Literature Review

Criteria

Article 1

QUANT

Article 2

QUANT

Article 3

QUANT

Article 4

REVIEW

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Daisy, V. T., & Sreedevi, T. R.

Link:

http://eds.a.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=4&sid=72619044-c224-4bc5-9982-cf6c3953f7d2%40sessionmgr4007&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=110819455&db=ccm

Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., … Bader, M. K. (2015). Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses' Hand Washing. American Journal of Critical Care, 24(3), 216-224. doi:10.4037/ajcc2015898

Knighton, S. (2017). The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of Hospitalized Adults in an Acute Care Setting. Open Forum Infectious Diseases, 4(suppl_1), S411-S412. doi:10.1093/ofid/ofx163.1029

João Manuel Garcia do Nascimento Graveto, Rita Isabel Figueira Rebola, Elisabete Amado Fernandes, & Paulo Jorge dos Santos Costa. Link:

https://doi-org.lopes.idm.oclc.org/10.1590/0034-7167-2017-0239

Article Title and Year Published

Effectiveness of a Multi-Component Educational Intervention on Knowledge and Compliance with Hand Hygiene among Nurses in Neonatal Intensive Care Units. 2015

Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses' Hand Washing

Published May 2015

The Use of Instructional Technology to Increase Independent Patient Hand Hygiene Practice of Hospitalized Adults in an Acute Care Setting. Open Forum Infectious Diseases.

Published in 2017

Hand hygiene: nurses’ adherence after training.

2018

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

The study was aimed to assess the effectiveness of a multi-component educational intervention on the knowledge and compliance with hand hygiene guidelines among nurses working in Neonatal Intensive Care Units.

The research investigated the reduction of infections in the hospital through observation of hand hygiene.

What handwashing procedures were performed by the medical personnel before patient contact part 1.

What is the level of effectiveness of training (I) in improving nurses’(P) adherence to hand hygiene(O)?”.

Design (Type of Quantitative, or Type of Qualitative)

A pre-experimental pre-test post-test design was adopted for the study. QUANT

Pre-experimental study design

. QUANT

A quantitative study was done using quasi observational data

Qualitative/ quantitative studies

This is a review

Setting/Sample

This study was conducted in 3 level III NICUs of selected private hospitals in Kerala

Total sample comprises of 60 nurses working in NICUs selected through purposive sampling technique from selected hospitals.

Two hospitals were used in the research

120 medical staff (Nurses and Physicians).

Health professionals working at the intensive care unit of a hospital.

Methods: Intervention/Instruments

The data was collected from 60 nurses working in 3 level III Neonatal Intensive Care Units of selected private hospitals in Kerala.

Qualitative research design.

Quasi-observational study

This integrative literature review was conducted following Cochrane’s PICOD strategy (Participants, Interventions, Comparisons, Outcomes, and Design.

Training nurses to adhere to handwashing.

Analysis

The data collection tool consisted of a knowledge questionnaire and an observation checklist to assess the hand hygiene compliance, developed based on World Health Organization hand hygiene guidelines.

The study was conducted across two health facilities

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Technology played a key role in improving the hands' hygiene through the development of equipment that encouraged nurses to wash their hands.

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Observational studies collected and analyzed.

Key Findings

Before the implementation of educational intervention, majority, (56.66%) had only moderate knowledge on hand hygiene and none of them had good level of knowledge. With regard to compliance with hand hygiene guidelines, majority, (65%) demonstrated poor compliance while none of them showed good compliance. There was a statistically significant improvement in the nurse's level of knowledge and compliance with hand hygiene guidelines after the completion of the multi-component educational intervention (P<0.001).

Observation of hand hygiene reduced the rate of new infections within the hospitals.

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The average compliance of medical personnel to hand hygiene was as low as 5.2%.

Medical personnel washed their hand twice less frequently when feeding patients, taking blood samples and insertion of a vascular catheter.

Most substituted gloves for handwashing.

Nurses showed inadequate hand hygiene techniques and adherence during their daily care routines. The reasons for this include the lack of adequate facilities for washing and drying hands inside the clinical areas, the lack of resources, the time factor, the existence of solutions of continuity in hands, and excessive workload.

Recommendations

Findings of the study recommends that hospitals should implement hand hygiene promotion programs among nurses by using multiple approaches and persistent encouragement and interventions in order to achieve sustained high level of appropriate hand hygiene practices among nurses working in various units of hospital settings.

The research revealed that there is a need for a collective effort from the nurses themselves and the hospitals to constantly remind the staff about hand washing.

Short handwashing times and noncompliance indicate the need for increased knowledge on hand hygiene and motivation to its adherence

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Nursing professionals should continuously update and monitor their knowledge and transfer it into clinical practice.

Quality can only be achieved through the implementation, training, and development of effective and adequate hand hygiene techniques. Some measures are perfectly feasible, such as the implementation of standard infection control measures; a greater dissemination of the importance of hand hygiene through training actions and flyers/posters placed in strategic locations.

Explanation of How the Article Supports EBP/Capstone Project

Hospital acquired infections are a major cause of morbidity and mortality in neonatal intensive care units. This article supports evidence-based practice because appropriate hand hygiene is singled out as the most important measure in preventing these infections.

The article explained the need for collaboration among the nurses to ensure no new infections that arise from lack of hand hygiene.

The article shows the results of a study done on hand hygiene techniques performed by health providers before patient contact

Handwashing adherence guidelines are important to improve this process, set targets for controlling HAI risks, and train teams in the use of infection prevention measures.

Criteria

Article 5

QUANT

Article 6

QUANT

Article 7

QUANT

Article 8

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Thoa, V. T. H., Van Trang, D. T., Tien, N. P., Van, D. T., Wertheim, H. F., & Son, N. T.

Link:

http://eds.a.ebscohost.com.lopes.idm.oclc.org/eds/detail/detail?vid=2&sid=72619044-c224-4bc5-9982-cf6c3953f7d2%40sessionmgr4007&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=S0196655315008792&db=edselp

AJIC: American Journal of Infection Control 1 December 2015 43(12):e93-e99

Lawal, T., Monsudi, K., Zubayr, B., Michael, G., Duru, C., Ibrahim, Z., & Aliyu, I.

Link:

https://doi-org.lopes.idm.oclc.org/10.4103/ijhas.IJHASpass:159_17

Niyonzima, V., Brennaman, L., & Beinempaka, F.

Link: https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129292283&site=eds-live&scope=site

Crawford, H., & Hallam, J. S.

https://doi.org/10.1177/2050312116675098Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., & Gordon, C. J.

Link: https://doi-org.lopes.idm.oclc.org/10.1186/s12879-018-3029-5

Article Title and Year Published

Cost-effectiveness of a hand hygiene program on health care–associated infections in intensive care patients at tertiary care hospital in Vietnam.

2015

Hand hygiene practices among nurses in health facility in a semi-urban setting.

2018

Practice and compliance

of essential handwashing

among healthcare workers at a regional referral hospital in Uganda: A quality improvement and evidence-based practice.

2018

2016 An educational intervention to improve hand hygiene compliance

2018

Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study

Assess the cost-effectiveness of a HH program in a large tertiary Vietnamese hospital.

Determine the knowledge and practices of hand hygiene among nurses in our institution.

Assess the availability and suitability of essential hand washing facilities, assess essential hand washing practice and compliance among healthcare workers (HCWs) on surgical and medical ED, ICU, medical and surgical general wards

The purpose of the research was to capture the experiences of HH among acute care nurses The aim of this study was to determine hand hygiene compliance following an educational program in an obstetric and gynecological hospital in Vietnam.

Design (Type of Quantitative, or Type of Qualitative)

Quantitative quasi experimental design was used. This was a before and after study of a hand hygiene program where HH compliance, incidence of hospital-acquired infections (HAIs), and costs were analyzed.

Quantitative

The study employed a cross sectional design and involved HCWs who were providing care to patients admitted in the selected units.

Qualitative approach-Interview Mixed method

Setting/Sample

The HH program was implemented in 2 intensive care and 15 critical care units.

This study involves 113 nurses of federal Medical Centre Birnin Kebbi, Kebbi State, Nigeria and it was conducted over 12 weeks.

The study was conducted at Mbarara Regional Referral Hospital in southwestern Uganda. The study was conducted in the five units that specifically treat critically ill patients: medical and surgical emergency (ED), ICU, and surgical and medical general wards.

Eight nurses in the US performing various roles were interviewed.Health care workers from neonatal intensive care, delivery suite and a surgical ward from Hung Vuong Hospital, Ho Chi Minh City, Vietnam undertook a 4-h educational program targeting hand hygiene. Compliance was monitored monthly for six months following the intervention. Hand hygiene knowledge was assessed at baseline and after six months of the study.

Methods: Intervention/Instruments

This was a before and after study of a hand hygiene program where HH compliance, incidence of hospital-acquired infections (HAIs), and costs were analyzed.

It was questionnaire based, which was pretested and self‑administered. Convenience sampling was adopted.

On each observational visit, two target patients were randomly selected using simple random numbers and all healthcare workers’ contacts with the selected patients were observed until the required sample size was reached.

Interview Participants completed a baseline questionnaire on HH knowledge and repeated this at 2 months after the intervention. The questionnaire consisted of 25 items with a combination of yes/no, multiple choice, and true/ false formatted question.

Analysis

Data collected before and after handwashing program intervention was analyzed.

.

Quantitative variables were summarized using means and standard deviations, qualitative variables were summarized using frequencies and percentages..percentages.

Hard data collection tools were used especially for collecting observation information and this could have resulted into Hawthorne effect.

Observational data collected, cross checked and analyzed.

An interpretative phenomenological analysis methodology was used.To analyze HH compliance over time, a multi-level mixed model analysis was used.

All hand-entered data were double-entered and screened for accuracy.

Key Findings

The HH compliance rate increased from 25.7% to 57.5% (P < .001). The incidence of patients with HAI decreased from 31.7% to 20.3% (P < .001) after the intervention. The mean cost for patients with HAI was $1,908, which was 2.5 times higher than the costs for patients without a HAI. The mean attributable cost of a HAI was $1,131. The total cost of the HH program was $12,570, which equates to a per-patient cost of $6.5. The cost-effectiveness was estimated at -$1,074 or $1,074 saved per HAI prevented. The cost-effectiveness was estimated at -$1,074 or $1,074 saved per HAI prevented. The intervention remained cost savings under various scenarios with lower HAI rates.

95 (99.0%) believed that hand‑washing is an important modality of reducing infection and cross‑ infection and only 1 (1%) did not believe in the role of hand‑washing in reducing the risk of infection. Although majority (76.0%) of respondents reported adhering to the principles of good hand hygiene, most (54.2%) of the respondents could not mention the steps in hand‑washing technique; 66 (68.8%) respondents wash their hands before attending to patients; however, almost all (99.0%) of the respondents wash their hands after attending to patients and after removing hand gloves.

Most of the wards had inadequate HH resources. The sink to bed ratio ranged from 1:1 to 1:33. HH resources were not always available. A total of 287 HH opportunities were observed from the five wards. The overall HH compliance before and after patient contact were 25.4% and 33.8% respectively. ANOVA showed ICU had significantly higher rates of HH than surgical ward before and after patient contact. HCWs in ICU and surgical emergency were 4.86 and 3.12 times respectively more likely to perform HH as compared to medical ward. No significant difference in HH compliance among professional categories before or after patient contact was detected.

There was a conflict between the perception of nurses and hospital management as far as HH is concerned.

The main finding of this study was that HH compliance rates improved significantly and were sustained over a six-month period following the intervention.

Recommendations

The HH program is an effective strategy in reducing the incidence of HAIs in intensive care units and is cost-effective in Vietnam. HH programs need to be encouraged across Vietnam and other countries.

Only 45.8% could correctly mention the steps in hand‑washing. This highlights the need to reeducate them on the steps in hand hygiene. Therefore, more proactive measures which should involve routine physical observation of the technique by superior officers with the aim of identifying and correcting defaulters should be encouraged.

The low rates of HH compliance reflect the need to put more emphasis on HH for improvement in the healthcare setting.

Infection prevention management needs to come up with proper training programs for HH for HAI to be done away with.Educational handwashing interventions should aim to measure hand hygiene compliance for an extended observation period to determine effectiveness. This hand hygiene model could be used in developing countries were resources are limited.

Explanation of How the Article Supports EBP/Capstone

The hand hygiene program is an effective strategy in reducing the incidence of HAIs in intensive care units and is cost-effective in healthcare settings.

This article is based on nurse’s proficiency on hand‑washing technique; this is so because they are often exposed to the risk of coming in contact with biohazards.

The focus of this study is to assess the availability and suitability of essential hand washing facilities, assess essential hand washing practice and compliance among healthcare workers which supports evidence-based practice.

The study looked at how nurses perceived HH. The finding of the study is correlated to the project capstone as it provides an insight on how nurses, the primary study subject view HH in the fight against HAIThe current study’s educational program was developed in consultation with HH experts and used WHO training guidelines to frame the evidence-based support of training. Educational programs are effective at reducing HCAIs.