Hospital acquired Infections (HAIs) are common incidence in healthcare organisation (taylor et al., 2016). HAIs increases the rate of mortality and morbidity of the patients along with an increase in the healthcare costs (Taylor et al., 2016, pp: 2). According to Taylor et al. (2016), the cross-infection risk of the patient admitted in the infectious disease ward or respiratory ward is high because these patients are immune-deficient and more exposed to infectious micro-organisms within the hospital ward. The surrounding environment of the infectious or the respiratory disease wards are infiltrated with harmful disease causing pathogens like multi-drug resistant Pseudomonas, Vancomycin-resistant enterococci (VRE), Clostridium difficile, Acinetobacter spp. and methicillin-resistant Staphylococcus aureus (Taylor et al., 2016, pp: 2). According to Dancer (2014, pp: 2) the spread of these infectious micro-organisms mainly occurs from the contaminated surfaces like the no-sterile needle, towels and other hospital tools along with tables and beds. However, study conducted by Dancer (2014, pp: 3) highlighted that the main reason underlying the spread of HAIs in the infectious and the respiratory disease ward of hospitals are the nurses. Since nurses spend most of the time with the patients in the infectious ward, the contaminated hands are the main source of nocomial or HAIs in the respiratory or the infectious ward. However, observing contact precautions is not comprehensive in reducing HAIs this is because, admitting patients in separate wards or cabins will further increase the overall healthcare costs (Taylor et al., 2016, pp: 1). Thus, proper precautions coming from the nursing professionals in the domain of infection control can be regarded to be effective in controlling the HAIs (Sarani et al., 2016, pp: 2). Grunda and Sopjani (2017, pp: 3) highlighted the compliance of proper hand hygiene and use of personal protective equipments like the face masks, gloves and clean aprons can help to prevent the chances of hospital acquired infection.
Clinical Question
Do increase in hand hygiene compliance helps in decreasing the rate of hospital acquired infections (HAIs)?
Details of the Search Strategy
Type of evidence: Digital evidence: Search of the research articles through electronic database search
Databases used for the search of the articles: Medline, PubMed and CINHAL
The search will aim to focus on the papers which are structured through evidence based practice and the systematic review
Initial search of the literary articles with the help of electronic database highlighted 30 relevant RCTs, qualitative studies, observational studies, cohort studies and systematic reviews. Of these total of five studies are selected. Of them one discescriptive time series study, two prospective ecological and interrupted time series study, one prospective observational study, one interventional studies
Determination of quality of the paper: Use of CASP tool
According to Luangasanatip et al. (2015, pp: 2), in order to increase the compliance of hand hygiene the nurses are required to be trained to follow World Health Organisation’s (WHO) five-step of hand hygiene protocol.
In order to increase the awareness of the importance of hand hygiene proper training of the nursing professionals are important. This training can be given through multimodal approach through multimedia communication, campaign, education, proper leadership and engagement (Aboumatar et al., 2012, pp: 3).
Evidence ‘Bottom Line’ Statement
Hand hygiene is an effective medium in order to reduce the rate of HAIs in the infectious and in the respiratory ward. Increase in the level of hand hygiene compliance among the nursing or the other healthcare professionals can be done through proper education and training of the nursing professionals and helping them to follow WHO five-step hand hygiene compliance
References
Aboumatar, H., Ristaino, P., Davis, R. O., Thompson, C. B., Maragakis, L., Cosgrove, S., … & Perl, T. M. (2012). Infection prevention promotion program based on the PRECEDE model: improving hand hygiene behaviors among healthcare personnel. Infection Control & Hospital Epidemiology, 33(2), 144-151. https://doi.org/10.1086/663707.
Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections. American journal of infection control, 41(6), 482-486. https://doi.org/10.1016/j.ajic.2012.08.009
Australian Government National Health and Medical Research Council. (2009). NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. Access date: 14th September 2018. Retrieved from: https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf
Dancer, S.J., 2014. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clinical microbiology reviews, 27(4), pp.665-690. DOI: 10.1128/CMR.00020-14
DiDiodato, G. (2013). Has improved hand hygiene compliance reduced the risk of hospital-acquired infections among hospitalized patients in Ontario? Analysis of publicly reported patient safety data from 2008 to 2011. Infection Control & Hospital Epidemiology, 34(6), 605-610. https://doi.org/10.1086/670637
Gruda, A. & Sopjani, I.,(2017). The Knowledge, Attitudes and Practices of Nurses Toward Management of Hospital-acquired Infections in the University Clinical Center of Kosovo. Materia socio-medica, 29(2), p.84. doi: 10.5455/msm.2017.29.84-87
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. bmj, 351, h3728. doi: https://doi.org/10.1136/bmj.h3728
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. https://doi.org/10.1016/j.ajic.2012.02.008
Salama, M. F., Jamal, W. Y., Al Mousa, H., Al-AbdulGhani, K. A., & Rotimi, V. O. (2013). The effect of hand hygiene compliance on hospital-acquired infections in an ICU setting in a Kuwaiti teaching hospital. Journal of infection and public health, 6(1), 27-34. https://doi.org/10.1016/j.jiph.2012.09.014
Sarani, H., Balouchi, A., Masinaeinezhad, N. & Ebrahimitabs, E., (2016). Knowledge, attitude and practice of nurses about standard precautions for hospital-acquired infection in teaching hospitals affiliated to Zabol University of Medical Sciences (2014). Global journal of health science, 8(3), p.193. doi: 10.5539/gjhs.v8n3p193
Stone, S. P., Fuller, C., Savage, J., Cookson, B., Hayward, A., Cooper, B., … & Roberts, J. (2012). Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. Bmj, 344, e3005. doi: https://doi.org/10.1136/bmj.e3005
Taylor, G., Gravel, D., Matlow, A., Embree, J., LeSaux, N., Johnston, L., Suh, K.N., John, M., Embil, J., Henderson, E. & Roth, V., (2016). Assessing the magnitude and trends in hospital acquired infections in Canadian hospitals through sequential point prevalence surveys. Antimicrobial Resistance & Infection Control, 5(1), p.19. https://doi.org/10.1186/s13756-016-0118-3
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