Enhancing Hand Hygiene in Aged Care Facilities


The health improvement actions are performed in the healthcare facility to enhance the health and well-being of the patients and communities through encouraging and enabling health choices and addressing health determinants creating negative health conditions (Novignon & Nonvignon, 2017). In residential aged care facilities, effective health improvement at all times is required so that the safe environment of living for the older people with varied diseases who can no longer live alone at home is created to ensure their satisfaction and well-being during old age. In this regard, the hand hygiene methods in care implemented by the carers at the residential aged care facility is to be critically evaluated and actions are to be taken towards its improvement.

The topic regarding hand hygiene in aged care facilities is to be discussed because it is the single best way in preventing the spread of any infection to older adults who are already suffering from frailty and various health issues (Hammerschmidt & Manser, 2019). The older adults in their elderly phase have low immunity and the evaluation regarding hand hygiene maintained by the carer is important to understand the way they are acting in implementing single best way to prevent infection and further health deterioration of the adults in care (Ahmed et al., 2020). Thus, the current essay is going to present a critical evaluation of the hand hygiene methods followed by carers in aged residential facilities by presenting the background and rationale for the topic. Thereafter, strategies are to be discussed to be followed and implemented in ensuring better health hygiene facilities at the aged residential care facility. Moreover, evaluation of the strategy is to be made to determine its success in promoting enhanced hand hygiene condition aged residential care by the carers.


Background and Context


Hand hygiene is referred to cleaning of one’s hand to substantially lower the potential pathogens on the surface of the hand to be transmitted from one person to another (Stadler & Tschudin-Sutter, 2020). In Australia, the average hand hygiene benchmark identified in 2020 by the Advisory Council of the Australian Health Ministry after conducting three-hand hygiene audits in a year is 80% (safetyandquality.gov.au, 2021). This indicates that effective hand hygiene in healthcare is mostly followed by carers, but there is lack of effective following of the methods in some care facilities which has led the benchmark failed to be improved further and reach 90% or more benchmark to prove absolute success. The Department of Health in Australia mentions that in 85.3% of cases the carer washes their hands before touching a patient and in 83.4% of cases the carer maintain hand hygiene after touching patient surroundings (safetyandquality.gov.au, 2021). It indicates that hand hygiene by the carer is not effectively maintained before caring for any patients and after touching the care surroundings which creates the risk of infection transfer from one patient to another or from the surrounding environment. This is because there is a high probability of the presence of infection from touching wide number of things or individuals before caring for a patient from where pathogens may remain in the hands of the carer to be transferred to the patient to cause the infection (Awwad et al., 2019). The risk is certain as nearly 113,000 hospital-acquired infections is raised for patients which indicates 2.1 cases per 100 patients in Australia (aihw.gov.au, 2018).

The 5 moments of hand hygiene set by the Australian Health Department are before touching a patient, before care procedure, after the procedure, after touching a patient and after touching patient surroundings (safetyandquality.gov.au, 2018). The analysis of the frequency of each moment followed in care by referencing the statistics of hand hygiene reported by the Department of Health Australia indicates the first and the fifth moments are least followed compared to others. Thus, effective action is to be taken to improve practising of the two moments as it would avert the risk of infection transfer from any unknown source or patient surroundings to the service users. The patient surroundings act as potential grounds of the presence of pathogens. This is because various individuals who have unknown pathogen or pollen carrying abilities touch the surroundings, as well as carers after taking care of other patients, touch the surroundings creating a breeding ground of mixed pathogen in the areas (Grayson et al., 2018). The pathogens on getting transferred to the patient create ability to complicate the health condition of the patients.

The hindered hand hygiene as mentioned in Australia is mostly seen in the residential aged care facilities. This is because of the overcrowding of patients in the facilities (aihw.gov.au, 2021a). It is evident from the study of Gould et al. (2017) where it is mentioned that nearly 52.5% of the patients on and above the age of 65 years and 58.6% of patients above the age of 80 years in Australia are in institutional residential care. This indicates that more than half of the aged population of Australia are living in residential care which creates situation for overcrowding them as there are only 3000 care facilities in supporting the population (aihw.gov.au, 2021a). In overcrowding condition, the hand hygiene by the carers in aged facilities are poorly maintained because of the increased care load to be managed within small amount of time and resource for the patients (aihw.gov.au, 2021a). As mentioned by Wretborn et al., (2020), increased workload and overcrowding of patients in care facility leads the carer fail to follow enhanced protocol of care. This is because the carer develop confusion regarding the way to manage the crowd during which they try to delivery care to most people at time leading to create chances of error such as hindered hand hygiene management.

In the residential aged facilities, the Australian government has not mandated the minimum staffing level to be maintained. This has caused many facilities to have poor staffing which has contributed to hindered hand hygiene management in caring for aged patients. It is evident as a decline of 21% nursing and allied staffs in the aged residential care in 2003 to 14.6% allied and nursing staff in the aged care in 2016 is seen in Australia (nhmrc.gov.au, 2021). This indicates that poor staffing level along with overcrowding has led to hindered hand hygiene management in aged residential care. This is because less qualified care staffs are present in provide care who may be overloaded with care to become unaware of all the hand hygiene protocols to be maintained leading to hindered management of hand hygiene in preventing infection transfer to the aged people. Therefore, the strategy to improve hand hygiene in the aged residential care facility is to be focussed on current healthcare improvement so that better infection prevention opportunities and enhanced well-being can be ensured for the aged people in Australia who are living away from home in care facilities.


The aim of the study is to critically evaluate hand hygiene methods followed in aged residential care facilities by the carers and develop changes to improve hand hygiene in the facilities.


To identify efficiency of hand hygiene process managed in residential care home for the aged people

To evaluate the improvement in hand hygiene process made by the carers in the residential aged care home after the implementation of improvement of change regarding the action

To analyse the challenges faced in making hand hygiene process improvement in the residential aged care facility

To develop recommendations to overcome the challenges faced in making hand hygiene process improvement in the residential aged care facility


The strategy to be developed for change is to focus on promoting hand hygiene management before touching patients and after touching the surroundings of the patients in aged residential care facilities. In order to frame and implement the required change strategy, Kotter’s Change Management model is to be followed. This is because the model informs systematic actions for stakeholder engagement, communication strategies, barrier analysis and others to be followed to successfully implement any changed strategies to create improvement (Haas et al., 2020). Lewin’s Change management Model is not to be followed because it does not allow providing specification of stakeholder management and environmental challenges and way they are to overcome during making improvement. It is a simplified model that does not clarify the complex methods involved in making the change (Hidayat et al., 2020).

The initial step of Kotter’s change model informs creating sense of urgency in making any change (Tyler, 2019). It indicates identifying potential threats due to the current situation and developing scenarios of risk to be faced in future on following existing practices to be informed to stakeholders to be involved in change. Moreover, opportunities to be faced in future with the change is to be examined (Mohiuddin & Mohteshamuddin, 2020). Thus, the stakeholders to be involved in the change are to be mentioned the current and future scenario of the existing hand hygiene technique to create sense of urgency in them to making the change and support implementing the change strategies. The second step of Kotter’s change management model is creation of powerful coalition between the stakeholders to be involved in change. This is to be created by identifying key leaders in the organisation to lead the change and stakeholders to be involved who are asked to be emotionally committed to building the team (Haas et al., 2020). In the current hand hygiene improvement, the leader would be administrative staff and the stakeholders to make the change would be nursing supervisor and manager at the residential care home. They are to be emotionally committed to work as a team to make the change which is to be achieved by developing trust and coordination between the team members.

The third step of Kotter’s model is creating vision and strategy for change by the leader to be followed by stakeholders (Tyler, 2019). In this aspect, the vision of the current change is creating holistic hand hygiene process in the residential aged care home that is followed by carers so that effective infection control is achieved and five moments of Hand Hygiene mentioned by the Australian Health Department is effectively achieved. Moreover, the strategies to be included are creating increased availability of hygiene products across the care surroundings and near patient beds, written and verbal reminder on walls, administrative support and hand hygiene training to the existing staffs (Gould et al. 2017). The increased frequency of availability of hand hygiene products such as alcohol-based hand sanitisers and others in aged residential surroundings creates increased opportunity and spending of less time to find sanitising agents for maintaining hand hygiene by the carers (Andersson et al., 2018). Moreover, the verbal information delivered at the initiation of each shift regarding hand hygiene and written hand hygiene information on the wall near the patients’ beds and surrounding would compel carers to remember and effectively follow hand sanitation. They would be forced to maintain hygiene before caring for the patients and after touching patient surroundings under any condition due to continuous reminder available in the form of written protocol.

The administrative support and training of hand hygiene improve hand sanitation frequency and management by the carers in residential aged care. This is because the administrative support makes the carer have assistance from the supervisor and managers to overcome their hindrance with hand hygiene management in caring for the patients. In addition, the training helps to make the carer learn regarding the skills and update their knowledge of maintaining hand hygiene in complex and overcrowded situation (Tartari et al., 2019). Thus, the processes suggested are effective strategies to be followed for leading better hand hygiene management and improvement in aged care facilities. The fourth stage of Kotter’s model informs that the developed vision and strategy for change is to be communicated to the stakeholders making the change. This is because clarified understanding of vision of change and strategies to be followed in achieving the change would make the stakeholders understand way they are to make the improvement and the role to be played by them in achieving successful change (Mohiuddin & Mohteshamuddin, 2020). In making the current improvement for hand hygiene, the administrative staff are to be use intranet facility to communicate the vision and strategies of change to the determinised stakeholders to make the change. Moreover, face-to-face meeting in the residential care homes is to be arranged between the leaders and stakeholders of change to make the leaders communicate the vision and strategies of hand hygiene improvement along with roles to be played by each stakeholder towrads making it a success.

The fifth stage of Kotter’s model indicates removing obstacles or barriers related to change or improvement. This is because they would hinder achieving the goals required for making successful change (Haas et al., 2020). In the current scenario of change, the barrier to be experienced in the lack of effective participation of the stakeholders in making the change. This is because carer would mention most of the time they are maintain hand hygiene with success and avoiding in some cases would relieve them of feeling intense burden of following too much protocol in delivering care to the patients in busy overcrowded environment. The barrier is to be avoided by communicating to the stakeholders regarding the risk to be faced due to be faced due to current minute mismanagement of hand hygiene and the way it would affect in future to further worsen acquired-infection concern from care him for adults. This is because informing risk and future impact of not following any change makes the carer in care environment understand the need for the change and avoid their negative behaviour that are acting as obstacles for the change to ensure its smooth success (Pittet, Boyce & Allegranzi, 2017).

The sixth stage of Kotter’s model is creating short-term wins for making the change. This is important as it helps to determine the effectiveness of the change plan in short-term and measure its success for long-term accomplishment (Haas et al., 2020). Thus, in the current change, the short-term wins of achieved full hand hygiene in few wards are to be initially focused and later it is to be implemented for the whole residential care facility. The seventh stage is building on the change that is making alterations in strategies based on the assessment of short-term wins to set better change goals for achievement (Haas et al., 2020). Thus, determination of any change in the strategic plan for change regarding hand hygiene improvement in residential aged care facility is to be done based on short-terms wins assessment. The final stage is anchoring the change in the culture of the organisation (Haas et al., 2020). For this purpose, continuous information of hand hygiene is to be informed to the new carers and other stakeholders involved in the change to be followed.


The evaluation of the intervention in improving hand hygiene among the carers in residential aged care home is to be initially done by taking feedback from the service users who are able to provide information regarding their care. This is because feedback from the service users provide valuable information regarding the way healthcare services are delivered by the carers. It provides effective insight regarding what extent the care provided in done in an enhanced manner and the further improved needed in delivering care (Griffiths & Leaver, 2018). Thus. accessing feedback from the patients regarding the extent to which they saw their carers managing hand hygiene after the implementation of the improvement is important nature of evaluation for the success of the change. It meets the aim of critically analysing the hand hygiene process management in the aged residential care facility. Moreover, it helps in determining the impact of the improvement made in respect to the process which is another objective of the study. This is because the feedback allows judgement of the extent of change in the hand hygiene process made by the carers in the care facility.

The other way of evaluating the intervention is performing an audit in the care home facility. This is because auditing helps to assess, analyse and improve the care of the patients in a systematic way. It acts as a process of measuring the efficiency of current practice against desired standards of care. It acts as a part of clinical governance and aim to safeguard quality care of the patients (Mohamed et al., 2019). Thus, auditing is to be executed to analyse the impact of the intervention of change for hand hygiene because it would help in determining to the extent to which the carer in the aged residential care facility are following hygiene management as per the mentioned change to meet the 5 standards of hand hygiene care set by the Australian Health Department. Moreover, auditing would help in identifying the challenge faced by the carer due to the current implementation of change in care for hand hygiene which are to be resolved for better and smooth care delivery efficiency among them for further condition. It indicates meeting the aim of evaluating critically the hand hygiene process and mete the objective of identifying the challenges to be faced further after improvement in the care facility.

The interview process is to be used as a part of evaluation of the success of the implemented change regarding hand hygiene. The interviewing of the carers is to be made. This is because interview helps in gathering qualitative information regarding the success or impact of any actions (Wilson et al., 2020). In this condition, the interviewing of the carer would led to determine to what extent they are maintaining hand hygiene after the implementation of the intervention regarding before touching the patients and surroundings to take care of the patients which is the key low hand hygiene rule identified among carers. Moreover, the interview would help in accessing understanding of the challenges due to the intervention faced by the carer and develop recommendations for them to resolve them to ensure better managing of the change for future.


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The above discussion mentions that out of the 5 key steps of hand hygiene mentioned by the Australian Health Department, it is seen that first and the last step are least followed in executing the process in many hospitals as well as aged residential care facility. It is identified that aged care home being overloaded with patients and having low staff is contributing to lower hand hygiene procedure been effectively followed by the carer to support the patients. Moreover, the hand hygiene issues are found to raise issues of hospital-acquired infection among the elderly leading to their deteriorated health condition. In this context, the change to be implemented is promoting hand hygiene management before touching patients and after touching surroundings of the patients in aged residential care facility. the strategies to be followed in implementing the change are creating increased availability of hygiene products across the care surroundings and near patient beds, written and verbal reminder on walls, administrative support and hand hygiene training to the existing staffs. The Kotter’s Change model is to be followed in implementing the change and the valuation process to be used for examining the impact of the change are feedback from patients, interview of carers and auditing of the care environment.


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