Hand Hygiene Education in Nursing Practice

Handwashing in medical facilities is one of the most effective procedures that help to reduce infection rates. However, this preventive measure has limited usage among health workers. For example, a study that investigated hand hygiene (HH) compliance in a children’s hospital demonstrated that the overall preintervention rate among medical staff was only 50.3% (Song, Stockwell, Floyd, Short, & Sing, 2013). There are different educational programs and protocols designed to solve this problem, and such efforts can bring a substantial decline in the frequency of hospital infections.

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Literature Evaluation Table

Criteria Article 1 Article 2 Article 3 Article 4
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
Barnett, A. G., Page, K., Campbell, M., Brain, D., Martin, E., Rashleigh-Rolls, R.,… Graves, N. Infection Control and Hospital Epidemiology, 35(8), 1029-1036. Chhapola, V., & Brar, R. International Journal of Nursing Practice, 21(5), 486-492. Chun, H.-K., Kim, K.-M., & Park, H.-R.
International Journal of Nursing Practice, 21(6), 709-715.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C.,… Bader, M. K.
American Journal of Critical Care, 24(3), 216-224.
Article Title and Year Published Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a National Hand Hygiene Initiative. 2014. Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit. 2014. Effects of hand hygiene education and individual feedback on hand hygiene behavior, MRSA acquisition rate, and MRSA colonization pressure among intensive care unit nurses. 2014. Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. 2015.
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The purpose of the research was to check whether there was a connection between the establishment of the National Hand Hygiene Initiative and the infection rates alteration. The objectives of the article were:
  • to evaluate the HH practices standard compliance;
  • to assess the effect of the handwashing instructional initiative on infection rates in a NICU.
The purposes of the research were:
  • to examine the regularity and the scrupulousness level of HH practice by nurses;
  • to evaluate the impact of the “methicillin‐resistant Staphylococcus aureus (MRSA) acquired incidence rate” and the “MRSA colonization pressure in a medical intensive care unit (MICU)” (Chun, Kim, & Park, 2014, p. 709).
The objective of the article was to scrutinize a new patient hand hygiene protocol created to decrease hospital-acquired infection levels and increase hand-washing compliance of the nurses working in an intensive care unit.
Design (Type of Quantitative, or Type of Qualitative) Quantitative research, Interventional study Quantitative research, Interventional study Quantitative research, Interventional study Quantitative research, Interventional study
Setting/Sample 38 Australian hospitals across 6 states. Neonatal intensive care unit/ over 27 000 cases for hand hygiene evaluation 24 nurses at a MICU Hospital/ 1-year rates of two common hospital-obtained infections
Methods: Intervention/Instruments The National Hand Hygiene Initiative/ Observation Hand washing instruction program/ Observation Hand hygiene education and individual feedback/ post-instruction assessments through observations and interviews A new patient hand hygiene protocol/ Calculation of infection rates before and in the course of the protocol used
Analysis Poisson regression, Akaike information criterion P-value/ confidence intervals P-value N/A
Key Findings The National Hand Hygiene Initiative was connected with the decrease in infection rates in 4 of the 6 states under the question. The immediate decrease in rates (10% and 28%) was recorded in two states. The linear reduction (8% and 11%) was noticed in two states. No alterations in infection statistics were recorded in the two states. The incidence of nosocomial sepsis showed a reduction from 96 per 1000 patient‐days to 47 per 1000 patient‐days before and after the intervention. HH compliance rate of the hospital health workers increased from 46% to 69%. The MRSA acquisition rate demonstrated a decline from 11.1% to 0% before and after the education. Also, the MRSA colonization pressure showed a reduction from 39.5% to 8.6%. Decreases in the 1-year infection ratio were recorded for the two infection types. However, none of the decreases was statistically significant.
There was also a slight improvement in the overall nurse compliance rate.
Recommendations Intervention methods like the National Hand Hygiene Initiative should be implemented to reduce infection rates. To arrange the productive nosocomial method of infection control and prevention, efficient HH practices should be employed. Providing individual feedback after HH education session is a very effective measure. To prevent infections in hospital settings, hand hygiene education is needed.
Explanation of How the Article Supports EBP/Capstone Project The results of the study prove that HH intervention is associated with reduced infection rates. The findings of the study prove that educational intervention regarding hand hygiene is effective in the prevention and reduction of infection rates in a NICU. The results indicate that hand hygiene instruction with feedback is effective in decreasing the acquisition rate of MRSA. The findings indicate that hospital-acquired infection incidence can be decreased by the implementation of the new patient hand hygiene protocol.
Criteria Article 5 Article 6 Article 7 Article 8
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
Jaggi, N., Rodrigues, C., Rosenthal, V. D., Todi, S. K., Shah, Saini, N.,… Radhakrishnan, K. International Journal of Infectious Diseases, 17(12), e1218-e1224. Johnson, L., Grueber, S., Schlotzhauer, C., Phillips, E., Bullock, P., Basnett, J., & Hahn-Cover, K. American Journal of Infection Control, 42(11), 1146-1151. Martínez-Reséndez, M. F., Garza-González, E., Mendoza-Olazaran, S., Herrera-Guerra, A., Rodríguez-López, J. M., Pérez-Rodriguez, E.,… Camacho-Ortiz, A. American Journal of Infection Control, 42(7), 713-717. Schweon, S. J., Edmonds, S. L., Kirk, S. L., Rowland, D. Y., & Acosta, C.
American Journal of Infection Control, 41(1), 39-44.
Article Title and Year Published Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India. 2013. A multifactorial action plan improves hand hygiene adherence and significantly reduces central line-associated bloodstream infections (CLABSI). 2014. Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients. 2014. Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. 2013.
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study The purpose of the research was to assess the effect of the “International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates” in eight cities in India (Jaggi et al., 2013, p. e1218). The goal of the study was to investigate the improvement of HH among healthcare employees and its relation to CLABSI rate reduction. The objective of the study was to evaluate “chlorhexidine (CHX) bathing and hand hygiene (HH) compliance in the reduction of NIs” in the intensive care unit (Martínez-Reséndez et al., 2014, p. 713). The research aimed to analyze the effect of education on alcohol-based hand rubs on the elimination of pathogen transmission in acute care settings.
Design (Type of Quantitative, or Type of Qualitative) A prospective, before-and-after cohort study Quantitative research, Interventional study Quantitative research, Interventional study Quantitative research, Interventional study
Setting/Sample 16 adult intensive care units of 11 hospitals/ 35 650 patients A 570-bed academic hospital in Columbia, MO Intensive care unit/ 1007 patients A 174-bed long-term care facility (LTCF)
Methods: Intervention/Instruments INICC method/ CLABSI rates compilation A multimodal action plan to enhance HH obedience/ HH adherence and CLABSI rates HH program/ Compilation of global and specific NI statistics Hand hygiene project/ Infection rates authorization
Analysis P value/ confidence intervals N/A P-value P-value
Key Findings The baseline rate was “6.4 CLABSIs per 1000 CL-days,” which was reduced to “3.9 CLABSIs per 1000 CL-days” in the second year and continued for three years of follow-up, being responsible for a 53% CLABSI rate reduction (“incidence rate ratio 0.47, 95% confidence interval 0.31-0.70; p = 0.0001”) (Jaggi et al., 2013, p. e1218). The HH compliance rate demonstrated a rise from 58% to 98% in 6 years. CLABSI rates reduced over the same period, from “4.08 per 1000 device-days to 0.42 per 1000 device-days” (Johnson et al., 2014, p. 1146). Over a 6-month period infection rates per 100 discharges were higher in the preintervention (PIP) compared with the intervention (IP) and also higher in the postintervention (PoIP) compared with the IP (“P =.0004 and.0109, respectively”) (Martínez-Reséndez et al., 2014, p. 713). Global infection rates per 1000 hospital-days were higher in the PIP than in the IP (“P =.0268”) (Martínez-Reséndez et al., 2014, p. 713). The rates of catheter-associated urinary tract infection (CAUTI) and ventilator-associated pneumonia (VAP) were higher in the PIP than in the IP (“P =.036 and.0001, respectively”) (Martínez-Reséndez et al., 2014, p. 713). There was also a reduction in isolation of Acinetobacter baumanniifrom VAP specimens (“P =.0204”) and isolation of Candida spp from CAUTI specimens (“P =.0005”) (Martínez-Reséndez et al., 2014, p. 713). Infection rates for lower respiratory tract infections (LRTIs) were reduced from 0.97 to 0.53 infections per 1,000 resident-days (P =.01) following the intervention, a statistically significant decline. Infection rates for SSTIs were reduced from 0.30 to 0.25 infections per 1,000 resident-days (P =.65).
Recommendations INICC approach should be implemented for CLABSI rate reduction. Health care worker adherence to appropriate HH protocols should be improved. A combined HH intervention should be used for the reduction of NIs in the intensive care unit. An education program on the use of alcohol-based hand rubs can lead to a decrease in infection rates in LTCFs.
Explanation of How the Article Supports EBP/Capstone The simultaneous introduction of the six components of the INICC approach was related to a significant decrease in the CLABSI rate in India. The reduction stayed stable during 3 years of follow-up. The findings of the study demonstrate that the improvement of HH adherence is linked to a reduction of CLABSI rates. The results of the study prove that combined HH intervention is effective in a global and specific infection rate reduction. The results show that an education program on the use of alcohol-based hand rubs can lead to a decrease in infection rates in LTCFs.

Conclusion

Although the studies have different time parameters, the general effect of hygiene education programs on infection management appears to be largely positive. The research evidence listed above demonstrates that a low level of handwashing adherence among health care workers is strongly associated with the frequency of hospital infections. This situation could be improved by hygiene compliance promotion, but the amount of time necessary for that change might be more than six months.

References

Barnett, A. G., Page, K., Campbell, M., Brain, D., Martin, E., Rashleigh-Rolls, R.,… Graves, N. (2014). Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative. Infection Control and Hospital Epidemiology, 35(8), 1029-1036. Web.

Chhapola, V., & Brar, R. (2014). Impact of an educational intervention on hand hygiene compliance and infection rate in a developing country neonatal intensive care unit. International Journal of Nursing Practice, 21(5), 486-492. Web.

Chun, H.-K., Kim, K.-M., & Park, H.-R. (2014). Effects of hand hygiene education and individual feedback on hand hygiene behaviour, MRSA acquisition rate and MRSA colonization pressure among intensive care unit nurses. International Journal of Nursing Practice, 21(6), 709-715. Web.

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. Web.

Jaggi, N., Rodrigues, C., Rosenthal, V. D., Todi, S. K., Shah, Saini, N.,… Radhakrishnan, K. (2013). Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India. International Journal of Infectious Diseases, 17(12), e1218-e1224. Web.

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Johnson, L., Grueber, S., Schlotzhauer, C., Phillips, E., Bullock, P., Basnett, J., & Hahn-Cover, K. (2014). A multifactorial action plan improves hand hygiene adherence and significantly reduces central line-associated bloodstream infections. American Journal of Infection Control, 42(11), 1146-1151. Web.

Martínez-Reséndez, M. F., Garza-González, E., Mendoza-Olazaran, S., Herrera-Guerra, A., Rodríguez-López, J. M., Pérez-Rodriguez, E.,… Camacho-Ortiz, A. (2014). Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients. American Journal of Infection Control, 42(7), 713-717. Web.

Schweon, S. J., Edmonds, S. L., Kirk, S. L., Rowland, D. Y., & Acosta, C. (2013). Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. American Journal of Infection Control, 41(1), 39-44. Web.

Song, X., Stockwell, D. C., Floyd, T., Short, B. L., & Sing, N. (2013). Improving hand hygiene compliance in health care workers: Strategies and impact on patient outcomes. American Journal of Infection Control, 41(10), e101-e105. Web.

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