Having had two recent placements on an elderly medicine and a surgical ward I quickly learned the importance of good hand hygiene. These placements required me to become competent in hand hygiene as on both wards I would come into contact with wound dressings and the prevention of infections spreading. Being included in daily wound dressings I was able to pick up the skill of hand washing fairly quickly.
Hand washing is a crucial factor in the prevention of controlling infection. Therefore it is vital that it is carried out correctly, however it can quite often be overlooked and not put into practice when it should be. On both of these placements I had decided with my mentors that a main focus of my experience on the wards would be to understand the importance of infection control, and how hand washing effectively would improve the care I provided. Before my placements I had basic knowledge of hand washing however I didn’t feel that it was to the extent that I needed.
This caused me to put time into learning from my mentors and also looking at guidelines and policies to gain a good understanding of infection control. I feel that from the many skills I have learnt from practice, hand washing would be the skill that I feel I have improved upon the most, therefore I feel that it would be appropriate to discuss how I have become competent in this particular skill. Hand washing essentially reduces the risk of microbial contamination. This then minimises the risk of infections being passed onto patients, clients, staff and visitors. Department Of Health, 2006) In order for microbes to cause any infection, they must gain an entrance into the body. Different organisms have different ways of entering the body, one of the most likely routes is from the hands; therefore it is crucial that the hands are always washed effectively. (Health Protection Agency, 2007) Hands must be decontaminated immediately before each episode of care or treatment that the nurse provides for the patient or client. This allows for the minimal risk of any spread of infection from one patient to another.
Hands should also be decontaminated after any care that is given as there will be a likely chance of the hands becoming contaminated or visually soiled. Microbes may be present in any body fluids, if the hands come into contact with any bodily fluids they may then be transferred from one patient to another. If the hands have become visibly soiled with dirt or any organic material, they should always be thoroughly washed with liquid soap and tepid water. The hand wash solution must come into contact with every surface of the hand.
The hands must be vigorously rubbed together for at least fifteen seconds in order for it to be effective. Some areas of the hands can often be missed; therefore special attention should always be paid to the tips of the fingers, the thumbs and the area between the fingers. (National Institute for Clinical Excellence, 2003) The wrists are also often missed when decontaminating the hands, this can be dealt with by ensuring that each wrist is washed by rubbing in circles with the opposite hand and then dried thoroughly with a dry paper towel. Health Protection Agency, 2007)
The World Health Organization (2006) suggests that there are five key times where hand decontamination is crucial. These five moments are, before and after patient contact, before any aseptic technique, after any exposure to bodily fluids and after coming into contact with a patient’s surroundings. Washing hands at these specific times will prevent any infection being spread from one patient to another. Washing hands before an aseptic procedure is vital.
If there were a wound dressing being performed hands would need to be washed as a precaution to reduce the risk of any microbes entering the wound. Decontaminating the hands will also promote healing of the wound. If hands are visibly clean, aqueous antiseptic solutions or alcohol hand gels may be used. Alcohol hand gels are designed to inactivate microorganisms or temporarily suppress their growth. (World Health Organization, 2009) Alcohol hand gels are particularly useful in certain situations where hand washing may not be convenient.
When using an alcohol based hand rub, the hands should be rubbed together for at least fifteen seconds, or until the solution has completely evaporated. However, if hands do appear to be soiled soap and water should always be used. Also if the patient that the nurse is providing care for has vomiting or diarrhoea the hands need to be washed with a liquid soap and warm running water. (Department of Health, 2006) Certain patients or clients will be more susceptible to infection, for example very young or older patients will be at a greater risk.
This is due to their immune system either not having been fully developed, or becoming less effective with older age. Therefore once they have contracted the infection it becomes a lot harder for the immune system to overcome and defeat. (Health protection agency, 2007) Before decontamination of the hands begins, all wrist jewellery and ideally hand jewellery if possible should be removed. This is necessary as microbes that could be potentially harmful to a patient or client can often harbour under or within the jewellery after hand washing, therefore the risk of infection is still fairly possible.
National Institute for Clinical Excellence, 2003) Any cuts or abrasions to the hands must be covered using a waterproof dressing. This will help to prevent any transient micro organisms harbouring within any wounds. Nails must be kept short as this is also a potential area for transient micro organisms to settle. (Department of Health, 2003) As hand washing is such a crucial skill to have a, I decided I would need to use several types of reflective learning in order to achieve the necessary level of knowledge to become competent.
One of the techniques which I found to be most effective and suited my learning needs was role modelling. Role modelling is a process which allows students to learn and experience new situations without having to enforce a trial and error approach, as they have guidance from a mentor. (Bandura, 1977) Working alongside a mentor and other staff allowed me to more comfortable in certain clinical tasks, such as hand washing. It allowed me to observe how to effectively decontaminate my hands and when were the appropriate times to do so.
Also my mentor would observe any circumstances in which I was required to wash my hands, and would then give me any appropriate feedback or comments which she though could improve my technique. An example of this was after providing care to one of the patient’s on the ward my mentor observed that as I was decontaminating my hands I applied the soap before running my hands under water, which can potentially be harmful to the skin. I found this type of reflective learning to be very useful, as the observer can pick up on mistakes that I may have commonly overlooked.
Once these points had been brought to my attention I found it easier to remember to do them correctly, which will enhance the level of my skill. Jarvis and Gibson (1997) believe that all learning comes from experience, and that working in a professional environment is therefore the most effective learning experience that can be provided for students. Effective mentors acknowledge these concepts and provide learning opportunities for their students whilst in the clinical setting. Patricia Benner (1984) believes that there are five main stages to learning. These stages range from novice up to expert.
I would place myself at the novice stage so far in my training. This is the stage where the student has no experience in the tasks and experiences that they are expected to perform. Due to this they tend to rely on observing others in order to learn key skills that are needed. I would place myself at the novice stage as I had no previous knowledge of the hand washing technique prior to my training; therefore I relied on my mentors to gain most of my knowledge base. Another form of learning that has helped me to become competent in hand washing, has been the knowledge base and technique learnt whilst in university.
Most of the knowledge base that I used in order to enhance the standard of my skill came from lectures and practical lessons in university. The practical lessons were particularly helpful, as it gave me the chance to try the skill for myself before working in the clinical setting. In one of these practical sessions I was given the chance to use a hand lotion called wash and glow. This is applied to the hands before they are washed; after the hands have been thoroughly washed they are placed under a UV light.
This UV light will show where any of the hand lotion has been left on the hands. National Health Service (2008) I found this particularly useful as it highlighted the places that I had missed when washing which alerted me that I needed to pay particular attention to these areas when decontaminating my hands whilst in practice. Whilst in practice I was asked to participate in completing a hand washing audit. I found this helpful in becoming competent in hand decontamination. From completing the audit I was able to identify for myself the key times when hand washing was necessary.
I was also able to judge how long hands tend to be washed for in practice in order for them to be appropriately clean. I also used research of hand decontamination to find out how long was recommended for hands to be washed. From this research I found that ten to fifteen seconds was an adequate time to wash hands in for them to be sociably clean. (National Institute for Clinical Excellence, 2003) All of these learning experiences and reflection allowed me to enhance my knowledge base and understanding of the reasons for effective hand decontamination. The use of reflection played a large role in building upon the skill.
This was because it gave me the opportunity to address any areas where I was not performing the skill to the necessary requirement. I could then pick out these errors and correct them with the help of my mentors and from literature learned both in and outside of university. From the literature I have looked at and the information that I received whilst in the clinical setting I have become to understand the importance of hand decontamination. What is often viewed as a simple skill is one of the most important factors in reducing the rates of infections in a care environment.