Literature Review

Identifying a Researchable Problem

Walden University

NURS - 6052 -03 Essentials of Evidenced-Based Practice

March 13, 2016

Identifying a Researchable Problem

Hundreds of millions of patients worldwide are affected by healthcare associated infections every year (cite a source here-how do you know). The infections lead to severe illnesses, long-term disabilities, prolonged hospital stays and added costs to patients, their families, and the healthcare system (Cite source). Hand hygiene is the primary action to reduce the number of healthcare-acquired infections; a simple action maybe, but the compliance rates among the healthcare providers is the main problem (Cite source) . The purpose of this paper is to provide a summary on the issue of handwashing non compliance amongst healthcare workers and its relation to nosocomial infections. This paper will also generate five questions and describe how they are analyse for feasibility, as well as a PICOT question and a description of its variable. Additionally, ten keywords will be developped to help conduct the literature search.

Problem Identification

A crucial factor in selecting a problem is its significance to nursing, and evidence from the study should have potential to contribute meaningfully to nursing practice ( Polit & Beck, 2012). Nurses comprise s of 55% of the healthcare workforce and number more than 3 million. , aAs such, they represent the most critical group in hand higiene compliance as they spent the most time with the patients (McGonigle & Mastrian, 2012). Hand hygiene is a critical practice aimed at keeping the hands clean and free from pathogens or reduce the amounts before performing any medical procedure or touching a patient. Practicing hand hygiene is important in the prevention of cross infection in clinical settings. Healthcare workers need an easy to use, timely access to both skin protection and hand hygiene for good hand hygiene practice.

Studies show that most nosocomial infections are transmitted through the hands of healthcare practitioners. It is well-known that better hand hygiene practices among healthcare workers play a critical role in the prevention of transmission of infectious agents (Pittet, Allegranzi & Boyce, 2009). The practice of hand washing is one of the most effective ways of preventing the transmission of infectious diseases. , but dDespite the implementation of the Centers for Disease Control and Prevention guidelines for hand hygiene, the compliance among health practitioners remains low (Pittet, Allegranzi & Boyce, 2009).

Hand washing is a critical element of patient safety, as it prevents healthcare associated infections as well as the spread of antimicrobial resistance (Source? How do you know this?). The promotion of hand hygiene, therefore, presents a common challenge that calls for a multimodel strategy. Healthcare worker’s adherence to hand washing guidelines is poor and calls for a behavior change. Most studies have recommended multimodal strategies that include education of healthcare workers, audit and performance feedback practices, increased supply of water and soap, reminders, use of automated sinks and the use of alcohol-based hand rub (Pfoh, Dy, & Engineer, 2013).

Hospital-acquired infections carry a far-reaching and real threat to every individual admitted to hospitals. The pathogens from the hands of the healthcare workers are readily transmitted to the patients, hence hand hygiene practices substantially reduce this chance. Evidence-based guidelines for hand hygiene in clinical practice are very clear, but the compliance remains internationally low (Bukhari et al., 2011).

Significance of the Problem of Nursing Practice

Hand hygiene is considered as the most simple and the most effective way of preventing hospital-acquired infections. Despite the milestones and achievements made in epidemiology and infection control, the hygiene message has not been consistently translated into healthcaremedical practice, and the healthcare workers adherence to the guidelines for hand hygiene is unacceptably low. (Bukhari et al., 2011). The average compliance with the hand washing guidelines varies by from the patient wards, among health care workers categories, and based on the working conditions, but also varies according to the different definitions used in different studies (Pittet, Allegranzi, & Boyce, 2009). Comment by lisa south: Put the period at the end of the sentence-after the parenthesis.

Compliance with hand-washing recommendations is a very significant measure in the prevention of hospital-associated infections. Studies report that transmission of pathogens from the hands of healthcare workers is one of the primary sources of cross-infection in clinical settings and can be prevented by proper hand hygiene practices (Bukhari et al., 2011). There are cases of very low or insufficient compliance rates in developing and developed countries with the mean baseline rates of between 5% and 89%, making an overall average of 38.7% (Bukhari et al., 2011). Comment by lisa south: Studies? So more than one? But only one is cited? Comment by lisa south: Since you said “studies” cite more than one.

Variation in hand washing behavior across healthcare workers and hospital wards suggests the need for a strategic educational program. Nosocomial infections are a significant cause of complications in the ICU; withand hand-washing being the single most effective preventive measure, the compliance rates remain low (Bukhari et al., 2011). The association between handwashing non-compliance and surgical wards may also suggest a fact that understaffing reduces the quality of patient care. Hand washing has a proven benefit in the prevention of cross-infection. Hence the compliance, especially in the surgical and ICU wards, is paramount (Royal Pharmaceutical Society, 2014).

Studies and estimations by the World Health Organization (WHO) show hHealthcare-associated infections affect at least 1.4million patients on the global scale at any given time (Cite the source??? . In the surgical units, the burden of hospital acquired infections has significantly increased, leading to increased morbidity and mortality. In some instances, multidrug resistant pathogens are involved or are part of the infection, hence pose a challenge to effective treatment (Pittet, Allegranzi & Boyce, 2009). Proper hand hygiene is the simplest, single most important and the least expensive means of preventing the cross infections. The WHO and CDC (2009) guidelines on hand hygiene also propose the use of alcohol base hand rub as a means for routine hand disinfection. Comment by lisa south: Neither of these is on the reference list.

Questions Related to the Identified Issue This information needs to have an introductory paragraph (at least two sentences).

1. What are the hand hygiene practices among Healthcare workers?

Rationale

It is important to assess the types of hand hygiene practices commonly used by healthcare workers so as to determine the choices available and the recommended practices

2. What are the reasons for non-compliance with hand hygiene practice?

Rationale

It has been noted that there is moderate to low rates of compliance with standard hand hygiene practices among healthcare workers. It is, therefore, important to get to know the reasons behind the non-compliance.

3. What are the alternative hand hygiene practices?

Rationale

There exist more than one hand hygiene techniques from which healthcare workers can choose preferred as well as the simplest and most efficient method of hand hygiene practice.

4. What are the disparities in hand hygiene practices among different healthcare workers?

Rationale

The non-compliance to hand hygiene practices vary across the various cadres, ages and experience of health personnel. It is important to know the personal factors that are attributed to the variation between the different categories of health workers.

5. What can be done to improve hand hygiene practices in healthcare?

Rationale

It is also important to assess the actions that can be taken to encourage hand hygiene practices in healthcare.

The most appropriate question from the above-related questions is; Ddoes hand washing and appropriate staff dressing among the surgical ward nurses reduce cross infection during patient management?

Description of the PICOT Question

The PICOT question is: Does hand washing and proper staff dressing among the surgical ward nurses reduce cross infection during patient management? The elements of the table are:

P- (Patient, population, or problem): nurses, hospitalized patients I- (Intervention): hand washing and appropriate dressing C- (Comparison with other treatment/current practice): Nurses forget to wash their hands when switching from one patient to the other

O- (Desired outcome): Reduced incidences of cross infection (Davies, 2011)

Ten Possible Keywords that Could Be Used When Conducting a Literature Search for PICOT Question and A Rationale for Your Selections Again-have an introductory paragraph before listing these. Explain what you are doing.

1. “Hand washing." Don’t use quotation marks.

Rationale

Knowing the definition and practice of hand washing???? Make complete sentences.

2. “Hand hygiene."

Rationale

Alternative comprehensive description of clean hands

3. “Cross-infection”

Rationale

Assessing the effects of poor hand hygiene and its contribution to transmission of micro-organisms from one person to the other.

4. “Healthcare workers."

Rationale

The population or persons who participate in the study

5. "Healthcare-acquired infections."

Rationale

The results of transmission of micro-organisms through unhygienic hands

6. “Hand washing guidelines."

Rationale

What are the recommended hand washing practices for healthcare workers?

7. “Hand washing nonconformance”

Rationale

The percentage of conformity to the hand washing guidelines

8. "Hand hygiene strategies."

Rationale

The methods used to promote hand hygiene

9. "Nosocomial infections"

Rationale

The most common infection transmitted through unhygienic hands in the ICU

10. “Hand hygiene and cross-infections."

Rationale

Determining hand hygiene and the relationship with cross infections

Conclusion

Studies consistently show that better hand hygiene reduces the risks of cross contamination and nosocomial infections in Hospitals. Since most of the cross infections are thought to be transmitted through the dirty hands of healthcare workers, an assessment of the knowledge, attitude and practice of them is also necessary. Hospital-acquired infections carry a serious and real threat to all the patients admitted to hospitals, hence the assessment of healthcare worker’s hand hygiene practices is equally very significant.

References

Bukhari, S., Hussain, W., Banjar, A., Almaimani, W., Karima, T., & Fatani, M. (2011). Hand hygiene compliance rate among healthcare professionals.- PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved 11 March 2016, from http://www.ncbi.nlm.nih.gov/pubmed/21556474