Effect of Hand Hygiene Practice by Health Care Providers on HAI - Research Paper Example

Effect of hand hygiene practice by health care providers on HAI Population and Sampling The study will take into consideration a population of 2500 participants from 30 different acute care hospitals. The sample involving 500 participants (healthcare workers) will be selected through stratified sampling approach for consequent survey and observation. Stratified random sampling is an effective method for selecting participants in a heterogeneous population. Stratified sampling was considered the most convenient method that could facilitate sampling of different players in the healthcare setting ranging from doctors, nurses, cleaners, as well as administrators. Purpose statement and project objectives The purpose of this study is to develop a superior understanding of the impact of reinforcing hand hygiene practices in particular hand washing by healthcare providers on Healthcare Acquired Infections (HAI) in an acute care hospital setting. In other words, this paper will investigate healthcare workers compliance trends to hand hygiene protocols and, report if it has any influence on Healthcare Acquired Infections (HAI) cases in an acute care setting or otherwise. One of the key objectives of this study is to examine if effective compliance to hand hygiene policy by healthcare workers would result to positive effects towards reduction of HAI. Other objectives will include but not limited to: To determine if various acute care hospitals operate hand hygiene policy To establish the levels of adherence to the hand hygiene policy by the healthcare workers in the hospitals To encourage implementation of hand hygiene initiatives especially hand washing in various acute care hospitals with no such policy To improve hand hygiene compliance rate to 70% across all the professional areas by the end of the project To reduce HAI reported cases by 80% by the end of the project To increase hand hygiene awareness level among the healthcare workers to 90% by the end of the project To increase availability of hand washing facilities in all patient care areas to 80% by the end of the project To increase confidence level of healthcare workers in using water and detergents as the simplest and most valuable method of prevent spread of pathogenic microorganisms by 60% by the end of the project Evidence-based significance of the project It is the responsibility of each healthcare worker to provide safe care to all patients (Daniels, 2012). Every patient goes to healthcare facility to get well, but unfortunately, some end up getting infections while receiving treatment for other conditions at the hospital. Healthcare Acquired Infections (HAI) is undoubtedly a serious threat to patient safety and quality of care not only in the US but also in the entire world (Talbot, et al, 2013). HAI often bring about devastating financial, emotional, and medical effects on the lives of patients and worst of all such infections can even lead to lose of life. Key among the HAI infections includes Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Extended-Spectrum β-Lactamases (ESBLs) (CDC, 2014). According to the recent CDC HAI prevalence survey data at least 1 in 25 hospitals patients suffer from HAI in the US on a given day. Further studies by CDC revealed 722,000 HAI cases in the United States acute care hospitals in the year 2011, with approximately 75,000 deaths in the same year during hospitalization (CDC, 2014). It is noteworthy that preventing and eradicating hand HAI is one of the major current priority concerns of the US Department of Health and Human Services owing to the serious implications of HAI currently faced by the government in terms of direct medical cost. There is strong evidence from clinical experts and scientific research that Healthcare Acquired Infections (HAI) spread with increase in contact with contaminated surfaces (The Joint Commission, 2009). Because most healthcare workers provide care through their hands, they pose a great risk of contamination with disease causing microorganisms, which are further spread to the patients or among themselves (Anderson, Cummings & Kay, 2010). In other words, hands forms a critical vehicle through which bacteria, viruses and pathogenic microorganisms are spread within an acute care hospital. Studies indicate that pathogenic microorganism (transient microorganisms) have the capability of staying on healthcare worker’s hand for between 2 to 60 minutes. Infectious germs stuck on the hands of the healthcare worker can be easily transferred to the patient without knowledge of such transmission. Dyson, Lawton, Jackson and Cheater (2013) elucidate that the spread and transmission of disease causing organisms through hands has been a subject of study for a long period and as such it is supported by well-documented evidence and clinical expert opinion. For instance, World Health Organization clearly describes five vital instances where cross infections may occur through the aid of human hands. (i) Before patient contact (ii) after body fluid exposure, (iii) after patient contact, (iv) before an aseptic technique and (v) after get in touch with with the patient environment (WHO, 2009). This is a clear justification that there exist a large body of knowledge concerning implications of poor hand hygiene on spread of infectious pathogens. Hand hygiene especially hand washing using soap and water has been widely touted by various healthcare based agencies and experts for a long period as one of the most effectual and simplest method of preventing spread of infectious agents in healthcare set up (Goodliffe, et al, 2014). It is believed that hands act as the highway for spreading infectious microbial and therefore continuous compliance to hand hygiene would disrupt the spread of pathogenic microorganisms and thus reduces cases of HAI in the hospital. Effective compliance to hand washing practice is not only significant for preventing HAI cases but also promoting the safety of providers too considering that the risk of exposure is not limited to patients only (Pantle & Fitzpatrick, 2007). Despite this knowledge, there is still some laxity in compliance to hand hygiene practices by the health workers, which has consequently strained the efforts of healthcare regulatory agencies to prevent and reduces HAI cases in the US (Anderson, Cummings, & Kay, 2010). It is estimated that compliances rate to recommended hand hygiene policies in the US still lingers below 50%, a figure which is unacceptable in a society where both patients and healthcare workers are constantly increasing awareness of quality and safety of the medical services (The Joint Commission, 2009). A number of studies have highlighted multitude of factors that have contributed to poor hand washing compliance among the healthcare workers, key among them being lack of sufficient knowledge and awareness about the importance of hand washing in preventing contamination and spread of HAI, lack of access to hand washing facilities (IHI ,2010). Other reasons for poor hand hygiene include lack of strong dedication to hand hygiene policy by the organization, understaffing and insufficient time, lack of role models and that gloves are enough to safeguard patients against germs. Campaigns, initiatives and regulations that calls for the need to comply with hand hygiene practices especially hand washing in all human surrounding whether at home, workplace or restaurant have been in place for more that decade (Comer, Ibrahim, & McMillan, 2009). The recognition about hand hygiene especially, by international health based non-governmental organizations, local governments and corporate clearly justifies the significance of hand washing not only in hospitals but also in all human aspect. The Center for Disease Control and Prevention (CDC) has been a front-runner in reinforcing the significance of handwashing in prevention of HAI incidences not only in the US but globally. For a number of years CDC has championed in facilitating surveillance, laboratory research, outbreak exploration and prevention of HAI. The knowledge gained through these activities has played a critical role in publishing reviews of Guideline for Hand Hygiene from time to time (CDC, 2014). CDC is known for publishing Guideline for Hand Hygiene in Healthcare Settings, which contains a review of data over time relating to hand washing in healthcare environment. These publication forms one of the vital scientific documentary evidenced of the significance of reinforcing hand hygiene practices in the healthcare set up by the healthcare workers. World Health Organization (WHO) is another important institution that has taken time to research and publish extensive scientific information concerning hand hygiene practices including hand washing as an effective means of reducing and eliminating Healthcare Acquired Infections (HAI). The WHO Guidelines on Hand Hygiene in Health Care is one of such important documentary evidence on hand hygiene in a healthcare environment. The document provides conclusive guidelines, recommendations and strategies for healthcare workers on how to improve safety and quality of patient care and most importantly reduce spread of pathogenic microorganism that would lead to HAI cases (WHO, 2009). The WHO is also known for promoting the SAVE LIVES: Clean Your Hands campaign whose main objective was to sensitize the healthcare workers in the entire globe on the significance of hand hygiene in curtailing transmission of drug resistance germs in the healthcare setup. Implications for social change in practice Society is not a stagnated entity but rather an ever-changing one. Social change characterizes that constant alteration and key areas normally affected include behavior, social institutions, and values. Change can occur either naturally or induced by humans and therefore social change may be understood as a product of action of people or nature. People and or institutions act as critical agents of change and social change is so powerful that it can change policies, institutions, behavior, laws and even attitude to better influence values of the agents/sponsors. It is also valuable to note that change involves a collective action by people faced by a social problem rather than an individual with a view of coming up with effective solution to address the challenge at hand. For instance, the social change in this case involves changing the hand hygiene systems among the healthcare workers in order to solve the key social issue of high HAI prevalence. Social behavior change is undoubtedly such an important element of social change in every society especially if it has positive contribution to the development of the entire society. Changing the hand hygiene behavior of healthcare workers is an important initiative in the medical arena considering the negative social impact of poor hand hygiene practices in the society (Thanee, et al, 2013). Studies indicate that healthcare workers in the same institution or unit often demonstrate varied hand hygiene behavior indicating that individual characteristic may significantly determine someone’s behavior (Curtis, Danquah & Aunger , 2009). Understanding human behavior is such a complex affair to most sociologist and psychologists considering that determinants that influence human behavior are gained through different models, which are widely vulnerable to change. According to WHO (2009), three key models of behavior that can be used to analyze human behavior towards hand hygiene can be classified into three levels namely intrapersonal, interpersonal and community levels. Intrapersonal factors relate to personal traits that influence behavior and they may include aspects such as beliefs, attitudes, or knowledge. Interpersonal factors on the other hand refers to group process that influence behavior and they may include family, peers or friends who influence ones identity, orientation with surrounding and role definition. Finally, community factors refer to social links that can be either formal or informal between individuals, members or institutions (WHO, 2009). Social behavior change focusing on altering hand hygiene behavior of healthcare workers is vulnerable to influences from several factors (personal, interpersonal, community) and thus the need to implement robust hand hygiene interventions that cuts across all models of human behavior. Failure to do this over time has witness massive inability to motivate healthcare workers comply with hand hygiene practices thus high prevalence of HAI in our health sector. Key among the attributes that are likely to arouse and or alter healthcare Worker’s social behavior change towards hand hygiene include but not limited to motivation, knowledge, perception of threat, behavioral norm, and intention. For instance, perception that everyone is expected to clean his or her hands may arouse a regular trend towards hand hygiene (Muhammed Abdella, et al, 2014). The dynamics of behavior modification is a complex task with varied factors in play and as such offering guidelines and reinforcing awareness alone is not adequate to spur effective social behavior change in the practice. Commonly known hand hygiene practice established since our childhood is that one should wash his/her hand when the hands are visibly sticky or soiled (Huis, et al, 2012). Healthcare workers just like other people in the society tend to grow with this perception and would only clean their hands only for self-protection, that is, when their hands are physically soiled and they have a perceived feeling that the dirt is contagious. Thanee, et al. (2013) assert that this perception is unacceptable in a healthcare setup considering that it increases the risk of transmission of pathogenic microorganism thus the need to promote hand hygiene behaviors that would alter such perceptions. A healthcare setup being a vital community with great influence on the behavior change of key stakeholders consisting of doctors, nurses, student healthcare workers, administrators, the perceived behavior of the social network and peers would play a significant role in reinforcing a positive social behavior change towards hand hygiene. Studies indicate that Healthcare workers are likely to comply effectively with hand hygiene practices owing to perceived behavior and attitude of their peers, and superiors (WHO, 2009). Other important interventions that would reinforce behavior change towards hand hygiene practices among the healthcare workers include education and training, multidisciplinary teams, reminders, audit and feedback as well as patient empowerment (The Joint Commission, 2009). Definitions of terms Hand hygiene Any activity that entails cleaning of hands Healthcare Acquired Infections (HAI) Refers to infections acquired in a healthcare setup while receiving treatment for a different condition Hand washing Cleaning hands with plain or medicated soaps and water Healthcare worker A professional involved in the provision of patient care services to a client (e.g nurse, doctor, dentists, physiotherapists) as well as those with social link with patients (e.g receptionist, administrative staff, cleaners, security personnel) Healthcare Environment This include all the objects and individuals that make up the surrounding for providing patient care services(e.g staff, patients, buildings and partitions, medical equipment) Infectious agent This includes all forms of bacteria, virus, pathogen, and fungus, which are capable of attacking tissues of living creature and cause infection. patient An individual seeking for medical service in a healthcare setting Acute care This is a type of care that involves treatment of serious illness/injury due to trauma, accident or diseases but with expected short-term stay in hospital Assumptions and limitations A number of assumptions were noted in the conduct of the study key among them being participants’ cooperation in the study. The researcher assumed that all participants selected for the study would respond to the call and participate fully from the beginning to the end of the project. In other words, the researcher expects response rate to be at least 98% throughout the entire project. There is also an assumption that sufficient cases of Healthcare Acquired Infections (HAI) exist in the hospitals under study and cases of change in the occurrence of HAI will be successfully traced during the study. Another assumption is that healthcare workers in different hospitals but in the same working unit (wards) will demonstrate varied hand hygiene habit and if cases of HAI are reported during the study then the researcher will be in a position to directly trace the infections to the healthcare workers with poor hand hygiene behavior. Another major assumption is that all participants will understand all the survey questions and eventually give honest answers about their experience and compliance with hand hygiene. The researcher will stress on the confidentiality of the information gathered to enable the participants give truthful information based on the questions asked. The researcher also assumes that the secondary data gathered from the hospitals will be sufficient, reliable, relevant and up-to-date to assist in drawing effective conclusion about the study results. This is because the researcher plans to use both pre and post data about HAI case and the only identified source is the infection control/quality and risk management department of the hospitals involved in the project. The researcher came across a number of limitations key among them being the number of participants involved in the project and the period of the project. The study results would not meet the test for generalizability because the population of the study was small and above all, it did not cut across all the states in America. The sample was drawn from the hospitals in single state owing to lack of adequate resources. The time allocated for the project, which is nine months, was also not adequate to carryout and test the hypothesis effectively making it a major limitation to the study. The fact that the focus of the study was on healthcare workers with poor hand hygiene only without consideration for those with high compliance of hand hygiene was also major limitation to this research. Another major limitation was the use of a wide range of hand hygiene techniques in different hospitals, as this would not give true relationship between a particular hand hygiene technique (hand washing) and HAI rates in healthcare setting. Summary Hand hygiene especially cleaning with water and soap could be one of the best methods of cutting down Healthcare Acquired Infections (HAI) but unfortunately majority of healthcare workers are so reluctant to comply with it. This unacceptable behavior has led to significant increase in the number of HAI cases in both developed and the developing countries. HAI has been a major obstacle to the goal of promoting quality and safe patient care by healthcare providers across. There is increasing need to change the behavior and perception of healthcare workers globally about hand hygiene practices in order to prevent and eliminate HAI in the healthcare sector. Awareness alone with simplistic perception that enlightening people about germs transmission and diseases, is not enough to motivate healthcare workers into adhering to hand hygiene behavior. This is because a number of factors namely intrapersonal, interpersonal and community influence human behavior and these factors make it hard to understand and simplify dynamics of human behavior. The best remedy is to identify salient physical, psychological, social and biological factors that would promote the desired change in behavior of healthcare workers towards hand hygiene practices. Key among the recommended intervention for behavior change includes education and training, reminders, multidisciplinary teams, audit and feedback and finally systematic performance improvement techniques. References Anderson, D,. Cummings , K & Kay,K. (2010). Hand Hygiene Noncompliance and the Cost of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection. Infection Control and Hospital Epidemiology, 31(4): pp357-364. Center For disease Control and Prevention (CDC). (2014). Hand Hygiene in Healthcare Settings. Retrieved May 15, 2014 from: http://www.cdc.gov/handhygiene/Basics.html Comer, M,. Ibrahim, M & McMillan, VJ. (2009). Reducing the Spread of Infectious Disease Through Hand Washing. Journal of Extension, 47(1). Retrieved May 15, 2014 from: http://www.joe.org/joe/2009february/pdf/JOE_v47_1rb7.pdf Curtis, V,. Danquah, l & Aunger , R.(2009). Planned, motivated and habitual hygiene behaviour: an eleven country review. Health Education Research, 24(4): pp655-673 Daniels, T. (2012). Reconsidering Hand Hygiene Monitoring. Journal of Infectious Diseases, 206: pp 1488-90. Dyson, J., Lawton, R., Jackson, C., & Cheater, F. (2013). Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners. Implementation Science, 8(1), 1-9. Goodliffe, L., et al. (2014). Rate of Healthcare Worker--Patient Interaction and Hand Hygiene Opportunities in an Acute Care Setting. Infection Control & Hospital Epidemiology, 35(3), 225-230. Huis, A et al. (2012). A systematic review of hand hygiene improvement strategies: A behavioural approach. Implementation Science 7(29): pp 2-14. Retrieved May 15, 2014 from http://www.implementationscience.com/content/pdf/1748-5908-7-92.pdf Institute for Healthcare Improvement (IHI). (2010). How-to Guide: Improving Hand Hygiene. A Guide for Improving Practices among Health Care Workers. Retrieved May 15, 2014 from: http://www.shea-online.org/Assets/files/IHI_Hand_Hygiene.pdf Muhammed Abdella, N., et al. (2014). Hand hygiene compliance and associated factors among health care providers in Gondar University Hospital, Gondar, North West Ethiopia. BMC Public Health, 14(1), 1-14. Pantle, A & Fitzpatrick, K. (2007). Clean Hand Save Lives. Retrieved May 15, 2014 from: http://www.cec.health.nsw.gov.au/__documents/programs/clean-hands/final-report.pdf Talbot, T. R, et al. (2013). Sustained Improvement in Hand Hygiene Adherence: Utilizing Shared Accountability and Financial Incentives. Infection Control & Hospital Epidemiology, 34(11), 1129-1136. Thanee, E., et al. (2013). Hand Hygiene Behavior: Translating Behavioral Research into Infection Control Practice. Infection Control & Hospital Epidemiology, 34(11), 1137-1145 The Joint Commission .(2009). Measuring Hand Hygiene Adherence: Overcoming The Challenges. Retrieved May 15, 2014 from: http://www.jointcommission.org/assets/1/18/hh_monograph.pdf World Health Organization (WHO). (2009). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Retrieved May 15, 2014 from: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf Read More