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A quantitative research regarding the significance of hand hygiene in health care setting within the health care worker to decrease and control healthcare related infection.

Assessment 1: Research Proposal Part A  
A quantitative research regarding the significance of hand hygiene in health care setting within the health care worker to decrease and control healthcare related infection.
The main aim of this research is to decrease and control healthcare related infection and to spread the awareness regarding significance of hand hygiene through different hand hygiene programs, detect barriers of non compliance and apply appropriate strategies (Landelle, Marimuthu & Harbarth, 2014). It is the responsibility of the health care worker to wash their hand before, after and between the procedures and follow the 5 movement of hand washing procedure (Allegranzi & Pittet, 2009).  There are countless harmful opportunities microorganisms ready to transfer between patient and health care worker. Therefore improving hand hygiene is most essential methods to prevent from infection (Allegranzi & Pittet, 2009).
Almost 99,000 deaths and 1.7 million infections occur in each year in hospital due to not adhering infection control policies, which is transmitted form healthcare worker hand to the patients directly and indirectly (Button, Sreeramoju, Smith & Rivers, 2011). In 19th century Hand hygiene was introduced, when medical student did not wash hand and enter delivery suite from autopsy rooms, lead to increase in maternal mortality rate, due to puerperal fever (Stewardson, Allegranzi, sax, Kilpatrick & Pittet, 20011). Additionally another patient died in 1847 and his autopsy was examined and ravelled similar pathophysiology condition to the women died from puerperal fever. Therefore hand-washing policy was implement by Semmelweis, which revealed ten times drop in maternal mortality rate (Stewardson, et al., 2011).
Due to increase of infection in health care setting proven that patient is not being treated properly (Gould, et al., 2010). Patients are at risk in hospital of developing infections, maximum infections are spread through direct contact from the hand of health care worker to the patients (Gould, et al., 2010). Conventionally, hand washing has been proven the single effective way of decreasing infections (Gould, et al., 2010). Therefore Landelle, et al., (2014) observed, hand hygiene compliance among 560 healthcare worker, where 237 of the workers was nurses, 190 was physicians, and 133 were other healthcare workers. Yet hand hygiene compliance remains poor. Proper hand hygiene proves to decrease nosocomial infections, which lead to improve patient health condition, shorter hospital stay and reduce hospital budget (Gould, Moralejo, Drey & Chudleigh, 2010).  Good Hand hygiene means washing hand with antimicrobial soap or disinfecting with antiseptic agent (Erasmus, Daha, Brug, Richardus, Behrendt, Vos, & van Beeck, 2010). Hand hygiene helps to keep patients safe, but not following infection control policy keeps patient health at risk (Erasmus, 2010). Additionally due to lack of time, sinks and work overload, demotivate health care worker to implement hand hygiene (Baily, 2013).
I choose this topic because, while I had a placement at hospital, I witnessed health care worker was not washing their hand before and between the procedure such as dressing, catheterization, personal care which lead patient to have infected wound, UTI’s, rashes, MRSA. To promote hand hygiene, poster were displayed in different ward concerning cross-contamination, nosocomial infection and important of hand hygiene. Alcohol based hand rub made available in individual bottle to carry in pocket. Yet they were using gloves instead of washing hand. Despite of different infection control education, hand hygiene compliance remains poor in hospital
In 1975, hand hygiene policies were applied in hospital before and after doing invasive procedures using antimicrobial soap (Scott, Duty & McCue, 2009). Furthermore, Alcohol based hand rub was introduced to disinfect hands, when there were overload of work or sinks were unavailable (Erasmus, 2010). Progressively, alcohol-based hand rub used instead of hand washing (Gould, et al., 2010). MRSA is also called hospital-acquired infection because it’s a most common infection transmitted through the hand of health care worker to the patient. Hence, it is important to follow infection policy such as washing hand, using alcohol based hand rub and using PPE to reduce, prevent and save patients life from hospital associated infection (Gould, et al., 2010).
Literature Review
A comprehensive approach was used to search related article for above research such as Ovid, Cinahl plus, Cochrane library, PubMed, Medline and Google scholar. The article range between the 5 years limit.
Stewardson et al., (2011) survey, Hand hygiene become an effective technique, applied by Semmelweis in 1818-1865, that revealed puerperal fever can be decrease, if doctor perform surgical hand wash before and after invasive procedure. The world health Organization (2009) also survey, hand hygiene is the first method to prevent from hospital related infection. However, not following hand hygiene policy million of patients are affected, putting their health at risk, longer hospital stay leading to depression, increase hospital budget (Allegranzi & Pittet, 2009). Conversely, adopting new approach such as using alcohol based hand rub is an effective technique to prevent from infection (Gould, et al., 2010). WHO (2009) explained, nearly 1. 5 million patients are suffering from healthcare associated infection therefore, adopting new method encourage health care worker to be compliance with hand hygiene, leading to prevent from infection. Gould et al., (2010) show, various pathogens are resistance, due to incorrect use of antimicrobials. WHO (2009) stated, about 8-10% of patient in hospital suffer from health care related infection, due to not adopting proper hand washing technique. Thus, following hand hygiene procedures is the best approach to prevent from illness or disease related to hospital infection (Gould & Drey, 2013).
Borges, Rocha, Nunes and Filho (2012) observed, Hand hygiene promotion at university of Geneva Hospital for 2 years using direct observation, regardless there were not increase in the rate of hand hygiene compliance. Hence the infection level remains elevated. Additionally Lary, Hardie, Randle and Clavert (2013) directed another campaign using direct observation on 1365 health care worker, patient and their visitors, where there was higher level of compliance showed in health care worker while patient and visitor were non compliance with hand hygiene. Altogether 105 samples took from hands and 92 from surfaces, MRSA observed 5% in hands and in surfaces (Lary, et. al., 2013).
Lebovic, Siddiqui and Muller (2013) survey, the rate of hand hygiene compliance for 2 years by direct observation with 3387 health care worker using alcohol based hand rub and antimicrobial soap. The result showed, most health care worker used alcohol based hand rub compare with soap. Chen, sheng, Wang, Chang, Lin, Tien, Hasu and Tsai (2011) also survey, the rate of hand hygiene compliance on alcohol based hand rub which showed, hand hygiene compliance in 2007 was 95.5%. As a result MRSA rate also decrease in ICU by 8.9%. Chen at el., (2011) stated, health care associated infection was 16000 before hand hygiene programme but gradually decreases and become 1400 after HH programme. Additionally HH programme cost $233,000 where as health care infection cost $5,522,408. Hence health hygiene programme is less expensive and more effective approach to reduce infection (Chen, at el., 2011).
Ataei et al., (2013) compare hand-washing compliance between public hospital and private hospital. Public hospital had less number of sink and limited resources to wash hand (Ataei, et al., 2013). The overall hand hygiene compliance result showed 1.4% in private hospital whereas 6.2% in pubic hospital. Despite of being better facility private hospital had low compliance rate (Ataei, et al., 2013). Therefore lack of hand washing resources and irritation of skin due to frequent hand washing could be the reason of being non-compliance with hand hygiene (Ataei, et al., 2013). Bailey (2013) showed, due to lack of time, sinks and work overload, demotivate health care worker to implement hand hygiene (Bailey, 2013).
Despite of many research, awareness and educate done to decrease infection, yet some patient are suffering from hospital associated infection due to their low immunity system (Ataei, et al., 2013).
Identify Gaps
Gould et al., (2010) stated, various study were not able to explore the obstacles of being non-compliance with hand hygiene between healthcare workers. Also did not explain the hand hygiene protocols properly and unable to found the reports regarding the effectiveness of hand hygiene between patients (Ataei, et al., 2013). Likewise, there was a lack of instruction of how to and how often alcohol hand rub should be use and the side effect of it (Gould et al., 2010). Moreover, there is no proof that microorganism in health care workers were the same that found in patients.
The research did not compare the compliance rate of hand hygiene in hospital between different shift worker, different health care worker and patients (Chen, 2011). Yet, it is important to know in which section hand hygiene is missing in order to prevent from further transmission and colonization of infection (Chen, 2011).  Thus to increase hand hygiene compliance serious attention should commence methodologically research to study the effectiveness of completely planned hand hygiene and Implement those intervention (Gould et al., 2010).
Research aim and question
Since, it has been proven that effective hand hygiene lower the rate of hospital associated infection but the query is why health care worker is not being compliance with hand hygiene and what will encourage healthcare worker to be compliance with hand hygiene policies? Mathur (2011) state despite of all proof, Why Hand hygiene policies is not being following properly in health care settings? The aim of this research is to increase hand hygiene compliance through different intervention to limit the increase of infection and provide the infection free environment to the patient to save their life.
Hand hygiene is the single most effective method to control infection and least expensive way to decrease health care associated infection (Gould & Drey, 2013). If health care worker implement hand hygiene properly, it can drastically decrease infection alone. The above research shows implementation of hand hygiene approaches is feasible and supportable in most of the countries in order to reduce infection (Sax, et al., 2009). Additionally, this research is vital and will increase the knowledge regarding importance of hand hygiene in order to reduce infection (Sax, et al., 2009). Yet, furthermore research is required to know the reasons of being non-compliances recognize barriers and implement strategies to prevent patient form healthcare associated infection (Landelle, Marimuthu & Harbarth, 2014).
Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of Hospital Infection73(4), 305-315. doi: 10.1016/j.jhin.2009.04.019
Ataei, B., Zahraei, S. M., Pezeshki, Z., Babak, A., Nokhodian, Z., Mobasherizadeh, S., & Hoseini, S. G. (2013). Baseline evaluation of hand hygiene compliance in three major hospitals, Isfahan, Iran. Journal of Hospital Infection85(1), 69-72. doi: 10.1016/j.jhin.2013.07.001
Button, T., Sreeramoju, P., Smith, E. A., Rivers, B., Snapp, M., & Couger, D. (2011). Effectiveness of Reinventing System-Wide Hand Hygiene Program Utilizing Revised Hand Hygiene Observation Tool, Education, Hand Hygiene Champions and Development of an Interactive Intranet Based Data Entry Tool.American Journal of Infection Control39(5), E164-E165. doi: 10.1016/j.ajic.2011.04.278
Bailey, C. (2013). The Effects of Executive Involvement, Goal Setting, Targeted Education and Caregiver Recognition on Hand Hygiene Performance. Hand,30(40.00), 50-00. Retrieved from http://proventix.com/wp-content/uploads/2013/06/Cullman-Regional-Medical-Center-APIC-2013.pdf
Chen, Y. C., Sheng, W. H., Wang, J. T., Chang, S. C., Lin, H. C., Tien, K. L., … & Tsai, K. S. (2011). Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections. PloS one6(11), e27163. doi: 10.1371/journal.pone.0027163
Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., & van Beeck, E. F. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control and Hospital Epidemiology31(3), 283-294. doi: 10.1086/650451
Gould, D., & Drey, N. (2013). Types of interventions used to improve hand hygiene compliance and prevent healthcare associated infection. Journal of Infection Prevention, 1757177413482608. Doi: doi:10.1177/1757177413482608
Gould, D. J., Moralejo, D., Drey, N., & Chudleigh, J. H. (2010). Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev9. doi: 10.1002/14651858.CD005186.pub3.
Lary, D., Hardie, K., Randle, J., & Clavert, A. (2013). P120: Monitoring hand hygiene compliance and the distribution of MRSA in paediatric wards.Antimicrobial Resistance and Infection Control2(Suppl 1), P120. doi: 10.1186/2047-2994-2-S1-P120
Lebovic, G., Siddiqui, N., & Muller, M. P. (2013). Predictors of hand hygiene compliance in the era of alcohol-based hand rinse. Journal of Hospital Infection,83(4), 276-283. doi: 10.1016/j.jhin.2013.01.001
Landelle, C., Marimuthu, K., & Harbarth, S. (2014). CURRENT OPINION Infection control measures to decrease the burden of antimicrobial resistance in the critical care setting. Curr Opin Crit Care20, 000-000. doi: 10.1097/MCC.0000000000000126
Mathur, P. (2011). Hand hygiene: back to the basics of infection control. The Indian journal of medical research134(5), 611. doi:  10.4103/0971-5916.90985
Rocha, L. A., Nunes, M. J., & Gontijo Filho, P. P. (2012). Low compliance to handwashing program and high nosocomial infection in a brazilian hospital.Interdisciplinary perspectives on infectious diseases2012. doi: 10.1155/2012/579681
Stewardson, A., Allegranzi, B., Sax, H., Kilpatrick, C., & Pittet, D. (2011). Back to the future: rising to the Semmelweis challenge in hand hygiene. Future microbiology6(8), 855-876. doi: 10.2217/fmb.11.66
Scott, E., Duty, S., & McCue, K. (2009). A critical evaluation of methicillin-resistant< i> Staphylococcus aureus</i> and other bacteria of medical interest on commonly touched household surfaces in relation to household demographics. American journal of infection control37(6), 447-453. doi: 10.1016/j.ajic.2008.12.001
Sax, H., Allegranzi, B., Chraïti, M. N., Boyce, J., Larson, E., & Pittet, D. (2009). The World Health Organization hand hygiene observation method. American journal of infection control37(10), 827-834. doi: 10.1016/j.ajic.2009.07.003
Sroka, S., Gastmeier, P., & Meyer, E. (2010). Impact of alcohol hand-rub use on meticillin-resistant< i> Staphylococcus aureus</i>: an analysis of the literature. Journal of Hospital Infection74(3), 204-211. doi:10.1016/j.jhin.2009.08.023
The World Health Organization. (2009). Guidelines on Hand Hygiene in Heath Care: World Alliance for Patient Safety: First Global Patient Safety Challenge “Clean Care is Safer Care”, World Health Organization. Retrieved from http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf

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