Topic

Nursing research project on whether the nursing knowledge of hand hygiene protocol and use of personal projective equipments helps in the reduction of the hospital acquired infection

Hospital Acquired Infections (HAIs) is one of the common problems, which increase the length of stay in the hospital along with an increase in the overall healthcare costs. Thus increase in the rate of incidence of the HAIs hampers the overall process of care (Slimings et al., 2014). Barnett et al. (2013) stated that HAIs increase patient’s risk of death and increase their length of stay in the hospital. These incidences are common in the intensive care unit (ICU). Death in the ICU arising out of HAIs occurs due to bloodstream infection (BSI) (Barnett et al., 2013). The main source of the HAIs in Australia, is Clostridium difficile and such infection is common among the patients attending to the any area of an public hospital like inpatient department, psychiatric department, rehabilitation unit, aged care, emergency care unit and out-patient department. The HAIs arising out of Clostridium difficile leads to development of diarrhoea prolongs the weakness of the patients increasing their length of stay in the hospital (Slimings et al., 2014). According to Barbut et al. (2013), the main mode of the spread of the HAIs includes touch of contaminated hands over the wound. Barbut et al. (2013) further stated that patients who are immuno-compromised, the touch of the contaminated hands can spread the HAIs irrespective of the presence of the wound; here the propagation of the bacteria either takes place to the nasal route or the baccal routes. Apart from the touch of the contaminated hands, other mode of transport of the HAIs include sneezing, coughing, contaminated clothes and unsterilized needles or injection syringes, contaminated towels, floor surface. Out of these, the main source of HAIs is the contaminated hands of the nursing professionals. Since the nursing professionals spend the majority of the time with the patients, they are considered as the main hub of bacteria. Apart from these, a nursing professional who is suffering from flue can also act as a source of the HAIs leading to the spread of infection through sneezing and cough.

Sarani et al. (2016) stated that since the nurses are the part of the healthcare team that plays a major role in the taking care of the patients, the role of nurse in the prevention of the HAIs in imperative. In order to judge the level of knowledge of the nursing professionals, Sarani et al. (2016) conducted a descriptive study over 170 nurses working in the paediatric ward and medical surgical wards. The collection of the data was based on the questionnaire framed by the World Health Organisation (WHO) in the field of prevention of the HAIs. The analysis of the results highlighted that the 43% of the nursing professionals have poor knowledge about the importance of the HAIs, 37% mad moderate attitude towards the HAIs. Thus overall results pointed that lack of proper nursing knowledge and awareness are the main barriers towards the prevention of the HAIs. Salama et al. (2013) are of the opinion that increase in the level of nursing knowledge will help to increase the level of adherence of the hand hygiene among the nursing professionals along with the use of the PPE. Fashafsheh et al. (2015) also studied the level of the nursing knowledge towards controlling HAIs as they are min persons who are constantly exposed to the pathogens that may give rise to several lethal infections. The analysis of the results highlighted that in spite of having proper availability of the resources, the knowledge of the nursing professionals towards the prevention of the HAIs is low. Moreover, increase in the overall work-pressure due to the shortages of the care, decrease the rate of observance of the hand hygiene. Ceballos et al. (2013) stated that nursing driven quality improvement interventions helps in the reduction of the HAIs arising out of the catheter-associated infection, central-line associated blood stream infection (CLABSI), and ventilator associated pneumonia (VAP). Ceballos et al. (2013) also highlighted that lack of proper set-up, unavailability of resources and poor nurse: patient ratio decreases the protocol adherence.

Research Question

Thus the main research gap in the study, thought it has been proposed that proper nursing training helps to increase the awareness of HAIs among the nurses, there are not studies which are yet been conducted in order to study the validity of the statement. The present study will be conducted among the nurse managers who provide training to the nursing professionals in increasing awareness and practice adherence of hand hygiene and PPE to prevent HAIs. The nurse managers will be the best person to stay how training increases the practice adherence and how practice adherence will help to decrease the HAIs.

                                                                                                 Source: Created by Author

10 prospective nurse managers from the 3 different public hospital with more than 5 years of experience in this filed were selected for the research. Official mail was communicated with them stating the scope and the purpose of the research. Out of them 7 agreed and finally 3 was selected for the conduction of the qualitative interview with the help to open-ended questionnaire. However, before the initiation of the interview, they were asked to sign a consent form. Inside the consent form, the purpose and the scope of the research was clearly stated along with the rules and toe regulations of the privacy and confidentiality which the researchers will abide by. In the consent form, it was written that no personal questions will be there in the interview, they can leave the interview at any point of time without any prior notifications and they name and other identification details will be kept confidential.

The interview consisted of 4 questions and it lasted for 15 minutes. The interview was recorded with the help of the audio-recorded and was conducted within the hospital premises as per the convenience of the nurse managers. The recorded audio file was then transformed into a written format for the transcript generation. (Interview transcript is given in the appendix portion)

The main method of the data analysis was qualitative data analysis with a thematic approach. The transcript of the interview and read and re-read several times in order to generate codes as highlighted from the phrases of the interview and these phrases were used to generates themes. This process of theme generation is known as phenomenological research. Phenomenological research is a qualitative research. It is helpful in describing how human being experiences certain phenomenon. It attempts to set aside the biases and preconceived experiences or attitudes or mindset towards a particular situation (Van Manen, 2016). The selection of the phenomenological qualitative data analysis helped to understand the perspective of the nurse managers towards the prevention of the HAIs.

Literature Review

The main findings of the research highlighted that proper training of the nursing professionals on weekly basis help to increase their knowledge and the understanding of the importance of the hand hygiene and the use of the PPE towards the prevention of the HAIs. This increase in the level of knowledge and understanding increases the level of compliance of the HH and the use of PPE for the prevention of the HAIs. The research conducted by Szilágyi et al. (2013) highlighted that proper training about the importance of the hand hygiene by following the protocol of the WHO’s 6 step of the hand hygiene protocol helps to decrease HAIs by increasing the compliance. The nursing professionals who are trained weekly by WHOs 6-step of HH is found to have increased knowledge about dorsal and the palmar aspects of the hand cleaning along with cleaning of the finger-tips by the use of the alcohol hand rub. This helped in comprehensive reduction of HAIs arising out of touch of contaminated hands. The quasi-experimental study conducted by Allegranzi et al. (2013) stated that multi-modal implementation of the WHO-6 step of HH strategy helps to the nursing knowledge about the HAIs and how it can be prevented and this helps to increase the level of compliance. Increase in the level of compliance helps to decrease the level of HAIs (Allegranzi et al., 2013).

Another finding of the research highlighted that not only training and increase in the level of awareness, but increase in the availability of the resources also helps to increase the level of compliance of HH and use the personal protective equipments. Fischer et al. (2014) lack of the proper availability of the alcohol filled hand rub bottles at the bed side of the patients or unavailability of the alcohol hand rub decrease the rate of compliance. Moreover, the lack of proper availability of the PPE also decreases the level of compliance. In relation to statement, Amoran and Onwube (2013) stated that if the nursing professional is well-aware about the importance of HH and PPEs, then he or she will make the necessary efforts for the do the arrangements. However, Fischer et al. (2014) stated that PPEs are critical but are not enough towards giving comprehensive protection towards the development of the HAIs.

Conclusion

In response to the research question, it can be said that increase in the degree of the nursing knowledge about the HAIs, helps to increase in the level of compliance and thereby helping to decrease the chances of HAIs. Increase in the level of nursing knowledge can be done by giving proper training.

Relevance to the Nursing Knowledge

Along with increase in the training of the nursing professionals in the domain of observance of the hand hygiene and the use of the personal protective equipments for the prevention of the hospital acquired infection, proper environmental precautions must be taken. Dancer (2014) are of the opinion that traditional cleaning methods for the cleaning of the hospital surfaces are notoriously inefficient for the decontamination and is in-effective in controlling the rate of incidence of HAIs caused by vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and multiresistant gram-negative bacilli and Clostridium difficile. Thus new approaches for disinfection are required to be undertaken like automated dispersal systems, antimicrobial surfaces and use of steam. Though it is difficult to evaluate the cost-effectiveness of these methods but it is highly effective in controlling the incidences of the HAIs. Amoran and Onwube (2013) recommended increase in the level of the nursing work-force will help to decrease the nursing stress and the workload and this in turn will help to increase the level of compliance.

References

Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M. L., Moro, M. L., … and Donaldson, L. 2013. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. The Lancet infectious diseases, 13(10), 843-851.

Amoran, O. E., and Onwube, O. O. 2013. Infection control and practice of standard precautions among healthcare workers in northern Nigeria. Journal of global infectious diseases, 5(4), 156.

Barbut, F., Yezli, S., Mimoun, M., Pham, J., Chaouat, M., and Otter, J. A. 2013. Reducing the spread of Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus on a burns unit through the intervention of an infection control bundle. Burns, 39(3), 395-403.

Barnett, A. G., Page, K., Campbell, M., Martin, E., Rashleigh-Rolls, R., Halton, K., … and Graves, N. 2013. The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case–control study. BMJ open, 3(10), e003587.

Ceballos, K., Waterman, K., Hulett, T., and Makic, M. B. F. 2013. Nurse-driven quality improvement interventions to reduce hospital-acquired infection in the NICU. Advances in Neonatal Care, 13(3), 154-163.

Dancer, S. J. 2014. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clinical microbiology reviews, 27(4), 665-690.

Fashafsheh, I., Ayed, A., Eqtait, F., and Harazneh, L. 2015. Knowledge and Practice of Nursing Staff towards Infection Control Measures in the Palestinian Hospitals. Journal of Education and Practice, 6(4), 79-90.

Fischer, W. A., Hynes, N. A., and Perl, T. M. 2014. Protecting health care workers from Ebola: personal protective equipment is critical but is not enough. Annals of internal medicine, 161(10), 753-754.

Salama, M. F., Jamal, W. Y., Al Mousa, H., Al-AbdulGhani, K. A., and 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.

Sarani, H., Balouchi, A., Masinaeinezhad, N., and Ebrahimitabs, E. 2016. Knowledge, attitude and practice of nurses about standard precautions for hospital-acquired infection in teaching hospitals affiliated to Zabol University of Medical Sciences (2014). Global journal of health science, 8(3), 193.

Slimings, C., Armstrong, P., Beckingham, W. D., Bull, A. L., Hall, L., Kennedy, K. J., … and Richards, M. J. 2014. Increasing incidence of Clostridium difficile infection, Australia, 2011–2012. The Medical Journal of Australia, 200(5), 272-276.

Szilágyi, L., Haidegger, T., Lehotsky, Á., Nagy, M., Csonka, E. A., Sun, X., … and Fisher, D. 2013. A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps”. BMC infectious diseases, 13(1), 249.

Van Manen, M. 2016. Phenomenology of practice: Meaning-giving methods in phenomenological research and writing. Routledge.