Introduction
This reflective analysis explores the routine practice of hand hygiene compliance within a clinical nursing setting, a fundamental aspect of infection prevention and control in healthcare environments. As a Master’s student in nursing, I aim to critically evaluate this everyday practice using a reflective framework to understand its significance, effectiveness, and underpinning knowledge base. The purpose of this essay is to identify the strengths and weaknesses of hand hygiene practices in my area of work—an acute medical ward in a UK hospital—and assess whether these practices align with evidence-based guidelines. Gibbs’ Reflective Cycle (1988) will structure this analysis, providing a systematic approach to reflect on the practice through description, feelings, evaluation, analysis, and conclusion. Moreover, this essay will identify the types of knowledge that inform hand hygiene practices, laying the groundwork for a deeper discussion in Part 2 of the assignment. By engaging with relevant literature and reflecting on my observations, I seek to propose insights that could positively influence future practice.
Description of the Identified Practice
Hand hygiene is a cornerstone of infection control in healthcare settings, involving the use of handwashing with soap and water or alcohol-based hand rubs to remove pathogens from hands. In my workplace, an acute medical ward, hand hygiene is mandated before and after patient contact, after touching potentially contaminated surfaces, and before invasive procedures, following the ‘Five Moments for Hand Hygiene’ framework promoted by the World Health Organization (WHO, 2009). Compliance is supported through accessible handwashing stations, alcohol gel dispensers at bed points, and regular training sessions. However, adherence varies among staff, with observational audits indicating compliance rates of approximately 70%, below the recommended target of 90% set by local NHS trust policies. This inconsistency prompted my choice to reflect on this practice, as it directly impacts patient safety and healthcare-associated infection (HCAI) rates.
Evaluation of the Practice
Evaluating hand hygiene compliance reveals both strengths and areas for improvement. On the positive side, the ward’s infrastructure supports good practice; handwashing facilities and alcohol gels are readily available, and posters serve as visual reminders of the ‘Five Moments’. Additionally, regular mandatory training ensures that staff are aware of the importance of hand hygiene in preventing infections such as Clostridium difficile and Methicillin-resistant Staphylococcus aureus (MRSA). However, there are notable shortcomings. Compliance rates remain below target, particularly during busy shifts when time pressures lead to lapses. Furthermore, I have observed that some staff members perform hand hygiene perfunctorily, failing to adhere to the recommended duration of 20-30 seconds for handwashing or ensuring full coverage with alcohol gel. This inconsistency is concerning, as suboptimal hand hygiene directly correlates with increased HCAI risks, compromising patient safety (Allegranzi and Pittet, 2009).
Analysis Through Gibbs’ Reflective Cycle
Using Gibbs’ Reflective Cycle (1988), I delve deeper into this practice. Initially, describing the situation highlighted the discrepancy between policy and practice, which evoked feelings of frustration and concern, given the preventable nature of many HCAIs. Evaluating the practice revealed that while structural support exists, behavioural factors such as time constraints and lack of accountability hinder compliance. Analysing the issue in light of literature, I found that suboptimal hand hygiene is a widespread challenge in healthcare. Allegranzi and Pittet (2009) note that global compliance rates often hover around 40-60%, with barriers including workload, inadequate education, and poor role modelling. In my ward, while training is provided, it is often generic and not tailored to address specific barriers like time management during peak hours. Furthermore, the lack of real-time feedback or monitoring beyond periodic audits may contribute to complacency. Indeed, research suggests that interventions combining education with immediate feedback and leadership support can significantly improve compliance (Gould et al., 2017). Reflecting on this, I recognise that while the practice is evidence-based in theory, its application in my workplace requires enhancement to meet best practice standards.
Alignment with Literature and Evidence-Based Practice
The importance of hand hygiene is unequivocally supported by a robust body of evidence. The WHO (2009) guidelines underscore that effective hand hygiene can reduce HCAI rates by up to 40%, a finding echoed by numerous studies. For instance, Pittet et al. (2000) demonstrated that a hospital-wide hand hygiene campaign significantly lowered infection rates over a sustained period. In my workplace, the adoption of the ‘Five Moments’ framework aligns with these guidelines, indicating a theoretical commitment to evidence-based practice. However, the gap in compliance suggests that implementation is not fully effective. Gould et al. (2017) highlight that achieving sustained compliance requires multifaceted interventions, including regular audits, peer support, and addressing contextual barriers such as staffing shortages. Arguably, my ward’s current strategy lacks this comprehensive approach, focusing primarily on training without sufficient emphasis on monitoring or tailored solutions to situational challenges.
Types of Knowledge Underpinning the Practice
Reflecting on the knowledge base informing hand hygiene, I have identified several types of knowledge that underpin this practice, presented in the table below. These categories—propositional, procedural, personal, and ethical—provide a framework for understanding how knowledge shapes behaviour and practice in this area.
| Type of Knowledge | Description and Relevance to Hand Hygiene |
|---|---|
| Propositional (Scientific) | This includes evidence-based guidelines and research on infection control, such as WHO recommendations and studies demonstrating the link between hand hygiene and reduced HCAI rates (WHO, 2009; Pittet et al., 2000). This knowledge forms the theoretical basis for the practice. |
| Procedural (Practical/Experiential) | This refers to the practical know-how of performing hand hygiene correctly, learned through training and repeated practice. It includes techniques like the six-step handwashing method and knowing when to apply the ‘Five Moments’ in clinical scenarios. |
| Personal (Self-Knowing) | This involves individual awareness and motivation to adhere to hand hygiene protocols. Personal attitudes, such as a commitment to patient safety or response to workplace culture, influence compliance rates. |
| Ethical | This relates to the moral imperative to protect patients from harm. Nurses have an ethical duty to prevent infections through diligent hand hygiene, grounded in professional codes such as the Nursing and Midwifery Council (NMC) standards (NMC, 2018). |
These types of knowledge collectively inform hand hygiene practices but are not always integrated effectively in my workplace. For instance, while propositional knowledge is disseminated through policies, personal and ethical knowledge may be under-emphasised, contributing to variable compliance.
Conclusion
In conclusion, this reflective analysis, guided by Gibbs’ Reflective Cycle (1988), has illuminated the complexities of hand hygiene compliance in an acute medical ward. While the practice is supported by robust evidence and infrastructure, significant gaps in adherence undermine its effectiveness, posing risks to patient safety. The literature suggests that multifaceted interventions addressing behavioural and contextual barriers are essential for improvement (Gould et al., 2017). Furthermore, identifying the underpinning types of knowledge—propositional, procedural, personal, and ethical—reveals the multidimensional nature of this practice and highlights areas for targeted enhancement. The implications of this reflection are clear: fostering a culture of accountability and tailoring interventions to specific workplace challenges could bridge the gap between policy and practice. This analysis not only deepens my understanding of hand hygiene as a critical nursing practice but also provides a foundation for proposing actionable recommendations in future discussions, with the potential to positively influence clinical outcomes.
References
- Allegranzi, B. and Pittet, D. (2009) Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection, 73(4), pp. 305-315.
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit.
- Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H. and Taljaard, M. (2017) Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews, (9), CD005186.
- Nursing and Midwifery Council (NMC) (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S. and Perneger, T. V. (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. The Lancet, 356(9238), pp. 1307-1312.
- World Health Organization (WHO) (2009) WHO Guidelines on Hand Hygiene in Health Care. World Health Organization.
