The Effects Associated with Poor Hand Hygiene by Healthcare - Research Proposal Example

Introduction The hospital environment should provide patients with all possible measures to facilitate the healing process. In this technological era, various interventions have been developed in an attempt to ensure that the prognosis of a certain disease is not aggravated by the conditions around the hospital especially during in-patient hospitalization. Cases of Hospital Acquired Infections (HAI) have been reported hence facilitating the enactment of measures to combat or alleviate these infections. The Centre for Disease Control (CDC, 2014) has reported approximately two million patients fall victim of HAI annually and over 100,000 deaths. These statistics place emphasis on the need to consider HAI as a major health risk. The main causative agents of HAI (nosocomial infection) are bacteria, viruses, and fungi. The gram-negative bacteria are the most common microorganisms usually associated with most of the infections. The fact that the patients have a weak immunity, mainly due to the underlying sickness, facilitates the severity of the infection. Diseases causing bacteria, viruses, and fungi have the ability to propagate under poor hygienic conditions. Stringency of hygiene in the hospital environment has the capacity to contain the infections. Complacency or laxity by the hospital healthcare workers is an aggravating factor of poor hygiene in the hospital (Smith, 2009). However, it is highly unlikely that hospital staff will completely protect against the spread of microorganisms from one patient to another. Despite this, mechanisms have been adopted to reduce the chances of propagation of the disease causing agents. Hand washing is one of the strategies that have been adopted to ensure that the infectious agents are not transmitted from one person to another. The hands are the highly contaminated parts of the body of a healthcare provider, irrespective of whether they have used the gloves or not. It has been found that through proper hand washing more than a third of HAI can be prevented (Smith, 2009). This research proposal is an endeavor to elucidate the effects associated with poor hand hygiene by healthcare providers in an attempt to establish a strategy on the prevention of HAI. It also lays groundwork for a comprehensive understanding of the interventions that can be adopted order to ensure that the prevalence of HAI in hospitals is kept under control. The proposed research will also provide statistics on the current incidences of HAI so that there is an awareness on the state of our hospitals as it relates to HAI. Problem Statement HAI causes preventable deaths and complications in the hospital environment. Poor hand hygiene is the main cause of HAI. Healthcare workers including the nurses and doctors, use their hands in most of their dealings with the patients. The hands carry millions and millions of microorganisms, including viruses, bacteria, and fungi, which can easily be, transmitted to the next patient the healthcare personnel handles, when adequate measures are not put in place. The contamination of the hands of the personnel results to poor hand hygiene. This research project will endeavor to establish the precise implications of the poor hand washing strategies in the spread of infectious agents. Previous research has clearly established that hand hygiene is a key player in the spread of nosocomial infections (Canham, 2011). However, the emphasis that has been placed on the research findings has not been adequate. The research being proposed will provide further insight in order to ensure that the HAIs are given adequate attention. In addition, it will endeavor to add to the existing body of knowledge through the findings and conclusions made. Context Microorganisms are spread throughout the environment, some of which can cause infections. Hospital conditions provide an ideal environment for propagation of infection- causing microorganisms. In addition, the numbers and diversity of disease-causing agents are expected to be higher in the hospital settings, as opposed to other areas, because there are high chances that patients in the hospital may be infected with a wide range of pathogens. This means the choice of the setting for this project shall be an acute hospital setting. The acute setting has been chosen for a number of reasons. Firstly, the patients in this type of setting are mainly with complex medical conditions; hence, they are highly susceptible to other infections because of the weakened immunity. Hence, there is the need to understand the implications of hygiene (hand washing) among the patients. Significance of the Issue Human life is very vital and should be protected through all possible strategies. The CDC has reported HAI is causing deaths of over 100,000 American patients annually (CDC, 2014). Without proper interventions, that are well implemented, these deaths will continue to rise hence putting the population in a more risky situation. Hand washing has been shown to be a powerful strategy to reduce infections. However, the compliance levels are not the best. Having an understanding of the effects of non-compliance will facilitate the strengthening of campaigns on hand washing as a strategy to reduce HAIs. Understanding the effects of poor hand hygiene will also help the healthcare providers to make a consideration for a stringency in hand washing. Many health-based organizations approve hygienic strategies towards hand washing. This study will strengthen their findings by providing concrete evidence on why the practice should be considered across the board. CDC leads the way having laid the Guideline for Hand Hygiene in Healthcare Settings. In addition, the Institute of Healthcare Improvement provides the same views through the manual “Improving Hand Hygiene: A Guide for Improving Practices among Healthcare Workers”. On the other hand, the World Health Organization provides Guidelines for Hand Hygiene in Healthcare Settings. The proposed research will provide more research findings that will back some of these guidelines. One major aspect that this research will endeavor to promote is compliance with hand washing. Statistics indicate that the levels of compliance among hospitals in the United States of America falls around 50%, hence predisposing millions of citizens to life threatening HAI (Jonathan, et al. 2009; CDC, 2014). Having a clear understanding of the effects of poor hand hygiene will provide more information to policy makers and management of hospitals. It will encourage stringency in hand washing. Finally, there is inadequate information on the main causes of HAI and the implications of microbes in hospital setting. The proposed study will go further to identify the main microbes that are responsible for most of the HAI and how hand washing can help reduce their impact. Project Questions The study being proposed shall focus on getting answers to the following questions: 1 What are the predominant disease-causing agents that are prevalent in the hospital environment that are the main cause of HAI? 2 What is the role of hand hygiene in facilitating the eradication of HAI? 3 What is the role of the healthcare personnel towards promoting high levels of hand hygiene in the hospital? 4 How can hand hygiene be improved to ensure that it is more effective in facilitating eradication of HAI? These questions shall guide the proposed research there will be a conclusive position on the effects of poor hand hygiene conditions in the hospital setting and its contribution towards HAI. The highly emphasized position is the implications of hand washing on the eradication of disease causing microbes that are prevalent in the hospital setup. Through these questions, the study has a clear focus and framework in order to clearly relate HAI and hygiene. Methodology Study Design The appropriate design for this study is a quasi-experimental design as the research subject will be chosen as a convenience sample. The research design will be quantitative to determine the effect of poor hand-washing practice by health care providers. Quantitative research focuses on a group of individual with a specific pattern that is unique to that population and is particularly useful for investigating the effectiveness of an intervention (Terry, 2012). The variables to be examined are the health care providers as the dependent variable and the poor hand hygiene on Hospital Acquired Infection as the independent variable. A comparison will be made using retrospective data from the infection control department record. To achieve the goals and the objectives of the research effectively, several steps will be developed. The research will commence with the preliminary activities that will help make a justification of the study. These include a review of the existing literature on this topic. This shall be done extensively and will attempt to incorporate all the peer-reviewed literature related to the effect of hand hygiene in HAI. Another approach is the interviewing of experts on the topic to get their insight on the topic; in this, regard, interviewing some nurses and doctors will be paramount. Upon establishing these preliminaries, the research will go the development of a conceptual framework that will help focus on the topic. The researcher, based on the preliminary findings from the literature review and expert interviews shall develop this framework. The research will then advance to data collection and analysis. Then the findings will be obtained that will guide the revision of the conceptual framework developed after the preliminaries. The research will now be capable of drawing conclusions and recommendations. Finally, the final report shall be developed covering all the aspects of the research. Data collection Internal Review Board (IRB) approval will be obtained from the hospital as the first step to obtaining the data from the hospital. The study being proposed takes a quasi-experimental approach that will involve the administration of questionnaires, conducting interviews and a survey. The questionnaires shall be administered to the healthcare personnel. There will be a random selection of the healthcare personnel to fill the questionnaires. On the other hand, ward managers shall be interviewed while a survey will be done on the prevalence of hand washing by the healthcare personnel. The data collected using the questionnaires shall only have the name of the hospital and not any details that could reveal the identity of the healthcare provider. The interviews shall also be recorded based on the ward number that the manager represents and not by any details that reveals their identity. Data Analysis The data collected will be analyzed using SPSS for easier interpretation. The following measures shall be developed to ensure that the data collected is valid; firstly, the data collected through the questionnaires from the healthcare providers will be based on informed consent. They will be informed about the research and will receive an official email inviting them to provide the questionnaire data. The questionnaires will be sent online to ensure that they will be completed at their specified time. In addition, they will be allowed 24 hours before they return the questionnaires. The results will be tabulated and analyzed through graphical presentations where applicable. Theoretical Framework Infections in the hospital environment are quite prevalent. Reports of people that have died as a result of HAI are documented (CDC 2014). Media reports have also highlighted cases such as one for Acinetobacter baumannii infection (Pollack, 2010). The main entry routes for the infections are open wounds or areas where an individual had gone through surgery. Bacterial, viruses and fundi are the most notorious disease causing pathogens with the gram-negative bacteria such as, staphylococcus aureus and Klebsiella pneumonia being the most notorious. There arises complications because of the associated difficulty in treating these infections as a result of antibiotic resistance (Hagtvedt, Griffin, Keskinocak & Roberts, 2009). Hand hygiene has been cited as one of the main aspects that requires much attention in the prevention of hospital-related infections. The use of hand washing strategy has been universally accepted as a method of reducing the levels of infectious agents. Organizations and institutions such as the WHO, the Institute for Healthcare Improvement, as well as, the Centres for Disease Control appreciate the role of hand washing in preventing the spread of infectious agents. On the other hand, the non-adherence to hand hygiene has been identified by various research findings to be one of the main causes of nosocomial infections (Cummings, Anderson & Kaye, 2010). A very tight relationship has been identified to occur between HAI and hand washing by the patients and the hospital workers. Salama eta al (2012) conducted a research study that involved aspects, such as, education on hand hygiene, reminders on hand washing, group discussions, and monitoring of the infections. They particularly focused on the intensive care unit and attempted to monitor compliance by medical personnel in abiding with hand washing procedures in comparison to infection levels. Their findings categorically indicated there is a reduction in infection levels relative to the increased adherence to hand washing. Poor hand hygiene is a contributor to the resistance of bacterial strains to antibiotics. Bacterial resistance to antibiotics has occurred because of the continued use of antibiotics to treat infectious by a particular strain. The bacterial gene changes such that the drug becomes inactive towards the bacteria. This leaves the doctors with options of using antibiotics that have not been used very much such as colistin and polymyxin B. However, these antibiotics are potentially dangerous based on their ability to cause kidney and nerve complications (Al-Busaidi, 2010). All these problems can be alleviated through proper adherence to stringent measures that ensure hand washing is given first priority. It is also quite clear that effective hand washing requires the use of an antiseptic that reduces the survival of any type of bacterial strain, thus the patient is protected from an infection NOT treated for an infection with a medication that does not do its job Hospital-stay can be a precarious moment for a patient when adequate measures are not in place to prevent infections. Hospitals have very high chances of harboring many types of bacteria, viruses, and fungi because of the diversity of patients that are found in the hospital. These situations can be aggravated by non-adherence to adequate hygienic measures by the healthcare personnel. Harris et al (2011) established a significant reduction in the level of infections was strongly associated with hygienic practices observed in a hospital, such as, oral care, hand hygiene, as well as central-line catheter care. In addition, the number of deaths associated with complications associated with infections was substantially reduced. Poor hygiene has an underlying high cost involving the provision of medical services. In the first place, infections are difficult to treat since various disease agents act in different ways as they infect the patients. Some gram-negative bacteria and viruses are difficult to treat. This is based on the view that viral infections are hard to treat while some of the bacteria have developed resistance to the prevailing antibiotics. The overall cost implications that are involved with the development of new antibiotics, as well as, the ones used for prevention of the prevailing ones is usually high (Harris, Hanson, Christy, Adams, Banks, Willis, & Maciejewski, 2011). The use of hand washing to maintain hygiene has been proved to be an effective strategy for reducing these costs. Harris et al (2011) observed there is a reduction in the hospitalization period that is accompanied by an average reduction in the hospitalization cost of $ 12,136. In addition, the chances of the patient succumbing to a given infection are reduced by a 2.3%. This suggests that adequate hand washing can help reduce many costs, as well as, facilitate the patient recovery process. The loss of life and the treatment costs can be avoided through developing a thorough hand washing procedure. Hassan, Tucker, Patrick, Kountz, & Kountz (2010) developed a system of establishing the cost implications that are associated with the HAI. Their study found the length of stay in a hospital was increased by 3.3 days through acquired infections that could otherwise be prevented through adequate hand washing. On the other hand, they estimated the cost of taking care for the patients with such infections was increased with $ 10,375 ( Hassan, Tuckman, Patrick, Kountz, & Kohn, 2010). These statistics indicate it is possible to verify the results of inadequate hand hygiene based on the outcome cost implications. Poor hand hygiene by healthcare providers is also associated with poor glove use which causes more contamination. Through adequate interventions of glove use, healthcare providers can be in a position of avoiding unnecessary contamination (Paton, 2012). The healthcare personnel, while executing their duties, spread most of the microorganisms that cause most of the HAI. Gloves are used in almost all incidences that the healthcare staff handle a patient. The same glove that should serve as a preventive measure can be the source of infection because of the assumption by healthcare providers that they are protected as their patients. Summary Hand washing is a very basic procedure yet very vital in the prevention of HAI that are spread by healthcare personnel. This proposal is designed to expand on the established effects of poor hand hygiene in the propagation of HAI. Statistics by CDC have indicated that almost half of patients admitted in the hospital suffer from the HAI-related complications. It is also documented and established through research that these infections have resulted in a number of deaths (approximately 100,000 annually). Death is the ultimate effect of the infections though there may be other complications such as prolonged illness. Through this study, an analysis of the overall effects of poor hand hygiene will be considered while measures shall be proposed that can deal with the HAI. The findings will also elucidate the specific effects of each of the microorganisms that are associated with HAIs such as the bacteria, fungi, and viruses. The literature indicates, apart from the associated human suffering and death, it is highly costly to treat the infections. References Al-Busaidi, S. (2010). Healthcare workers and hand hygiene practice: A literature review. Retrieved from http://atp.uclan.ac.uk/buddypress/diffusion/?p=1515 Canham, L. (2011). The first step in infection control is hand hygiene. The Dental Assistant, 42-46 Centers for Disease Control, (2014). Data and statistics: HAI Prevalence survey. Retrieved from http://www.cdc.gov/hai/surveillance/ Cummings, K. L. , Anderson, D. J. , & Kaye, K. S.(2010). Hand Hygiene noncompliance and the cost of hospital-acquired methicillin-resistant staphylococcus aureus infection. Hagtvedt, R. , Griffin, P. , Keskinocak, P. , & Roberts, R. (2009). A simulation model to compare strategies for the reduction of health-care-associated infections. Interfaces, 39(3), 256-270,298-300. Harris, B. D., Hanson, C., Christy, C., Adams, T., Banks, A., Willis, T. S., & Maciejewski, M. L. (2011) Strict hand hygiene and other practices shortened stays and cut costs and mortality in A pediatric intensive care unit. Health Affairs, 30(9), 1751-61. Hassan, M. , Tuckman, H. P. , Patrick, R. H. , Kountz, D. S. , & Kohn, J. L. (2010). Hospital length of stay and probability of acquiring infection. International Journal of Pharmaceutical and Healthcare Marketing, 4(4), 324-338.  Hassan, M., Tuckman, H. P., Patrick, R. H., Kountz, D. S., & Kohn, J. L. (2010). Cost of hospital-acquired infection. Hospital Topics, 88(3), 82-9. McBryde, E.S., Bradley, L.C., Whitby, M & McElwain, D. L. (2004). An Investigation of Contact Transmission of Methicillin-resistant Staphylococcus aureus. Journal of Hospital. Infections. 58(2), 104–8. Otter, J. A. & French, G.L (2009). Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor. Journal of Clinical Microbiology. 47(1):205-7 Paton, N. (2012). OH to promote proper glove use, says RCN. Occupational Health, 64(7), 6. Pollack, A. (2010). Rising threat of Infections Unfazed by Antibiotics. Retrieved from http://www.nytimes.com/2010/02/27/business/27germ.html?em=&adxnnl=1&adxnnlx=1267412412-yP2bfl/3pu4+g34XVmluJA&_r=0 Romano-Woodward, D. (2012). On-hand advice. Occupational Health, 64(8), 13-15. Salama, M. F., Jamal, W. Y., Mousa, H. A., Al-Abdulghani, K. A & Rotimi, V. O. (2012). The effects of hand hygiene compliance on hospital acquired infections in an ICU setting in Kuwaiti teaching hospital. Retrieved from http://www.jiph.org/article/S1876-0341(12)00130-X/abstract Smith, S. M. (2009) A review of hand-washing techniques in primary care and community setting, Journal of Clinical Nursing. 18(6), 786-790. Read More