CHAPTER ONE INTRODUCTION
“There is a huge missed opportunity for health care professionals to contribute to hand hygiene as they miss 1 in 2 of all hand cleaning opportunities.” --WHO, 2006
“What kills women with childbed fever is you doctors who carry deadly microbes from sick women to healthy ones!”—Louis Pasteur, 1870
1 . 1. Background of the Study 1.1.1. Nosocomial infection burden Nosocomial infections or healthcare acquired infections can truly be a grave toll for hospital management as much as it is for end-beneficiaries, customers, and stakeholders. Mortality reaches 80,000 annually ; 3 patients die per minute ; 10-20% % incidence globally, and figures are expectedly higher in Third World settings. This is not to mention the corollary problem of emerging microorganisms resistant to overuse of prophylactic and anticipatory shotgun antibiotic therapy as empirical solution. The damage wrought is paramount, reaching a cost of one billion pounds per year in Europe alone, resulting from these.1 excluding priceless, needless mortalities and morbidities
1.1.2. Role of Hand Hygiene Institute of Medicine has identified nosocomial Infection to be the most common complication for hospital patients and hands are the most common mode of transmission. In 1991, Harvard Practice Study on adverse events in health care indicated that surgical site infections were the second most frequent type of adverse event for inpatients, constituting 13%. One study
established an excess mortality caused by NI to as high as 44% in ICU patients.2 In a local study at Makati Medical Center by Tupasi & Littaua, mortality rate was reported to be all NI cases documented 4.6 % of
in the intensive care unit , and authors conclude that risk factors
included invasive and manipulative procedures. “Majority of deaths from NI were associated with the use of respiratory equipment and Foley catheters which were potentially preventable by strict adherence to aseptic techniques”. 3
1.1.3 Reality of Poor Compliance Despite it being a seemingly simple practice, and despite the acknowledged fact that proper hand hygiene is considered the most critical, the most cost-effective measure of adequate infection program, compliance behavior management has been a protracted managerial headache globally. Indeed in our age of ever increasing sophistication, those seemingly simple practices but with grave implications ironically are difficult to address. While the techniques involved in hand hygiene are simple, the complex interdependence of factors that determine hand hygiene behavior makes the study and management of hand hygiene complex.
1.1.4. Hand Hygiene Compliance : A Managerial Challenge It is now recognized that improving compliance with hand hygiene recommendations depends on altering human behavior and managing the environment. Input from behavioral and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social need4 Speaking for all levels of health care workers , probably the major reason this seemingly simple problem is always taken for granted is the reality that the impact of something not so visible daily to the naked eye will always be swept under the rug amidst more outright demands concerns in patient care. The rest of the justifications like forgetfulness, lack of time, inconvenience, complications, etc. are simply alibis. Given this, the greater burden falls on health care managers to do something so that compliance can be improved, and for health sector in general to come up with more evidence-based materials to convince HCW as well as policy-makers and managers about its importance.
1.1.5 Nosocomial Infection & Patient Safety Nosocomial infection control is a large part of patient safety, whose importance is currently being...