INTRODUCTION:

Hand hygiene is a significant practice for health care providers and is considered as leading measure to reduce the incidence of health care related infections. According to centre for disease control and prevention (CDC) “Hand washing for hand hygiene is act of cleaning the hands with or without the use of water or another liquid, or with the use of soap, for the purpose of removing soil, dirt, and/or microorganisms[1].” Although hand washing is very simple and basic nursing procedure, compliance with hand hygiene among health care workers is as low as 40% [2-4]. To overcome this problem continuous efforts are being made to identify effective and sustainable strategies.

Thus, WHO has prescribed hand washing guidelines for the moment before touching a patient, before performing aseptic procedures, after being at risk of exposure to body fluids, after touching patient surroundings [5]. Many studies have shown that bacteria that cause hospital-acquired infections are most frequently spread from one patient to another through hands of healthcare workers the centers for diseases control and prevention (CDC) estimates that approximately 90,000 of patients die because of result of hospital acquired infections every year [1]. Nurses are considered as ‘nucleus of the health care system’ as they comprise a great share of health care workers and they spend maximum time with patients [6]. Thus, compliance of staff nurses with hand washing guidelines seems to be crucial to prevent the cross contamination among hospitalized patients. Therefore, the present study was conducted to explore about the compliance of staff nurses for hand hygiene practices before and after medication administration as an important measure to avoid transmission of harmful germs and prevention of hospital acquired infections.

STATEMENT OF THE PROBLEM:

A descriptive study to assess the hand hygiene practices among staff nurses during drug administration at selected tertiary hospital of Ludhiana, Punjab.

OBJECTIVES OF THE STUDY:

1 To assess the provision of facilities available for hand hygiene among staff nurses.

2 To assess the hand hygiene practices during medication administration among staff nurses.

MATERIAL AND METHODS:

This descriptive study was conducted in all the inpatient wards of selected tertiary hospital of Ludhiana with the aim to assess the compliance and hand hygiene practices among staff nurses while administering medication. Ethical permission was obtained from the institutional ethical review committee. A convenience sampling technique was used to enroll the staff nurses. A total of 200 staff nurses were selected as sample size. Brief information was given about the purpose of the study and consent was taken from subjects before data collection. The participatory observation was done to assess hand washing practices during routine work. Data was collected using the following tools. Tool no 1 was socio demographic details of staff nurses, Tool no. 2. was a performa to assess the availability of hand washing facilities, Tool no. 3 was self structured checklist to assess the hand hygiene practices of staff nurses. Tools were validated by experts in the field of nursing. Baseline data was collected with the help of interview schedule for socio demographic data. Descriptive statistics and inferential statistics were used for analysis of data in SPSS 16 version.

Table 1: percentage distribution of subjects according to socio-demographic characteristics N=200

Demographic variables	f	Percentage
1. Age (in years)
20-30	132	66.00
30-40	53	26.50
40-50	14	07.00
50-60	01	00.50
2. Gender
Male	04	02.00
Female	196	98.00
3. Qualification
GNM	147	73.50
B.Sc. (N)	49	24.50
Post Basic B.Sc. (N)	04	02.00
4. Total work experience (in years)
<1	35	17.50
1-5	73	36.50
5-10	34	17.00
>10	58	29.00
5. In service education
Yes	188	94.00
No	12	06.00

RESULTS:

Socio-demographic characteristics of staff nurses:

As shown in Table 1, among 200 staff nurses 66% were in age group of 20-30 years and majority (98%) of them were females. As per their qualification, most of staff nurses at around 73% possess GNM diploma and 36.5% had experience between 1 to 5 years, followed by 29% who had experience more than 10 years. Further, 94% had attended the in-service education programme related to hand hygiene.

Availability of hand washing facilities

As per availability of hand washing facilities among 200 staff nurses (Table 2), 97% had access to wash basin, out of which 61% had one wash basin in their ward whereas 30% staff nurses working in critical care units had easy access to wash basin with one in between two beds while 6% of staff nurses had one wash basin in each cabin of the ward. Whereas, only 3% staff nurses had no availability of wash basins in their ward. Further, 54.5% had provision of elbow operated taps, around 44% used hand operated ones and about 97.5% nurses had working water taps. Soap was available to 91.5% of staff nurses. Almost 74% of staff nurses had provision of hand drying agents, out of which 54% had access to drying provision in clean condition, 20% had access to dirty drying provisions. Thus majority of them had access for basic amenities required for hand washing.

Table 2: Percentage distribution of available hand washing facilities among staff nurses (N=200)

Available Facilities	f	Percentage
1. Availability of wash basins
Not available in ward	006	03.00
One in each cabin	012	06.00
Only one in ward	122	61.00
One in between two beds	060	30.00
2.Type of tap available
Hand operated	089	44.50
Elbow operated	109	54.50
auto-operated tap	002	01.00
3.Working status of tap
Working	195	97.50
Not working	005	02.50
4.Availability of soap stand
Yes	183	91.50
No	017	08.5
5.Soap available at wash basin
Yes	183	92.00
No	017	08.50
6.Availability of drying provision
Yes	147	73.50
No	053	26.50
7.Condition of drying provision
Clean	108	54.00
Dirty	040	20.00
Out of stock	052	26.00

Findings regarding hand washing practices:

Figure 1 reveals performance of hand washing by staff nurses during medication administration. It was observed that only 7.5% had performed hand washing both before and after the administration of medication whereas 27.5% done only before medication and 53.5% after the procedure. While, 11.5% staff nurses had not washed their hand during drug administration. Hence, hand washing practices was found to be significantly low among staff nurses. There was no statistical relationship of hand hygiene practices with socio-demographic variables and available facilities.

DISCUSSION:

The most important factor in preventing the cross infection in hospital is performance of hand hygiene among health care workers. So the present study was conducted to assess the hand hygiene practices during medication administration. Present study revealed that only 7.5% staff nurses performed hand washing both before and after medication and the findings were supported by Khaled M. et.al. (2008), who reported that adherence to hand washing was only 11.6% among health care workers[7]. Moreover, hand washing practices were regardless of facilities available to them as 97% of nurses were having accessibility to all the basic amenities of hand washing. Thus, the present study has shown the significant light on hand hygiene practices among staff nurses. It was found that hand hygiene practices were deficit and need an immediate acknowledgement for its improvement through in-service education and inculcation as a habit in daily routine.

REFERENCES:

1. Centers for disease control and prevention. Guidelines for hand hygiene in health care settings. Morbidity and mortality weekly report. 2002. Vol. 51 / No. RR-16. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf

2. Y. Longtin, H. Sax, B. Allegranzi, F. Schneider, and D. Pittet. Videos in clinical medicine. Hand hygiene. The New England Journal of Medicine.;364;2011: article e24.

3. J. Tibballs. Teaching hospital medical staff to hand wash. Medical Journal of Australia. 164(7);1996: 395–398.

4. D. Pittet, S. Hugonnet, S. Harbarth et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene, The Lancet: 356(9238):2000. 1307–1312.

5. WHO. Hand Hygiene: Why, How & When-brochure. Revised in august 2009. Available at: http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

6. Abu AlRub R. Nursing shortage in Jordan: what is the solution?. Journal of Professional Nursing 2007; 23(2):117-120.

7. Abd Elaziz KM, Bakr IM. Assessment of knowledge, attitude and practice of hand washing among health care workers in Ain Shams University hospitals in Cairo. J Prev Med Hyg. 50(1); 2009:19-25.

Received on 16.11.2014 Modified on 02.12.2014

Asian J. Nur. Edu. and Research 5(2): April-June 2015; Page199-201

DOI: 10.5958/2349-2996.2015.00040.3