Surgical Hand Wash
Introduction
The changes in the environment have led to the increase in the number of diseases caused by the increase in contamination due to viruses and bacteria. Such contamination is transmitted from one individual to another through the hands and other parts of the body, thus, making hand washing one of the most important actions or protocol an individual must do. Likewise, hand washing is also the most important protocol a medical practitioner, most especially nurses, must be executed. It has been reported that hand washing is considered the most important procedure in preventing nosocomial infections, because many types of these infections may be caused by organisms transmitted on the hands (1975). With this information at hand, this paper aims to discuss four nursing principles under the Nursing Practice Framework and the corresponding nursing behaviors that must be done in line with such principles. Such would be supported by different journals and health policies.
Nursing Principles that Influence Surgical Hand Washing
It has been reported that the aims of hand washing before and after a surgery include removing visible dirt from and reduce potential pathogen numbers on skin, minimize the bacterial load within the surgical glove, and minimize the risk of surgical site contamination should the glove be perforated or torn during surgery (2004). However, this process is not as simple as it seems, for the process of surgical hand washing is guided by several principles. Among the principles under the Nursing Practice Framework, four principles were chosen, which are perceived to influence and guide the process and use of surgical hand washing. The first principle is the principle of safety, which emphasizes that a nurse must practice its profession in a safe and competent manner, thus, preventing the nursing practitioner to engage in exploitation, misinformation, and misinterpretation concerning health care products and nursing services. The second principle influencing the process of surgical hand washing is the principle of outcomes, which means that the nursing practitioner must not bring discredit upon the reputation of the nursing profession, thus, he or she must be able to promote and preserve the trust that comes between the patient and the nurse. This also means that the nursing practitioner must be able to treat the personal information of the patient as confidential. The third nursing principle is the principle of accuracy, which accentuates that fact that the nursing practitioner must act in accordance with the agreed standards and laws of the profession and relevant to the nurse’s area of practice. Lastly, the fourth principle considered is the principle of equity, which involves extending and expressing respect for the dignity, culture, values, and beliefs of an individual, thus, helping to support his or her health, well-being and informed decision-making ( 2003).
Nursing Behaviors in line with the Chosen Principles
Emphasizing on the principle of safety, it can be perceived that this involves practicing safety and protecting both the welfare of the nurse and the patient through effective and proper surgical hand washing techniques. This includes taking off rings, wristwatches, and other jewelries that might become the source of bacterial contamination of the patient. The principle outcomes emphasizes on how the nursing practitioner builds and protects the trust and confidentiality of the condition of the patient, and thus, involves gaining confidence from the patient. Gaining confidence would enable the nursing practitioner to be trusted by the patient, given his or her condition. The nursing behavior associated with this principle is proving to the patient of the cleanliness, readiness, and trustworthiness of the nursing practitioner. This can be shown by the nursing practitioner through providing information to the patient that his or her hands were decontaminated, thus, not providing the patient with further infection or infestation. The principle of accuracy involves complying with the different laws and standards set by the nursing practice and the medical institution. The nursing behavior that must be exhibit by the practicing nurse should include complying or following the set hand-washing policies set by the hospital. Lastly, in line with the principle of equity, the nursing behavior that must be employed by the practicing nurse must include reminding the patient and other hospital staffs, such as nurses, doctors, and medical technologists to also observe proper and effective hand-washing protocols.
Rationale for the Chosen Principles
As mentioned above, the principle of safety involves taking off rings, wristwatches, and other jewelries during hand washing. The rationale behind this is that these jewelries may be the source of contamination and the transfer of bacteria from the hands. It has been reported in one study that ring wearing was associated with 10-fold higher median skin organism counts, such as contamination with Staphylococcus aureus, gram-negative bacilli, or Candida species, and a stepwise increased risk of contamination with any transient organism as the number of rings worn increased (2003). In this regard, ring wearing increases the risk for hand contamination and may somehow worsen the condition of the patient. This principle was chosen because this becomes important in the sense that safety must be the priority of the nurse, and one way to do this is to remove agents that may hinder the nurses from providing the best healthcare they could offer. The principle of outcomes was chosen because nursing practice is a give-and-take relationship, wherein the patient entrusts his or her condition and welfare to the nurse, who must be competent and trustworthy enough to be given such responsibility. In this regard, the trust and the confidence of the patient can be obtained through knowledge that the nursing practitioner would not be the cause of further complication and worsening of his or her condition. One way to do this is to prove to the patient that the nurse’s hands are clean and decontaminated, thus, helping to control bacterial contaminations. It has been emphasized in one study that hand decontamination is crucial to control nosocomial infections, as microorganisms are disseminated mainly through the hands (2000), and cause complications, increased hospital stay, additional financial burden, and increased mortality (2005).
The principle of accuracy was chosen as it highlights compliance of a nursing practitioner to follow agreed standards and laws set in their medical institution. In this regard, the emphasis on having adequate hand-washing policies for hospital personnel must be implemented. One study emphasized that policy for hospital personnel should include hand washing with antiseptics before doing surgery or certain other invasive procedures such as catheterizations, but hand washing with only soap and water between more routine patient contacts ( 1975). However, the problem with using antiseptics is that it can cause excessive dryness, cracking and dermatitis. In this regard, the hospitals favor a hand-washing policy that reserves the use of antiseptics for special situations where the risk of infection is greatest and where resident as well as transient flora on the hands or personnel may cause infections in patients, and a policy that allows hand-washing with soap and water for routine patient care (1975). This is also supported by the new JCAHO Patient Safety Goal, and assures the compliance of nurses in line with this policy (2007). Lastly, the principle of equity was chosen because this emphasizes the equal treatment of nurses towards other medical or hospital practitioners and towards their patients. In this regard, the nursing practitioner must be able to remind other hospital staffs, the patients, and the visitors to also wash their hands in order to decrease the risks for bacterial and viral contamination. It would be helpful to remind hospital staff to wash their hands too (2007), which can be done using soap and water, and antiseptic scrubs, such as alcoholic chlorhexidine, chlorhexidine aqueous hand wash, and povidine iodine hand wash (2004).
Conclusion
It can be concluded that nursing behaviors are being supported by nursing principles, which guides and enables nursing practitioners to effectively extend and render proper and appropriate healthcare to their patients. In addition, the discussion has also emphasized on the importance of surgical hand washing for nursing practitioners and other medical professionals, as the hands serve to be the primary agent that contribute to various infections and contaminations of the patient. From this, hand-washing policies must be strictly followed in order to ensure the health and well-being of patients.
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