Hygiene refers to the practices that communities perceive as upholding or preserving healthy living, while an infection is an attack of parasites on a host organism. Hospitals being public places where both sick and healthy people mingle are likely to be more vulnerable to infections compared to other places. The sources of infections in hospitals include hospital staff, patients and the inanimate environment.
Maintenance of hand hygiene is one of the simplest yet most effective methods in prevention of infections. In spite of the society emphasizing on the importance of hand hygiene, many people including health care personnel, do not adhere to this practice as recommended. This study focuses on adherence of Health Care Personnel (HCP) to hand hygiene practices and nosocomial or hospital-acquired infections.
Numerous studies have shown that the hands of HCP are the most likely vehicle of hospital-acquired infections. Research has shown that, Proper hand hygiene can remove more than 90% of infection-causative pathogens present on the hands. It is, therefore, crucial that HCP adhere to proper hand hygiene practices. However, adherence to satisfactory hand hygiene by HCP has been poor. According to Beck and Schmidt, (2001), only 40% of HCP adhere to proper hand hygiene posing the risk of increased nosocomial infections.
The healthcare code of ethics calls upon HCP to uphold beneficence, or rather “act in the best interest of the patients”. Proper hand hygiene among HCP with the aim of decimating nosocomial infections is therefore, a beneficent practice. Notably, nurses are more in contact with patients than any other HCP. This means that nurses are more likely to transmit nosocomial infections to patients. Adherence to hand hygiene practices by nurses, therefore, has immense potential to reduce nosocomial infections.
Problem Statement/ Hypothesis
The main challenge from various researchers on hand hygiene has been, how to increase adherence. This study will seek to establish the relationship between the incidences of nosocomial infections reported in a given hospital to the adherence levels of its HCP to hand hygiene. To this end, the study hypothesizes that: The higher the levels of adherence to hand hygiene by HCP, the lower the levels of nosocomial infections.
Objectives
The main objective of this study is to study hand hygiene practices among HCP and its relationship to nosocomial infections.
Specifically the study aims at:
Studying hand hygiene techniques used by HCP and their levels of adherence to the techniques.
Establishing the number of nosocomial infections reported in a selected hospital and correlate the adherence of HCP to hand hygiene, to the number of infections.
Evaluating the reasons for or against adherence to various hand hygiene techniques.
Offering recommendations to increase adherence to hand hygiene practices.
Expected Outcomes
The study expects to establish an in-depth coverage of hand hygiene practices by HCP in a selected hospital. A correlation of the hand hygiene practices to the number of nosocomial infections in the hospital will be done. The resultant challenges and weaknesses will prompt appropriate solutions that can be implemented. Increased adherence to hand hygiene practices shall reduce nosocomial infections.
Nursing Theorist/ Theory
Nursing theories recommend two basic measures to prevent nosocomial infections: Cutting off transmission routes and separating the source of infection from the rest of the hospital (Pratt, 2009). The nursing profession recommends the former measure since it is much more proactive. Nurses ought to eschew from implementing the latter because it could mean putting a patient in total isolation against their will, (Garner, 2006). Moreover, the threat of airborne infection could still loom even after isolation.
Two main types of microorganisms are present on the skin. These are the resident flora and the transient flora. Resident floras reside on the skin while transient floras are introduced into the body by medical devices such as catheters or during trauma. Studies have shown that it is transient flora and not resident flora that are responsible for the majority of hospital infections.
Hand washing easily removes transient flora. Hand washing removes loose transient flora by removing dirt. Hygienic hand washing using antiseptics (medicated soap or alcohol) added to detergents removes entirely all the transient flora and effectively reduces chances of infections. The reduction in the levels of transient flora (infection-causative agents) is the ultimate way of reducing nosocomial infections.
Literature Review
Numerous researchers have conducted studies on hand hygiene in various social settings such as restaurants, schools, parks, sporting venues, hospitals, among others. In spite of increasing levels of pathogens in the environment; nearly all the studies have reported poor adherence to hand hygiene practices. Nursing researchers have touted hand hygiene among HCP, as one of the most effective ways of in preventing hospital-acquired infections through indirect contact. Pratt (2009) attributes 90% of nosocomial infections to indirect contact. Infected patients touch objects, instruments or surfaces. Subsequent contact from the object or surface is likely to result in an infection to a second (mostly a HCP) or a third (another patient). (Ryan, Christian & Wohlrake, 2001), concur with the nursing theory by stating that hospitals adherence to hand hygiene has the potential to reduce nosocomial infection by 80%. This makes proper hand hygiene a crucial practice that has tremendously beneficial outcomes.
A study by (Kennedy & Burnett, 2011) identified the following as factors influencing adherence of HCP to hand hygiene: The status of the HCP, the place of work (ward, intensive care unit, theatre etc), the sex of the HCP (males show less commitment to hand hygiene compared to females). Others factors include the use of protective gear (gloves, gowns), the type of hand hygiene substances and equipment provided and their positioning (soaps, towels, sinks), the number of staff in a particular facility among others. A survey by Pratt (2009), reported 48% compliance out of 2,834 opportunities observed opportunities for hand hygiene.
There are various hand hygiene techniques. Pratt (2001) categorized hand hygiene techniques into three. (1) Routine handwash (using ordinary water and anti-microbial soap). (2) Hygienic hand washing (using water and medicated soap or alcohol-based hand rubs). (3) Surgical hand antisepsis (hygienic hand washing performed by surgeons prior to an operation). The study recommends HCP to conduct antiseptic hand washing prior to performing invasive procedures such as placement of indwelling and intravascular catheters, prior to dressing wounds and prior to handling patients at a high risk of infections such as newborns.
Alcohol based hand rubs are appropriate where hand washing facilities are inadequate and in case the hands are not soiled with dirt or contaminated with body fluids (Bloomfield, Aiello, Cookson, O’Boyle & Larson, 2007). Alcohol based antiseptics eliminate transient flora rapidly due to their mechanical detergent effects. Moreover, the rubs exert a sustained antimicrobial activity on the remaining flora (Ryan et al, 2001). According to Pittet, (2007), the disinfectants also retard the resident flora and, making them suitable in the elimination of microorganisms over long periods of time. The disinfectants are suitable in the elimination of all bacteria and the clinically relevant viruses, fungi and yeasts (Kennedy & Burnett 2011).
However, surveys have shown that frequent exposure of skin to water and soap can result in skin irritation and consequently damage while alcohol based hand rubs have a tendency to cause drying of the skin (Ryan et al, 2001). Some surveys reported that 25% of nurses exhibited signs and symptoms of dermatitis at some point in their careers. Majority of them attributed the condition to frequent hand washing. Research has shown that repeated use of waterless alcohol-based hand antiseptics containing emollients can improve skin condition and curb dermatitis. Forced air driers are not appropriate for use in clinical areas (Van de Mortel & Murgo, 2006). The equipment is noisy, can only be used by one person at a time and they are responsible for a number of infections. In their place (Kennedy & Burnett, 2011) recommends the use of paper towels. They should be placed near the sink away from splashing water.
Expected Outcomes
Contrary to previous studies on this topic, this research proposal seeks to address hand hygiene using a two pronged approach. (1) Study the adherence levels to hand hygiene of HCP in a hospital setting. (2) Establish the number of nosocomial infections reported over a given period in the selected hospital. Attributing the rise in nosocomial infections in a hospital to poor hand hygiene, is likely to trigger an empathetic response from the HCP of the hospital. It is expected that HCP, hospital administrators inclusive will act in the best interest of patients.
The study is, therefore, expected to yield more a comprehensive coverage of the topic and present proactive approaches to solving the resultant challenges and weaknesses. It is expected that, the study will be a wake-up call to HCP to adhere to hand hygiene, while challenging hospital administrators to play their part to ensure that all HCP uphold hand hygiene. This could come in the form of availing more sinks per a given number of HCP, changing the substances the HCP currently use among other interventions.
It is also expected that the nursing students will implement the recommendations of this study. Nursing students are expected to adhere to proper hand hygiene practices and carry on the practices to hospital settings. It is expected that adherence to hand hygiene practices by all HCP, student nurses inclusive will decimate hospital-acquired infections.
Research Design
Experimental design of the project
The subjects of the study will be selected from 2 leading general hospitals whose combined HCP can total 300. Via the hospital administrators, the study will request voluntary participation of as many HCP from the selected hospitals as possible. The analysis will be based on data from 50 respondents. The sample will be representative of HCP of both sexes (25 men and 25 women), well distributed to accommodate the professional statuses of the participants, factor in the participants’ years of practice, among other relevant considerations.
A quasi experimental technique based on a randomized block design shall be chosen. The blocks shall be based on the techniques of hand hygiene (methods and frequencies) various HCP used. Therefore, the blocks shall be; (1) Routine hand washing, (2) Antiseptic, (3) hygienic hand washing disinfection (3) Surgical hand disinfection. The study will also seek to obtain statistics and information on hospital-acquired infections from healthcare administrators.
Collecting and Measuring Data
In this research, survey questions will be used to collect data. The survey questions will then be disseminated to all the volunteer participants via email. A request will be made to the participants to pass the survey to their friends in order to increase the response rates.The questions in the surveys will have an opportunity to gather data, which measures both independent and dependent variables (Caliński, Tadeusz & Kageyama, 2003). Independent variables include will include location of paper towel, soap dispenser, and automatic faucet while dependant variable shall be hand-washing behaviors (techniques and frequencies). In addition, the survey has the potential of collecting data, which refers to both quantitative and qualitative variables. Further, the survey includes questions on age, years of practice, gender, and the use of Likert scale.
Houser (2008) argues that scales require respondents to depict their attitude towards certain abilities and traits. For this research, five-point Likert scale has been selected and, it will be included in the survey questions. The scale comprises of statements, which are attitude based, and require respondents to agree or disagree. This will help in the elimination of biases, which may impact research results. Creation of anonymity on the survey will aid in developing confidence on respondents to participate effectively since the survey is sensitive to personal issues. However, respondents will be requested to complete the survey within a week. This period creates adequate room for data collection.
Further, the research focuses on attaining qualitative data by using interview questions. These questions will comprise of both closed and open-ended questions. In order to create room for probing for clarification of data, open-ended questions will be used while the closed questions will be dichotomous questions. As such, interviews will be used in research to enable collection of immediate suggestions and comments on the research topic. In addition, interviews will facilitate in eliminating replication of data from the same respondent.
Expected Outcomes and Changes
It is expected that the survey will yield research data, which is substantial for making analyses. This is because it is expected that a minimum of 50 surveys will be completed successfully. The anticipated data will comprise of respondents comments on hygiene and infection in hospitals (Ralph, & Taylor, 2005). Further, in the use of interviews, it is expected that respondents may be embarrassed to provide accurate data (Beck, & Schmidt, 2001). As such, changes such as making the interview process optional for respondents will aid in mitigating the negative impact of the interview process.
Evaluation Method of the Findings
The data collected from the research will be analyzed quantitatively through the use of multivariable and regression analysis. This form of analysis will aid in identifying the relationship, which exist between the independent and dependent variables (Fitzpatrick, & Kazer, 2011). Moreover, regression analysis will provide a room of identification of the correlation, which exists between the variables. Further, a comparison of data from survey questions and interview questions will be made in order to establish the validity, reliability, and accuracy of the collected data from research.
Conclusion
Maintenance of high levels of hygiene is an aspect that societies emphasize on for a universal reason; keep infections at bay. Hospitals, more than any other place abound in vulnerability to infections. Researchers have touted the hands of Health Care Personnel (HCP) as the most likely vehicle of hospital-acquired (nosocomial) infections. Moreover, HCPs are supposed to uphold beneficence by “acting in the best interest of patients)”. In light of these circumstances, it is appalling that only 40% of HCP adhere to proper hand hygiene practices. These developments prompted this research proposal.
The main objective of this study is to establish hand hygiene practices among HCP and its relationship to nosocomial infections. Researchers on the topic have revealed that HCP adherence hand hygiene has the potential to reduce nosocomial infections by up to 80%. Other researchers have reported several factors as affecting adherence to hand hygiene. Some of these factors include sex of the health worker, type of hand hygiene substances and equipment, professional level of HCP among others. The use of alcohol-based hand rubs has been touted by several researchers as ideal. However, other studies have reported significant cases of dermatitis, attributed to frequent hand washing, among nurses.
The study hopes to obtain and analyze credible data from 50 respondents using questionnaires (survey questions) emailed to numerous volunteer HCP in two hospitals. Experimental design will be based on randomized block design while analysis of results will use multivariable and regression analysis. This form of analysis will aid in identifying the relationship, which exist between the independent and dependent variables. It is expected that the study shall establish the relationship between the hand hygiene and nosocomial infections, present challenges and weaknesses in the on the issue of hand hygiene. It is expected that the study will increase adherence to hand hygiene by HCP while challenging nursing students to uphold hand hygiene now and in the future. Moreover, it is expected that the study will generate solutions and recommendations to improve adherence as well address any other emerging issues.
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