Healthcare problem
Healthcare associated infections (HAIs) are the infection acquired by a patient in a healthcare facility, such as hospital, nursing home, outpatient clinic and rehabilitation facility. Such infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated pneumonia. HAIs are major complications of healthcare and have been linked with high mortality and morbidity (Chen et al., 2017). On an annual basis, 1 in 25 US hospital patients are diagnosed with atleast any one of the types of infection related to hospital care. In addition, infections also occur in other forms of healthcare settings (Liu et al., 2017).
Healthcare associated infections (HAIs) are caused by drug-resistant pathogens that contribute to significant burden on the healthcare system of the United States. The social and economic impact of the high incidence of HAIs has been mostly negative. The issue has been greatly compounded by the recent decline in the development of novice antibiotics that target certain pathogens (Holý& Forsythe, 2014). Healthcare agencies in the country are making many attempts to restrict the occurrence of HAIs through diverse approaches including prevention practices, financial incentives and surveillance systems. However, much remains unachieved till date as the control of HAIs has not been upt-to-the-mark. Percival et al., (2015) opined that it is now the responsibility of respective healthcare settings to adhere to evidence-based strategies that can reduce the increasing rate of HAI.
Handwashing has been denoted as a positive technique to keep patients safe from HAIs across health care settings. Research indicates that regular handwashing among healthcare professionals, especially nurses, is a low-cost and simple action that can prevent the rapid spread of microbes responsible for causing HAIs (Chen et al., 2017). In the present care setting, compliance to handwashing protocols is low, and there is a poor level of awareness regarding the importance of handwashing among the professionals.
HAIs have unquestionably made substantial impacts on the overall healthcare system and patient outcomes. Quantification of the economic burden of the disease has been attempted in the past. The main impact of HAIs on the healthcare setting are attributed to unnecessary utilization of resources and burden on healthcare staffs. This is related to increased length of patient’s stay at the healthcare setting due to infection. There is a negative psychological impact on the patients as well as they suffer from depression and poor health outcomes (Septimus et al., 2014).
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PICO Question |
|
|
P(patient/problem) |
Healthcare associated infection |
|
I(intervention/indicator) |
Handwashing |
|
C(comparison) |
No handwashing |
|
O(outcome) |
Reduced infection |
The PICO question that is addressed through the present research is as follows-
Significance of problem
“Does regular handwashing practice of healthcare professionals reduce incidents of HAIs among patients admitted at healthcare settings?”
Keywords
Keywords are the words or small phrases that are inserted in the electronic databases for retrieving the appropriate hits. These words are taken from the research question and research objectives, and are indicative of the main terms used. They might be applied as single or in combination with each other to make the search more defined. The keywords used for this research were as follows- healthcare associated infection, hospital infection, HAI, infection, control, controlling, prevention, prevent, hand washing, washing, hand, hands, healthcare, hospital, care setting.
The articles retrieved from initial search includedboth appropriate and inappropriate hits. Search in databases such as PubMed, Science Direct, and CINAHL led to extraction of 1926 articles in total. These were searched using a inclusion criteria. The articles published after the year after 2012, having full-text documents and having relevance to research question were selected for the study. Scrutiny was done by first reading the title of the articles and then analyzing the abstract of the articles.
Research evidence- Grave et al., (2016) studied the cost-effectiveness of the Australian National Hand Hygiene Initiativewhose implementation was between 2009 and 2012. The study outcome was rate of Staphylococcus aureus bacteraemia, and the baseline comparators were the eight state and territory hand hygiene programs. The setting was the Australian public healthcare system with 1,294,656 admissions. The study had the inference that the Australian National Hand Hygiene Initiative was cost-effective. The researchers suggested that the policy makers must raise the pressing question of whether cheaper health benefits might be achieved through allocation of scarce infection prevention budgets. Stiller et al., (2016) explored healthcare facility design and provision of equipment as the contributing factors for infection control strategies through a literature search. The study found that accessible hand rub dispensers,when placed near a patient’s bed, is an effective measure of infection control.
Non-research evidence- Ellingson et al., (2014) highlighted that internationally recognized guidelines for hand hygiene in care settings include the 2009 WHO Guidelines on Hand Hygiene in Health Care and the 2002 CDC Guideline for Hand Hygiene in Healthcare. These have been put forward after extensive research done as a multiyear international initiative and include reviews of almost 1000 publications. These were mainly consistent with the CDC guidelines. Yokoe et al., (2014) opined that continual progress in healthcare research has taken the center stage in the recent past. There has been some advancements in the understanding of HAIs however much is yet to be done in this regard. Hand washing has been pointed out to be one of the most effective strategies for curbing HAIs.
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Authors |
Journal Name/ WGU Library |
Year of Publication |
Research Design |
Sample Size |
Outcome Variables Measured |
Level (I–III) |
Quality (A, B, C) |
Results/ Author’s Suggested Conclusions |
|
Salama et al. |
Journal of Infection and Public Health |
2013 |
Prospective, interventional study |
12 doctors and 26 members of the nursing staff at Mubarak Al-Kabir Teaching Hospital, a Ministry of Health hospital affiliated with the Health Sciences Center of Kuwait University |
Hand hygiene (HH) compliance rate among healthcare workers (HCWs), effect on the nosocomial infection rates in the ICU of our hospital, |
III |
B |
Handwashing is an effective measure for reducing nosocomial infections in hospitals including ICUs. Reduction in rate of infection with multudru resistant bacteria is a noteworthy finding. Alcohol based sanitising gels are of prime importance for hand washing. Care workers must adhere to the guidelines set in place by respective settings in a stringent manner. |
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Fox et al. |
American journal of critical care |
2015 |
Preexperimental study design |
In the year before protocol implementation, 2183 patients were admitted to the ICU and 2326 patients were admitted during the protocol. They were all included in the study. |
Comparison of 12-month rates of 2 common hospital-acquired infections, central catheter–associated bloodstream infection and catheter associated urinary tract infection. Nurses’ hand-washing compliance was also measured before and during use of the protocol |
II |
C |
Though reduction was both types of infections were reported. However, this reduction was not statistically significant. Hand washing compliance among nurses was also improved. Hand washing on a regular basis holds to potential to prevent hospital infection, however, continual quality improvement efforts arerequired for monitoring change practices. |
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Abrdaboh et al., |
American Journal of Medicine and Medical Sciences |
2016 |
Three phase intervntionstudy |
Four hundred eighty participants were recruited of which 100 were physicians and 380 were nurses |
Hand hygiene knowledge among care profesisonalsand impact on HAIs |
III |
B |
Hand hygiene protocol adherence is a simple and affordbale way of preventing HAIs in healthcare settings. A prolonged approach for educating professionals must be taken up by the respective settings. This is more important for critical care units. |
|
Marimuthu et al., |
Antimicrobial Resistance and Infection Control |
2014 |
Systematic review |
Studies that have assessed the association between hand hygiene enhancement and methicillin-resistant Staphylococcus aureus (MRSA) rates |
Difference in rate of HAIs after implementation of hand hygiene practice |
I |
A |
Enhancement of hand hygiene compliance effectively reduces MRSA rates. MRSA-related surgical site infections has been significantly low. Alcohol based hand rubs can be used extensively while hand washing. |
|
Thu et al. |
American Journal of Infection Control |
2015 |
Before and after study with a hand hygiene program as the intervention |
2 intensive care and 15 critical care units |
Cost effectiveness of hand hygiene (HH) program in reducing HAIs |
II |
A |
Hand hygiene program is a cost effective program in reducing HAIS incidence. Low and middle income countries should consider this strategy. |
|
Smiddy et al. |
American Journal of Infection Control |
2015 |
Systematic review |
Qualitative literature review |
Impact of adherence to hand hygiene guidelines |
I |
A |
When health care workers comply with hand hygiene guidelines, it reduces the risk of HAI |
|
Little et al. |
The Lancet |
2015 |
Randomised controlled trial |
Individuals having received treatment through general practices in England |
Effectiveness of internet-delivered hand washing intervention for reduction of infection |
II |
B |
Internet intervention for hand washing has an important effect in reduction of infection transmission |
Current practice
There is an urgent need of implementing robust hand washing protocol in the concerned health care setting. Policy reforms are crucial in this regard that would make hand washing practice a part of the care protocol to be adhered to. The setting must consider having provision for alcohol based rubs and cleansers that are to be used for hand washing before and after handling a patient. While all units are to follow the set protocol, the same is to be more stringently followed for Intensive Care Units (ICU). The setting needs to allocate sufficient funding and allocation of resources to enable the implementation of the change practice.
The key stakeholders who are to play a significant role in the recommended practice change are nurses, physicians, careproviders. A proactive approach is required from these stakeholders in adhering to the hand washing protocol as a responsible healthcare professional. These care providers are to have a deep understanding of the importance of hand washing in reducing incidence of HAIs. The stakeholders are to provide input on how the change can be propagated throughout the organization. Collaboration between the stakeholders is needed to exchange ideas for effective decision-making.
The main challenges that the care setting are to witness in implementing the recommended practice change is lack of leadership and insufficient funding. Leadership is essential for the clinical managers to be exhibited so that all employees are motivated to adhere to hand hygiene protocol. Research indicates that clinical leaders fail to showcase the required style and extent of leadership that fosters a required change in collaboration with the team members within a required time frame. Further, there might be a lack of resources and funding that promotes spread of education among the professionals and lays the provision for availability of hand washing means (Dunn, 2016).
Clinical leaders are to begiven an opportunity to enhance their leadership skills throughcontinual professional development. Further, training is to be provided to the professionals so that they can align their practice with the objectives of the practice change. Sessions can be conducted on a regular basis that would have industry-based professionals coming in to interact with the leaders and guide them in the suitable direction. Sessions are also to be organized with members of the different professional teams so that they can resolve any interpersonal conflicts, if present (Ginter et al., 2018).
The chief outcome for the practice change would be changes in the rate of HAIs after adherence to hand washing protocol among care professionals. Data is to be collected on a regular basis across the setting that is to be then analyzed using a relevant data analysis tool. The Healthcare-Associated Infections (HAI) Data Analysis and Presentation Standardization (DAPS) Toolkit is known to define best practices and methods for organizations to present HAI data to both technical and consumer audiences (Dunn, 2016).
Impact
References
Abdraboh, S. N., Milaat, W., Ramadan, I. K., Al-Sayes, F. M., &Bahy, K. M. (2016). Hand hygiene and health care associated infection: an intervention study. American Journal of Medicine and Medical Sciences, 6(1), 7-15.
Chen, Y., Zhao, J. Y., Shan, X., Han, X. L., Tian, S. G., Chen, F. Y., …&Luo, A. (2017). A point-prevalence survey of healthcare-associated infection in fifty-two Chinese hospitals. Journal of Hospital Infection, 95(1), 105-111.
Dunn, R. (2016). Dunn and Haimann’s Healthcare Management.Health Administration Press.
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.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., …& Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.
Ginter, P. M., Duncan, J., & Swayne, L. E. (2018). The Strategic Management of Healthcare Organizations.John Wiley & Sons.
Graves, N., Page, K., Martin, E., Brain, D., Hall, L., Campbell, M., …& Barnett, A. G. (2016). Cost-effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated Staphylococcus aureusbacteraemia. PloS one, 11(2), e0148190.
Holý, O., & Forsythe, S. (2014). Cronobacter spp. as emerging causes of healthcare-associated infection. Journal of Hospital Infection, 86(3), 169-177.
Liu, H., Herzig, C. T., Dick, A. W., Furuya, E. Y., Larson, E., Reagan, J., … & Stone, P. W. (2017). Impact of State Reporting Laws on Central Line–Associated Bloodstream Infection Rates in US Adult Intensive Care Units. Health services research, 52(3), 1079-1098.
Little, P., Stuart, B., Hobbs, F. D. R., Moore, M., Barnett, J., Popoola, D., … & Yao, G. (2015). An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. The Lancet, 386(10004), 1631-1639.
Marimuthu, K., Pittet, D., &Harbarth, S. (2014). The effect of improved hand hygiene on nosocomial MRSA control. Antimicrobial resistance and infection control, 3(1), 34.
Percival, S. L., Suleman, L., Vuotto, C., &Donelli, G. (2015). Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control. Journal of medical microbiology, 64(4), 323-334.
Salama, M. F., Jamal, W. Y., Al Mousa, H., Al-AbdulGhani, K. A., &Rotimi, V. O. (2013). The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital. Journal of infection and public health, 6(1), 27-34.
Septimus, E., Weinstein, R. A., Perl, T. M., Goldmann, D. A., &Yokoe, D. S. (2014). Approaches for preventing healthcare-associated infections: go long or go wide?. Infection Control & Hospital Epidemiology, 35(7), 797-801.
Smiddy, M. P., O’Connell, R., & Creedon, S. A. (2015). Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. American journal of infection control, 43(3), 269-274.
Stiller, A., Salm, F., Bischoff, P., &Gastmeier, P. (2016). Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrobial Resistance & Infection Control, 5(1), 51.
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.
Yokoe, D. S., Anderson, D. J., Berenholtz, S. M., Calfee, D. P., Dubberke, E. R., Ellingson, K. D., … & Lo, E. (2014). A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. American journal of infection control, 42(8), 820-828
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