Nursing Student and Infection Prevention - Essay Example

NURSING AND INFECTION PREVENTION By Nursing and Infection Prevention Abstract Healthcare operatives’ hands are the most often mode for the transfer of healthcare-related risks from patient to patient in most healthcare settings. From such findings, the prevention and control of health care related infections (HCAIs) has constantly been an essential measure of nursing practice. The evolution of pathogens and the increase of hand wash decontaminants have made it hard for medical practitioners to choose their preferred decontaminates. These choices have to take into consideration the flaws of each hand washing substance hence making the decision even harder. The reason for using an evidence-based quality is that it has led to improvement and healthcare transformation from the 1960s. It also underlines the need for restructuring care that is operative, safe, and effective. The set experiment was placed to understand the decision-making patterns of these operatives by using an EBM scheme. The experiment was done on nursing students to highlight borrowed knowledge on infection prevention and control. Though the experiments looks similar to the experiment done by Chief Nursing Officer for Research at Belton Hospital Lee, further studies on weaknesses of decontaminants was done Additionally, a preferred substance was also put to account. Student nurses and registered nurses (RN’s) were recorded articulating their hand hygiene decision-making as they worked through different clinical scenarios on a computer simulation. This study would allow observers to comprehend what factors the students were taking into consideration in choosing a decontamination technique ranging from hand washing, using alcohol fashioned hand rub and gel, as well as using both substances apart from wearing gloves. The results demonstrated an overuse of gloves, and underuse of gel, which was attributed to the fact that the students saw other seasoned operatives doing so or had an opinion on how clean the substances would make them feel. For instance, some students suggested that ‘gel does not feel clean,’ even though it is actually more effective. Further investigation showed that there was little sign that contributors were making risk assessments decisions grounded on the individual patient, or the tasks that were realized when a swab test was done to each of their hands. Choice of hand decontamination substances and whether to use gloves seemed to be grounded on a habitual description based on if the task was ‘clean’ or ‘dirty’. Keywords: Hand Hygiene, Alcohol-fashioned hand rub, Antimicrobial soap, Antiseptic agent, Antiseptic hand wash, Antiseptic hand rub, gels, clinical gloves. Nursing Student and Infection Prevention Qualitative research might appear unscientific and anecdotal to several medical scientists. Conversely, as the criticisers of evidence-based medicine are swift to point out, medicine itself is more than the application of scientific rules. Clinical practices, based on personal observation, reflection, and judgment, is needed to interpret scientific results into treatment of individual patients. In every step of performing a qualitative research, it is vital to asses’ different questions that are presentable to the topic. For instance, in this paper, questions such as what hand hygiene? What are the consequences of poor hand hygiene in the nursing field? What problems are RNs and student nurses faced with I making a proper hand cleaning agents? What kind of hand cleaning agents are presently used in the nursing field and more are all featured. The main purpose of this is to comprehend the phenomenon of infection prevention through hand washing and a further case study is also featured for the practicality of the study. In an attempt to widen the scope of evidence based medicine, recent workshops have included units on other subjects for instance earlier medical research studies as that of The University of Geneva study on ‘Determinants of Good Adherence to Hand Hygiene Among Healthcare Workers’. The evidence based practice and article have revealed that healthcare operatives’ hands are the most often modes of transferring healthcare-related risks from patient to patient and in the healthcare environment. From such findings, the prevention and control of health care related infections (HCAIs) has continually been an essential measure of nursing training. During the previous decade, apprehensions about the escalation in HCAIs have led to more weight on infection deterrence and control. The grand strategies for preventing HCAIs offer the most logical and comprehensive advice, grounded on up-to date proof to prevent the increase of HCAIs in acute medical care environments (Dougherty & Lister, 2015, p. 13). The reasons to enforce such guidelines are vitally placed to safeguard hands from impurities with organic substance and microorganisms. This fact reduces the possibility of cross-transmission of microorganisms to healthcare operatives and patients (Dougherty & Lister, 2015, p. 17).  In 2008, the National Patient Safety Agency responsible for several safety practices in England and Wales placed more emphasis on its ‘clean hands save lives’ campaign that was initially established in 2004. The Department of Health consequently printed a set of requirements on hand hygiene conduct to guarantee that health and community care workers conform to the Care Quality Commission’s laws requests for cleanliness and contamination control (Caballero, 2012, p. 67). On the other hand, in reaction to global fears associated with HCAIs, WHO (the World Health Organization) also fashioned procedures that would improve hand hygiene in healthcare facilities (WHO, 2009, p. 115). For generations, hand washing using soap and water has been regarded as a degree of personal hygiene. Perhaps, the idea of decontaminating hands using an antiseptic agent instead of using water and soap began in the 19th century. Evidentially in 1822, a French pharmacist established that solutions comprising of chlorides of lime or soda possibly would get rid of the vulgar odours allied with human corpses and that such solutions might be used as disinfectants and antiseptics. Three years later, in 1825, an article published by this pharmacist detailed that health workers attending to patients with infectious diseases would avoid contamination by moisturizing their hands with a chloride solution. However, his contribution was not taken seriously and consequently in 1846, Ignaz Semmelweis detected those women whose newborns were delivered by medical scholars, and doctors in the First Obstetrics Clinic at the General Hospital of Vienna constantly had a greater mortality rate than those whose were delivered by midwives in the Second Clinic. As he went through more on the study why these babies were perishing, he found that the healthcare workers had a displeasing odor on their hands notwithstanding washing their hands with soap and water. As of 1847, he asserted that medical scholars and doctors clean their hands with a chlorine solution before and after attending to every patient in the clinic. The maternal death rate in the First Clinic consequently dropped intensely and continued to lower years to come. This involvement by Semmelweis characterizes the first suggestion indicating that cleansing heavily soiled hands with a disinfectant agent before and after patient contacts can decrease health-care related transmission of transmissible diseases more efficiently than hand washing with only soap and water. Nonetheless, numerous decades have passed and the number of hand washing disinfectants has changed from that used in 1847. This has caused a lot of confusion mostly on the perspective of what type of hand wash to use. For seasoned physicians a preferred hand wash material is usually made in terms of experience in the medical field, on the other hand this is on the same for students who are in medical school and are preparing to join the medical world. Hand Hygiene In the research process of writing this paper, it seemed vital to answer a few questions such as what is hand hygiene, and what cleaning agents have been brought into the nursing field over the past century. These questions are relevant in the sense that one can relate to the problem statement in deterring a measure of clean hands and what has changed in regards to the options presented to medical practitioners. For a long time, hand hygiene has been related to personal hygiene of washing ones hand before cooking, or handling hygienically sensitive material or after visiting the toilet. In medical terminologies, it refers to a universal term that used to mean hand washing, antiseptic hand wash, surgical hand antisepsis, or antiseptic hand rub in between attending to a patient (Joint Commission Resources, Inc. 2008, p. 5). Student nurses have always been advised to adhere to proper hand hygiene while working through clinical scenarios. However, this might have been easy for them in 1847 when this was achieved by washing hands with solutions comprising chlorides of lime or soda. Currently hand decontamination can be done by using of Alcohol-fashioned hand rub, Antimicrobial soap, Antiseptic agent, Antiseptic hand wash, Antiseptic hand rub, gels, and the use of clinical gloves. Alcohol-Based Hand Rubs An alcohol-containing solution intended for application to the hands for decreasing the number of feasible microorganisms on the hands. In most cases, such Alcohol-fashioned solutions frequently contain a consecration of about 60% to 95% of either ethanol or isopropanol (Rhinehart, Friedman, & Rhinehart, 2006, p. 9). Antimicrobial Soap These soaps are also regarded as detergents since they are composites that have a pathogen cleaning action. They are made up of both hydrophilic and lipophilic properties and can be separated into four groups, which are non-ionic, cationic, amphoteric, and anionic detergents (Bennett, Jarvis & Brachman, 2007, p.5). Even though these products employed for hand washing or antiseptic hand wash in health-care sceneries characterize numerous sorts of detergents, the word “soap” is used to denote to such detergents in this parameter (Bennett, Jarvis, & Brachman, 2007, p.5). Antiseptic Agent These antimicrobial substances applied to the skin to decrease risk of infection from microbial flora. For example chloroxylenol (PCMX), alcohol, triclosan, chlorine, hexachlorophene, iodine, quaternary ammonium compounds, and chlorhexidine (Behrens-Baumann, & Kramer, 2002, p.12). Antiseptic Hand Wash Washing hands with water and soap or other detergents containing an antiseptic agent with antiseptic-containing solutions designed for frequent use (Block, 2000, p.5). These substances reduce the risk of infection from microorganisms on unbroken skin to an opening baseline level after satisfactory washing, rinsing, and drying. The substance is best used since it has broad spectrum, of fast-acting, character that is beneficial to attending to numerous amounts of patients at a short time (Block, 2000, p. 5). Waterless Antiseptic Agent or Gel These antiseptic agents do not dictate the use of water to clean ones hands. After smearing this agent, the hands are brushed together until the agent dries (Lippincott, Wilkins, & Ovid Technologies, Inc., 2004, p. 9). Surgical Hand Scrub These are antiseptic-containing solutions that considerably reduce the risk of infection from microorganisms when attending to patients who need surgical procedures (Altman et al., 2010, p. 10). Hand Washing Current guidelines state that an alcohol-based hand rub and gel should be used for hand hygiene unless hands are evidently soiled, or in the presence of patients with diarrhoea that may be due to clostridium difficile or Norovirus (WHO 2009; HPS, 2013, p. 34). Hand hygiene should be performed according to the World Health Organization’s ‘5 moments for Hand Hygiene’ before touching a patient, before clean/aseptic procedures, after body fluid exposure risk, after touching a patient, after touching a patient’s immediate surroundings (Sax et al., 2007, p. 45). Decision-Making The use of these hand decontaminations by student nurses makes it hard for them to know which is best to use at a particular scenario. Despite the numerous choices of hand washing substances, student nurses have failed to adopt well with some of them. The adoption of alcohol-fashioned hand rubs is considered the acceptable regulation for hand hygiene in most medical training centers. However, disquiet has been brought forward about their lack of effectiveness against spore-forming risks. Without a doubt, certain forms of iodophors, notwithstanding at a concentration oddly higher than the one contained in antiseptics, no hand hygiene agent containing alcohols, triclosan, hexachlorophene, chloroxylenol, and chlorhexidine is reliably sporicidal against Clostridium or Bacillus. Mechanical friction when washing hands with soap and water might help physically eliminate spores from the surface of unclean hands. As for gels they can only be used when hands are not visibly soiled, furthermore they are not supposed to be used prior to handling medical gas cylinders because of the risk of ignition. effective against Clostridium difficile and Norovirus. When caring for a patient with either of these organisms, hands must be washed with soap and water. Due to these reasons student nurses have been known to prefer the use of medical gloves, however, research has shown that the use of gloves does not replace the need for hand hygiene by either hand rubbing or hand washing. It is common knowledge in nursing school to inform scholars that Gloves can have pores that may allow microorganisms to pass through and hands should be cleaned before and after wearing gloves. With all the known flaws to the available hand hygiene measures available today the key factor on why there exists a lack of compliance with hand decontamination is proposed to be the complexity of the decision-making process required (Whitby et  al., 2007, p. 12). Qualitative research particularly highlights and addresses research questions that are dissimilar from those deliberated by clinical epidemiology. Qualitative research can investigate practitioners’ attitudes, opinions, and partialities, and the whole question of how evidence is fashioned into practice. The value of qualitative methods lies in their capability to pursue methodically the kinds of research questions that are not easily answerable by experimental methods. For this paper the research questions placed were: 1. With the changes in hand cleaning agents over the years, which ones are most preferred? and why? 2. What is the difference in decision-making policies between students and RNs? 3. What clinical scenarios affect the normal decision making policies in medical practitioners? In addition, do they correlate with NHS set hand-cleaning regulations? Hypothesis Over the past years, nurses have been a section of a drive that reflects possibly more modification in nursing education than any observed from the turn of the century. Guidelines in nursing schooling in the 1960s recognized nursing as an practical science. This was the admission of the practices profession as adopted in the age of knowledge. In the mid-1990s, it became evident that producing new information was not sufficient in the practice in order to alter better patient consequences, new information provided had and still has be fashioned into clinically beneficial forms, efficiently applied across the entire care environment within a scheme context, and valued in terms of telling impact on health care outcomes. Case Study The preferred experiment was that similar to of Dr. Lee, K in it was also done using done by use computer simulation. Just as earlier stated by the Chief Nursing Officer for Research at Belton Hospital using survey, interview, and observational approaches in hand hygiene investigation possibly would result in prejudiced results (Pittet, 2004, p. 9-14). Self-report were also out of question since they could be corrupt by an individual’s mood or stress level, and could be miss leading of an individual just memorized the procedure to pass the test set by the experiment and not practical in their working areas as suggested by Jenner et al (2006, p.75-110). Lee et al (2008, p. 12-17) also observed that in a teaching hospital experiential significant difficulties with compliance were high, as distinct by nonconformity from actions compulsory by local rule. These reasons form earlier experiments of a similar nature and articles on the subject matter a computer simulation holding various scenarios. All scenarios were practical in any health care facility for instance Emptying and clean commode or catheter bag, when striping a bed, when assisting a patient to sit or lie in a bed, when assisting a patient to clean up for instance washing their hands and face, when attending to dressing a wound or attending to a dental case. Aim of the Experiment The aim of this experiment was to document participants articulating their hand hygiene decision-making as they worked through different clinical scenarios on a computer simulator, to comprehend what factors they were taking into consideration in selecting a hand decontamination method and to wear gloves Strength of Study The population in this article was well described as they took a random sample of ten nursing students and ten registered nurses (RN’s) to see if teaching had impacted students enough to be aware of certain airborne and contact pathogens. For a qualitative study, this sample size is adequate enough with fifteen subjects. It also eliminates any biases with the subject selection when they randomized the selection of each person. There was no intervention during this research but there was a control. The control group of this study was the RN’s comparison with nursing student’s techniques to see the effectiveness of each hand-washing agent. Swabs were taken from each group’s palms and fingers after each hand washing exercise to determine if they eliminated any possible trace of infection. Data Collection A volunteer sample of participants was obtained, seven of whom were pre-registration nursing students and the rest were RN’s. The nursing students had already been tested on ‘Standard Infection Control Precautions’ during their first year studies as stipulated in the nursing curriculum and were on second placements. The RNs had vast experience in the field and had more knowledge on the matter at hand. Their purpose was to form a control group to Of all the participants who took part in the experiment, three students were aged below 25, but the others were older (Ker & Bradley, 2010, p. 32). The RNs’ age varied between 26 years and 45 years. Similar to Lees’ experiment, an online representation of a patient bay was adopted using the philosophies of psychological reliability and legitimacy to present scenario-based responsibilities or challenges within a fitting context (Hung & Chen 2003, p.7-13). Data Results and Analysis The experiment used a thematic analysis where recordings from participants were transcribed precisely and constantly worked through a comparative analysis (Barbour, 2008, p. 13). The information attained was categorized and interrogated to detect similarities, alterations, and patterns that were evident in past experiments and published articles. An independent researcher was then given the data in order to check the establishment of accounts into themes and all student and RNs statements relating to hand decontamination and glove use. Figure 1: Number of students choosing each option for the 10 tasks BEFORE Empty and clean commode Empty catheter bag Strip soiled bed Strip non-soiled bed Assisted hands + face wash Help up to sit Remove dirty dressing Before sterile dressing After sterile dressing Mouth care using sponges Apron+gloves 15 15 15 10 11 0 15 15 5 13 Apron 0 0 0 0 1 1 0 0 3 0 Gloves 0 0 0 5 4 0 0 0 7 2 None 0 0 0 0 0 14 0 0 0 0 AFTER Empty and clean commode Empty catheter bag Strip soiled bed Strip non-soiled bed Assisted hands + face wash Help up to sit Remove dirty dressing Before sterile dressing After sterile dressing Mouth care using sponges soap and water 12 13 5 1 1 0 13 0 10 13 Gel (alcohol-based hand rub) 1 0 0 14 14 13 0 15 0 1 soap or gel 2 2 10 0 0 0 2 0 5 1 None 0 0 0 0 0 2 0 0 0 0 The experiment showed that scholars gave the reason that this was what they had seen or been taught on placement. It appeared to have become a routine practice or a ‘habit’ rather than being a conscious decision based on risk assessment. In one case, this seemed to have occurred in the very first placement. Wards where there had been many wounds or ‘infected’ patients appear to have been influential. One student suggested they would be ‘in trouble’ if they did not conform. The highest percentage from all the selected students was in favour of using antiseptic soap and water as well as surgery scrub before and after attending to patients with open wounds. Another larger group preferred soap and water to the use of both soap and gel. They would wash using gel before attending to a patient but use soap after attending to them. Lastly, there were students who preferred using gel before and after attending to patients. Further interviews showed that the students knew the flaws of each decontaminating substance and used gloves despite cleaning with either soap and water or gel. However, when asked on each of their preference, students using soap and water highlighted that even after using gloves, they saw the necessity to clean their hands thoroughly to avoid any infection. On the other hand, students using gel suggested that the soiled gloves were enough to keep large pieces of unwanted material out and gel due to its antiseptic nature of dealing with any micro-pathogens. The study showed that no students made a decision on whether to clean their hands before attending to a patient or a medical procedure based on infection percentages. For instance, when attending to a situation that involved an open wound, they would thoroughly clean beforehand, but this would not be so when helping a patient to sit. This culture would be repeated when washing hands after dressing an open wound, as they would clean more. On the other hand, most of them would use gel after the case of helping a patient to sit, but some of them would not clean at all after cleaning. Discussion The study showed that the students washed their hands before or after attending to patients due to medical requirements. The RNs knew when to use what substance in between working with patients though they also washed according to the medical case presented to them. However, they made their decisions more causally using gel than the students do. They were more attentive to minor medical conditions such as helping a patient to sit. In conclusion, Personal experience is often characterised as being anecdotal, ungeneralisable, and a poor basis for making scientific decisions. However, it is often a more powerful persuader than scientific publication in changing clinical practice. Due to this fact using evidence based practice in determining what makes medical practitioners use dissimilar hand cleaning agents presented a good opportunity to show how EBP are favourable I the practical field of nursing. 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