Introduction
The increased prevalence of HCAI (Healthcare Associated Infections) is a key problem in healthcare that affects the quality as well as the safety of care delivered to patients ( Polin et al., 2012). Essentially, HCAI are described as the types of infections that are usually acquired in care settings during the process of receiving treatments. In regard to this, NICU (Neonatal Intensive Care Unit) is one of the highly affected unit due to the unique vulnerabilities of the newborns. As such, neonates have various vulnerabilities such as low birth weight, invasive procedures, and impaired defense mechanism increase their vulnerability to these infections.
These infections usually result to serious health problems and are among the leading causes of deaths witnessed in NICU. According to a survey conducted by the “Pediatric Prevention Network”, about 11.2% of patients in the NICU are affected by these infections and they are the leading cause of deaths recorded in the NICU. Moreover, these infections result to various health as well as economic consequences among patients, the patient’s family and the entire healthcare system. In regard to this, HCAI prolong the length of stay in the hospitals whereby this increases the amount of health expenditure incurred by the infant’s family and the healthcare organizations (Schweizer et al., 2013. In relation to this, studies indicate that HCAI increase the amount of health expenditure by about $ 100 million whereby this amount is used in providing care to infants affected by these infections. Moreover, HCAI prolong the length of hospital stay whereby this limit the provision of health services to other patients. Furthermore, this increases utilization of resources among the patient’s family (Polin et al., 2012).
Based on the health as well as the economic consequences associated with HCAI, it is crucial for healthcare providers to develop evidence-based interventions to minimize incidences of HCAI in the NICU. In regard to this, improving hand hygiene is one of the most effective strategy that can be used to minimize incidences of HCAI in the NICU (Mathur, 2011). However, despite the fact that healthcare workers are aware on the effectiveness of hand hygiene in regard to minimizing HCAI, most of them do not maintain the appropriate hand hygiene practices. Healthcare associated infections within this unit have been largely attributed to poor hand hygiene and lack of proper directives or guidelines that offer a holistic approach to hand hygiene. This paper seeks to examine the effectiveness of a hand hygiene bundle in preventing healthcare associated infections within the NICU.
As such guided by the PICO question, “For NICU unit inpatients does the use of a hand hygiene bundle as compared to routine care help in preventing hospital acquired infections?”, this paper seeks to further explore this issue by visiting the existing evidence on this approach and determining its appropriateness in this unit.
P- NICU inpatients
I-Hand hygiene bundle
C-Routine care
O- Reduction in healthcare associated infections
Hand hygiene bundle is multimodal intervention strategy that comprises of various components such as administrative support in relation to enhanced hand hygiene, surveillance, education, performance feedback, reminders and enabling access to ABHR (Alcohol-Based Hand Rub). On the other hand, routine care comprises of the standard components of hand hygiene that involves washing of hands with water and antiseptic soaps. In the light of this, the study shall focus on evaluating the effectiveness of bundling strategy as compared to routine care in minimizing incidences of HCAI among inpatients in the NICU unit.
In order to gain a clear understanding on the issue, a broad literature search was conducted on nursing literature using various databases. The databases used in conducting a literature search included; AbInform, NCBI, and JBI.
According to Pincock et al., (2012), the use of hand hygiene bundle is an effective strategy that helps to minimize incidences of HCAI and foster optimal clinical outcomes among hospitalized patients. The study found out that bundling reinforces changes in behavior among the healthcare workers whereby this promotes the adoption of safe hand hygiene practices thereby minimizing incidences of HCAI. Moreover, the strategy helps in the sustenance of efficient hand hygiene practices and fosters the adoption of excellent care practices that focus on infection reduction among the healthcare professionals. Additionally, bundling promotes collaboration among the healthcare workers whereby this fosters good care practices especially in hand hygiene.
Similarly, a study by Luangasanatip et al., (2015) emphasizes that bundling intervention is an efficient strategy that enhances compliance of healthcare workers with safe and excellent hand hygiene practices as compared to the standard practices. The study asserts that hand hygiene bundle is an efficient intervention that leads to rapid, sustained and substantial improvements in regard to hand hygiene compliance among the healthcare professionals in clinical settings. Furthermore, this strategy fosters accountability among the care workers whereby this enhances the adoption of safe hand hygiene practices. More importantly, bundling strategy promotes the creation of safe working environments whereby promotes the provision of quality as well as safe care to hospitalized patients. Polin et al., (2012) asserts that HCAI are among the major healthcare problems witnessed in NICU that results to serious health complications and increase the morbidity as well as mortality rates in the unit. In relation to this, the enhancement of hand hygiene is a crucial approach that minimize these infections in the unit and foster the wellbeing of neonates. The author emphasizes the importance of incorporating multimodal strategies such as bundling to minimize cases of hospital acquired infections among the neonates and reduce the mortality as well as morbidity rates in the unit.
According to Mathur, (2011), multimodal strategies such as bundling are more effective in enhancing the adherence of healthcare workers to safe hand hygiene practices as compared to single interventions. The study stresses that multi-faceted strategies that focus on administrative support, availability of ABHR, training of healthcare professionals and reminders in places of work are highly effective in enhancing hand hygiene among the healthcare workers. In relation to this, the study emphasizes the need for healthcare organizations to foster the adoption and sustenance of safe hand hygiene practices. This minimizes incidences of HCAI among hospitalized patients and leads to better clinical outcomes.
The study by Schweizer et al., (2013), found out that multi-faceted strategies that comprise of reminders, administrative support, education and feedback are highly effective in relation to improving safe care practices that promote hand hygiene. In addition, the study asserts that bundles can foster compliance of healthcare workers to hand hygiene and minimize the level of infections that are acquired while undergoing treatments in care settings. Moreover, Schweizer et al., (2013) emphasizes the need for healthcare organizations to adopt the use of hand hygiene bundles as an effective method for minimizing HCAI in care settings and foster optimal outcomes.
References
Luangasanatip, N., Hongsuwan, M., Limmathurotsakul, D., Lubell, Y., Lee, A. S., Harbarth, S., & Cooper, B. S. (2015). Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis.
Mathur, P. (2011). Hand hygiene: back to the basics of infection control. The Indian journal of medical research, 134(5), 611.
Pincock, T., Bernstein, P., Warthman, S., & Holst, E. (2012). Bundling hand hygiene interventions and measurement to decrease health care–associated infections. American journal of infection control, 40(4), S18-S27.
Polin, R. A., Denson, S., Brady, M. T., Papile, L. A., Baley, J. E., Carlo, W. A., & Byington, C. L. (2012). Strategies for prevention of health care–associated infections in the NICU. Pediatrics, 129(4), e1085-e1093.
Schweizer, M. L., Reisinger, H. S., Ohl, M., Formanek, M. B., Blevins, A., Ward, M. A., & Perencevich, E. N. (2013). Searching for an optimal hand hygiene bundle: a meta-analysis. Clinical infectious diseases, cit670.
