Knowledge and Skills Hand Hygiene Reflective Essay
This is a reflective essay based on personal experience of hand washing and hand hygiene practices in clinical practice. It focuses on the most recent policy and guidelines from the National Health Service (NHS) England and NHS Improvement which will be discussed in more detail below. Reflective practice is commonly used by nurses and other healthcare practitioners as a learning and development strategy since it facilitates the reviewing of one’s skills, perspectives and actions in order to determine strengths and weaknesses requiring improvement (Miraglia and Asselin, 2015).
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This work will use Rolfe et al’s reflective model (Rolfe et al., 2001). In the first section of this reflection (What?), details of my personal experience with regards to hand washing practices will be provided. The next section (So What?) will be a discussion of my actions and the consideration of current evidence. The third section (Now What?) will address the implications of this experience for my future practice. Finally, this essay will end with a conclusion that summarises the key points of this work.
As a nurse in training, I had a discussion with my mentor on the NHS’s recently published policy and guidelines for standard infection control precautions (Royal College of Nursing (RCN), 2019; WHO, 2009). I explained to my mentor that to wash my hands correctly, I started with making sure I was bare below the elbow. I would then wet my hands under running water before applying enough soap from the soap dispenser, which is normally placed on the wall in front. I then cover my hands with the soap and start to decontaminate the back of my hand, making sure to rub the palm of one hand over the back of my other hand, with fingers over- laced, repeating the process on my other hand. Next I decontaminate the interdigital space, which is heavily contaminated and often missed. I do this by interlacing my fingers and rubbing them together. Afterwards, I interlock my fingers on the opposing palm and rub them together again. I do this to decontaminate the back of my fingers. Following these steps, I rotate my right hand around my left thumb and repeat the sequence. It is also important to decontaminate the fingertips and nails of both hands. I do this by rubbing my fingertips of my left hand in the palm of my right-hand and repeating with my other hand. Rotating my right hand around your left wrist and then repeating on the other side. When washing your hands rinse them thoroughly under running water, making sure to wash away all the soap. Some wash basins have a hand moisturiser pump to use, as residual soap can dry skin out. To finish off my hand washing, I then close the tap off using my elbow to prevent my hands from getting contaminated. Finally, I dry my hands with a paper towel and discard it in the provided bin (WHO, 2009).
In a clinical setting, five specific moments are important for when you need to carry out hand hygiene. The NHS England and NHS Improvement (2019) recommend the washing of hands before performing hand hygiene using alcohol-based hand rubs and this should be done before touching a patient, before performing aseptic procedures, after body fluid exposure, after touching a patient, and after touching the immediate surroundings of the patient (NHS England & NHS Improvement, 2019). Furthermore, hand washing should be done before and after using gloves (NHS England & NHS Improvement, 2019).
My mentor explained to me that my hand hygiene practices deviated greatly from current recommendations and the NHS’s policy which emphasises the performing of good hand washing with special care taken to clean the fingertips, thumb and between the fingers. This forms the basis for hand hygiene while alcohol rubs should not be used for hand hygiene when exposure to norovirus is suspected or proven. In this instance hand hygiene should be performed using nonantimicrobial liquid soap and water. Unless carrying out a clean or aseptic procedure, where use of antimicrobial liquid soap is indicated (NHS England and NHS Improvement, 2019).
On reflection, I understand that it is far more important to use good hand washing techniques to stop the spread of infection, than just using gloves and alcohol rub alone. Furthermore, I will always make sure to not use the gloves and alcohol rub provided as a means to replace good hand washing and hygiene practices with the aim of protecting myself from the perceived threat of infection due to contact with patients. This would be classified as an emotional reason for glove use (Loveday et al., 2014) since there is no clear evidence to suggest I would be at risk of contracting an infection from the patients, especially if I practiced a good hand washing technique. However, most hospital-acquired infections occur via direct contact between healthcare professionals and patients (World Health Organisation [WHO], 2009) and this is due to poor compliance among healthcare professionals with hand hygiene guidelines, especially hand washing (RCN, 2019; WHO, 2009).
If good hand washing practise is not used then this could increase the risk of transmitting micro-organisms between patients, myself and other staff (Wilson and Loveday, 2014). These hospital-acquired infections are often due to antibiotic resistant microorganisms and they are thought to affect about 300,000 persons yearly (National Centre for Health and Care Excellence [NICE], 2017) and cause an estimated 9,000 deaths (NHS England, 2011).
After reading the new NHS policy again with my mentor, it became clear to me that gloves and alcohol rub are classed as Personal Protective Equipment (PPE) to be used in addition to good hand washing practices in cases when there could be a possible exposure to blood and/or other body fluids, not-intact skin or mucous membranes (NHS England & NHS Improvement, 2019). This highlights the fact that good hand washing is effective for routine use during interactions with patients.
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Moreover, it is the responsibility of the nurses and other healthcare professionals alike, to make sure they adequately wash their hands to protect themselves and others around them from infections around the hospital. If someone is not doing this correctly, it would be good practise for me to demonstrate the correct way to them. Education is key to good hand hygiene and this is why posters are on the hospital walls near the wash basins. Behaviour is influenced by knowledge, belief systems and the circumstances of the situation. Healthcare professionals see themselves positioned differently within the environment depending on the context of the risk; they can either be at risk or be the cause of the risk (Jackson and Griffiths, 2014).
The SCIPs (Standard Infection Control Precautions) are comprised of ten elements and the new policy addresses two of these elements: hand hygiene and PPE. However, good hand hygiene which is based on an effective hand washing technique is seen as the basis for preventing hospital-acquired infections (WHO, 2009).
This experience has taught me just how important adequate hand hygiene practise is within the clinical setting. It can make a big difference to vulnerable patients and even their families during their stay. I have realised just how easy it is to pass infections on from person to person in the hospital, if proper hand washing techniques are not performed correctly. As a student nurse it is my responsibility to ensure that other students and healthcare professionals are doing everything we can to prevent infections. Referring to section 19 of the NMC code: “Be aware of, and reduce as far as possible, any potential for harm associated with your practice” (NMC, 2015). I will carry on this knowledge and experience onto my next placement and report any bad practise I may come across. The patient is the main focus of care and it is my duty to promote good and safe practise within the healthcare setting. Furthermore, I will ensure that I first locate the nearest basin and wash my hands according to the guidelines every time before and after I attend to a patient (RCN, 2019). In addition, I will use alcohol rubs each time after washing my hand in compliance with the NHS guidelines and policy (NHS England and NHS Improvement, 2019).
In conclusion, this reflective essay has helped me analyse a personal experience with regards to hand washing and hand hygiene practices. I understand that knowledge is key for good practise and educating other healthcare professionals and service users is paramount for a safer hospital environment. Furthermore, if bad practise is witnessed, this should be reported to the nurse in charge. Nurses are responsible for their own safety and for the safety of their patients. Potentially allowing infection to be spread through bad hand hygiene would be bad practise. Techniques of hand washing and hand hygiene practices should be studied regularly, according the recent guidelines and policy of the NHS.
- Jackson C, Griffiths P (2014) Dirt and disgust as key drivers in nurses’ infection control behaviours: an interpretative, qualitative study. Journal of Hospital Infection 87, 71-76.
- Kersh A, Helms S, de la Feld A (2018) Glove-related allergic contact dermatitis. Dermatitis 29(1), 13 – 21.
- Loveday HP, Lynam S, Singleton J, Wilson J (2014) Clinical glove use: healthcare workers actions and perceptions. Journal of Hospital Infection 86, 110-116.
- Miraglia R, Asselin ME (2015) Reflection as an educational strategy in nursing professional development: an integrative review. Journal of Nurses Professional Development 31(2), 62 – 72.
- National Institute for Health and Care Excellence (NICE) (2017) Antimicrobial stewardship: changing risk-related behaviours in the general population. www.nice.org.uk/guidance/ng63. Accessed 13/07/2019.
- NHS England (2011) English national point of prevalence survey on healthcare-associated infections and antimicrobial use, 2011: preliminary data. https://www.google.co.uk/url?sa=t&rct=j&q=&eloading="lazy" src=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjRne6e97LjAhUsUBUIHbHYCIAQFjAAegQIAhAB&url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fpublications%2Fhealthcare-associated-infections-hcai-point-prevalence-survey-england&usg=AOvVaw1FWTXyb_HHlX2AW9ovzPcA. Accessed 13/07/2019.
- NHS England & NHS Improvement (2019) Standard infection control precautions: national hand hygiene and personal protective equipment policy. file:///C:/Users/folak/OneDrive/Documents/Academic%20Knowledge/Brief%20500520/NHS%20England%20&%20NHS%20Improvement%202019.pdf. Accessed 13/07/2019.
- Nursing and Midwifery Council (NMC) (2015) Section 19. “Be aware of, and reduce as far as possible, any potential for harm associated with your practice”. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf. Accessed 12/07/2019
- Rolfe, G., Freshwater, D., Jasper, M. (2001). Critical reflection in nursing and the helping professions: a user’s guide. Basingstoke: Palgrave Macmillan.
- Royal College of Nursing (RCN) (2019) Hand Hygiene. https://rcni.com/hosted-content/rcn/first-steps/hand-hygiene. Accessed 22/07/2019.
- World Health Organisation (WHO) (2009) WHO guidelines on hand hygiene in health care (First global patient safety challenge clean care is safer care. https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf;jsessionid=8203576018C8507BBC252E79F0099C7E?sequence=1. Accessed 13/07/2019.
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