Effectiveness Of A Comprehensive Hand Hygiene Program For Reduction Of Infection Rates

Best Practice

Hospital acquired infection or HAIs are one of the major concerns of healthcare facilities around the world as the data of World Health organization revealed that more than 10 million people are affected due to HAIs around the world (Pincock et al., 2012). More than 150,000 reports are registered in Australia every year within which thousands have to lose their life (Fuller et al., 2012). Despite living in the 21^st century and modern healthcare science technologies, worldwide presence of hospital acquired infections are the primary reason I am interested in this aspect of infection and its control (lander4s et al., 2012). Therefore, I am interested in identifying strategies using which healthcare facilities can control this phenomenon. The primary aim of this assignment is to provide details of three best evidences about hospital acquired infection and validating the research findings collected from those articles

Best Practice	Level of Evidence	Study Design	In-text Citation in CDU APA 6th Format Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper
Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility	4	Cross sectional study	Schweon, Edmonds, Kirk, Rowland and Acosta (2013).
Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections	3	Uncontrolled Longitudinal study	Al-Tawfiq, Abed,  Al-Yami and Birrer (2013).
Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby	5	Observational study	Birnbach et al. (2012)

The primary aim of the study was to identify the hand hygiene strategies used in long-term care facilities as researchers are primarily focused about hand hygiene acute health care facilities and very less studies are variable on long-term care facilities. From may 2009 to 2011, all the infection and hospitalization data were collected from a 174 bed long-term care facility where hand hygiene and healthcare hygiene educations were provided and it was found that rate of infection decreased d from 0.97 to 0.53 infections per 1,000 resident days. As well as 54%, compliance rates were observed within that time-period which indicated 100% compliance has the ability can reduce infection rates to a considerate level.  Therefore, the research article was able to prove the statement that in long-term as well as acute healthcare facility, hand hygiene technique has the ability to reduce the rates of infection to a specific level. 

This paper discusses about the hand hygiene and its widespread usage among healthcare professionals, which is found to be very low and not followed by the healthcare professionals. Therefore, the objective of this assignment was to find out the compliance of hand hygiene overtime and provide the rate of device associated infection so that compliance level could be assessed. Researchers conducted a descriptive time series related study from October 2006 to December 2011 in a healthcare facility with 350-bed in Saudi Arabia. They used the multimodal program for the promotion of hand hygiene activities as well as they calculated the device related infection in the healthcare facility. Results determined that the multimodal approach helped to promote hand hygiene as compliance improved from 38% in 2009 to 83% in 2011. As well as the rate of Ventilator-associated infection decreased from 6.12 to 0.78. therefore, it was evident that hand hygiene was able to provide holistic protection from the infection in healthcare facilities. 

Level of Evidence

As most of the hand hygiene reports are associated with healthcare professionals and patients, visitor related reports are very limited. It is assumed that alcohol-based hand sanitizer increases the hand hygiene compliance rate in visitors however, to determine the rate of it, the researchers of this research aimed to find this result. For the purpose, the researchers chose the observational control study and tested three interventions such as a desk sign important all visitors to use AHS, a free-standing AHS dispenser present directly in front of a security desk where the visitors will sign, and a amalgamation of a freestanding AHS dispenser and a sign. It was observed that the compliance to hand hygiene improved when AHS dispenser and sign was used as an intervention and other two failed to improve the compliance percentage. T5herefore, healthcare facilities should use techniques to implement visitors HHCD so that holistic control of hospital-acquired infections could be controlled

The article by Al-Tawfiq et al. (2013) was chosen as the best practice regarding this research aspect as the study design it used in this research was able to provide a statistical significant and reportable data about the long term care facilities and the rate of infections after the implementation of hand hygiene strategy. However, the approach was affected by season changing and adverse effect of environment therefore; the application of this method on multivariate setting is questionable (Fuller et al., 2012). Further, the results found through this result were relevant as most of the long-term healthcare facilities are not inclusive of hand hygiene technologies. Hence, using such strategies is useful in increasing the compliance level of hand hygiene strategy among the healthcare facilities of long-term care facilities (Landers et al., 2012). Further, the result also revealed that using such techniques was useful in reducing the rate of infection among the patients as professionals were using alcoholic hand hygiene solution for disinfection purpose. Moreover, the aim of this research was to find out research articles and strategies that helped to identify the importance of hand hygiene and its ability to prevent different infections that can affect the health of patients by increasing their hospital stay. This is because this study was included in the best evidence category (Pincock et al., 2012). 

The second article by Birnbach et al. (2012) and its descriptive time series related study was important for its research purpose as the time and a large healthcare facility helped to identify the compliance level of patients regarding hand hygiene as well as identify the level of device related infection and rate of reduction in those infections due to hand hygiene strategy. This study and its finding was appropriate to our research aim as it directly provided a link between health hygiene and its beneficial effect in reducing the rate of nosocomial infection through hand of health professionals as well as devices (Allegranzi et al., 2013). This strength of the study was useful in determining the research aim it was observational as well as case control study where validation of the research aim was present (Armellino et al., 2013). However, the longitudinal interventional aspect of the study limited the application of the study in smaller healthcare facility as the study was not designed for small and limited healthcare facility (Huis et al., 2012). Therefore, all these aspect of the research study helped to include this research article in the best evidence section because it directly mentions the fact that hand hygiene is responsible for reduction of nosocomial infection and increased compliance can also reduce the device related infection in healthcare facilities (Fuller et al., 2012). 

Study Design

The third article by Schweon et al. (2013) was about hand hygiene compliance level among hospital visitors and it is one of the most neglected aspect of hand hygiene compliance study (Ellingson et al., 2014). There are limited amount of studies have been conducted in which compliance level of visitors are assessed. Therefore, the strength of this research was its different approach to the healthcare associated infection as visitors are important stakeholders if the healthcare associated infections are taken into consideration (Pincock et al., 2012). Further, the strength of this research article was its interventions and comparison between those three interventions so that the most effective intervention could be identified (Huis et al., 2012). Further, the results were relevant as of provided the most effective intervention that can decrease the rate of healthcare associated infection, which is spread by the visitors and the research was able to provide a clear and effective intervention using which this target could be achieved (Grol et al., 2013). Therefore, this article was included in the research as third best evidence article as it was able to provide a different dimension to the research study and provided an important intervention using which the rate of hospital-acquired infection could be decreased (Huis et al., 2012). 

The findings of the systematic review and best evidence researches are applicable in the nursing practice for healthcare facilities because to control the rate of healthcare associated infections are very crucial in modern healthcare facility (Allegranzi et al., 2013). As mentioned in the study of Al-Tawfiq et al. (2013), first of all the level of compliance of the professionals working in facility towards the hand hygiene should be assessed and then further interventions to increase the compliance should be done. For this purpose, all the healthcare professionals will be asked to join a special educational training session so that the thought of importance of hand hygiene can be reinforced. Further, the visitors and their hand hygiene should also be a concern as they also contribute i8n the rate of infection. For that purpose, the intervention by Birnbach et al. (2012) should be used as it has the ability to increase the rate of compliance by 83% and decrease the infection to a major extent. Besides these, the healthcare facility should also be concerned about the device and related infection rate as device related infection are a major source of infection hence, maintaining device related infection at controllable level is important for every healthcare facilities (Schweon et al., 2013). The barriers in achieving this could be the lower understanding of the staff and healthcare facilities as well as the laid-back attitude of the staff regarding hygiene and infection control (Zellmer et al., 2015). Hence, educational and training sessions are important for this prospect (Ellingson et al., 2014). Further, proper security and surveillance should be present in the healthcare facility so that visitors and infections associated to them could be controlled and prevented (Randle, Firth & Vaughan, 2013). Therefore, the evidence collected from the research articles is applicable on healthcare facilities with proper training and educational sessions. 

References

Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M. L., Moro, M. L., … & Donaldson, L. (2013). Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. The Lancet infectious diseases, 13(10), 843-851. DOI: https://doi.org/10.1016/S1473-3099(13)70163-4

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. Doi: 10.1016/j.ajic.2012.08.009

Armellino, D., Trivedi, M., Law, I., Singh, N., Schilling, M. E., Hussain, E., & Farber, B. (2013). Replicating changes in hand hygiene in a surgical intensive care unit with remote video auditing and feedback. American journal of infection control, 41(10), 925-927. DOI: https://doi.org/10.1016/j.ajic.2012.12.011

Birnbach, D. J., Nevo, I., Barnes, S., Fitzpatrick, M., Rosen, L. F., Everett-Thomas, R., … & Arheart, K. L. (2012). Do hospital visitors wash their hands? Assessing the use of alcohol-based hand sanitizer in a hospital lobby. American journal of infection control, 40(4), 340-343. Doi: 10.1016/j.ajic.2011.05.006

Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical care, 50(3), 217. doi:  10.1097/MLR.0b013e3182408812

Ellingson, K., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., … & VanAmringe, M. (2014). Strategies to prevent healthcare-associated infections through hand hygiene. Infection Control & Hospital Epidemiology, 35(8), 937-960.  DOI: https://doi.org/10.1086/677145

Fuller, C., Michie, S., Savage, J., McAteer, J., Besser, S., Charlett, A., … & Jeanes, A. (2012). The Feedback Intervention Trial (FIT)—improving hand-hygiene compliance in UK healthcare workers: a stepped wedge cluster randomised controlled trial. PloS one, 7(10), e41617. DOI: https://doi.org/10.1371/journal.pone.0041617

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care. John Wiley & Sons.

Huis, A., Schoonhoven, L., Grol, R., Donders, R., Hulscher, M., & van Achterberg, T. (2013). Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. International journal of nursing studies, 50(4), 464-474.DOI: https://doi.org/10.1016/j.ijnurstu.2012.08.004

Landers, T., Abusalem, S., Coty, M. B., & Bingham, J. (2012). Patient-centered hand hygiene: the next step in infection prevention. American journal of infection control, 40(4), S11-S17. DOI: https://doi.org/10.1016/j.ajic.2012.02.006

Marra, A. R., & Edmond, M. B. (2014). New technologies to monitor healthcare worker hand hygiene. Clinical Microbiology and Infection, 20(1), 29-33. DOI: https://doi.org/10.1111/1469-0691.12458

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. DOI: https://doi.org/10.1016/j.ajic.2012.02.008

Randle, J., Firth, J., & Vaughan, N. (2013). An observational study of hand hygiene compliance in paediatric wards. Journal of clinical nursing, 22(17-18), 2586-2592. DOI: https://doi.org/10.1111/j.1365-2702.2012.04103.x
 
Schweon, S. J., Edmonds, S. L., Kirk, J., Rowland, D. Y., & Acosta, C. (2013). Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. American journal of infection control, 41(1), 39-44. Doi: 10.1016/j.ajic.2012.02.010

Zellmer, C., Blakney, R., Van Hoof, S., & Safdar, N. (2015). Impact of sink location on hand hygiene compliance for Clostridium difficile infection. American journal of infection control, 43(4), 387-389. DOI: https://doi.org/10.1016/j.ajic.2014.12.016