Clostridium difficile (C. diff) infections are a significant issue that can result in patient deaths (Barker et al., 2017; Boyce & Zingg, 2017). They are also incredibly prevalent in healthcare settings. Among care-associated infections, C. diff can be responsible for about 12% of the cases, and every year, it leads to at least 15,000 deaths in the US (Barker et al., 2017, p. 1154). However, such infections can be prevented with the help of hand hygiene, and the proposed evidence-based practice (EBP) project will focus on this possibility.
The suggested PICOT can be phrased as follows: in hospitalized adults infected with C. diff (P), does hospital hand hygiene protocol (soap and water and hand sanitizer) (I), compared with CDC recommended hand hygiene protocols for C. diff, (C) increase prevention of C. diff infections (O), after the first 48 hours or after 3 midnights of the patient’s hospital stay (T)? Consequently, the project’s purpose is to compare the two approaches to hand hygiene to determine which of them should be used in the hospital. The significance of the project can be explained by the importance of the issue and the gaps in the knowledge associated with it, which will be explored below.
Nowadays, it has been established that C. diff can contaminate hands and gloves (Barker et al., 2017; Boyce & Zingg, 2017). The contamination occurs when people come in contact with the infected or the environmental surfaces near them, which is common for care providers. Consequently, it is evidenced that workers may be the main reason for the transmission of C. diff in healthcare settings (Boyce & Zingg, 2017, p. 374). However, hand hygiene can prevent C. diff infections.
Currently, it is known that different forms of C. diff can be removed through different approaches to hygiene. The spores, which are particularly important for transmission, are removed with the help of water and soap; antiseptics are not helpful in this case. The vegetative form, which is understudied, is effectively removed by antiseptics; however, it is not clear if it contributes to C. diff transmission (Boyce & Zingg, 2017, p. 374-376). As a result, it is mostly recommended to use water and soap, even though, as pointed out by Boyce and Zingg (2017), more research is needed.
The CDC (2015) recommends water and soap for the prevention of C. diff infections, which, as shown above, is the common suggestion. The CDC (2015) also approve of a relatively recent guideline, which focuses on acute care hospitals and proposes the same course of action (Dubberke et al., 2014, p. S52). In summary, modern evidence-based guidelines support a specific approach to hand hygiene aimed at preventing C. diff infections. This approach differs from the hospital protocol, which also includes the use of hand sanitizer. As shown by the recent literature on the topic, the latter method may be explained by the understudied nature of the vegetative form of C. diff (Boyce & Zingg, 2017, p. 374-376). Thus, it appears necessary to compare the effectiveness of the two approaches to ensure the use of the more appropriate one, which is the purpose of the proposed project. Its outcomes would be important for its settings, but they would also contribute the data for future EBPs.
To summarize, C. diff can be the cause of patient deaths, and it is a major and prevalent problem in healthcare settings. It has not been fully explored, but the existing evidence about it was employed for EBPs. Mostly, they consist of the recommendation to use water and soap to prevent infections. However, the gaps in the knowledge on the topic might require changes depending on the importance of the vegetative form of C. diff for its transmission. As a result, the comparison of different approaches to hand hygiene can produce more data and foster the development of best practices in the field. Therefore, given the importance of hand hygiene and the dangers associated with C. diff, as well as the gaps in related research, the clinical significance of the proposed project is proven.
References
Barker, A., Zellmer, C., Tischendorf, J., Duster, M., Valentine, S., Wright, M., & Safdar, N. (2017). On the hands of patients with Clostridium difficile: A study of spore prevalence and the effect of hand hygiene on C difficile removal. American Journal of Infection Control, 45(10), 1154-1156. Web.
Boyce, J., & Zingg, W. (2017). Role of hand hygiene in Clostridium difficile control. In D. Pittet, J. M. Boyce, & B. Allegranzi (Eds.), Hand Hygiene (pp. 373-377). New York, NY: John Wiley & Sons.
CDC. (2015). Healthcare-associated infections. Web.
Dubberke, E. R., Carling, P., Carrico, R., Donskey, C. J., Loo, V. G., McDonald, L. C.,… Gerding, D. N. (2014). Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2), S48-S65. Web.