Infection Prevention in Hospitals: The Importance of Hand Washing Among Surgical Nurses Presentation

Introduction

  • Hospital-acquired infections (HAIs) are contracted in scientific settings.
  • Associated with vital morbidity and mortality.
  • Hand washing (HW) – precautionary apply for HAI prevention.
  • HW could contain cleaning soap & water or alcohol-based hand-rubs.
  • Thesis: HW data & compliance is crucial for improved outcomes.

Hospital-acquired infections (HAIs) are sickness contracted within the hospital surroundings. They are related to vital morbidity and mortality. One precautionary measure that may forestall HAIs is hand washing (HW) earlier than and after every affected person contact. Adherence to HW pointers is required to cut back HAI charges.

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The Problem and Its Significance

  • Scope & Importance:
    • HAIs are infections acquired in scientific settings.
    • Leading trigger: pathogen transmission throughout contact/care (Magill et al., 2014).
      • Procedure-related or device-related.
    • HAIs account for prime morbidity, mortality, & prices.
      • UTIs, surgical-site infections, pneumonia, and so forth.
    • In 2011, 722,000 HAIs reported & 75,000 fatalities (Magill et al., 2014).
    • US HAI prevalence is 3.5-9.9% (Park et al., 2014).
    • Costs come up from prolonged LOS & readmission charges.
    • HAI fee discount – an vital high quality indicator.
  • Potential Application to Clinical/Educational Practice:
    • HAI prevention requires transmission-based precautions.
    • Hand washing (HW): Simple precautionary measure for stopping HAIs.
    • Adherence to really helpful HW practices – decrease HAIs (Ellingson et al., 2014).
      • Soap and water.
      • Alcohol-based hand-rubs.
    • Noncompliance excessive amongst clinicians (>50%) (Ellingston et al., 2014).
    • HAIs in surgical wards: wound infections.
      • Increase LOS & healthcare prices; trigger discomfort.
    • Surgical-wound infections are ~1/4 of all HAIs (Magill et al., 2014).
    • HW compliance might doubtlessly scale back hospital HAI charges.
  • Conceptual Definitions of Key Variables:
    • Hand washing: a disinfection apply to cut back HAI danger.
    • Hospital-acquired infections: inpatient pathological states acquired in hospitals.
    • Inpatient: an unwell individual receiving institutional care.
    • Surgical-site infections: sepsis in post-operative wounds.
    • Pathogen: An infectious agent, e.g., micro organism.
  • Theoretical Rationale:
    • Theoretical framework utilized: deliberate habits principle (PBT).
    • PBT: a decision-making framework
      • Social habits relies on perceptions.
      • Perceptions modulated by “attitudes & beliefs about control” (Javadi, Kadkhodaee, Yaghoubi, Maroufi, & Shams, 2013, p. 53).
    • Subjective attitudes or norms drive habits.
    • Normative beliefs are anticipated group/particular person objectives.
    • Perceived management relies on norms & beliefs.
    • Nurses’ management & beliefs affect HW apply intentions.
    • Goal: enhance post-surgical HAI outcomes.

Hospital-acquired infections (HAIs) are affected person pathological states, e.g., urinary tract infections (UTIs) and pneumonia, which originate from inside hospital settings. According to Al-Tawfiq, Abed, Al-Yami, and Birrer (2013), pathogen transmission throughout nurse-patient contact – process or machine insertion or elimination – is implicated in HAIs which can be related to excessive morbidity, mortality, and healthcare prices because of an prolonged size of keep (LOS) and excessive readmissions. In 2011, 722,000 HAIs had been reported with 75,000 of them leading to deaths (Magill et al., 2014). Currently, HAI prevalence within the US is estimated to be 3.5-9.9% (Park et al., 2014). Therefore, HAI fee discount is a crucial high quality indicator for hospitals.

HAIs might be prevented via transmission-based precautions. One such security measure is hand washing (HW). Adherence to HW practices – cleaning soap and water or alcohol-based hand-rubs – is related to decrease HAI charges. Noncompliance by clinicians, which is as excessive as 50%, will increase the HAI danger (Ellingston et al., 2014). Common HAIs in surgical wards are wound infections that account for one-quarter of all HAIs.

Hand washing is antiseptic apply meant to decrease the chance of HAI. Hospital-acquired infections are pathological states absent within the affected person on the time of admission, which means that they had been acquired throughout the hospital surroundings. An inpatient is an unwell individual admitted for a specific situation. Surgical-site an infection refers to sepsis in post-operative wounds. A pathogen is an infectious agent, akin to a bacterium or fungi.

The theoretical mannequin utilized on this examine is the deliberate habits principle (PBT), a decision-making framework. PBT holds that social habits relies on perceptions modulated by “attitudes and beliefs about behavioral control” (Javadi et al., 2013, p. 53). The subjective norms drive habits, whereas normative beliefs form group or particular person objectives. Perceived management influences the intention to show a specific habits, e.g., hand hygiene.

Research Objectives

  • Compare pre- & post-intervention HW abilities of nurses.
  • Assess coaching impression on HAI charges.

Research Questions:

  • How do pre- & post-intervention HW abilities of nurses evaluate?
    • P = workers nurses within the surgical ward;
    • I= academic intervention;
    • C= pre-intervention HW abilities;
    • O= improved HW abilities;
    • T= 4 weeks.
  • What is the impression of coaching on HAI charges?
    • P = workers nurses within the surgical ward;
    • I= academic intervention;
    • C= pre-intervention HAI charges;
    • O= decline in HAI charges;
    • T= 4 weeks.

Research Hypothesis:

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  • H1: the post-intervention HW abilities of nurses > pre-intervention scores.
  • H2: HAI charges will decline after the coaching/intervention.

Rationale:

  • Inappropriate hand hygiene practices enhance the HAI danger.
  • Therefore, multimodal HW packages can enhance HAI indicators.
    • Staff coaching, affected person training, & compliance monitoring (Ellingson et al., 2014).
  • Previous research used observations – time-consuming & restricted exterior validity.
  • The proposed quantitative examine – greater generalizability to:
    • Hospitals’ HW practices;
    • Nursing curriculum – emphasis on HW as EBP.
  • PBT principle improvement: training influences nurses’ security intentions.
  • Awareness of HW as EBP in HAI fee discount.

The proposed examine seeks to match HW abilities and HAI charges earlier than and after an academic intervention for workers nurses working in a surgical unit. Its goals are two. The first one is to match pre-intervention and post-intervention hand washing abilities of surgical workers nurses. The second one is to evaluate the impression of hand hygiene coaching of RNs on surgical-site an infection charges.

The proposed examine will search to reply two analysis questions developed from the goals. They embrace; amongst surgical nurses (inhabitants), how do pre- (comparability) and post-intervention (intervention) hand washing abilities (end result) evaluate after 4 weeks (time)? And, in nursing workers (P), how does coaching readily available hygiene (I) in comparison with no training (C) impression hospital-acquired an infection charges (O) after a 4-week interval?

The examine will measure pre- and post-intervention HW abilities and HAI charges earlier than and after the coaching. Two scientific hypotheses are formulated primarily based on these variables. The first one (H1) is that the post-intervention hand washing abilities of nurses might be greater than the pre-intervention scores. The second speculation (H2) is that HAI charges will decline considerably on the hospital’s surgical ward after the 4-week coaching or academic intervention.

Inappropriate hand hygiene practices are related to elevated HAI danger. Multimodal HW packages, akin to workers coaching, affected person training, and compliance monitoring, are linked to decrease HAI charges (Ellingson et al., 2014). Previous research primarily used the commentary methodology, which is time-consuming and susceptible to researcher bias that limits its exterior validity. The rationale for utilizing a quantitative design within the proposed examine is to extend the generalizability of its outcomes to many hospitals and nursing faculties. The analysis may even contribute to the event of the deliberate habits principle (PBT), as it can present if academic intervention influences nurses’ security intentions. Additionally, the examine will result in larger consciousness of hand washing as a hospital intervention for decreasing HAI charges.

Methods

Research Design

  • A quasi-experimental design.
  • Comparison: pre- and post-intervention measures:
    • HW abilities of nurses;
    • HAI charges on the surgical ward.
  • Intervention: A four-week academic program designed for nurses.
  • Data assortment factors: earlier than & after the intervention.
  • To take a look at intervention efficacy & outcomes.

The examine will use a quasi-experimental design to match pre- and post-intervention scores on two measures: hand-washing abilities of nurses and hospital-acquired an infection fee on the surgical ward. The intervention might be a four-week academic program readily available hygiene designed for workers nurses. The goals are to check the efficacy of coaching and decide its impression on HAI charges.

Sampling Plan

  • Specific design: easy random sampling.
  • A pattern (N=25) drawn from surgical workers nurses.
  • Representative pattern – consideration for:
    • Age, gender, academic stage, & years of expertise.
  • Target inhabitants: workers nurses in a surgical ward:
    • US hospital’s database.
    • The nursing workforce: sampling body.
  • Inclusion Criteria:
    • RNs with a BSN or its equal;
    • Staff nurses offering direct affected person take care of >1 yr;
    • Accessible inhabitants – RNs accessible throughout information assortment;
    • RNs consenting to take part in HW coaching.
  • Exclusion Criteria:
    • RNS who’ve obtained HW coaching earlier than;
    • RNs not concerned in post-operative care.
  • Sample measurement:
    • 25 RNs at a surgical ward;
    • Average variety of nurses in a US hospital = 250 (assumed);
    • 10% of 250 = 25 topics (satisfactory statistical energy).

The examine will make use of easy random sampling design, whereby eligible workers nurses might be drawn randomly from the goal inhabitants. It will contain consideration of demographic traits, together with age, gender, academic stage, and years of expertise, to make sure a consultant pattern. The examine inhabitants would be the variety of nurses working on the chosen facility’s surgical ward at first of information assortment. The hospital’s database might be used to attract a sampling body. The topics will participate in a structured academic intervention readily available hygiene delivered via an internet platform.

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A researcher should outline the premise for together with or excluding a possible topic from a examine. The inclusion standards for this examine are registered nurses (RNs) possessing not less than a Bachelor of Science in Nursing (BSN) or equal {qualifications}, offering direct care to postsurgical sufferers for no less than one yr, accessible to the researcher in the course of the deliberate information assortment interval, and consenting to participate in a coaching program readily available washing. The exclusion standards are RNs who’ve undergone coaching on HW practices earlier than and people not concerned in caring for postoperative sufferers. The pattern measurement anticipated for this analysis might be about 25 workers nurses primarily based on the belief that 10% of the goal inhabitants within the hospital will give satisfactory statistical energy to determine an impact. Therefore, assuming the power has 250 RNs in its surgical wards, 10% of this quantity will give 25 topics.

Data Collection Methods

  • Facilities:
    • Online informational booklets & sources (web sites) – academic intervention.
    • Video clips on HW practices.
    • Running water, antiseptic cleaning soap, & alcohol hand-rubs – surgical ward.
  • Equipment:
    • Semi-structured questionnaire for information assortment – demographic information & HW scores.
    • HAI chart – to gather HAI episodes.
  • Procedures:
    • Passive recruitment strategy – via the nurse supervisor;
    • Signing of the knowledgeable consent type by the themes;
    • No management group; solely intervention group;
    • Pre-intervention hand washing abilities measured (questionnaire);
    • Baseline HAI fee on the ward recorded;
    • A 4-week coaching readily available washing – provided on-line;
    • Post-intervention HW abilities assessed (questionnaire);
    • Post-intervention HAI fee decided primarily based on chart information.
  • Ethical concerns:
    • An assurance of no hurt to topics.
    • Informed consent previous to participation.
    • Privacy and confidentiality concerns.
    • No exaggerations, coercion, or deception.
    • Honest & clear communication.

The services that might be used embrace on-line informational booklets and academic sources readily available washing packages which have been carried out in surgical environments. HW apply pointers, protocols, and video clips accessible in web sites may even be used within the coaching. Other services that might be required embrace operating water, antiseptic cleaning soap, and alcohol-based hand-rubs stationed on the surgical wards. Data assortment tools for this examine will embrace a semi-structured questionnaire to seize the themes’ demographic data and HW scores earlier than and after the intervention. Pre- and post-intervention HAI charges might be obtained utilizing an HAI incidents chart.

The examine will use a passive recruitment methodology. The nurse supervisor will assist recruit eligible RNs from the surgical ward to take part within the analysis. The topics will first signal an knowledgeable consent type earlier than being allowed to participate within the examine. Pre-intervention hand washing abilities and baseline HAI fee might be measured utilizing a questionnaire and a chart, respectively. Subjects will obtain a four-week on-line coaching. Post-intervention HW abilities and HAI fee might be obtained to find out intervention efficacy and outcomes.

The key moral concerns on this examine embrace making certain that topics are usually not uncovered to hurt all through the analysis course of and acquiring knowledgeable consent earlier than permitting them to take part. Additionally, their privateness and confidentiality of the data they may give might be ensured. The researcher will guarantee full disclosure of right details about the analysis and sincere and clear communication to the themes in the course of the examine. Responses to their questions or issues might be quick and satisfactory.

Operational Definitions of Key Variables

  • Hand washing coaching (IV) – academic intervention for nurses.
    • Improve HW data for higher wound care.
  • Hand hygiene data (DV) – topics’ HW abilities.
  • Surgical website infections (DV) – HAIs occurring <30 days post-operation.
  • Staff nurses – RNs offering care in surgical wards.

The unbiased variable (IV) is hand-washing coaching. It is operationalized on this examine as structured instruction or academic intervention for enhancing workers nurses’ data of hand washing practices for higher post-operative outcomes. The two dependent variables (DVs) are hand hygiene data and surgical website infections. The operational definition of the primary variable is the abilities gained from an academic program on HW practices. Surgical-site infections consult with hospital-acquired infections that happen inside a 30-day postoperative interval. In this examine, workers nurses consult with RNs offering care within the surgical ward during which the examine will happen. They represent an vital a part of a hospital’s HAI management workforce (Rock, Harris, Reich, Johnson, & Thom, 2013).

Instruments

  • Description:
    • HW questionnaire (HWQ) & HAI chart (HAIC);
    • HWQ: measurement of HW data;
    • HAIC: evaluation of HAI charges;
    • HWQ– demographic & HW data sections.
  • Number of Items:
    • HWQ: 5 objects readily available washing practices;
    • HAIC: three objects on HAI incidents.
  • Validity:
    • Content validity: skilled critiques of things for appropriateness;
    • Revision of low-score objects;
    • Face validity: grammar, readability, & relevance of things;
    • Pilot critiques by workers nurses.
  • Reliability:
    • Test-retest process (5 RNs) – 14 days aside;
    • Retest scores = take a look at scores: instrument dependable.
  • Scoring:
    • % scores in HWQ objects;
    • % HAI incidents – each device-related & procedure-related.

The examine will use two devices to gather quantitative information: an HW questionnaire (HWQ) and an HAI episode chart (HAIC). The HWQ might be used to measure hand-washing data of the themes earlier than and after an academic intervention, whereas the HAIC will assess the HAI charges on the surgical wards. The HWQ instrument could have two elements: demographic and HW data sections. The variety of objects on the HWQ and HAIC might be 5 and three, respectively.

Content validity of the HWQ might be enhanced via skilled critiques to find out the appropriateness of the objects to measure the supposed variables. Reviewers will fee the objects as both acceptable or inappropriate and provides solutions on easy methods to enhance them. The measures with low scores might be revised to replicate their feedback. Face validity might be achieved utilizing pilot critiques involving workers nurses who will assess the grammar, readability, and relevance of the objects. Instrument reliability might be ascertained via the test-retest process carried out 14 days aside on a pattern of 5 RNs. The scoring of HWQ objects and HAI incidents will contain percentages.

Data Analysis

  • Statistics
  • Descriptive statistics:
    • Frequency & dispersion of demographic traits;
    • Also, imply & variance of the themes’ HW data.
  • Inferential statistics:
    • T-test: comparability of pre- & post-intervention HW information & HAI fee;
    • Chi-square take a look at: correlations between post-intervention HW data & demographic traits.
  • Software:
    • Statistical Package for Social Scientists (SPSS).

The evaluation plan will contain sorting and coming into the info from the HW questionnaire and HAI chart into the Statistical Package for Social Scientists (SPSS) software program for descriptive and inferential evaluation. Thus, the process will proceed in two steps. In descriptive statistics, the frequency and dispersion of the demographic traits of the themes might be decided. This methodology may even give the imply and variance of HW data amongst workers nurses within the surgical ward. In inferential statistics, a t-test might be employed to match the pre- and post-intervention information on HW data of the themes. Additionally, chi-square exams might be utilized to determine a correlation between post-intervention HW data values and age, academic stage, or years of expertise.

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Methods of Safeguarding Human Subjects

  • Maintaining confidentiality:
    • Protection of the themes’ proper to privateness;
    • Unique identifiers/codes throughout recruitment – no precise identify or handle;
    • Web-based supply of coaching & questionnaire – to keep up anonymity.
  • Securing knowledgeable consent:
    • Participant data sheet: examine function, design, & advantages;
    • Consent type: every topic’s obligations, e.g., voluntary withdrawal.
  • Minimizing dangers:
    • Convenient entry to on-line coaching materials & sources;
    • No publicity to extra hurt than regular;
    • Nondisclosure of topics’ identities or addresses;
    • No financial incentive for participation.

Safeguarding of human topics will contain sustaining topic confidentiality utilizing distinctive identifiers as a substitute of names or addresses. The coaching and questionnaire administration may even be web-based to protect participant anonymity. Informed consent might be sought earlier than the examine. An data sheet will point out the examine’s function, design, and potential advantages. Risks to the themes might be minimized via handy entry to on-line coaching sources and nondisclosure of participant id or handle.

Summary/Concluding Statement

  • HAIs account for prime morbidity, mortality, & prices;
  • HW – A primary precautionary measure for stopping HAIs;
  • Objectives:
    • Compare nurses’ pre- & post-intervention HW data;
    • Assess coaching impression on surgical-infection charges.
  • Quasi-experimental design & pattern of 25 surgical nurses;
  • Intervention: A 4-week on-line training program;
  • Quantitative measures investigated:
    • HW data & surgical-site an infection fee.
  • Study implications:
    • Emphasis on HW practices by hospitals & academia;
    • Refresher programs to advertise compliance.

Hand washing (HW) is a basic to protected scientific apply. Adherence to HW pointers can scale back hospital-acquired infections (HAI) which can be related to excessive morbidity, mortality, and healthcare prices (Magill et al., 2014). The proposed examine will use a quasi-experimental design; 25 RNs will obtain a 4-week on-line academic intervention and their pre- and post-intervention data and HAI charges in contrast. The examine has implications for hospital security apply or coverage and nurse coaching packages.

References

Al-Tawfiq, J. A., Abed, M. S., Al-Yami, N., & Birrer, R. B. (2013). Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in vital discount in well being care-associated infections. American Journal of Infection Control, 41(6), 482-486. Web.

Ellingson, Ok., Haas, J. P., Aiello, A. E., Kusek, L., Maragakis, L. L., Olmsted, R. N., … Yokoe, D. S. (2014). Strategies to forestall healthcare-associated infections via hand hygiene. Infection Control and Hospital Epidemiology, 35(8), 937-960. Web.

Javadi, M., Kadkhodaee, M., Yaghoubi, M., Maroufi, M., & Shams, A. (2013). Applying principle of deliberate habits in predicting of affected person security behaviors of nurses. Materia Socio Medica, 25(1), 52-55. Web.

Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., … Fridkin, S. Ok. (2014). Multistate point-prevalence survey of well being care-associated infections. The New England Journal of Medicine, 370, 1198-1208. Web.

Park, H. Y., Kim, S. Ok., Lim, Y. J., Kwak, S. H., Hong, M. J., Mun, H. M., … Choi, S. H. (2014). Assessment of the appropriateness of hand floor protection for well being care staff in keeping with World Health Organization hand hygiene pointers. American Journal of Infection Control, 42(5), 559–561. Web.

Rock, C., Harris, A. D., Reich, N. G., Johnson, J. Ok., & Thom, Ok. A. (2013). Is hand hygiene earlier than placing on nonsterile gloves within the intensive care unit a waste of well being care employee time? A randomized managed trial. American Journal of Infection Control, 41(11), 994–996. Web.

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