Whether hand-hygiene can effectively help in the reduction of communicable infections within hospital setting (I: Intervention)among nursing professionals (P: Population)in order to effectively acquire positive patient outcome and reduce the possibility of in-hospital infections.
According to Castle et al. (2014), it has been mentioned that 1 out of 10 patients experience nosocomial infection during the tenure of their hospital stay. It has further been estimated that, approximately 1.4 million people suffer from Health-care associated infections (HAI) every year on account of poor hygiene practices at hospitals (Castle et al., 2014). It should be critically noted in this context that, hospital acquired infection contribute to a cumulative of 1.7 million infections and almost 99,000 death every year (Ariyaratne et al., 2015). As mentioned by Allegranzi et al.(2013), healthcare associated infections can be defined as infections that patients invariably acquire while receiving treatment for their medical condition. The infections are preventable and are mainly transmitted to the patients during surgical procedures and through medical equipment that include catheters, syringes, surgical instruments and ventilators. As stated by Chun et al. (2015), HAIs account for a major proportion of morbidity and mortality cases across the United States of America. Further, it has been stated that at any point of time, 1 out of 25 hospitalized patients are affected by an infection worldwide (Cruz & Bashtawi, 2016) . In general, health-associated infections occur across a multitude of hospital settings that include, Acute care hospitals, Ambulatory surgical centres, Dialysis facilities, Outpatient care unit and Long-term care facilities (Gould et al., 2017). In order to address the emerging health concern, the U.S department of Health and Human Services, has laid down healthcare-associated infection objectives for the promotion of health and well-being (Gould et al., 2017). The high-priority objectives intend to prevent infections caused by methicillin-resistant Staphylococcus aureus and central line associated bloodstream infections (Higgins & Hannan, 2013). In this regard, it should be mentioned that the most common type of health associated infections include, catheter-associated urinary tract infections, surgical site infections, bloodstream infections, Pneumonia and Clostridium difficile (Chun et al., 2015). HAIs pose an increased risk of developing complications within the care facility and at the same time also possesses the potential to transmit from one unit to another (Huis et al., 2014). However, it is interesting to note in this context, that studies have suggested that proper implementation of preventive practices can help in reducing the rate of infection to almost 70% (Liu et al., 204). The Work Health and Safety Act 2011, aims at the prevention of harm caused to the health, safety and welfare of the care providers (Huis et al., 2013). In context to the healthcare sector, the act considers the implementation of infection control measures. Implementation of effective infection control such as hand hygiene is essential to maintain a reduced incidence of infection. It should be mentioned in this regard that, between 1977 and 2011, a total of 20 studies have been conducted at hospital based setting that clearly indicated a direct co-relation between the impact of hand hygiene and infection rate (Luangasanatip et al., 2015). Further, some of the studies mentioned that improved hand hygiene led to reduced rate of infection and transmission of the infection. Studies have further revealed that, use of alcohol based hand rub can reduce the infection rate but is less effective in comparison to increased hand washing compliance. A number of research studies have revealed that improved hand hygiene can prevent the rate of infection caused by microorganisms. The most common microorganisms that cause infection include, bacteria, fungus and viruses. While 90% of the infections are caused by bacteria, the remaining 10% are caused by viruses and fungi (Maheshwari, 2014, Huis et al., 2013). Staphylococcus aureus, Escherichia coli, Enterococci and Pseudomonas aeruginosa are the most common types of bacteria that cause medical infections (Gould et al., 2017). Infections caused by microorganisms have the potential to spread from one individual to another through contact. Contact here refers to unclean hands and handling contaminated surgical instruments and hospital equipment. Contact does not necessarily refer to touching an infected person but also includes touching an infected door or handle that could spread the infection to a normal patient. Cross contamination is also another method through which infection can spread. The process of cross-contamination is a multistep process and includes a number of steps that comprises of the following (Nair et al., 2014):
- Presence of organisms wither on the skin or inanimate objects
- The transfer of infectious agent to the hands of the healthcare worker
- The organisms have the tendency to survive on the skin for several minutes
- Inadequate and ineffective hand hygiene, that causes the organism to remain on the skin
- Direct contact with a normal patient and transmission of the infection
The possibility of transmission of infection does not remain restricted to hospitals but also includes aged care facilities and community nursing homes. Microorganisms such as bacteria are typically found on the hands of the care providers who engage themselves in dressing of wound and handle patient secretions (Shinde & Mohite, 2014). In fact presence of bacteria has also been detected after the completion of clean procedures such as checking blood pressure or checking pulse of the patient. Studies reveal that the correct procedure of hand washing and maintenance of hand hygiene must include five moments. The moments include; observing hand hygiene before touching a patient, prior to a procedure, after a procedure is performed or exposure of body fluid, after touching a patient and after touching the surroundings of a patient (Shinde & Mohite, 2014). This clearly is against the common notion that states observing hand hygiene is only important after direct contact with the patients. Observing hand hygiene is important on many other occasions and according to the WHO guidelines is an integral procedure that healthcare professionals must comply with. It is critical to note in this context, that despite the underlying importance of observing hand hygiene, healthcare professionals encounter a large number of obstacles that prevent the professionals from complying with the standard routine of hand hygiene (Salamati et al., 2013). The prevalent perception about patient priority over hand hygiene, and gloves being an effective barrier that prevent the transmission of infection serve as obstacles that prevent care providers to comply with hand hygiene technique.
Relevance to nursing knowledge:
Hand hygiene can be defined as the single most important tool that effectively helps in the transmission of the infections between the patients and professionals (Nair et al., 2014). As stated by WHO, a few definitive data on patient studies have identified a number of patient-care activities that can possibly lead to the transmission of the infection (Salamti et al., 2013). Majorly, presence of bacteria have been detected in the hands of the hands of the healthcare workers after activities like wound care dressing, intravascular catheter care, respiratory tract care and handling body fluid or secretions. In addition to this, presence of bacteria have also detected on the hands of the care providers after clean contact that comprises of activities such as recording patient temperature, pulse or blood pressure. According to Shinde and Mohite (2014), hand washing technique is the most effective method of reducing the incidence of infections as it works effectively on a broad range of microorganisms. Studies have reported that effective compliance with hand hygiene technique can help in the reduction of infection rate by an impressive 60% (Luangasanatip et al., 2015). Therefore, it can be said that the importance of hand hygiene has been proven to be effective by different researchers, but at the same time on account of lower compliance, the infection rate is yet to be controlled to an appropriate percentage.
Therefore, on the basis of the exhaustive literature review, it can be said thata significant number of papers have talked about the efficacy of maintenance of hand hygiene and its positive implication on the reduction of the infection. It was typically revealed that ineffective and improper hand washing technique has resulted in an increase in the hospital based infection rate among the patients. The literature review vividly described the five important instances that have been identified as the moments that can lead to the transmission of the infection. The review also highlighted the important WHO guidelines that list the hand washing routine that must be followed by the care professionals (Salamati et al., 2013). However, it should be noted that despite the effectiveness of the hand hygiene technique on the reduction of infection, the technique is yet to be assimilated within the healthcare sector (Ariyaratne et al., 2015). A major gap has been identified in terms of attitude and perception of care professionals towards compliance with hand hygiene. None of the papers in the literature review talked about the obstacles that professionals encounter while dealing with patients that restricts them from complying with the hand hygiene procedure. Also, none of the papers focused on the imparting training and knowledge about the efficacy of hand hygiene to the health care professionals.
The project framework that would be followed in order to address the research question appropriately would include four major steps. The four steps would broadly comprise of identification of the research gap and framing a research question, adapting a suitable study design and selection of suitable participants, collection and interpretation of collected data and data analysis to retrieve results and outcome.
· Identification of the research gap
· Devising the research question on the basis of the research gap
· Selection of study design
· Consideration of sampling and population size
· Designing selection criteria for participants
· Collection of research data (qualitative data in this case, qualitative data would be obtained from five nursing professionals working in five different hospitals through semi-structured questionnaire response
· Interpretation of the data transcript (questionnaire-response)
· Data analysis
(The data analysis method chosen is the interpretative phenomenological analysis method)
Method of data-collection:
10 nursing professionals working in three different healthcare organizations with a minimum work experience of at least 3 years were shortlisted to participate in the research study process.An official permission was undertaken from the three healthcare organizations that was considered for the study. The participants were contacted through official mail and were briefed about the objectives and the significance of the study. Out of the 10 participants that were contacted, three did not respond and two responded in negation. The study was thus conducted with a total of five participants. The five participants were then interviewed at their convenience of date, time and venue. The confidentiality of the responses of the participants along with the ethical consideration of autonomy and privacy was obtained. The interview comprised of five questions and lasted for a period of ten minutes and the interview was recorded using an audio recorder which was later transcribed into a hard copy format for data interpretation.
Method of data-analysis:
The method used for analysing the data was qualitative data analysis. The interview transcript was read and re-read a number of times in order to highlight important excerpts and connect them to meaningful themes that were aligned to the aim of the research. This method is known as the interpretive phenomenological analysis and is best suited for analyzing semi-structured interviews (Smiddy et al., 2015). It helps in building new theories on existing one.
Theme 1: Patient priority leads to compromise with effective hand hygiene practices
Nurse 1: “Prioritizing patient becomes primary and many a times the routine is missed”
Nurse 2: “I think HH is not that important if I am using alcohol swabs”
Nurse 3: “HH is extremely important and it should be followed irrespective of using gloves”
Nurse 4: “If I am using gloves already, HH is secondary”
Nurse 5: “I think it is a waste of time and cuts down on the time given to the patient.”
Theme 2: Training helps in effective compliance with hand hygiene
Nurse 1: “HH training is important and helps in reducing the transmission of infection”
Nurse 2: “Training helps us in identifying events that require HH”
Nurse 3: “I am not aware of any such training”
Nurse 4: “Training is important and should be mandatory for professionals to follow”
Nurse 5: “I do not think you need training for that”
Findings of research:
Therefore, it can be stated that the findings of the research has significantly highlighted two important themes that include: patient priority leads to compromise with HH routine and incorporation of training helps in effective compliance with HH among professionals. Hence, it can be said that with effective training and stringent infection control policies professionals can be trained to comply with hand hygiene practices.
Therefore, on the basis of the discussion it can be said that the research study could properly address the research question. Further, the study helped in the identification of the underlying reasons that serve as barriers for professionals to comply with HH practices. Also, it can be said that implementation of effective training programs can help in significant infection control.
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