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Leading education for nursing staff about hand hygiene in Saudi Arabia Essay Example

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Introduction part:

Hand hygiene involves interventions and amalgamations of interventions aimed at decontamination of hands so as to reduce healthcare related infections and also inhibit microbial resistance [ CITATION ElS15 l 1033 ]. Healthcare related infection is a significant cause of mortality and morbidity and hand hygiene is an effective preventive mechanism. HAIs also has significant economic consequences and leads to prolonged hospital stays.

In 1843, Oliver Wendell Holmes discovered that clinicians were involved in the spread of puerperal sepsis. Indeed, recent studies have proved that without proper hand hygiene, medical staff are responsible for cross infections within the hspital [ CITATION Haa07 l 1033 ].
Various studies investigating compliance with hand hygiene in hospitals have shown that hand hygiene compliance in hospital settings rarely goes past 50%[ CITATION Buk11 l 1033 ]. With such behaviours from medical personnel, patients in health care facilities are put at risk of acquiring infections that they never had at the time of admission. Most of the infections acquired within hospital environments are actually spread through direct contact, particularly through the hands of medical workers[ CITATION Gou11 l 1033 ]. Hand hygiene, such as decontaminating the hands after handling patients, has been shown as critical in reducing healthcare related infections.

The aim of this education leading of education is to increase nurses’ awareness on the importance of consistent hand hygiene in their places of work.

Driving forces part:


8.2% of inpatients in England acquire healthcare related infections. About 5000 of those infected die annually, and the country spends about £930 million yearly on related expenses [ CITATION Gou11 l 1033 ].

In the united states, 5% of patients, which is about two million cases, acquire infections through a similar means, resulting to more than 100,000 deaths and costing the country 4.5 billion USD per year (Gould, Moralejo, Drey, & Chudleigh, 2011).

In Canada, the story is no different. More than 220,000 people acquire healthcare related infections yearly, resulting in an annual death toll of around 8,000 (Gould, Moralejo, Drey, & Chudleigh, 2011)

National (In Saudi Arabia)

8.5% of infections in Saudi Arabia result from nosocomial infections[ CITATION AlM11 l 1033 ]. This is quite much higher than the rates in other developed countries.

Rate of medical personnel noncompliance with hand hygiene policy in Saudi Arabia stands at 49.7% while the world average is 60%. This indicates a high rate of noncompliance even if it is below the world average[ CITATION AlM11 l 1033 ]. This correlates with the findings of Bukhari, et al. (2011), which found the compliance rate to the 50.3%.

There is low level of awareness on the importance of hand hygiene among healthcare workers in Saudi Arabia[ CITATION Mah13 l 1033 ]. A majority of healthcare workers do not observe hand hygiene even when conducting operations.

Primary research part:


This part is about methods of gathering data base online so write them as points in the poster .

in this part please write about 100 words in the speech notes

PESTLE part:


The leaders are changed frequently and this influences hand washing policy implementation because some leaders may not give it priority in the institution.

Saudi Arabia’s government and other high-ranking institutions support policies that aim at improving infection control in the hospitals (Mahfouz, et al. 2014). This helps in the provision of water, antiseptics and other equipment needed in the hospitals.


Handwashing campaigns receive financial support from financial institutions and the government that enable the hospitals to fully implement the policy (Mahfouz, et al. 2014).

Hand hygiene will prevent more infections from arising which will help to reduce the patient’s medical bills.

Most nurses are influenced by the behaviour of their seniors and they also show negative behaviour towards hand washing policy implementation (Al Zahrani, et al. 2014). For example, when the supervisors do not follow hand hygiene policy requirements or direct the same to subordinates, then there is likely to be non-complacency in practice. Some nurses lack knowledge of IPC policy that they can use to reduce the number of infections (Buhkari, et al. 2011).


Various technologies can be used to reduce the number of infections; for example, hospitals can adopt electronic hand washing practices (Cheng, et al. 2011). The automated faucet system sense motion so that one just needs to place hands and the it dispense water and soap. This ensures that no touching of the parts that could also lead to spread of infections. The use of automated hand washing systems should be interchanged with the use of direct observation so that the best results can be determined (Cheng, et al. 2011).

Policies and guidelines that direct health practitioners on proper hand hygiene are available in Saudi Arabia (Gulf Cooperation, 2012). They must comply with the WHO Five Moments policy guidelines, which states that hands should be cleaned before and after handling patients, aseptic procedures, after being exposure body fluid, and after touching patient’s surroundings. This ensures that infection is controlled at all the five points. Compliance lessons should be offered to all the nurses and those who fail to comply should be punished (Erasmus, et al. 2010).


Environmental safety is one of the key pillars of health; if the hospital environment is not clean, then infections can easily spread through hand. Lack of proper hand hygiene among health practitioners leads to new infections, which prolongs patients stay at the hospitals (Al-Mendalawi and Buhkari, 2011). The health care environment can be protected from harmful germs from the patient by following the WHO Five Moments hygiene guidelines (WHO, 2006).

SWOT part:


Hospitals have well trained health professionals who understand the need for hand safety and infection control. Hospitals also receive financial support from the government which enables them to have all the required cleaning areas. The programme can tap on these resources and implement system change, training, evaluation and feedback, constant reminders as well as develop an institutional safety climate.


Most nurses lack knowledge of Infection Prevention Control policy; hence, the do not see the need for implementation. Nurses are also influenced by their senior’s hand hygiene practices. Lack of infections control education among health practitioners is a cause of non-compliance in Saudi Arabia (Bukhari, et al. 2011). This is a challenge for the program because they might not see its value to their health safety needs.


There are various health causes that can be introduced to the hospital staff to ensure hand hygiene compliance in the hospitals (Malfouz, 2014). Their compliance will influence their peers thus, leading to a reduction in new infections. There are hospitals that have high compliance rates in Saudi Arabia and other hospitals can learn from them on how they improved their compliance rates.

There may be lack of follow up and monitoring from the supervisory government agencies. This leaves the hospitals on their own to implement and ensure that hand hygiene policy is followed. This is a threat because without supervision, hospitals may not have the internal structures for monitoring.

Nine dimensions’ part:

Inspiring shared purpose

Leaders should inspire individuals doing different work to keep their values and principles even when they are under pressure. They should be ready to take personal risks for the benefit of all. Taking the lead in hand hygiene will, therefore, inspire other team members to come on board. The success of the process will be determined by willingness of the participants.

Leading with care

A good leader should understand the emotions that affect the team and care for them so that they can be able to focus their energy on providing better services for the patients. This will help create an understanding of the hindrances healthcare providers face in implementing hand hygiene and help alleviate them. Assessment will be done on how open members are to discuss the hindrances they have faced in the past.

Connecting our service

Leaders should understand how things are done in different organisations and understand the implications of different goals, structures, and cultures so that they can make links, share risks and collaborate. By borrowing from organisations that have implemented hand hygiene effectively, I would be possible to identify and avert any challenges. I will access myself based on the ability of the staff to adopt the recommended hand hygiene actions.

Sharing the vision

Leaders should convey the message of what everyone is working towards in a clear, honest and consistent way. They should be able to describe the future changes in a manner that inspire hope and reassures the patients and the staff. As such, the staff should not feel as if they are being coerced into practicing hand hygiene, but be made to understand and appreciate the importance of the process. Assessment will be done to determine if the staff have understood the importance of the program.

Teaching and learning strategies part:

Promote Awareness
on the importance of hand hygiene among healthcare workers. This strategy relates to the cognitive domain of Bloom’s theory because it involves the acquisition, comprehension, and application of knowledge. Educational materials such as posters, and interactive training programmes (e.g. Q&A sessions and Buzz sessions where all participants contribute their thoughts and ideas) will be implemented to provide healthcare workers with information regarding the importance of maintaining hand hygiene, when hand hygiene is important, and methods of promoting skin care e.g. the use of hand lotions after washing hands.

Promote awareness on policy and guidelines on hand hygiene. This requires the recall of previous learned information; hence, remembering is required as stated in the Cognitive Domain Bloom’s theory. There is a disconnect between healthcare workers and policy guidelines on personal hygiene in a healthcare setting. Posters containing key sections of the policy guidelines will be placed at strategic locations within the hospital. Target areas include doors and notice boards.

Train healthcare workers on proper use of alcohol-based hand sanitizer. This relates to behaviourism theory because participants will choose continue using hand sanitisers based on the results. If people’s skin reacts to the sanitiser, then they will withdraw from using the hand wash, which will negatively affect hand hygiene. However, if they realise that the sanitiser is safe on hands, they will be stimulated to use it more in the future, which will promote better hand hygiene. This is the premise of behaviourism theory: people first test the process and wait for the results to determine whether they will continue its use. For effective cleansing and decontamination of hands, proper procedure must be followed. This procedure involves first removing all physical dirt on the hands because the sanitiser only removes germs. A small amount of the sanitiser is then applied on the palm and rubbed gently to cover all the surfaces of the hand, including the fingers. Demonstrative videos will be used to train the staff on the required guidelines, how to apply the sanitizer, how long, and why.

Promote the use of medical gloves. This strategy is linked to Maslow’s theory because it targets the need for personal hygiene. Personal health falls within the safety needs of Maslow’s hierarchy of needs. Using gloves ensures that people take personal initiative to ensure that they do not get contaminations that may affect their health. Healthcare workers will be educated on the importance of using gloves of the right size and type. Visual educational materials will be issued to demonstrate how gloves can transfer germs from one part of the patient to another.

Train healthcare workers on proper use of soap and water. This strategy requires the use of cognitive abilities of leaning, remembering, and application; hence, relates to Bloom’s theory. It is also developed based on Behaviourism theory because use of the suggested materials will be determined by the reaction of the staff. For example, some people may not use soap and water because they believe it dehydrates their hands; so, monitoring will be done to determine if there is a negative reaction. Training videos will be provided on how to apply soap, and how long to rub it on hands before washing off. Educational materials on the proper use of towels and faucet will also be issued.

Improve understanding of proper hand hygiene practice. By applying Maslow’s theory, participants will be motivated to implement other less common hand hygiene procedure such as keeping short nails. Safety is key pillar in Maslow’s hierarchy on needs and so people are instinctively inspired to health safety needs. Apart from cleaning the hand, there are other hygiene concerns such as size and type of nails. Training will, therefore, cover the proper size of nails and other jewellery, such as rings, that might impact the effectiveness of cleaning techniques by hiding germs. Videos will be used so that participants can see how germs can hide under nails or jewellery.

Learning theories part:

Maslow’s theory

It states that people are motivated to attain certain goals and when one need is achieved a person seeks to fulfil the other need and so on. This theory includes five needs which are arranged in hierarchical levels within a pyramid. He argued that the lower needs must be satisfied before meeting higher growth needs (Maslow, 1943). In promoting hand hygiene among nurses, the team leaders must ensure that they meet the demands and the most basic needs of the nurses such as salaries. Sanitation structures and hand washing taps and antiseptics must be available. Giving attention to their needs will motivate the nurses.

Behaviourism theory

This theory analysis what is observable in a person’s behaviour and the changes in the behaviour when the individual is subjected to a stimulus (Warburton, Houghton and Barry, 2016). It proposes that individuals are conditioned to either repeat or avoid an action depending on the response they receive. If an action elicits a positive response such as a praise or a reward, the person is likely to repeat the action and if it elicits a negative response such as a punishment, the individual is likely to avoid it. The nurses who observe hand hygiene should be rewarded and those who do not should be punished, as this is likely to influence other nurses’ behaviour.

Bloom’s theory

This theory analysis what is observable in a person’s behaviour and the changes in the behaviour when the individual is subjected to a stimulus (Warburton, Houghton and Barry, 2016). It proposes that individuals are conditioned to either repeat or avoid an action depending on the response they receive. If an action elicits a positive response such as a praise or a reward, the person is likely to repeat the action and if it elicits a negative response such as a punishment, the individual is likely to avoid it. The nurses who observe hand hygiene should be rewarded and those who do not should be punished, as this is likely to influence other nurses’ behaviour.

Evaluation part:

Direct observation and monitoring of hand washing practices after the teaching and learning strategies is completed. A feedback form will be used to record observations. This will be used to record hand washing opportunities carried out by nurses, physicians, and other healthcare workers. The programme will essentially record feedback on compliance data by healthcare workers for a period of two months. One individual will be used to discreetly record the data so as to avoid interference (Sax, et al., 2009). Data will be analysed to detemrine if there is an increase in hand hygiene compliance.

Electronic Monitoring System, particularly CCTV surveillance, will be used to record the frequency of hand washing and use of hand sanitiser. Data will be analysed with previous records to determine the percentage of increased usage, which will correlate with the increase in hand hygiene compliance. Since electronic monitoring provides visual records, it is accurate and free from bias. Since the hospital has inventory on the rate on utilisation of these products, consumption will be monitored during a period of two months. The data will be compared with previous data to determine whether there has been an increase or a decrease. As noted by Bischoff, Reynolds, Sessler, Edmond, and Wenzel (2000), increased use of antiseptics is an indication of improved companiance with hand hygiene.

Evaluation will be done using data sheets and feedback forms regarding in-hospital infection rates. Healthcare related infection within the hospital will be recorded for a period of two months and compared with previous data at the end of the study period. Haas and Larson (2007) note that there is a correlation between HAI rates and hand hygine, but this may be confunded by other external factors. Therefore, HAI rates reduce significantly during this period, it will be an indication that hand hygien compalice has improved.

Conclusion part:

There is a concerning rate of hospital related infections. These infections are costing governments billions of dollars to treat and in the worst cases, hundreds of lives are lost. In Saudi Arabia, in particular, 8.5% of infections of all infections are acquired within hospital environments. Studies have shown that hand hygiene can lower this rate significantly. However, there is significant lack of compliance on hand hygiene policy. Therefore, there is a need to create awareness and educating healthcare workers on the importance of hand hygiene is necessary. A combination of techniques for creating awareness can significantly improve the current situation. However, to determine the effectiveness of the leading education, several techniques for observation and monitoring are required. At the end of the period of education and awareness, it is expected that hand hygiene compliance among healthcare workers will improve.


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