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Clinical Questions that are answerable with research evidence

You are the Nurse Unit Manager on a hospital medical ward. The infection control team recently identified low hand hygiene compliance (20%) of your staff. You need to put in place measures to increase hand hygiene compliance on your ward. Discuss what evidence based measures you would put in place to improve hand hygiene compliance.

Now days it has been seen that infections are spreading at a considerable rate through low hand hygiene compliance among the staff members of a hospital. According to Azim & McLaws (2014) one of the most important methods of preventing the increase of pathogens that includes viruses and bacteria in a hospital medical ward can be through maintaining hand hygiene. So, it has no become a major issue among the unit managers of a hospital in increasing the hand hygiene compliances among the staff members of the ward. Boyce (1999) commented on the fact that hand hygiene is essential in the medical ward for keeping the patients safe from infections and thereby it reduces the chances of infections. Moreover, hand hygiene is essential in order to prevent the further spread of hand spread diseases among the patients that are coming due to low hand hygiene factors.

Despite the modern development in the healthcare systems, the patients are still staying vulnerable towards the inadvertent harm in the hospitals. It is seen that nearly 20% of the staff members in the hospital medical ward are identified to have low hand hygiene conformity by the infection control team. Dunton & DeVita (2012) had a view that this is one of the major factors that increase the chances of spreading the infectious diseases among the patients. It is to be remembered that the patients arrive at the hospital in order to cure themselves from the persisting diseases rather than getting themselves more infected by other diseases that are caused through unhygienic practice maintained by the staff members. Kumar et al. (2014) commented that the nurses who come in close contact with the patients get their hands contaminated in the due course of routine care of the patients. Contamination of hands occur due to coming in contact with the materials and contaminated surfaces at the time of changing the dresses of the patients, checkups and at the time of giving medicines. In addition to this,  Peters (2010) opinioned that at the time of helping out the patients at the time of their visits in bathroom or inserting the catheter in the urinary system and later not washing the hands properly is another cause of contamination of hands. So, in order to give the patients the right amount of care and hygiene in the hospital and not making them infected with other’s diseases, requirement of hand hygiene is essential within the hospital environment.

In addition to this, Dunton & DeVita (2012) commented that based on PIO, practitioners facilitate evidence based practice. PIO is the acronym of Population Intervention Outcome. The population signifies the patients and their characteristics of diseases. The Intervention refers to the influence of diseases on other Patients and staff members if not the staff has washed their hands. According to Azim & McLaws (2014) the Outcome of this can that microbes will spread from the infected patients to other patients that may cause harmful results and even death of the patients.  On the other hand, PICO is same that of PIO but the “C” signifies comparison component that is needed as an alternative of the diseases.

Searching for as well as collecting evidences addressing the questions

In addition to this, Sakihama et al. (2014) commented that hand hygiene reduces the spread of infections to nearly 75%. It is statistically measured that nearly 4-5 millions of patients die every year due to low hand hygiene among the staff members.  Singh Joy (2010) also had an opinion that in the initial development of the hospital facilities, maintenance of hand hygiene is one of the initial factor that need to be taken care of among the patients. This is mainly done to secure the patients from the contaminated diseases and also to maintain the hygiene factor among the hospital environment. There are some questions asked to staff members that are answerable with research evidence are given below:

a) How often do you wash your hand daily in clinics?

b) How far are you concerned about maintaining cleanliness in clinics?

c) To what extent you know that microbes are spread through low hygiene?

According to Simon & Costers (2011) the pathogens are the viruses and bacteria that are spread through low hand hygiene compliances of the medical ward of the hospital through the staff members. The areas that are around the perineum and other areas such as trunk, hand and armpits are loaded with microbes and touching those areas and then not washing hands properly may cause transmit of diseases from one place to another. Girard et al. (2002) commented on the fact that the types of microbes’ are- Klebsiella, Candida, Norovirus, Rotavirus, Hepatitis A virus, Adenovirus, Enterobacter etc. are spread on the hands of the staff members of health care unit. Moreover, diseases such as chronic dermatitis, chronic renal failure, and diabetes also cause microbes that are also spread through low hand hygiene factor. Lee (2014) had a view that even after taking the pulse, temperature, touching the hands, shoulder of the patients and also by taking readings of blood pressure makes the hands of the staff members and nurses contaminated. Patient gowns, bedside furniture, bed lines etc if not properly washed using disinfectants can also spread microbes through the hands of the nurses and other health care staff members.

Mumford et al. (2014) had an opinion that the pathogenic organism that transmits the pathogens through hands is present on the skin of the infected patients and are transferred through the hands of the nurses and healthcare workers. Inadequate cleaning of the hands or not cleaning at all and touching the other patients also spread the microbes from one patient to the other. Ataei et al. (2013) had a view that this thereby makes the environment of the hospital full of microbes and the patients become susceptible towards other chronic diseases.

According to Berger & Glenn (2012) the Centers for Disease Control and Prevention or CDC has a review regarding the maintenance of hand hygiene among the staff members of a hospital in order to maintain the hygiene factors among the hospital environment and patients. The health care workers and the nurses get their hands contaminated by using two types of pathogens such as transient or contaminating and resident or colonized micro-organisms. So, Budimir-Hussey et al. (2013) had a vision that the nurses or healthcare units should not wear any kind of jewellery, rings or watches that can lead to colonization of bacteria underneath the skin that causes the spread of contaminated diseases. According to CDC guidelines, hand drying is equally important similar to drying of hands since the micro-organisms tend to thrive in a moist atmosphere.  Azim & McLaws (2014) had a view that according to the guidelines of CDC, the medical staff members need to  adopt procedures for hand hygiene such as using antiseptics, alcohols, antibacterial soaps at the time of touching each of the patient or after seeing and touching the contaminated patients.

Appraising and Synthesizing Evidence

Birnbach (2012) commented on the fact that the surgical instruments also need to be washed properly after the operations done and also before doing the operation. Proper usage of gloves, gowns also need to be treated and disinfected before and after the patients are operated or given medicines and fitting medical equipments into the body of the patients. Hintikka, Kainulainen & Anttila (2010) had an opinion that the guidelines of CDC have clearly mentioned that the health care unit staff members need to wash their hand before touching a patient, before a procedure and after the procedure that exposes the body fluid and can cause infection. In addition to this, even after touching the patient and after touching the surroundings of the patient’s, the health care units that includes the staffs and nurse need to wash hands properly using disinfectants in order to prevent the spread of contaminated diseases (Kouni et al. 2014).

According to Pittet (2000) the medical sciences are getting advanced day to day with the introduction of modern technology, medicines and modern medical devices. But along with the advancement of medical science, the issues and diseases that are caused with the low hand hygiene is also increasing in a fast pace. So, in order to prevent the spread of contaminated diseases through hands, the hygiene factor needs to be improved in a considerable rate for maintaining the hygiene within the medical wards and hospital. Stewardson, Russo & Grayson (2014) had an opinion that the promotion of hand hygiene within the hospital and among the medical staff members is not less than 150 years. This is done in order to use hygienic methods for prevention of contaminated diseases among the patients through the hands of the medical staff members.

Kumar et al. (2014) commented on the fact that previously the rate of infection that was caused due to low hand hygiene was high; 1 patient out of 5 patients get infected through it. This was caused due to less usage of disinfectants and sanitation and thereby caused spread of infection among the patients. But due to the promotional activities such as information leaflets, lectures, automated dispensers and workshops also help in improving the mentality of the medical workers and thereby this resulted in the improvement of usage of antiseptics for cleaning the hands. According to Dunton & DeVita (2012) these promotional activities also help in making the health care staff members to understand the utility and importance of usage of antiseptics, antibacterial soaps and usage keeping their hands clean for preventing the spread of infectious diseases. It has been statically measured that now day the ratio of deaths regarding the spread of contaminated diseases has reduced to an extent but still has not reduced completely. Still, 20% of the staff members are not using proper disinfectants and that is causing the spread of the microbes among the other patients (Gillen, 2015).

With the increase in consciousness regarding the requirement of hand hygiene necessity, the health care staff members that include nurses, doctors and other workforce members need to use proper substances for the purpose of hand hygiene. According to Azim & McLaws (2014) the substances that are essential for the purpose of cleaning the hands and making it disinfectant are- soaps and detergents, antibacterial soaps, hand sanitizers, ash and mud. Using these substances, the micro-organisms that causes the spread of contaminated diseases are killed thereby making the patients free from the other infectious diseases. Birnbach (2012) commented on the fact that usage of alcohol based hand rubs, the microbes automatically gets removed that result in reducing the spread of microbes among the patients. In addition to this, the usage of disinfectant medical gloves and gowns also help in reducing the ill effects of the contaminated diseases and their spread.

Conclusion

Throughout this literature review, it is seen that there are several ill-effects of the infectious diseases that are spread through low hand hygiene among the staff members of the medical ward. It is therefore essential to use hand hygiene by washing hands with disinfectants and thereby drying them for the future purpose. The gloves and gowns along with other medical equipments also need to be disinfected and cleaned before their usage for operating or curing or testing the patients. In addition to this, the CDC guidelines are also discussed regarding the necessity and requirement of hand hygiene. Moreover the evidence based measures that are adopted for increasing the consciousness regarding hand hygiene is also discussed vividly.

References

Ataei, B., Zahraei, S., Pezeshki, Z., Babak, A., Nokhodian, Z., Mobasherizadeh, S., & Hoseini, S. (2013). Baseline evaluation of hand hygiene compliance in three major hospitals, Isfahan, Iran. Journal Of Hospital Infection, 85(1), 69-72. doi:10.1016/j.jhin.2013.07.001

Azim, S., & McLaws, M. (2014). Doctor, do you have a moment? National Hand Hygiene Initiative compliance in Australian hospitals. The Medical Journal Of Australia, 200(9), 534-537. doi:10.5694/mja13.11203

Azim, S., & McLaws, M. (2014). Doctor, do you have a moment? National Hand Hygiene Initiative compliance in Australian hospitals. The Medical Journal Of Australia, 200(9), 534-537. doi:10.5694/mja13.11203

Berger, B., & Glenn, L. (2012). Multidisciplinary hand hygiene factors in hospitals. American Journal Of Infection Control, 40(7), 682. doi:10.1016/j.ajic.2012.05.006

Birnbach, D. (2012). “Hand hygiene compliance by visitors to hospitals—we can do better.â€Â Response to letter titled “Hand hygiene compliance by visitors to hospitals—can we do better?â€Â. American Journal Of Infection Control, 40(9), 900. doi:10.1016/j.ajic.2012.07.009

Boyce, J. (1999). It Is Time for Action: Improving Hand Hygiene in Hospitals. Annals Of Internal Medicine, 130(2), 153. doi:10.7326/0003-4819-130-2-199901190-00011

Budimir-Hussey, M., Ciprietti, L., Ahmed, F., Tarola, C., Lo, A., & El-Masri, M. (2013). Exploring Physician Hand Hygiene Practices and Perceptions in 2 Community-Based Canadian Hospitals. Journal Of Patient Safety, 9(3), 140-144. doi:10.1097/pts.0b013e318283f56d

Dunton, D., & DeVita, S. (2012). State Public Health Department Performs External Observations of Hand Hygiene Compliance in All Maine Acute Care Hospitals, 2011. American Journal Of Infection Control, 40(5), e159-e160. doi:10.1016/j.ajic.2012.04.282

Girard, R., Aho, L., Goetz, M., Labadie, J., & Lejeune, B. (2002). Alcohol-based hand gels and hand hygiene in hospitals. The Lancet, 360(9344), 1510-1511. doi:10.1016/s0140-6736(02)11444-9

Hintikka, A., Kainulainen, K., & Anttila, V. (2010). Two reality TV series reveal the reality of hand hygiene compliance in two Finnish hospitals. Journal Of Hospital Infection, 76, S46. doi:10.1016/s0195-6701(10)60155-7

Kouni, S., Kourlaba, G., Mougkou, K., Maroudi, S., Chavela, B., & Nteli, C. et al. (2014). Assessment of Hand Hygiene Resources and Practices at the 2 Children’s Hospitals in Greece. The Pediatric Infectious Disease Journal, 33(10), e247-e251. doi:10.1097/inf.0000000000000376

Kumar, P., Gupta, S., Kapil, A., Vij, A., & Singh, I. (2014). A Comparative Study of Hand Hygiene Practices in Operation Theaters in Tertiary Level Hospitals in Delhi, India. JRFHHA, 2, 87-93. doi:10.5005/jp-journals-10035-1021

Lee, A. (2014). Hand hygiene and bacteraemia rates in Australian hospitals. Australian And New Zealand Journal Of Public Health, 38(1), 87-87. doi:10.1111/1753-6405.12160

Mumford, V., Greenfield, D., Hogden, A., Debono, D., Gospodarevskaya, E., & Forde, K. et al. (2014). Disentangling quality and safety indicator data: a longitudinal, comparative study of hand hygiene compliance and accreditation outcomes in 96 Australian hospitals. BMJ Open, 4(9), e005284-e005284. doi:10.1136/bmjopen-2014-005284

Peters, J. (2010). Insufficient evidence to determine the effectiveness of measures to prevent occupational irritant hand dermatitis. Evidence-Based Nursing, 14(1), 21-22. doi:10.1136/ebn.14.1.21

Pittet, D. (2000). Improving Compliance With Hand Hygiene in Hospitals •. Infect Control Hosp Epidemiol, 21(6), 381-386. doi:10.1086/501777

Sakihama, T., Honda, H., Saint, S., Fowler, K., Shimizu, T., & Kamiya, T. et al. (2014). Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals. Journal Of Patient Safety, 1. doi:10.1097/pts.0000000000000108

Simon, A., & Costers, M. (2011). Impact of three multimodal countrywide campaigns to promote hand hygiene in Belgian hospitals. BMC Proceedings, 5(Suppl 6), O63. doi:10.1186/1753-6561-5-s6-o63

Singh Joy, S. (2010). Hand Hygiene in Hospitals. AJN, American Journal Of Nursing, 110(7), 66-67. doi:10.1097/01.naj.0000383941.60838.20

Stewardson, A., Russo, P., & Grayson, M. (2014). Doctor, do you have a moment? National Hand Hygiene Initiative compliance in Australian hospitals. The Medical Journal Of Australia, 201(5), 264-265. doi:10.5694/mja14.00718

Gillen, S. (2015). More nurses getting dermatitis as a result of hand hygiene campaigns. Nursing Standard29(24), 0-0. doi:10.7748/ns.29.24.0.2924990

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