Comparison of Surgical Hand Rubbing with Traditional Surgical Hand Scrubbing - Research Proposal Example

Lecturer Comparison of surgical hand rubbing with traditional surgical hand scrubbing Chapter one Backgroundinformation Surgical site infection is a problem that is globally recognized as it causes significant morbidity due to delayed wound healing, wound breakdown and sepsis. This can result to high cost of hospitalization to patient as a result of increased hospital stay and surgery revision. Hand antisepsis therefore remains the best technique to remove transient microorganisms and decrease the number of residential skin flora in the hand that can cause contamination of the surgical site resulting to surgical infection. Surgical hand scrubbing is washing hands using hand microbial soap and water. This was the main traditional method of removing microorganisms from the hand prior to a surgical procedure. The norm was using antimicrobial soap and water to wash hands with chlorhexidine and iodine. The more recent is hand rubbing, which is the preparation of hand using the alcohol hand rub. The alcohol is rubbed to the hand to inactivate microorganisms and temporarily suppress their growth. The preparation used contains a mixture of alcohol and chlorhexidine gluconate. The traditional surgical hand asepsis was mainly done by using povidone iodine or chloerhexine based detergents. More recently, alcohol hand rub has been introduced to replace the traditional hand scrubbing using povidone iodine. Its introduction has been successful in has it has shown greater effectiveness, lesser irritation as compared to the traditional method and requiring less time to wash hands. The replacement of the traditional hand scrub with alcohol hand rub has been evident in some institution continental Europe while other countries such as Singapore has maintained the use of hand scrubbing. Justification Despite the effectiveness of alcohol hand rub, studies have indicated lack of trust among the health care providers in the efficacy of alcohol hand rub over the additional hand scrubbing. This has made many health care providers across the world to continue using the traditional hand scrubbing instead of alcohol hand rubbing. Confirmation of the efficacy of the surgical hand rubbing over the traditional hand scrubbing will therefore help to convince the health care providers to use the surgical hand rubbing technique instead of the traditional surgical hand scrubbing. Significance of the study The increase in use of alcohol based hand rubs have resulted to a number of trial studies that compares the efficacy of alcohol hand rub against the traditional hand scrubbing using povidione iodine before surgery. Current evidence regarding surgical hand antisepsis stipulates that alcohol hand rubs functions better in reducing the number of microorganism in the hand prior to surgery as compared to the traditional hand scrub. However, this does not translate directly in the reduction of surgical morbidity. Hence by doing a research to determine the efficacy of both methods, the health personnel will gain a lot in determining the best method to use during surgical procedures. Chapter two Literature review Globally Across the world, many health care providers have adhered to the traditional hand scrubbing due to lack of confidence over the efficacy of the alcohol hand rub. Countries have not concluded to whether use alcohol hand rub or surgical scrubbing for washing hands before surgery. For example, the European recommendations for surgical hand disinfection concluded that no criteria exist to determine on whether to use surgical hand rubbing as compared to the surgical hand scrubbing. Other countries such as France have preferred surgical hand rubbing as opposed to the traditional surgical hand scrubbing. In Singapore Currently in Singapore, both in public and private hospitals, alcohol hand rubs are not the choice methods of surgical hand antisepsis as they are not routinely used. Many hospitals prefer the traditional hand scrubbing using the povidone iodine as compared to the new technique of alcohol hand rubbing. This is due to lack of local studies that compare the traditional hand scrub with the alcohol hand rub and other active ingredients. In one of the study, the efficacy and cost of the alcohol based hand rub was compared to hand scrubbing. Study showed that alcohol rub with chlorhexine was more effective than the traditional scrub of povidone iodine in the reduction of colony forming units, cost less by 67 percent and it has a sustained bacterial activity. In another study, comparison of the efficacy of surgical hand rub and surgical hand scrub in the prevention of surgical site infection within a period of 30 days was done. The study showed that surgical site infection rate was high in hand scrubbing protocol as compared to the hand rubbing protocol. In hand scrubbing protocol the surgical site infection rate was 2.48 percent while in hand rubbing it was 2.44 percent(Parienti et al.). In a study, the antiseptic effectiveness and acceptability of alcohol based waterless solution (61 % ethyl alcohol and 1% CHG) was compared with 7.5% povidone iodine. The study showed that the alcohol based waterless solution was more effective in reduction of colony count and had a better antimicrobial efficacy than the povidone iodine. The health care workers also preferred the use of alcohol hand rub due to the easiness of use and better skin condition. In another systematic review study, the effectiveness of alcohol based solutions in hand asepsis was determined. The study showed that alcohols are more effective for preoperative cleaning of the hands of surgical personnel. It also concluded that additional of CHG to alcohol based solutions produced residual antimicrobial properties on the skin. In a randomised control trial, ethanol/ chloehexidine gluconate hand rub was compared to traditional povidone iodine surgical scrubs. The study showed that CHG 1% + Ethanol 61% had an immediate antimicrobial count of 0.00 while povidone iodine 7.5% immediate antimicrobial count was 4.1. The CHG 1%+ Ethanol 61% had a residual effect of 0.0 while povidone iodine 7.5% was 4.1. In another study, both the ethanol/ chloehexidine gluconate hand rub and traditional povidone iodine surgical scrubs were applied for five minutes in hand hygiene. Their onset and spectrum of actions was compared. Povidone iodine 7.5% had a broad spectrum of action with a fairly rapid onset of action. Ethanol 61%+ CHG1% had a very broad spectrum of action with a very rapid onset of action. Advantages and disadvantages of surgical alcohol hand rub The surgical alcohol hand rub advantages include, reducing the time needed to wash hands using water and reduced cost of hand disinfection by 67 percent. It also has immediate bactericidal effect which is long lasting. The only disadvantage of this technique is that it cannot be used when the hands are soiled. Advantages and disadvantages of surgical scrub The surgical hand scrub can be best applied when the hand is soiled. When it precedes the surgical hand rub, it can work best to prevent surgical site infection. However, surgical scrub procedure consumes a lot of time for health workers and utilizes a lot of the hospital resources in terms of water. Literature show that studies have been done to compare the efficacy of both surgical hand scrubbing and surgical hand rub in the prevention of surgical site infection. Studies show that surgical hand rub is more efficient than surgical scrub in the prevention of surgical site infection though many countries have not implemented the use of surgical hand rub. This is due to lack of enough literature on the same. Therefore, this study will help the hospitals choose the best method of hand hygiene by comparing the advantages and disadvantages of both surgical hand rub and surgical scrub. Chapter three METHODOLOGY Research Design The study design will be convenience sampling to compare the use of surgican hand rubbing and the traditional surgical hand scrubbing. Study Area The study will carried out in the hospital. It is a hospital owned by the Ministry of health Study Population  The study population will comprise of surgeon,assisstant surgeons and scrub nurses working at the hospital. Inclusion and Exclusion Criteria  Inclusion Criteria Any surgeon and scrub nurse who gives an informed consent to participate in the research. Those who will be present at the time of reasearch that is Surgeons and scrub nurses doing case during this period of time. Those participating must have previous experience with conventional surgical scrub protocol in the operating theatre .Surgeons and scrub nurses involving in general surgery Exclusion Criteria Health personnel who are not working in theatre and those who are not willing to participate in the research.Dirty surgical cases (e.g. Haemorrhoidectomy, fistula, abscess cases).Surgeons and scrub nurses who did not complete providing samples for culture prior or after the operation. Surgeons and scrub nurses with missing baseline data. Sampling Technique and Sample Size Sampling Technique The respondents (sample size) at the hospital will selected using conveneient method of sampling. Sample Size The respondents qualifying for the study were selected using systematic random sampling technique. The sample size was determined by the sample size standard formulae: N    =        (Fischer et al, 1998)  Data collection procedures        Instruments  A researcher administered questionnaire will be utilized to collect data. There will be also pencils to be used to fill the questionnaires. The questionnaire will be given to every identified respondent in the hospital after an informed consent has already been obtained Validity  The questionnaire will be developed in English and will be pre-tested following which the post pre-tested questionnaire will be reviewed and validated to ascertain the suitability of the tool used. Study Limitations The financial constraints due to typing, printing and travelling and time unavailability will be the major limitations in study which will need proper adjustments to ensure a successful study. Pre-Testing The questionnaires will be  pre-tested in a different hospital. This will test the efficiency and effectiveness to collect the required data so as to meet the set objectives. Adjustments will be then done to ensure validity and reliability of the data collected in using the questionnaire in the actual study. Data Collection Process This will include administration of questionnaires. The researcher-administered questionnaires will be appropriate to ensure that the nurses and doctors can express their opinion by filling the questionnaires. The researcher will explain to the health staffs the procedure for an informed consent. After completion, the researcher will thank the health personnel for the cooperation and support. Management and Analysis Data categorization and coding will carried out during preparation of questionnaires. Each day data that will be collected will be entered, coded and keyed into variables using PASW Statistics version 18 software, Fisher’s exact test and Chi-square test Ethical Considerations  A letter of introduction will be obtained by the researcher from the department.   Consent from the hospital manager who will be obtained after explaining the intentions of my research. Informed consent will be obtained from the nurses and doctors by explaining to them the purpose of the study and allowing them to sign a consent form from informed point of view. Confidentiality and respect will be maintained throughout the research process. Conclusion Across the world, many hospitals have not decided on whether to use surgical hand scrub or surgical hand rub as a method of hand asepsis. This is due to lack of literature that compares the efficacy of the two methods. The above study will therefore compare the efficacy, effectiveness and preference of the two hand aseptic techniques. This will enable various hospitals across the world to choose the best method of hand hygiene by comparing the advantages and disadvantages of the two methods. Work cited Parienti, Jean Jacques et al. Hand-Rubbing with an Aqueous Alcoholic Solution vs Traditional Surgical Hand-Scrubbing and 30-Day Surgical Site Infection Rates: A Randomized Equivalence Study. Vol. 288. N. p., 2002. World Health Organization.WHO Guidelines on Hand Hygiene in Health Care. World Health Organization, (2009). Appendix Budget for the study ITEM QUANTITY PRICE (KSH). TOTAL Fare 5 trips Printing Proposal Final research 710 pages Study tool Binding 2 copies (proposal and research findings) Lunch and miscellaneous Total Work plan January February March April May June July August September Selection of research topic. Writingof research proposal Data collection Data analysis Finalising report Read More