Improving Nurses Compliance with Standard Precautions OfInfection

Question: Discuss about the Improving Nurses' Compliance with Standard Precautions Of Infection? Answer: The term psychosocial refers to the effect of one's social environment on mental health. The behaviour associated with agreement on rules for infection control and prevention depends on a person's ability to understand its importance and it is affected by the social perspective of how it can ensure the safety of those associated with the procedure. Unrealistic optimism is a cognitive bias that triggers a belief in a person that they are less likely to experience an infection as compared to other individuals. Brain imaging studies of the prefrontal cortex have shown that optimism bias that prompts an individual towards negative behaviour that there exists a selective failure regarding updates and reduced neural coding of information that is undesirable about a future outcome (Sharot, 2011). Behaviour that chooses risky options are therefore more likely to occur in individuals who process information available to them in a less rational manner. The extent which an individual can control the risk of contracting or spreading an infection depends on the health locus of control. An understanding of behavioural sciences may help reduce the spread of nosocomial infections by helping health workers to adhere to regulations regarding disinfection and procedures such as hand washing. Studies show that during patient care hospital associated infections occur due to cross-contamination that occurs due to non-adherence to safe practices. A study at a hospital in Birmingham found that compliance with infection control procedures was lower among doctors than nurses(Stein, 2003). Yet another study found that Universal Precautions taken by nurses in a Hong Kong hospital were inadequate. (Chan, 2002). Shaping cognitive determinants through social, behavioural corrections can be made through evaluation of health locus of control of healthcare professionals (Pittet, 2004). 1. Before I commenced my programme of education, washing hands, disposal of waste, and disinfecting surfaces was carried out as per the awareness of a lay person that I was taught at home. And I have to admit that the extent of cleanliness that I could adhere to as a child, I seldom adhered to all the rules at all times. My usual excuse was that I was always in a hurry. Having learnt about cross contamination and the dangers that non-adherence can expose a person and to those in one's care are well understood. The spread of multidrug- resistant bacterial infections and viruses such as HIV make me adhere to the rules at all times. There is a considerable difference in my understanding of infection control and the measures required. Earlier I lived and worked in settings that posed fewer risks as compared to a hospital where the risks are much higher and so is the need to adhere to practices that minimize infection risks. A study that evaluated found that the presence of peers increased compliance with hand washing. Out of a total of 47,694 opportunities of hand washing, when health workers were alone the compliance was 20.85% which increased to 27.90% in the presence of one or more peers. (Monsalve, 2014). Only training without behavioural inputs does not improve compliance among nurses (Whitby, 2006). A review of nurses' compliance with infection control found that it was 40% across several studies (Erasmus, 2011). Minimal handling and clustering of nursing procedures showed improvement in compliance in a neo-natal intensive care facility (Lam, 2004). According to the theory of reasoned action, an individual believes that compliance with a particular behaviour will lead to favourable outcomes and, therefore, there is an increased likelihood to perform the behaviour. In an experiment, it was found that when educational intervention was made, it led to differences in nurse compliance (Creedon, 2006). Educational and training interventions improved compliance of nurses with infection control procedures (Adly, 2014). It may not always be possible for me to adhere to standard procedures for infection control. But discussing the issue with peers, performing procedures without thinking, a necessity of performing procedures get reinforced with educational inputs. When there is a lack of time, I may try to use a hand rub, depending on the condition of patient contact and the length of patient contact. A lack of time as the main reason for non-compliance with steps required for infection control among health professionals. But the fact that it can expose patients and co-workers and the health worker to risks of hospital acquired infections which may be life-threatening or increase the duration of patient's stay in hospital means that no reason for non-compliance should be acceptable. In spite of work pressures and working in a time constrained manner safety precautions cannot be given a miss during procedures. Whether it is hand washing, surface disinfection of skin or hospital surfaces maximum commitment to adherence to good practices should be the objective of every health professional. Training programmes and educational content about exposure to risks due to non-compliance should be a regularly given. Discussions about the importance of compliance amongst health workers on a regular basis promote hand disinfection. Time flies but managing a given task in the available time is important. In particular, hospitals and community health centres have an added responsibility to work in the given time because we are dealing with human lives. Any shortfall in compliance is likely to cause human suffering either to ourselves or the patients. So the excuse of not having time is unreasonable. The responsibility of not allowing cross contamination lies with the health care worker. The risk of hospital-acquired infections can jeopardize the lives of patients, colleagues and visitors to the hospital. The biomedical model of medicine continues to be the dominant model in medical sciences. It follows the classical approach or the factor-analytic approach usually employed by the scientific community in the West. (Engel, 1980); (Domenech., 2011). Training based on just the biomedical model causes the establishment of beliefs and attitudes that are likely to be less effective for the patient's treatment. But when training includes a biopsychosocial model, the beliefs and attitudes of the healthcare professionals undergo a radical change(Engel, 1980). When adopting biomedical approach the health professionals are more likely to dehumanise the patient whereas a biopsychosocial approach, helps them to treat the patient as a person and include the physical, mental and social aspects of the patient's personality. As per the biomedical approach, only the body of the patient receives treatment, and the treatment remains rather non-holistic in kind. The adherence to practices of infection con trol are much better when using the biopsychosocial approach; there is a minimum risk of cross contamination and transfer of infectious agents. The patient's treatment gets personalised, and the thoughts, wishes, preferences of the patient receive attention from the staff. The levels of social and mental suffering of the patient get addressed. Patients receive treatment from physical and physiological perspectives. According to the biomedical model the patient's economic, social and psychological concerns need to be addressed (Elliot, 2009). Training in the biopsychosocial approach to infection control makes the health professional responsible towards the patient. It becomes necessary to take responsibility for one's health and adherence to the practices that cause minimal contamination and transfer of infectious agents from one surface to another gain paramount importance. When not following standard protocols, the professional knows that the health consequences for colleagues, patients and the society will be substantial. The patient may have more knowledge about infection control and may advise the healthcare worker to follow standards of precaution or remind about hand washing protocols. The case of a psychologist who stated, I have no need to wash my hands. I do not touch my clients - this appears to be a case of unrealistic optimism where the psychologist has a bias towards a practice and refuses to wash hands due to minimal contact with the patient. What the mental health professional has chosen to ignore is that the environment of the hospital has several points of contact other than the patient from where infection could spread. Door handles, washrooms, taps, furniture surfaces, and others. The belief that the practice of not washing hands is safe and does not pose a risk to oneself, or the patient is misguided. Even if something happens, there is little chance that anyone will find out and this encourages a callous attitude. An internal locus of control and person-centred approach will prompt the doctor to practice hand hygiene and promote it among peers. Scenario 2 - A practitioner who believes they only need to use hand gel to cleanse their hands for the whole of their working period. A psychosocial approach will help such a practitioner to practice the hand washing protocol and not depend entirely on using on a hand gel for cleansing because of the need to be a role model in the presence of junior colleagues and patients. Because the patient believes that you know what is best for prevention of infection and they may even imitate your behaviour. Because hand washing is the most basic component of preventing health care-associated infections, it is important to think rationally and avoid putting patients and oneself to risk (Mathur, 2011). Some suffer from dissonance based irrational belief that they are not at risk. A biopsychosocial approach would prompt the doctor to adopt a responsible and ethical approach to hand disinfection. Inability to follow standard procedures for infection control is one of the main reasons for the spread of nosocomial infections. I have observed several occasions when health care workers fail to adhere to practices for containing the spread of infections. The reasons for non- compliance are varied and many. On most occasions the reason cited is - lack of time. On many occasions there is the belief that even if something happens no one will ever find out. What people forget is that they are not immune to many of the pathogens that they are transferring through unsafe practices. They may be exposing their family and friends to risk. There are occasions when those working with patients are themselves suffering from an infectious illness, and they may come to the work place, exposing the patients to the danger of avoidable diseases. Vaccination of nurses with influenza vaccine has been adopted s a preventive strategy (Jackowska , 2015). But the fact that many doctors are responsible role models and set a standard for the health care staff to follow. Peers also affect the behaviour of colleagues. Compliance and adherence to standard norms for infection control are better when working in a group. Regular educational interventions play a role in helping to achieve compliance with standard procedures for infection control. These interventions could be in the form of lectures, pamphlets, posters and handouts. The sense of responsibility towards oneself, family, peers, patients and colleagues can help in increasing compliance and fight the menace of hospital acquired infections. An increased awareness in health and social care settings will lead to enhanced compliance with infection control. References Adly, R.M., Amin, F.M. Aziz, M.A.A.E., 2014. Improving Nurses' Compliance with Standard Precautions ofInfection Control in Pediatric Critical Care Units. World journal of nursing sciences, Volume 3, pp. 1-9. Chan, R. , Molasiottis, A., Eunice, C., Virene, C., Becky, H., Chit-ying, L., Frances, S., Pauling, L., Ivy, Y., 2002. Nurses knowledge of and compliance with universal precautions in an acute care hospital. International journal of nursing studies, 39(2), p. 157163. Creedon, S., 2006. Infection control: behavioural issues for healthcare workers. Clinical Governance: An International Journal, 11(4), pp. 316-325. Domenech., J., 2011. Impact of biomedical and biopsychosocial training sessions on the attitudes,beliefs, and recommendations of health care providers about low back pain:A randomised clinical tria. Pain, Volume 152, pp. 2557-2563. Elliot, P., 2009. Infection Control: A Psychosocial Approach to Changing Practice. s.l.:Radcliffe Publishing. Engel, G. L., 1980. The clinical application of the biopsychosocial model. The American journal of Psychiatry, 137(5), pp. 535-544. Erasmus, V. D. T. B. H. R. J. B. M., 2011. Systematic Review of Studies on Compliance with Hand Hygiene. Infection control and hospital epidemiology, Volume 31, pp. 283-294. Jackowska T, P. K., 2015. Prevention of nosocomial infections in the pediatric ward - own experiences. Developmental period medicine, 19(2), pp. 225-34.. Lam, B. L. J. . L. Y., 2004. Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection. Paediatrics, 114(5). Mathur, P., 2011. Hand hygiene: Back to the basics of infection control. Indian Journal of Medical Research, 134(5), p. 611620.. Monsalve M.N., Pemmaraju, S.V., Thomas, G.W., Herman, T., Segre, A.M., Polgreen, E., 2014. Do peer effects improve hand hygiene adherence among healthcare workers?. Infection control and hospital epidemiology, 35(10), pp. 1277-85. Pittet, D., 2004. The Lowbury lecture: behaviour in infection control. Journal of Hospital Infection , Volume 58 , Issue 1 , 1 - 13, 58(1), pp. 1-13. Sharot, T., Korn, C.W. Dolan, R.J., 2011. Unrealistic optimism is cognitive bias that triggers a belief in a person that they are less likely to experience an infection as compared to other individuals.. Nature Neuroscience, Volume 14, p. 14751479. Stein, A.D., Makarawo, T.P. . Ahmed, M.F.R., 2003. A survey of doctors' and nurses' knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals. Journal of hospital infection, 54(1), p. 6873. Whitby, M. M., McLaws, M.-. L. . Ross, M.W., 2006. Why Healthcare Workers Dont Wash Their Hands:A Behavioral Explanation. infection control and hospital epidemiology, 27(5), pp. 484-492.