Changing Hand Hygiene Behavior To Prevent the Spread of Clostridium Difficile - Dissertation Example

?Outline I. Introduction: A healthcare-associated infection is an important cause of morbidity and mortality among hospitalized patients worldwide. Clostridium difficile associated disease (CDAD) is a major cause of healthcare associated infection. Epidemiologic studies continue to demonstrate the positive effects of simple hand washing for preventing transmission of pathogens in health care facilities. II. Background: The WHO guidelines for hand hygiene in prevention of nosocomial infection, especially C.difficile. A. Problem of interest: Changing Hand Hygiene Behavior at the Point of Care. B. Significance of the problem/purpose of the literature review: Hospital Acquired Infections (Nosocomial), especially Clostridium difficile are increasing in number, morbidity, and mortality. Nosocomial infections are preventable through proper hand hygiene.  C. PICO question: For RN’s, LPN/LVN and NA (nursing assistants) working on patient care areas, will changing hand hygiene at the point of care prevent the spread of C.difficile D. P=Population-RN’s, LPN/LVN and NA’s providing primary patient care. E. Intervention: Scheduled educational classes introducing CDC’s “WHO model for Hand Hygiene.  F. Comparison- Comparison: RN; LPN and NA knowledge pre and post training. “A comparison of pre and post-tests will be conducted to determine the participant’s understanding of the WHO model and the impact of hand washing technique on the incidence of Clostridium difficile.  G. O =Outcome-Nursing staff will demonstrate and utilize CDC’s:”WHO Model for Hand Hygiene” thereby preventing the spread of Nosocomial infections such as Clostridium difficile. III. Methods-  A. Sampling strategies (examples-search process, databases accessed, year restrictions, types of studies, key terms used in the search).  B. Data evaluation (criteria you considered when deciding to utilize a piece of literature).  IV. Findings-  A. Compare and contrast findings (integrate findings, identify important strengths or  weaknesses of utilized studies/literature, do results of majority of studies agree or disagree).  B. Identify limitations of the literature review process (examples-could only locate literature that seems dated by our standards, lack of published empirical studies on the topic, rationale for using non-empirical studies, lack of studies in nursing but did locate studies in another discipline)  V. Discussion  A. What has been concluded from the findings  B. Advantages and disadvantages of findings  C. How the findings could be utilized in nursing practice  VI. Conclusion- Hand washing (soap washing and water), contact precaution and meticulous environmental cleaning with an EPA-registered disinfectant are effective in preventing the spread of the organism. Abstract Background The World Alliance for Patient Safety launched by The WHO in 2004 advocates a “clean care is safer care” program, in which health care leaders sign a pledge to take specific steps to reduce hospital associated infections in their facilities. Hand hygiene is the first focus in this worldwide initiative. Recognizing a worldwide need to improve hand hygiene in healthcare facilities, the WHO produced Advance Draft, launched its “Guidelines on Hand Hygiene in Health Care” along with the “Implementation Toolkit” that have been available since 5 May 2009 on the occasion of the launch of the “Save Lives: Clean Your Hands” initiative. The WHO regards hand hygiene as an essential tool for the prevention of nosocomial infection, but compliance in clinical practice is often low. Methods Relevant scientific literature and international evidence-based recommendations (Meta Analysis Sources) were studied. Results Hand washing (soap washing and water), Hygienic hand disinfection, contact precaution and meticulous environmental cleaning with an EPA-registered disinfectant are effective in preventing the spread of the organism. Compliance can be improved by training, and by placing hand-rub dispensers at the sites where they are needed. Conclusions Improved compliance in hand hygiene can reduce the nosocomial infection. Behavior change at the Point of Care limits the spread of Clostridium difficile. Keywords: Hand hygiene, changing hand hygiene behavior, health care associated infections (HAI), Clostridium difficle (C.difficle). Introduction A healthcare-associated infection is an important cause of morbidity and mortality among hospitalized patients worldwide. Clostridium difficile associated disease (CDAD) is a major cause of healthcare associated infection. Epidemiologic studies continue to demonstrate the positive effects of simple hand washing for preventing transmission of pathogens in health care facilities. Health care workers are frequently reminded of the importance of hand hygiene in preventing infections. However, compliance by healthcare workers with recommended hand hygiene procedures has remained low. Recognizing a worldwide need to improve hand hygiene in healthcare facilities, the WHO produced “The Advance Draft’’ launched its “Guidelines on Hand Hygiene in Health Care” along with the “Implementation Toolkit” in May 2009 on the occasion of the launch of the “Save Lives: Clean Your Hands” initiative (WHO 2009). With production of the Advanced Draft, the strategy for implementation was also developed along with a wide range of tools to help healthcare settings translate the guidelines into practice. A key feature of the implementation strategy is a very novel concept, “My five moments for hand hygiene” (Sax et al. 2007). It integrates the indications for hand hygiene in five essential moments during the sequence of healthcare delivery and facilitates understanding and appropriate practice performance. Background The WHO regards hand hygiene as an essential tool for the prevention of nosocomial infection, but compliance in clinical practice is often low, there is a need of more research to know the reliable and efficient method of compliance amongst in HCWs. Hand Hygiene Changing Behavior at the Point of Care   The World Alliance for Patient Safety launched by the WHO in 2004 advocates a “clean care is safer care” program, in which health care leaders sign a pledge to take specific steps to reduce hospital associated infections in their facilities. Hand hygiene is the first focus in this worldwide initiative. The WHO’s “Guidelines on Hand Hygiene in Health Care” (WHO 2009) are believed to be the gold standard for hand hygiene worldwide. These Guidelines have been finalized. The Centers for Disease Control and Prevention's (CDC's) Healthcare Infection Control Practices Advisory Committee (HICPAC) published its comprehensive Guidelines for Hand Hygiene in Healthcare Settings in 2002. One of the principal recommendations of this guideline was that waterless, alcohol-based hand rubs (liquids, gels or foams) are the preferred method for hand hygiene in most places due to the superior efficacy of these agents in rapidly reducing bacterial counts on hands and their ease of use. Alcohol preparations also rapidly kill many fungi and viruses that cause healthcare-associated infections. The guideline recommended that healthcare facilities develop multidimensional programs to improve hand hygiene practices (Boyce and Pettit 2002). These global consensus guidelines reinforce the need for multidimensional strategies as the most effective approach to promote hand hygiene. Key elements include staff education and motivation, adoption of an alcohol-based hand rub as the primary method for hand hygiene, use of performance indicators, and strong commitment by all stakeholders, such as front-line staff, managers and health care leaders, to improve hand hygiene (WHO 2009). Studies have found that on average, health care workers adhere to recommended hand hygiene procedures 40 percent of the time (with a range of 5 to 80 percent) (Vicca 1999). These studies implemented various interventions to improve hand washing, but reviewed effects by evaluating responses over a short time frame, without demonstrating long-lasting behavioral improvements. Two studies demonstrated the use of multidisciplinary interventions to change the organizational culture on frequency of hand washing that resulted in sustained improvements during a longer follow up time period (Larson 2000 and Pittet et al.2000). Institute for Healthcare Improvement (2006) suggests observing comprehensive patient run across rather than just individual acts of compliance or noncompliance-in order to confirm that all aspects of an institution's hand hygiene protocol are followed. Most health care facilities now put some effort into programs to improve compliance. "Have you cleaned your hands?" a recent change that may improve the attention given to hand hygiene is the Joint Commission (2007) patient safety requirement that entails hospitals encourage patients and families to become involved in the patient's care. The Partners in Your Care program, developed at the University of Pennsylvania School of Medicine, encourages patients and their families to ask health care personnel if they have cleaned their hands before they provide care; increases in hand hygiene compliance of 35% to 60% have been reported when this program is used (Joint Commission 2007). In a study, Pittet et al. (2000) determined the order of hand hygiene compliance before and during implementation of a program of hand hygiene improvement in Geneva, Switzerland. This hospital-wide program resulted in an increase in the rate of compliance from 48% to 66% over a three-year period and significant decreases in the number of hospital-acquired infections. The program which is quite effective even today was designed to be multidisciplinary, innovative and sustained over years rather than months with animated color posters displayed in 250 locations in the hospital in those health care workers also collaborated. Topics included hand hygiene, hospital-acquired infections, and protecting hands with creams, among others. Three to five poster designs were displayed at any one time and changed weekly. The program also emphasized the availability of bottles of alcohol-based hand sanitizer at each bedside. The most significant factor in the success of the program was that members of the hospital management made it a hospital-wide priority, allocating funds to the campaign. It encouraged the participation of senior staff, participating themselves. Hand hygiene is simple, but improving compliance requires leadership, collaboration, accessibility of hand hygiene products, feedback on compliance and infection rates, and individual accountability. Clostridium difficle and Clostridium difficile associated disease (CDAD) In 1995, the Society for Healthcare Epidemiology of America (SHEA) published a clinical position paper on C. difficile associated disease and colitis (Gerding et al. 1995), which dealt in great details about epidemiology, diagnosis, prevention and treatment. Clostridium difficile (C. difficile) a gram positive anaerobic bacillus that is closely related to the one that causes tetanus and butalism is associated with gastrointestinal infection, diarrhea and pseudo membranous colitis. C. difficile generally afflicts older hospitalized patients treated with antibiotic drugs. Clostridium difficle (C. difficile) accounts for 20% -30% of cases of antibiotic-associated diarrhea and is the most commonly recognized cause of infectious diarrhea in healthcare facilities (Bartlett 2002). Annually the excess hospital costs due to its infection in the US are estimated to be $3.2 billion for the years 2000–2002 (O’Brien et al. 2007). Between 2002 and 2006 hospital outbreaks were severe (Loo et al. 2005) and recurrent (Pepin et al. 2005). Its infection has been on rise in the US and elsewhere. The recent emergence and spread of virulent strain of C. difficile which is commonly known as NAP1/B1/027 produces more potent toxin and recurrent infections was first identified in Quebec, Canada in late 2002 and has since been found in most states in the U.S. Clostridium difficile associated disease (CDAD) is a major cause of healthcare associated infection causing morbidity and mortality. The spores are found in hospitals, and medical care facilities, located on the floors, furniture, linens, toilet seats, telephones, shared instrumentation and healthcare workers hands and accessories (Dumsford et al. 2009). According to McFarland et al. (1989) environment samples showed 29% positive for C. difficile from rooms occupied by asymptomatic patients and 49% in rooms having patients with CDAD. Fawley and Wilcox (2001) showed significant incidence of C. difficile due to environmental factors. Realizing the severity and threat to patients, hospitals and other healthcare facilities the control and prevention of the disease is really challenging, steps have been taken to stop the spread of C. difficile, but more needs to be done.  There are plenty of questionnaires, forms, posters and tools available for health care workers, NA, RNs, and LPN/LVN on hand hygiene for educating and protecting themselves from the infection or transmission for better care outcome. Regular on line training and awareness programs are conducted, besides encouragement to introduce newer quality tools and quality management by CDC, the WHO, IDSA and SHEA considering local/regional ethics and perspective in a dozen of language. There is no scarcity of resources and tools, however behavior and mind set are limiting factor in success of evidence based protocols and practices. Method There are many papers published recently about the importance of hand hygiene in preventing HAI. The literature review was conducted using Meta Analysis Sources, for example, the WHO, CDC’s, SHEA and IDSA and other quality publications. Finding “Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of a successful hand hygiene promotion program”(Boyce and John 2008). There is no shortage of relevant literature, guidelines and there is no hesitation to acknowledge the commendable job of the WHO, CDC, SHEA, Joint Commission and IDSA for their role in the field of prevention and control of nosocomial infections. Further research is needed to develop reliable and reproducible methods for monitoring hand hygiene compliance. Discussion The efficacy of antiseptic hand wash or hand-rub preparations against C. difficile has become a great concern as none of the agents (including alcohols, chlorhexidine, PCMX, and triclosan) is effective against virulent strain. Washing hands with soap and water may help to physically remove spores from the surface; however, rigorous regimen of hand hygiene is required. Hand washing (soap washing and water), contact precaution and meticulous environmental cleaning with an EPA-registered disinfectant are effective in preventing the spread of the organism (McFarland et al. 1989). According to Haas and Larson (2008) hospitals can improve compliance of hand hygiene by assessing the barriers to it, measuring the rates of compliance, education staff on the importance of hand hygiene, making sanitizing products more available for staff use, and holding staff accountable.  They think that lasting improvement in hand hygiene is a collaborative effort that depends on the committed support of hospital administrators. Conclusion The strategic goals that are generally agreed by the experts of prevention and control of all infectious diseases are: to detect, report, and prevent transmission of infectious organisms, and the interventions that include aggressive detection, isolation of patients, appropriate hand hygiene, thorough disinfection of the environment and personal equipment. Even though, every aspect of the mentioned intervention may seem self-evident, the key to preventing transmission practice of all components. Better compliance and audit to redesign the process is showing results in controlling the disease, albeit, significant data are not available globally of radical change. It is prudent to suggest that hand hygiene exceeds current practice in most health care settings. Reference Bartlett JG (2002). Clinical practice. Antibiotic-associated diarrhea. N Engl JMed; 346:334–49. Boyce, John M (2008). Hand hygiene compliance monitoring: current perspectives from the USA. 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