In a health facility exposes patients, visitors and health

 In healthcare, good hygiene is important as it
prevents many diseases and infections (Malliarou, 2017). The issue of hand
hygiene is important because approximately 10 percent of patients admitted
worldwide will acquire healthcare associated infection (HAI) while in hospital
(Jowitt et al., 2016). Healthcare
worker’s hand are the primary medium for the transmission of pathogens from
patient to patient in healthcare facilities. The skin of patients may be
colonized with pathogens, and when they shed this skin, it covers the surfaces
of their environment (Allegranzi & Pittet., 2009).  The transmission of pathogens usually occurs
when a health worker touches a patient’s environment. Despite no direct contact
between the healthcare worker and the patient, transmission still occurs
(Allegranzi & Pittet., 2009). In many health facilities, workers wear
gloves to prevent HAI, but this is ineffective due to their improper use by
health care workers and the fact that microorganisms can survive for several
minutes which is sufficient for an individual to contaminate a large area
(Pronovost, 2015 A lot of resources are devoted to maintaining
high levels of hygiene in healthcare facilities. However, hand hygiene is
usually overlooked despite its role in the spread of diseases (Mathur, 2011).
Poor hand hygiene in a health facility exposes patients, visitors and health
workers and their families to diseases and infections. Simple tasks performed
by healthcare workers such as checking the temperature of patients and changing
their gowns can expose both the patient and the healthcare worker to harmful
microorganisms (Shabot et al., 2016). To
ensure good hand hygiene, it is essential
for healthcare workers to scrub their hands vigorously using soap and water to
ensure all microorganisms are destroyed (Widmer, 2013).The scope of the problem of
hygiene in healthcare can be analysed by looking at HAI that patients suffer
from when undergoing treatment in healthcare facilities (Al-Tawfiqa &
Tambyahc, 2014). In England there are approximately 100 000 cases of HAI which
result in close to 5000 deaths annually (World Health Organization, 2007). HAI
costs the National Health Service approximately 1 billion pounds a year and in
the United States, there are 2 million cases of HAI annually at the cost of
approximately 5 billion dollars. Also, 90 000 deaths are as a result of HAI (Fox et al., 2015).  Evidence from studies shows that poor hand
hygiene is the primary cause of HAI and to reduce infections and increase
patient safety health facilities will have to encourage and maintain hand hygiene
(World Health Organization, 2007). The introduction of
alcohol-based hand sanitizers has had a positive impact as it has allowed
healthcare staff to frequently and conveniently sanitize their hands. Despite
the introduction of alcohol-based hand sanitizers adherence to hand hygiene
standards remain as low as forty percent and this includes large well-resourced
facilities (Longtin et al., 2011). In
many health facilities around the world understaffing is a major problem and
places a heavy workload and pressure on existing staff, leaving them little
time to focus on maintaining required hand hygiene standards (Ellingson et al., 2014). In some health
facilities, sinks are placed in inconvenient locations which results in their
limited use (Kendall et al., 2016). Also,
cultural issues play a part in hand hygiene standards such as the case of
Muslims who shun the use of alcohol-based hand sanitizers as alcohol is taboo
in their religion (Van de Mortel et al.,2017).
Management or senior staff in health facilities play a vital role in hand
hygiene as they must be role models and must set an example to other staff
members otherwise they will pay little attention to hygiene rules and
guidelines. Health facilities have workers from different
professions such as nurses, physiotherapists, radiographers, sonographer and
doctors and this has a direct impact on the level of hand hygiene of each
worker (Allegranzi & Pittet, 2009). This implies that individuals from
different professions are trained differently with each profession placing a
different emphasis on the importance of hand hygiene (Allegranzi & Pittet, 2009).
The area in a health facility that individual works also influences their level
of hand hygiene (Allegranzi & Pittet, 2009). Health workers who work in the
intensive care unit and surgery rooms demonstrate  high levels of hand hygiene due to the policies
placed by their units because of the sensitive condition of patients in these
areas (Allegranzi & Pittet, 2009). However, this approach is not entirely successful
as HAI still occurs as health workers from less hygienic parts of the facility
visit these areas. For instance, sonographers usually go to the intensive
therapy units to perform bedside scans. As a result, it is essential for health
facilities to ensure that all departments are subject to the same high
standards of hygiene.  An important aspect of hand
hygiene is the attitude and perceptions of healthcare workers towards this
issue. A research conducted on the perception of healthcare workers in Malaysia
raised the importance of this issue (Birks
et al., 2011). The research indicated that despite extensive training and
efforts by healthcare facilities to highlight the importance of hygiene to its
workers, their perception of the importance of hygiene determined their level
of hand hygiene (Birks et al., 2011). It
is impossible to monitor every health worker at a health facility so to
overcome this issue it is important for staff to be highly motivated and
receive mentorship from senior staff members to ensure they continue learning
and developing professionally. The attitude of health workers plays a role in their
level of hygiene in a healthcare facility (Dreidi
et al., 2016). A health worker with bad attitudes often careless when it comes
to their duties and is more likely not to maintain the required levels of
hygiene (Dreidi et al., 2016). The cause
of negative attitudes of healthcare workers is mainly due to displeasure caused
by their working environments such as long working hours or an unreasonable
workload. Negative attitudes can be prevented by management and senior staff
members communicating with workers to gain knowledge of the challenges they
face and to find solutions to this challenge. Health facilities have few
private rooms for patients and open ward designs, and semi-private rooms make
reducing HAI and improving hygiene difficult (Stichler 2013). Poor hand hygiene
can 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 no
national standards, rules or laws for hand hygiene in health facilities. A
government program that includes measurement and feedback from patients will be
an effective method improving the national level hand hygiene (Bhat et al. 2015). .The caseA patient complained through
Patient Advised and Liaison Service (PALS) of the trust about her experience in
the ultrasound department. She was experiencing post-menopausal bleeding and
was referred to the ultrasound department by her general practitioner (GP). Prior
to the scan the sonographer informed her that the scan would be performed both trans-abdominally
and trans-vaginally to evaluate the lining of the uterus and the ovaries in greater
detail. She gave her consent to the procedures. However, according to the
patient, the sonographer did not carry out hand hygiene before performing the
transvaginal 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 of
confidence in the sonographer and the system at large. She also mentioned she
had both trans-abdominal and transvaginal scans in the past in this trust and
other trusts during which the sonographers observed all the necessary hygiene
in each of the scans and wondered why things had changed. She was concerned
that health service users would potentially be exposed to infection if the
infection control policy of the trust is not adhered to by the staff. The
department however, has not been able to verify if the information in this
complaint is entirely true.  DiscussionA
critical evaluation of the case will require an in-depth analysis of the
procedures and methodology used by the sonographer. The patient was suffering
post-menopausal bleeding and determining the cause the sonographer decided to
perform both trans-abdominally and transvaginal scan as recommended by
departmental and BMUS guidelines. The complainant did not mention if the
sonographer observed hand hygiene before the initial trans-abdominal scan. The
major issue in this case arises from the lack of hand hygiene before the
transvaginal scan. Understandably, with transvaginal ultrasonography, there is higher
possibility of cross-contamination involving microorganisms which increases the
risk of disease or infection to the patient (Buescher
et al., 2016). So it is not surprising that the patient was more concerned
about the hand hygiene prior to the transvaginal scan.  To prevent the spread of disease and
infection in a medical facility, it is essential for medical staff to wash and
cover themselves and to use sterilized or disinfected equipment (Allegranzi
& Pittet, 2009). The sonographer may have displayed negligence and a
disregard for the safety of the patient by providing the least amount of
protection or safety. In this case, hand sanitization was vital as the
sonographer could have easily transferred bacteria or a virus to the outer
layer 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 and
infection, and the sonographer should have taken extra care when performing a
transvaginal scan. The low hygiene standards expose the sonographer to the risk
of disease and infection which can quickly spread throughout the health
facility as the sonographer is exposed to sick individuals with weak immune
systems (Mathur, 2011).The event had negative
psychological and emotional impact on the patient. The patient was already
suffering from post-menopausal bleeding which is a serious condition which put
her in distress. She gave her consent and placed her trust in the sonographer
because the sonographer was a professional who was assisting her. During the
transvaginal scan, the patient experienced psychological distress as she was
put in a helpless position while being exposed to a procedure that was
potentially harmful to her. As a result, the patient lost trust in the medical
facility and the safety of medical procedures. The fact that she had knowledge
of trans-abdominally and transvaginal scans as she had undergone the procedures
in the past will make restoring her faith difficult. The long-term impact of
the case on the patient is that she may be unwilling to give her consent to
medical procedures in the future and may seek less effective methods of
treatment and put her health at risk. The case will also make other women who
use the medical facility less willing to give their consent to gynaecological
scans especially transvaginal scans out of the fear that they may be exposed to
the risk of disease and infection. The community that the health facility
serves will be less willing to use its services as the low levels of hygiene
and patient are highly discouraging.Recommendations
for PracticeAfter analyzing the
literature that is related to the case, I learned that poor hand hygiene has a
significant impact on patient care. Also, I learned that health care
professionals could pose a threat to the health patients by not upholding high
hygiene standards. The case I presented exposes the psychological impact the
lack of hand hygiene can have on a patient and their attitude towards
healthcare. A recommendation I can use from my literature review that can put
into practice is the use of tools and methods that can be used to monitor hand
hygiene adherence in a health facility. An effective method that can be used
universally is direct observation where healthcare workers are monitored to
ensure they maintain the required hygiene standards (Ellingson et al., 2014). Automated monitoring of hand hygiene
involves devices that record the use of hand hygiene dispensers by staff
members and their movements, especially when entering a patient’s room (Polgreen et al., 2010). As such, this system is
effective for large healthcare facilities where active monitoring of healthcare
staff would be difficult (Polgreen et al.,
2010). An additional method of monitoring and measuring hand hygiene adherence
is volume-based measurement which involves measuring the amount of soap or hand
sanitizer used by a health facility as hand hygiene is an accurate measure of
the level of hygiene in a health facility (Jeanes,  2003). The use of video recording to analyze
hand hygiene in a facility is a highly effective and cost friendly method (Reynier et al., 2016). The use of these
monitoring and evaluation methods could have easily prevented the issue of poor
hand hygiene presented in my case. It could have as well verified if what the
patient said was entirely true.A recommendation I have
derived from the analysis of the literature review relating to my case is the
use of the five rules of hand hygiene which were created by the World Health
Organization (Landers et al., 2012). The rules
of hand hygiene state that before and after a healthcare worker touches a
patient, they must sanitize their hands (World Health Organization, 2018). When
a healthcare worker wants to clean a patient or change their clothes they must
sanitize their hands (World Health Organization, 2018). Upon exposure to the
body fluids of a patient, a healthcare worker must sanitize their hands.
Lastly, when the health worker touches the surroundings of a patient they must
sanitize their hands (World Health Organization, 2018). The rules of hand
hygiene have proven an effective strategy in promoting hand hygiene in
healthcare facilities especially in third world countries with healthcare
facilities that have limited resource.Another recommendation that
is vital to the case will be to introduce and practice patient empowerment as a
tool for hand hygiene. The empowerment of patients involves giving them a
platform and encouraging them to speak out when healthcare workers do not
sanitize their hands (Lastinger et al.,
2017). As such, this would have prevented the exposure of the patient in my
case to the risk of disease and infection.Also it is highly
recommendable for sinks which are meant for hand-washing be situated very close
to the entrance of procedure room to enable the sonographer and other
healthcare workers easily access these sinks.  ConclusionEvidently, good hygiene is
important as it prevents many diseases and infections. Evidence from studies
shows that poor hand hygiene is the primary cause of HAI and to reduce
infections and increase patient safety health facilities will have to promote
and improve hand hygiene. Alcohol-based hand sanitizers has allowed healthcare
staff to frequently and conveniently sanitize their hands but despite its
introduction adherence to hand hygiene standards remain as low as forty percent
even well-resourced facilities. A major issue with the case arises from the
poor hand hygiene before the transvaginal scan. Preventing the spread of
disease and infection in a medical facility is important and is essential for
medical staff to wash and cover themselves and to sterilize or disinfect
equipment. The sonographer displayed negligence and a disregard for the safety
of the patient by providing the least amount of protection or safety. In this
case, carrying out hand hygiene was vital as the sonographer could have easily
transferred bacteria or a virus to the outer layer of the gloves which would
have come into direct contact with the patient. Microorganisms can survive for several
minutes, and in this case, the patient could have easily contracted a sexually
transmitted disease due to the negligence of the sonographer as the vagina is a
sensitive organ which is extremely susceptible to diseases and infection.

The event had negative
psychological and emotional impact on the patient who was suffering from the
serious condition and was put in a helpless position while being exposed to a
procedure that was potentially harmful to her health. The lasting impact of the
case on the patient is that she may be unwilling to give her consent to medical
procedures in the future and may seek less effective methods of treatment. The
case will also make other women who use the medical facility less willing to
give their consent to trans-abdominally and transvaginal scans out of the fear
that they may pose a risk to their health. To improve hand hygiene in the
healthcare field, it is essential to introduce measures such as monitoring hand
hygiene adherence and the rules of hand hygiene presented by the World Health
Organization

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