Listening C02

Listening C02

Extract 2: Questions 37 to 42

You hear a clinical nurse educator called Jennifer Seiver giving a presentation on the subject
of hand hygiene.

37 What surprises Jennifer about the issue of hand-hygiene routines?

A the range of conditions that can result from neglecting them.

B the attitude of many healthcare staff towards them.

C the variation in policies designed to promote them.

38 Jennifer mentions recent data on infection levels to support her point that

A there appears to be complacency within the health sector.

B there seem to be falling standards amongst healthcare staff.

C there is an increase in the number of patients being affected.

39 Jennifer suggests that the concept that hand-hygiene can prevent infections

A has been weakened by the introduction of new technology.

B has long been accepted as essential to good healthcare practice.

C has been more readily acknowledged in some branches of medicine.

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40 Jennifer feels that hand hygiene is particularly valuable because

A it may be easily be imbedded in an individual’s habitual behaviour.

B it provides protection from the most commonly found organisms.

C it is an uncomplicated procedure that comes at very little cost.

41 What problem does Jennifer identify with direct observation as a method of

monitoring hand-hygiene compliance?

A Observers tend to make subjective judgements.

B The presence of observers can influence staff behaviour.

C Observers may not always provide a good model of compliance.

42 Jennifer mentions car seat-belts to underline her point that hand hygiene

A needs to become an automatic action.

B is an instinctive response to personal danger.

C needs to be a conscious decision on each occasion.

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Audioscript

F: Hi everyone. My name’s Jennifer Seiver, I’m a clinical nurse educator and I’m here
today to talk about something very familiar to us all. It’s a routine that can
potentially save numerous lives and one that we’ve all been taught since we were
toddlers; hand hygiene. This is described by many healthcare workers as possibly
the single most important tool in preventing the development of healthcare-
associated infections between patients; infections such as staphylococcus
aureus, clostridium difficile, MRSA and gram-negative bacteria. Most hospitals have
strict policies and guidelines that we must all abide by. So if it’s so important, why do
we continue to see such an underutilisation of such a basic practice? Why don’t we
follow the procedures that should already be ingrained? This, unfortunately, has
proven difficult to determine.

Let’s first put things into perspective with new data from the Centres for Disease
Control and prevention in the USA which found that one in 25 patients acquires a
healthcare-associated infection during their hospital care. Now for whatever reason,
this figure doesn’t tend to set off any real alarm bells in people, but that adds up to
about 700,000 infections a year; a little more alarming. The clincher, however, is of
those, 75,000 patients die from their infections. That’s an incredible number, and
one that should shock anyone hearing it, because it’s a number that quite often
reflects human neglect and forgetfulness. One may even suggest at times laziness.

Stopping the spread of infection by way of hand hygiene is hardly a new concept. Its
importance was first brought to life in the mid-nineteenth-century when it was
found that physicians who washed their hands before delivering babies prevented
deaths in postpartum women. Such an idea was initially ridiculed, as most new
theories are, but even now after centuries of knowledge it seems to me we’re still
in many ways ridiculing it by simply overlooking this basic practice. In stopping the
spread of infection, even the most advanced healthcare is of little use if the basic
principles of hand hygiene are neglected. We have valuable technologies and
intricate tools at our disposal to prevent hospital-acquired infections, and yet such
advancements can so easily be made redundant if healthcare workers don’t toe the
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line and simply neglect to wash their hands. That doesn’t sound like genuine
advancement to me.

One of the most valuable things about hand hygiene is that it works for so many
different types of organisms, and you get a lot of bang for the buck so to speak; such
great protection from so many nasty things by such a simple and inexpensive action
that any person can do with ease. The issue is that you have to practice it at a high
level of compliance for it to work. Within a hospital setting there are so many
opportunities for hand hygiene, and it’s difficult to get to a level of compliance
where we’re able to make changes to infection rates. What we need to do to combat
this is to turn hand washing into what many people already suppose it is; an
instinctive ritual.

So how do we monitor people in a healthcare setting without hovering and

interfering? The gold standard in monitoring hand-hygiene compliance is direct
observation. But the reliability of this method to measure true, actual compliance is
questionable. This is because it increases dramatically when observers, who are
usually well known to the staff, are circulating in the unit. The rates then decline
almost immediately once they’ve gone. Furthermore, being a known staff member
also influences this. I’ll give you an example. In one study, we hired a student for
hand-hygiene observation in the same unit as a well-known staff member. We found
that the staff member observed close to 70% compliance and the student observed
close to 30%. The bottom line is that there’s a big discrepancy there.

The main problem associated with a lack of hand hygiene compliance, I believe, is
that humans are not in fact naturally hardwired to perform hand hygiene in the
absence of sensing a substance on their hands. If compared with the use of seatbelts
for example, most people don’t even think about putting the seatbelt on when they
get into a car. They do it on a subconscious level, and they’re usually not even aware
they put it on. That’s where we need to be with hand hygiene, hardwired so that we
do it without even thinking about it. When a behaviour is hardwired like that, you
can always sense when you didn’t do it because you start to feel uncomfortable. It’s
a long process, however, to get to that end point. [784 words]
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https://www.healio.com/infectious-disease/nosocomial-infections/news/print/infectious-
disease-news/%7Bdd1e115b-8a00-4889-9e85-8566391f2541%7D/infection-prevention-in-
hospitals-the-importance-of-hand-hygiene

KEY

37 B

38 A

39 B

40 C

41 B

42 A .