Hand Hygiene

Good ethics is the foundation of an organization’s character. It is what distinguishes it from the conglomerate of businesses in today’s society. Ethical behavior is the glue that bonds employees and customers to the organization.

It is a code of conduct that guides an individual in dealing with others. Ethical issues have are a major concern in business because they have become more complex due to international business expansion and the diversified nature of large corporations. Government regulation and legal requirements have become more stringent in the effort to stem unethical practices in corporations.Finegan (1994) affirms, “the corporate world has come under increasing pressure to behave in a socially responsible manner” (p. 747). Organizations have come to realize that more is at stake if this behavior continues to consume the workplace.

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Handwashing in the health care setting has been promoted for generations and is recognized as the single most important procedure for preventing infection. The healthcare industry has an ethical and legal obligation to protect and promote the well being of its patients.This obligation should not be administered lightly and upheld by those within the authority to do so. Ethical behavior in the health care industry is essential and desirable; however, determining which behavioral actions are ethical and which are unethical is difficult. Although never will everyone agree on specific ethical standards, everyone should agree that setting ethical standards is vital. Therefore, administrators of health care institutions and health care providers should work together to establish codes of ethics which define boundaries for ethical behaviors in the health care industry.Background Historically, the hand hygiene story begins in 1822 when moistening hands with liquid chloride solution was advocated for contagious disease interruption.

More notably is the Ignaz Semmelweis’ work in 1846 when he insisted physicians and students their hands with a chlorine solution between each clinic patient proving that contaminated hands cleansed with an antiseptic agent between patient contacts reduced the transmission of infectious disease and patient facility more effectively than soap and water washing.The 1950 staphylococcus outbreaks and subsequent investigations led to a preventative strategy focused on healthcare personnel. A series of written recommendations, emphasizing hand cleansing as essential to disease interruption, include the CDC guidelines recommending healthcare practices for implementation in hospitals followed by APIC recommendations and the use of alcohol-based hand rinses. This HICPAC guideline advocates alcohol gels as the ultimate agent for compliance by healthcare workers (HCWs) performing responsibilities.Infections related to healthcare are among the most important causes of morbidity and mortality in hospitalized patients. A study of prevalence carried out by the World Health Organization (WHO) in 55 hospitals from 14 countries showed that 8. 7% of hospitalized patients contract Nosocomial Infections (NI). The importance of NI in terms of morbidity, mortality, impact on quality of life in patients and relatives and secondary economic costs, has been emphasized repeatedly in the last years.

In the developed countries, around 5-10% of patients admitted to hospitals for acute conditions presented an infection that was not being incubated or present at the time of admission. Healthcare-related infections are the direct cause of 80,000 deaths in the U. S. and 5,000 deaths in England every year. According to data from the survey on Prevalence of Nosocomial Infection in Spain (NI) affected between 7% and 9% of patients admitted in Spanish hospitals.These data are very similar to those for developed countries in terms of frequency, economic cost and mortality. NI present many of the characteristics that define a significant problem in patient safety: affect millions of people all over the world, complicate patient care, contribute to the patient death or temporary/permanent disability, increase resistance to antimicrobials and generate substantial additional costs in the treatment of the patient disease.

Ethical Concerns in Healthcare SettingsThe concept, which emerged in the 19th century, was only formularized in the 1970s with the subsequent development of guidelines on hand hygiene practices in hospitals by recognized bodies associated with the practice of infection control. Hand hygiene is now recognized as an integral part of the quality of patient care, and is included in the standards for hospital accreditation. Ethical issues are a concern in any business, but they are particularly sensitive in the healthcare industry. In the health care industry ethics has to be examined from the perspectives of investors, mployees, patients, competitors and the environment.

Hospitals and large healthcare systems often have a code of ethics that they expect all members of their staff to follow related to the health, safety, and well-being of patients and family members including the practice the hand hygiene that seeks the reduce healthcare associated infections (HAIs). Unethical practices in healthcare can lead to serious and sometimes life-threatening effects on people. Ethics are stressed in all fields of medical education in order to instill socially accepted, ethical values into students.Healthcare ethics represent moral values that are generally regarded as acceptable by society. Certain medical professions, such as physicians, have a code of ethics that is expected to be followed by every member of the industry. Everyday, the average person is exposed to millions of germs.

Public bathrooms, hospitals and the workplace are a breeding ground for a plethora of microscopic enemies. These germs lie in wait, ready to infect passersby with a variety of illnesses. Many go to extreme measures in order to reduce their exposure, whether it is hand washing, the use of disinfectant or even wearing masks over their faces.

Hand hygiene, often previously referred to as hand washing, is critical in the prevention of healthcare-associated infection by reducing the incidence of cross-infection. This is a simple measure but all too often is poorly carried out and compliance with hand hygiene recommendations is sub-optimal amongst a range of healthcare professional groups. Effects of Poor Hand Hygiene Poor “hand Hygiene” is recognized as the largest problem associated with healthcare-associated infections affecting 1. million patients in American hospitals each year. It is cited in the American Journal of Infection Control as “the most important practice to reduce the transmission of infectious agents in healthcare settings” (p. S96).

It is one of the top ten causes of death in the U. S. at 99,000 annually Infections complicating 7 to 10 percent admissions with most being preventable. The Indian Journal if Medical Microbiology (2010) reports, “HAI rates remain high despite an increase in awareness and actions to reduce these infections” (p. 104).The CDC guidelines for hand hygiene are well established and recognized by staff, yet the compliance rate is significantly low. The Center for Disease Control Prevention: Morbidity and Mortality Weekly Report (2002) cited these additional factors influencing adherence to hand hygiene compliance: lack of active participation in hand hygiene promotion at individual or institutional level, lack of role model for hand hygiene, lack of institutional priority, lack of administrative sanction for noncompliers and rewards for compliers, and lack of institutional safety climate (p.

23).These factors indicate the need for organizational leadership to become more involved in the enforcement of employment practices by displaying ethical leadership since the CDC only recommends guideline for hand hygiene. There is also a cost to hospitals who do not seek to reduce HAI’s through prevention. The following table illustrates the per patient cost of HAI’s based on a report published from medical and economic literature to provide a range of estimates for the annual direct hospital cost of treating healthcare-associated infections in the U. S. Keep in mind, new Medicaid and Medicare legislation requires hospital to bear these costs.The Attributable Per Patient Costs of all HAI’s # of infections Range of per patient cost estimates based on 2007 CPI-U Range of per patient cost estimates based on 2007 CPI for Inpatient hospital servicesRange of total cost using CPI-U (billions)Range of total cost using CPI for Inpatient hospital services (billions) All HAI ‘s$1,737,125 $16,359 – $19,430 $20,549 – $25,903 $28. 4 – $33.

8 $35. 7 – $45. 0 Adapted from the CDC report The Direct Medical Costs of HAI’s in U. S. Hospitals and the Benefits Prevention by Douglas Scott (2009). Benefits of Hand Hygiene The benefit of the practice of good hand hygiene is invaluable to those served.Patients will not have to deal with the risk of cross contamination and the inconvenience of prolonged hospital stays due to preventable infections that can be attributed diarrhea, eye infections and respiratory infection. The Keystone Project (2005) reported savings of 1578 patient lives saved in study conducted after 15 months of hand hygiene practice, (cited in Bennett & Brachman’s Hospital Infections, 2007, p.

266). Patient lives that can potentially be saved is enough reason to ensure the implementation and use of this practice in healthcare settings. There is also an advantage to staff and the organization under this practice.There’s nothing better than employees loving their jobs and feeling safe in its environment. Staff will work more productively knowing measures are in place to keep them and patients safe.

They will have an increase confidence when handling patients knowing they have taken preventative action in hopes of providing the best care for their patients. The following lists advantages to the staff and healthcare setting: •Improved quality of work – tasks are done more effectively and efficiently. •Increased confidence when handling patients – patients are reassured of the services provided.

•Cooperative atmosphere – workplace harmony. Decrease in sick days – more time engaged in your career choice. •Safe work environment – feeling of workplace security.

•Feeling of satisfaction – creates intrinsic motivation and rewards. As an organization, the benefits of promoting hand hygiene are seen in the savings of billions of dollars in healthcare costs. Presumably these costs are contributable to rising cost in healthcare and the need for healthcare reform. Taking preventative measure not only benefits patients and hospitals the growing economic instability in the U. S. The following tale illustrates the varying cost of reducing preventable infections up to 70 percent.

The maximum savings were an astounding 25. 0 – 31. 5 billion dollars. Range of Estimated Annual Direct Medical Cost of all HAI’s Adjusted by the Preventable Proportion of Infections Range of estimates (billions)20% of infections preventable (billions) 50% of infections preventable (billions) 70% of infections preventable (billions) 2007 CPI-U $28. 4 – $33. 8 $5. 7 – $6. 8 $14.

2 – $16. 9 $19. 9 – $23. 7 2007 CPI hospital inpatient services $35. 7 – $45. 0 $7. 1 – $9. 0 $17.

9 – $22. 5 $25. 0 – $31. 5 Adapted from the CDC report The Direct Medical Costs of HAI’s in U. S. Hospitals and the Benefits Prevention by Douglas Scott (2009).

Ethical Leadership Ethical conduct should be displayed through ethical leadership. Corporate responsibility for implementation of these guidelines lies with the chief executive officer or the director of each healthcare institution but the individual has an obligation to comply with best practice. Hand hygiene is the single most important intervention to prevent transmission of infection and should be a quality standard in all healthcare institutions. Senior healthcare workers such as medical consultants, nurse managers and others must act as role models to actively promote hand hygiene and to ensure better compliance.Social hand hygiene may be achieved with plain soap and warm water or an alcohol hand rub, but antiseptic hand hygiene, such as before patient contact, requires an antiseptic hand wash agent. How Organizations can Influence Ethical behaviors Organizations can influence ethical behavior by creating an ethical climate in the workplace.

Kinicki & Kreitner’s (2009) four functions organizational culture can be applied in healthcare settings to encourage and shaped the identity of the organization through its employees and their conduct. Give members an organizational identity – culture can be change to fit the identity of the organization. It should be aligned with the practice of good ethics. •Facilitate collective commitment- ethical leadership shows new employees that you’re all this together. It gives them a sense of belonging to something greater than themselves. •Promote social system stability- this helps reduce stress in workplace by creating a positive supporting working environment.

•Shape behavior by helping members make sense of their surroundings – employees should not feel out of sorts at work.Everyone should be aware of the company’s goals and how they plane to accomplish them (p. 40-41). Conclusion Hand hygiene programs are an investment to healthcare facilities because when more and more workers practice good hygiene, the rate of hospital infections are shown to decline. In Switzerland, a hand hygiene program was implemented at the University of Geneva hospitals and was able to improve and sustain the hand hygiene compliance rate from 48 percent to 66 percent resulting in a significant decline in the number of HAI’s. Dr.

John Boyce, chair of Hand Hygiene task force at the CDC, stated that is hospitals are able to sustain hand hygiene compliance rates 70-80 percent, a substantial reduction of healthcare-associated infections would be seen. Most hospitals in the U. S. have implemented some form of a hand hygiene program; however, not all hospitals have committed the same amount of resources. Successful hand hygiene programs report that campaigns must be implemented hospital-wide to make a lasting impact. The state of Pennsylvania adopted a campaign encouraging patients to ask clinician, “did you wash your hands”?This campaign continues to see success as efforts are cooperatively supported from the administration level down to each worker’s unit. While hand hygiene noncompliance does not warrant legal action, it is inarguably an ethical concern that should be addressed and enforced by the organizational leaders of the healthcare industry.

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