A Healthcare Problem

Hospital-acquired infections (HAIs) are among the most critical challenges for hospitals across the country. Unfortunately, patients acquire infections during treatment, such as while using a catheter, especially for the critically ill. Healthcare associated infections (HAIs) cause morbidity, disability and lower quality of life, as well as increasing cost and mortality (Musu et al., 201). Hospital-acquired infections place a significant burden on individual patients and the healthcare organization through increased cost of treatment and extended hospitalization.  Therefore, Mitchell, Quilab, Johnson, and Schadt (2019) proposes the need for interventions, such as education of health care workers to improve hand hygiene compliance to prevent hospital-acquired infections and improve the quality of care for patients. Although hospitals could use one of the numerous interventions to reduce hospital-acquired infections, hand hygiene is the most effective because hands carry the infectious agents.

The Significance of the Problem

The issue of hospital-acquired infections is one of the most critical due to the implications for the quality and safety of care provided to patients. Whenever patients visit a hospital, they expect to have a safe environment to receive their care and achieve optimal recovery. However, their expectations are sometimes affected when they acquire infections in the course of their treatment. The problem is worse among critical patients in the Intensive Care Unit (ICU), and other similar settings in which patients depend on tools, such as catheter to support their treatment.  Musu et al. (2017) affirm that patients in the ICU are at a high risk of hospital-acquired infections. Therefore, such individuals are prone to infections, which affect their healing process, extend hospital stays, and increase the cost of treatment. besides, the infections affect the quality of life of patients because of the need for extended care as they treat the infection (Musu et al., 2017). Therefore, the problem is significant and requires timely interventions to prevent infections and ensure safe and quality care to hospitalized patients.

Current Healthcare Practices

Hospitals use various approaches to prevent and reduce the rate of hospital-acquired interventions in their facilities. One of the commonly used interventions includes hand hygiene practice among health care providers, such as nurses. Luangasanatip et al. (2019) suggest the efficacy of a multi-modal intervention, including hand hygiene (HH) compliance in reducing hospital-acquired infections. Washing hands regularly prevents the risk of hospital-acquired infections since hands carry the infectious bacteria that nurses can easily transmit to patients. Therefore, hand hygiene practice is an evidence-based, best-practice intervention in the prevention of hospital-acquired infections. Furthermore, Thirkell et al. (2018) suggested the need for the integration of digital tools to improve the use of multimodal hand hygiene practice in health care settings. Thus, hospitals should educate their health care staff and promote hand hygiene practices through such mechanisms as regular audits to reduce the rate of hospital-acquired infections, and improve the health and wellbeing of the patients under their care. Hence, simple initiatives, such as hand hygiene interventions are effective in preventing hospital-acquired infections.

Effects of the Problem

Hospital-acquired infections are significant challenges for health care organizations and individual patients due to the high cost of caring for the infected patients and the reputation damage for the hospital. Hospitals suffer a direct and indirect cost due to hospital-acquired infections. For example, they have a cost burden of the additional needs of patients who acquire an infection while receiving care for unrelated medical conditions. Besides, they experience a low level of patient outcome and satisfaction whenever patients develop an infection under their care. Other effects of the infection include failure to protect the patient, which has a detrimental effect on their cultural background (i.e., values, health behavior, and preferences). Patients who acquired infections in a hospital could have declined trust in the ability of the facility and care provided to protect them (Sickbert-Bennett et al., 2016). Furthermore, they could have a declined quality of life as they remain in the hospital longer receiving treatment for a problem unrelated to their original disease. Therefore, hospitals fail to protect the dignity of patients whenever they are not able to prevent hospital-acquired infections.

Literature Review

A literature review is a critical part of research since it helps to locate and analyze the available evidence relating to the topic of study. The researcher, in the current study, conducted a detailed literature search to identify seven relevant articles (five research articles and two non-research articles) related to hand hygiene compliance as an intervention in reducing hospital-acquired infections. Hence, to conduct a comprehensive search of literature from online sources, one should first create a search strategy, which involves the identification of key terms from the topic. For instance, the key terms for the current study were: “hand hygiene,” “hand hygiene compliance,” “prevention,” “hospital-acquired infections,” and “intensive care unit.” The terms were keyed into the search field of the identified online databases, such as Ebscohost, to generate possible sources of evidence. Although the search produced hundreds of potential sources, only a few were selected for the review.

The literature search generated various research and non-research evidence sources that provided evidence in support of the use of hand hygiene compliance in preventing hospital-acquired interventions. Sickbert-Bennett et al. (2016) conducted research that revealed the efficiency of a program designed to enhance hand hygiene compliance among health care providers in a hospital through the successful engagement of all healthcare personnel to monitor and evaluate compliance at a personal level. Another article was on research conducted by Mitchell, Quilab, Johnson, & Schadt (2019), which established that educating health care workers, such nurses, increase hand hygiene compliance to reduce the cost of hospital-acquired infections. Therefore, it is essential to engage healthcare workers during evidence-based practice and conducting regular education programs to increase the rate of compliance.

Although the study focused on non-research evidence, it was necessary to ensure that the articles used were from reputable sources. “Clean Hands Count for Safe Healthcare” is a source of non-scholarly evidence since it does not involve collection and analysis of empirical data; however, it is written through the CDC guidelines, which makes it reputable. The discussion focuses on efficacy of handwashing practices to protect patients from infections while at the hospital. Another source of non-research evidence is “Infection Control 4: Good Hand-Hygiene Practice For Hospital Patients,” published in the Nursing Times, which includes topics of great concern for nurses and the health care system in general. The article is a six-part series, discussing the importance of hand hygiene in preventing infections, and a source of expert opinion about the use of hand hygiene as a safety measure in hospitals.

PICO Question

The PICO question focuses on the patient/population, intervention/indicator, comparison/control, and outcome of the study. For the current research, the PICO question is, “Among ICU patients, how does hand hygiene practice, compared to other environmental cleaning approaches, prevent hospital-acquired infections?” The question will be answered through a detailed collection and analysis of data to establish whether hand hygiene is more effective compared to other environmental cleaning interventions in preventing hospital-acquired infections.

Recommended Practice Change

Hospitals should implement effective mechanisms to prevent HAI and improve the quality of care provided to patients. Therefore, to achieve the objective, healthcare organizations should implement evidence-based processes, such as hand hygiene, to address the problem identified in the PICO question. The evidence provided in the matrix table indicates the effectiveness of hand hygiene practice in preventing hospital-acquired infections. One of the necessary and practical changes is to educate care providers about the importance of hand hygiene and proper hand hygiene practice to improve compliance (Sickbert-Bennett et al., 2016).  Besides, the hospital should conduct regular education programs for nurses and other health care providers to improve the level of compliance with hand hygiene practice (Mitchell, Quilab, Johnson, & Schadt, 2019). Furthermore, nurse leaders should monitor the level of compliance to achieve the expected outcomes. Overall, the changes should occur at the organizational level and engage all care providers in improving care delivery.

The Process for Implementing the Practice Change

The implementation of the proposed change will engage various stakeholders in the hospital. The hospital administration will provide necessary resources for the implementation of the education and monitoring hand hygiene practice. Furthermore, nurse leaders will ensure effective use of the resources and compliance with hand hygiene among nurses. Finally, nurses will be the actual implementers by adopting the actual hand hygiene practice. However, the implementation process could face some barriers that might affect its success, such as possible resistance by nurses and a shortage of nursing staff, which could increase the workload and interfere with regular hand washing. Therefore, the nurse leader should collaborate with the hospital administration to address the barriers to achieve the successful implementation of the change. Various strategies could be useful to overcome the obstacles, such as effective communication and engagement of nurses in the change process to prevent resistance. In addition, the hospital management should ensure the adequacy of nursing staff and motivate the current ones to avoid turnover. One of the indicators to measure the outcome (the O in PICO question) of the recommended change practice would be a reduction in the number of cases of hospital-acquired infections pre- and post-implementation.

Conclusion

Hospital-acquired infections are a severe challenge for hospitals across the country. Although hospitals are expected to provide safe and quality care to patients, the goal is mostly hindered by HAI, which poses a significant threat to patients and the organization. Thus, health care providers should research to identify the best practice in identifying the issue, such as hand hygiene practice, as well as implementing the strategies in practice. If implemented appropriately, hand hygiene practices would address the challenges and improve the quality and reduce the cost of health care across the country.

References

CDC. (2020). Clean Hands Count for Safe Healthcare. Retrieved from https://www.cdc.gov/patientsafety/features/clean-hands-count.html

Chadwick C (2019). Infection control 4: good hand-hygiene practice for hospital patients. Nursing Times [online]; 115, 9: 27-29. Retrieved from https://www.nursingtimes.net/clinical-archive/infection-control/infection-control-4-good-hand-hygiene-practice-hospital-patients-29-08-2019/

Luangasanatip, N., Hongsuwan, M., Lubell, Y., Limmathurotsakul, D., Srisamang, P., Day, N. P. J., Graves, N., & Cooper, B. S. (2018). Cost-effectiveness of interventions to improve hand hygiene in healthcare workers in middle-income hospital settings: a model-based analysis. Journal of Hospital Infection, 100(2), 165-175.

Mitchell, A., Quilab, M. T., Johnson, S., & Schadt, C. (2019). The effect of education on improving hand hygiene compliance among healthcare workers. Hospice & Palliative Medicine International Journal, 3(3).

Musu, M., Lai, A., Mereu, N. M., Galletta, M., Campagna, M., Tidore, M., … & Mura, P. (2017). Assessing hand hygiene compliance among healthcare workers in six Intensive Care Units. Journal of Preventive Medicine and Hygiene, 58(3), E231.

Sickbert-Bennett, E. E., DiBiase, L. M., Willis, T. M. S., Wolak, E. S., Weber, D. J., & Rutala, W. A. (2016). Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerging infectious diseases, 22(9), 1628.

Thirkell, G., Chambers, J., Gilbart, W., Thornhill, K., Arbogast, J., & Lacey, G. (2018). Pilot study of digital tools to support multimodal hand hygiene in a clinical setting. American Journal of Infection Control, 46(3), 261-265.

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