الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Health care associated infections is a major problem for patient safety and its prevention is first priority for settings and institutions committed to making health care safer.Health care associated infections implies prolonged hospital stay, long- term disability, increased resistance of microorganisms to antimicrobials, massive additional financial burdens, an excess of deaths, high costs for the health systems and emotional stress for patients and their families.
Infection prevention and control are challenging in most health care settings, and rising rates of health care-associated infections are a major concern for patients and health care practitioners.Good hand hygiene is one of the most critical control strategies in health care associated infections management. Hand hygiene is defined as any method that removes or destroys microorganisms on hands. It is well-documented that the most important measure for preventing the spread of pathogens is effective hand washing. Hand hygiene programs should include clear guidance on procedures for the removal of common pathogens from the hands.The fundamental principle of hand washing is removal, not killing. The amount of time spent washing hands is important to reduce the transmission of pathogens to other food, water, other people and inanimate objects (fomites), such as door knobs, hand railings and other frequently touched surfaces. Proper hand hygiene involves the use of soap and warm, running water, rubbing hands vigorously for at least 20 seconds.
Many factors have contributed to poor hand washing compliance among health care workers, including a lack of knowledge among personnel about the importance of hand hygiene in reducing the spread of infection and how hands become contaminated, lack of understanding of correct hand hygiene technique, understaffing and overcrowding, poor access to hand washing facilities, irritant contact dermatitis associated with frequent exposure to soap and water, and lack of institutional commitment to good hand hygiene.
Studies have shown that to improve hand hygiene performance, it is particularly important to promote a culture that empowers staff to speak up when non-adherence is observed.The hand hygiene intervention package is a group of best practices that individually improve care, but when applied together should result in substantially greater improvement.
Understanding hand hygiene practices among HCWsis essential in planning interventions in health care.Education of HCWs is an inherent component of the work of the infection control team. Through education, the infection control team can influence inappropriate patient-care practices and induce improved ones. Education is important and critical for success and represents one of the cornerstones for improvement of hand hygiene practices.It is important to emphasize that educational programs alone are inadequate for long-lasting improvement, and other behavior modifying strategies must be included in a multifacetedapproach in order to achieve change. There is also clear evidence that adequate physical facilitiesfor hand cleansing could affect the success of the program itself and must certainly be in place.However, theseconsiderations do not negate the critical role of the formal education program for achieving better adherence to handhygiene.It is important,therefore, to continue to use the formal education program as one feature of the implementation strategy for hand hygieneimprovement in health care.
There isconvincing evidence that improved hand hygiene throughmultimodal implementation strategies can reduce infectionrates.
Patient empowerment is a new concept in health care and has now been expanded to the domain of patient safety. Even though the term can have different meanings and interpretations, empowermentin health care generally refers to the process that allows an individual or a community to gain the knowledge,skills, and attitude needed to make choices about their care. Patient empowerment is generally required in order for patients to participate. Thusempowerment refers to a process that, ultimately, leads patients to participate in their care.
The organization should provide easy, convenient access to hand hygiene products, gloves, lotions, sinks, and the like and should ensure that staff are satisfied with the products used.Organizations should have written policies and procedures in place that describe when and how staff are expected to perform hand hygiene and how staff are to be educated and trained.
Leadership should be defined broadly to include not only the organization’s executives, officers, and directors but also the clinical staff leaders in each area and the leaders of teams and improvement initiatives.
Chronically non-adherent staff may need oversight, with possible disciplinary action, to motivate changes in behavior. Some organizations hold managers and staff directly accountable for hand hygiene performance and tie performance to merit increases.
Safety culture and culture of safetyrefer to an organization’s commitment to safety that is evident at all levels from frontline personnel to executive management.To improve hand hygiene performance, it is particularly important to promote a culture that empowers staff to speak up when non-adherence is observed.It is important to directly engage staff in a hand hygiene improvement initiative. Rather than dictate changes in behavior, we should have staff identify obstacles and solutions. This type of staff engagement can be helpful in identifying remediable factors, obtaining staff buy-in, and improving adherence rates.One way to engage staff in performance improvement is to use incentives and rewards.