Nursing research proposal hand hygiene

Running head: hand hygiene compliance 1

hand hygiene compliance 8

Hand Hygiene Education Implementation and Nurses Compliance in Reducing Nosocomial Infections

Grand Canyon University NRS-490

March 31, 2019

Background

Hygiene is a very crucial factor in prevention of infection in any health care facility. Also, compliance of handwashing ensures patients safety, aids in the treatment and recovery of hospitalized patients. Hand hygiene is important action performed by healthcare works to prevent transmission of healthcare associated infection (Smiddy, O’Connell & Creedon, 2015). Health care professionals such as doctors, nurses, physical therapist and laboratory technicians, take the responsibility of providing efficient, effective and quality care that will improve the health of their patients.

The purpose of this paper is to discuss the change proposal project components the author has been working on throughout the course. The goal of health care works rendering a quality, effective and efficient care to their patient in the health care setting will be difficult to achieve if the rate handwashing adherence is below expectation. Unclean healthcare environments harbor germs that can cause disease, thereby placing the patient at risk of developing infection instead of recovering from their present health condition. Healthcare providers inability to comply with hand hygiene is one the main reason patient develop hospital acquired infections (HAIs). Healthcare employees have the lives of patient in their hands therefore, hand hygiene should not by any means be neglected or dominated out in any healthcare facility.

Approximately 250 health care specialists in a Metro Detroit facility happened to be watched and assessed directly; prior to the start of the exercise, participants were selected based on their hand washing comprehension and compliance. Partakers expresses that they observed improvement on handwashing practices and that most nurses complied to hand washing guidelines evidenced by some significant reductions in the rate of transmission of HAIs within the healthcare facility. HAIs are the infections a patient acquire during the period of hospitalization. The result of the research showed a huge decrease in the spread of nosocomial infections due to progress of hand hygiene training and nurses’ compliance to handwashing protocols. These infections mostly manifest during or after 48 hours of admission or thirty days after discharge from the hospital or health-care facility. The author of this research study sees HAIs as a dangerous disease with many complications. Because inadequate handwashing practices by healthcare workers are the main cause of spread of hospital acquire infections, it is important to educate staff members on proper hand hygiene, implement plan to encourage hand hygiene compliance in the healthcare settings. Blood-stream, ulcers / surgical wounds, CAUTI and respiratory infections are the most common types of HAIs

Problem Statement

Good hand hygiene practice is one of the essential factors in planting an end to cross infections and HAIs. However inadequate handwashing among healthcare providers leads to transmission of infection from one patient to another and they end up contacting the infection and it keeps spreading. (Hinz, McGee, Huitema, Dickinson, & Van Enk, 2014). The necessity of handwashing and adherence in the hospital setting is to facilitate the reduction of HAIs. Some healthcare corporations that are known to be very compliant with handwashing guidelines maintains the high hygiene level and generally have a good treatment that guarantees powerful healthcare system that assist with the standard health and wellbeing of patients. In order to secure patient safety, all health care environment should be kept clean at any given time. When health care facilities are clean, micro organism have no place to grow which will prevent or reduce the extent at which nosocomial infections spreads.

Healthcare workers in Detroit Medical Center were examined for a reduction in nosocomial infections via hand hygiene teaching and adherence monitoring. The writer noted that most healthcare workers do not adhere to handwashing because of lack of education. Some of them complained that they don’t have time to practice hand hygiene as a result of lack of handwashing equipment, high patient ratio, skin irritation and lack of hand hygiene monitoring. Nosocomial infection is defined as infection a patient contracted during their stay in the hospital (Thoa et al., 2015). This infection is very harmful and can jeopardize patient safety. Nosocomial infection is very common and occurs everyday in the hospital, while it can be avoided if the healthcare workers are compliant with hand hygiene protocols within the facility and when providing patient care. Evidence has shown that facilities where caregivers do not practice adequate hand hygiene results to distribution of nosocomial infections.

When healthcare workers neglect handwashing, they pose dangers of acquiring infection to patients and others. Nurses are the closest to patients and their hands are always on the patient when providing care therefore, inadequate hand hygiene is the leading cause of spread of nosocomial infection. This problem is the reason why the researcher wants to know if in an acute care setting healthcare providers(P) will implement hand hygiene education and compliance (I) on hand hygiene practice(C) to decrease nosocomial infections (O) within four weeks period(T).

Purpose of the Change Proposal

It is the responsibility of all healthcare providers to advocate for every patient to make sure that each person obtains safe, efficient, effective and quality healthcare services. Also, healthcare providers should endeavor to work as a team to provide solution that will improve the overall well-being of the patient. Moreover, it will be difficult to accomplish this aim if the healthcare environment increases the chance of contracting the infection as a result of noncompliance of hand hygiene practices. Handwashing practice is the cheapest and simple precaution that prevents spread of nosocomial infections in the hospital and healthcare workers must observe adequate handwashing while rendering patient care. There are so many explanations for noncompliance of handwashing among healthcare workers such as, unawareness, working overtime which may cause burnout. Additionally, laying emphasis on the change proposal which targets to encourage compliance of hand hygiene and education will inspire healthcare workers to observe hygiene at its peak, therefore reducing the rate at which nosocomial infection is being transmitted. Reducing expenses and medical cost utilized to treat complication developed from nosocomial infection is one of the objectives for the proposed change. The hand hygiene program is an effective strategy in reducing the incidence of hospital-acquired infections and is cost-effective (Thoa et al., 2015).

Nosocomial infection delays treatment in the hospital but when the rate of spread is reduced, the hospital will have brief length of stay patient are hospitalized because the process of treatment will be faster and not delayed. This will make bed available for other patient who need it for critical conditions. With few ill patients in the healthcare settings nurses, doctors, lab technicians and other healthcare providers will pay attention and take them serious thereby achieving the aim of providing safe, effective, efficient and quality healthcare services. World Health Organization published guidance on a standardized multistep technique to promote coverage of all surfaces of the hands with hand hygiene product, estimating 20–30 seconds for hand rubbing, Wash hands with warm or cold water. “There is no evidence that warm water is superior to cold water, although tepid water may be better tolerated” (Ellignson et al.2014).

PICOT

Many researchers use this acronym PICOT to expand their research question(s). P- signifies problem/population/patents, I- represent intervention to fix the problem, C- denotes comparison or opposite of the intervention. O- means the outcome and finally T symbolizes the timeframe used to achieve the desired outcome(s). utilizing the project change proposal, the recognized population provided in this research comprises of healthcare workers in the acute care setting. Intervention in the study is the implementation of education on hand hygiene. Comparison is the hand hygiene practice compliance. The study’s outcome is the decrease in spread of nosocomial infection and the time to achieve this is four weeks. The PICOT used for the change proposal identified is for healthcare workers in the acute care setting(P), hand hygiene education implementation(I) and compliance to hand hygiene practices(C) decreasing nosocomial infections (O) for the period of four weeks (T).

Literature Search Strategy Employed

The author utilized the research plan to search for literature from various database that is linked to the project topic. Essential information related to the topic were gathered from the numerous research plan. The researcher used PICOT to create the research question, this makes it easy to select vital evidence on techniques in which healthcare providers in the acute care setting can prevent the spread of nosocomial infection and comply to hand hygiene guidelines. The authors concentration was focused on identifying some current studies in respect to education on handwashing compliance and prevention of nosocomial infections. Cochrane and MEDLINE are outstanding database online question that was used for the search plan.

Evaluation of the Literature

High quality research literature was used to conduct this study which is pertinent to the problem statement, for example, Lawal et al., (2018) article is the research study learning about hand hygiene practices in the healthcare facility in a semi-urban setting, reply to the research question on how the knowledge and practices of hand hygiene among healthcare worker decrease nosocomial infection. Nurses knowledge on the correct technique involved in hand hygiene is deficient. Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018) article is the research study on availability and suitability of essential hand washing facilities, assess essential handwashing practice compliance among healthcare workers. The choice of literature the researcher used is in line with the statement of problem hence supplying essential data to the research study.

Applicable Change or Nursing Theory Utilized

Non-compliance of adequate hand hygiene practices among acute care nurses illustrates that it is crucial to have an intervention available to help improve the knowledge of healthcare workers on the importance of hand hygiene and adherence. Since substantial number of healthcare workers response is poor, the change applied can assist in reducing the problem which requires finding out why the acknowledgment to adequate hand hygiene practice is deficient. Nurses will be well informed and educated on the benefits of hand hygiene if they are aware and implement the theories in behavioral changes which is very vital in successful program application of decreasing the rate of nosocomial infections. Knowing hand hygiene behavior assumes and predict attitude of an individual with the help of planned behavioral theory.

Proposed Implementation Plan

It is very imperative to practice the standard precautions that will help promote hand hygiene. Hand hygiene compliance is the basis of infection control programs (Phan et al., 2018). The author suggested intervention for this research includes, explaining the importance of educating healthcare providers to carry out hand hygiene protocols appropriately while providing patient care. Seminars on hand hygiene compliance should be conducted to help nurses to work together as a team and come up with the thoughts that can assist with the practice of hand washing such as wearing gloves, placing hand sanitizers at the major locations like patient’s door, hallway, breakroom, around the computer and the nurse’s station.

It is recommended to perform hand hygiene before touch a patient, before clean procedure, after touching a patient, when hands are visibly dirty and after touching the environment (Lau, Tang, Mak & Leung, 2014). These strategies will enhance hand hygiene compliance among healthcare workers. The success of this project was assessed using quiz, posters and monitors. The study is evaluated every week for consecutive four weeks to check the progress of hand hygiene training and compliance protocols likewise decrease of hospital acquired infections. Results are compared every week with initial result at the beginning of the project and summarized. There was reduction in nosocomial infection because of compliance of adequate hand hygiene.

Potential Barriers to Plan Implementation

Negligence, laziness and non-compliance to adequate hand hygiene protocol are among the behaviors that hinders the success of the proposed change to encourage the standard rules of adequate hand hygiene in the acute care setting. It might be difficult for healthcare providers to adjust to the change thereby delaying the intended plan to enhance sanitation. Leaders and managers should provide support, filter ideas, and remove barriers to implementation of best practices identified by positive deviants for improving hand hygiene compliance (Marra & Edmond, 2014). Healthcare providers are to be prompted of their duty to render safe, effective, efficient and quality patient care. To achieve this goal, it is imperative to comply to hand hygiene practices.

Evidence of Revision

Evidence based practice is an approach which involves many stages that require thorough check and finances to function well. My mentor and I will make a detailed budget of how the method will work. Everything should be planned within the budget made by the financial manager. Every step is taken keenly for the practice to function well. Since my project is on hand hygiene, the finances of the evidence-based practice will be high. Money is needed to set up a facility more hand sanitizer dispensers and portable hand sanitizers and pocket hand lotions stationed at work stations which is conducive for nurses who use the area. The finances may come from donors, well-wishers, investors and the government.

Conclusion

To goal of standard health care service is to improve patient outcome, safety and wellbeing and not to expose them to nosocomial infection. Globally, nosocomial infection is a major concern in the healthcare setting and the key cause of poor handwashing, which can be prevented by adequate hand hygiene practices. Hand hygiene is the most cost effective, inexpensive and easiest measures toe reduce or prevent nosocomial infection in the healthcare settings. Hand hygiene education should be encouraged in the acute care setting to reduce the rate individual contracts and transmit nosocomial infection.

References

Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., ... & VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960.

Hinz, K. L., McGee, H.M., Huitema, B. E., Dickenson, A. M., & Van Enk, R. A., (2014).

Observer accuracy and behavior analysis: Data collection procedures on hand hygiene compliance in a neurovascular unit. American Journal of Infection Control, 42 (10),

1067-1073.

Lau, T., Tang, G., Mak, K. L., & Leung, G. (2014). Moment‐specific compliance with hand hygiene. The clinical teacher, 11(3), 159-164.

Lawal, T. O., Monsudi, K. F., Zubayr, B. M., Michael, G. C., Duru, C., Ibrahim, Z. F., & Aliyu, I. (2018). Hand hygiene practices among nurses in health facility in a semi-urban setting. International Journal of Health & Allied Sciences, 7(3), 191.

Marra, A. R., & Edmond, M. B. (2014). New technologies to monitor healthcare worker hand hygiene. Clinical Microbiology and Infection, 20(1), 29-33.

Niyonzima, V., Brennaman, L., & Beinempaka, F. (2018). Practice and compliance of essential handwashing among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice. Canadian Journal of Infection Control, 33(1), 33-38.

Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., & Gordon, C. J. (2018). An educational intervention to improve hand hygiene compliance in Vietnam. BMC infectious diseases, 18(1), 116.

Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T., Wertheim, H. F., & Son, N. T. (2015). Cost-effectiveness of a hand hygiene program on health care–associated infections in intensive care patients at a tertiary care hospital in Vietnam. American journal of infection control, 43(12), e93-e99.

Appendix A

Quiz on hand hygiene

1. Hand washing noncompliance among healthcare providers can be transmitted through inadequate hand hygiene?

A. True

B. False

2. it is recommended to wash hand with soap and water for how long?

A. 30 Seconds

B. 10 Seconds

C. 20 Seconds

D. 5 Seconds

3. When is the right time to perform hand hygiene? Select all that apply.

A. Before eating

B. After coughing, sneezing or nose blowing

C. After using the bathroom

D. Before and after each patient care

E. All of the above

4. How can transmission of germs be avoided?

A. Wearing mask

B. Avoid touching sick people

C. Practicing hand hygiene

D. Staying away from others

5. Healthcare provided are required to wash their hand before each patient contact?

A. True

B. False

6. Hand hygiene education implementation encourage hand washing practice adherence?

A. True

B. False

Appendix B

http://handwashingexperts.com/wp-content/uploads/2016/11/Stop-Super-Bugs.png

Author- Brain Grease Retrieved from www.1st-in-handwashing.com Hand washing Poster

Rate of Nosocomial Infections Before Implementation of Hand Hygiene Education

Week 1 Week 2 Week 3 Week4 200 400 500 600 Week 1 Week 2 Week 3 Week4 180 300 480 500 Week 1 Week 2 Week 3 Week4 160 240 440 400 Week 1 Week 2 Week 3 Week4 120 220 420 380

Rate of Nosocomial Infections After Implementation of Hand Hygiene Education