sonographer was a professional who was assisting her. During thetransvaginal scan, the patient experienced psychological distress as she wasput in a helpless position while being exposed to a procedure that waspotentially harmful to her. As a result, the patient lost trust in the medicalfacility and the safety of medical procedures.

The fact that she had knowledgeof trans-abdominally and transvaginal scans as she had undergone the proceduresin the past will make restoring her faith difficult. The long-term impact ofthe case on the patient is that she may be unwilling to give her consent tomedical procedures in the future and may seek less effective methods oftreatment and put her health at risk. The case will also make other women whouse the medical facility less willing to give their consent to gynaecologicalscans especially transvaginal scans out of the fear that they may be exposed tothe risk of disease and infection. The community that the health facilityserves will be less willing to use its services as the low levels of hygieneand patient are highly discouraging.Recommendationsfor PracticeAfter analyzing theliterature that is related to the case, I learned that poor hand hygiene has asignificant impact on patient care. Also, I learned that health careprofessionals could pose a threat to the health patients by not upholding highhygiene standards.

The case I presented exposes the psychological impact thelack of hand hygiene can have on a patient and their attitude towardshealthcare. A recommendation I can use from my literature review that can putinto practice is the use of tools and methods that can be used to monitor handhygiene adherence in a health facility. An effective method that can be useduniversally is direct observation where healthcare workers are monitored toensure they maintain the required hygiene standards (Ellingson et al., 2014). Automated monitoring of hand hygieneinvolves devices that record the use of hand hygiene dispensers by staffmembers and their movements, especially when entering a patient’s room (Polgreen et al.

, 2010). As such, this system iseffective for large healthcare facilities where active monitoring of healthcarestaff would be difficult (Polgreen et al.,2010). An additional method of monitoring and measuring hand hygiene adherenceis volume-based measurement which involves measuring the amount of soap or handsanitizer used by a health facility as hand hygiene is an accurate measure ofthe level of hygiene in a health facility (Jeanes,  2003).

The use of video recording to analyzehand hygiene in a facility is a highly effective and cost friendly method (Reynier et al., 2016). The use of thesemonitoring and evaluation methods could have easily prevented the issue of poorhand hygiene presented in my case.

It could have as well verified if what thepatient said was entirely true.A recommendation I havederived from the analysis of the literature review relating to my case is theuse of the five rules of hand hygiene which were created by the World HealthOrganization (Landers et al., 2012). The rulesof hand hygiene state that before and after a healthcare worker touches apatient, they must sanitize their hands (World Health Organization, 2018).

Whena healthcare worker wants to clean a patient or change their clothes they mustsanitize their hands (World Health Organization, 2018). Upon exposure to thebody fluids of a patient, a healthcare worker must sanitize their hands.Lastly, when the health worker touches the surroundings of a patient they mustsanitize their hands (World Health Organization, 2018). The rules of handhygiene have proven an effective strategy in promoting hand hygiene inhealthcare facilities especially in third world countries with healthcarefacilities that have limited resource.

Another recommendation thatis vital to the case will be to introduce and practice patient empowerment as atool for hand hygiene. The empowerment of patients involves giving them aplatform and encouraging them to speak out when healthcare workers do notsanitize their hands (Lastinger et al.,2017). As such, this would have prevented the exposure of the patient in mycase to the risk of disease and infection.Also it is highlyrecommendable for sinks which are meant for hand-washing be situated very closeto the entrance of procedure room to enable the sonographer and otherhealthcare workers easily access these sinks.  ConclusionEvidently, good hygiene isimportant as it prevents many diseases and infections.

Evidence from studiesshows that poor hand hygiene is the primary cause of HAI and to reduceinfections and increase patient safety health facilities will have to promoteand improve hand hygiene. Alcohol-based hand sanitizers has allowed healthcarestaff to frequently and conveniently sanitize their hands but despite itsintroduction adherence to hand hygiene standards remain as low as forty percenteven well-resourced facilities. A major issue with the case arises from thepoor hand hygiene before the transvaginal scan. Preventing the spread ofdisease and infection in a medical facility is important and is essential formedical staff to wash and cover themselves and to sterilize or disinfectequipment.

The sonographer displayed negligence and a disregard for the safetyof the patient by providing the least amount of protection or safety. In thiscase, carrying out hand hygiene was vital as the sonographer could have easilytransferred bacteria or a virus to the outer layer of the gloves which wouldhave come into direct contact with the patient. Microorganisms can survive for severalminutes, and in this case, the patient could have easily contracted a sexuallytransmitted disease due to the negligence of the sonographer as the vagina is asensitive organ which is extremely susceptible to diseases and infection.The event had negativepsychological and emotional impact on the patient who was suffering from theserious condition and was put in a helpless position while being exposed to aprocedure that was potentially harmful to her health. The lasting impact of thecase on the patient is that she may be unwilling to give her consent to medicalprocedures in the future and may seek less effective methods of treatment. Thecase will also make other women who use the medical facility less willing togive their consent to trans-abdominally and transvaginal scans out of the fearthat they may pose a risk to their health.

To improve hand hygiene in thehealthcare field, it is essential to introduce measures such as monitoring handhygiene adherence and the rules of hand hygiene presented by the World HealthOrganization


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