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Improving Hand-Hygiene Practices among Health-Care-Workers in Endoscopy Suite

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Improving  Hand-Hygiene Practices among Health-Care-Workers in Endoscopy Suite

Presenter: Shamsa Hadi

Students, Aga Khan University School of Nursing & Midwifery, Pakistan


Endoscopy Suite is an area where different invasive procedures are performed. Considering the risk of nosocomial infections, the issue of ineffective Hand-Hygiene Practices (HHPs) amongst Health Care Workers (HCWs) was prioritized. It was observed that despite having knowledge about hand-hygiene, HCWs did not comply with it frequently. Despite of the facilities of basins and hand sanitizers, HCWs were changing gloves without washing their hands. Moreover, resort to hand sanitizers were preferred than hand washing after various procedures. Even if hand-washing was practiced, it was performed without following correct steps of hand-washing. It was also observed that patient-care-attendants were taking sample bottles to laboratory with bare hands and ignored washing their hands. AKUH Joint Commission International Patient Safety Goal 5 Hand-Hygiene Guidelines (Policy#PolB1.1-B, 2014) affirms that hand-hygiene is the cost effective way of preventing the transmission of infection, therefore, it should be considered as an integral part of patient care.


To improve the Hand-Hygiene Practices among Health Care Workers.


Unstructured interviews were conducted from nurses, technicians, patient-care-attendants and doctors for their HHPs using 5W-1H questions working in morning and evening shifts in Endoscopy Suite, AKUH in March and April, 2015.


For root cause analysis, fish bone diagram was used to identify the possible causes of this problem. The most important cause identified was lack of time due to workload. Additionally, few HCWs especially housekeeping staff and patient-care-attendants demonstrated lack of knowledge in performance of proper hand washing technique. It was a common perception that hand sanitizers work almost equivalent to hand washing and therefore, the use of hand sanitizer after procedure and removal of gloves was enough to practice. It was assumed that if gloves are worn during procedure, then hands are clean and do not require hand washing. It was also perceived that hand sanitizers create skin irritation and dryness thereby should be least used. It was presumed that hand washing was essential only for in-patient visits not for out-patient consultations. Furthermore, there was no staff or patient education material e.g. Q-cards or pamphlets that could sensitize HCWs to comply with hand-hygiene on ongoing basis.


The principle of Problem-Solving Process was used to resolve this issue. By using this process, the possible solutions were brainstormed and literature was reviewed. The action plan was developed on the multimodal-interventional strategy that includes educational reinforcement sessions, verbal and visual reminders by display of hand-hygiene flyers in every room, over hand-washing basins, screen savers on computer desktops and pocket-sized reminder cards.


The project contributed towards improving HHPs in Endoscopy Suite with shared responsibility of management and HCWs.


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