NRS 493 EBP Project Discussion

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1. Based on how you will evaluate y

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2, Why?Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?

Literature Review

Angelica Garza

GCU

NRS 493

Amy Foss

July 18, 2021

NRS 493 EBP Project Discussion

Literature Review

Introduction

This chapter of the paper would present a literature review to investigate what the literature says about hand hygiene practices and its effect on the prevention of infection transmission and the reduction of infection spread. By reviewing the literature, this paper will try to gather evidence in support of the PICOT question.

In home health care setting (P) do hand hygiene practices (I) compared to no hand hygiene practices (C), prevent transmission of infection (O) reduce the spread of Infections within 30 Days since the Start of the Project (T)?

Literature Review

Phan et al (2018) hypothesized that an educational intervention is effective in improving hand hygiene compliance and would reduce healthcare acquired infections. Thoa et al (2015) aimed at evaluating the cost effectiveness of a hand hygiene program on infections of patients in intensive care unit setting. In comparison, McDonald et al (2020) aimed at exploring the hand hygiene practices in the home healthcare settings in their research paper. Phan et al’s study involved 206 health care workers of a Vietnamese hospital aged between 22 and 54 years from three departments, including NICU, delivery suite and surgical ward, while McDonald et al’s study participants involved 50 nurses conducting 400 home care visits. The sample of Thoa et al’s(2018) study included two intensive and fifteen critical care units in a big hospital based in Vietnam.

Phan et al (2018) came up with the finding that the hand hygiene educational program contributed to the enhancement of knowledge regarding hand hygiene practices among the healthcare workers. Thus, this study provided evidence that an educational program on hand hygiene practices improves hand hygiene knowledge and compliance. Thoa et al came up with the finding that the hand hygiene program contributed to the reduction of healthcare acquired infections in intensive care settings and had cost–effectiveness. McDonald et al (2020) observed that there were 2014 opportunities for hand hygiene practices with the most frequent opportunity being the implementation of hand hygiene norm as soon as arrival at a home. They observed the hand hygiene adherence rate to be 45.60%, and the highest number of times the hand hygiene practice was adhered to after establishing contact with body fluids.

The limitation of Phan et al’s (2020) study was that the researchers could not perform a systematic review of the knowledge increase of hand hygiene practices on hospital acquired infections, and therefore, the researchers could not confidently conclude that the educational program was ultimately effective in decreasing infections within the health care setting. The study also included the limitation of Hawthorne effect, which might have contributed to the increased hand hygiene compliance rates. The limitation of McDonald’s study included that this study had some sampling bias while recruiting the nurse volunteers and potential observer bias. Like Phan et al’s study, this study also involved the Hawthorne effect influencing nurse practice as they were being observed.

Hammmerschimdt and Manser (2019) aimed at exploring the perspectives of registered nurses and managers on the knowledge of hand hygiene. The sample population of the study included 165 registered nurses and 27 nurse managers from various nursing homes across Germany. The study came up with the finding that the majority of nursing managers are nurses had comprehensive knowledge of hand hygiene practices. Despite the availability of knowledge of hand hygiene practices, the accountability of staff compliance with hand hygiene norms fell on nursing managers who functioned as a role model for the staff. The limitation of this study was that this sample of nursing managers included was small and that could be a reason that the study results might not be used for generalization. Selection bias was also apparent in this study as nurses interested in preventing infection might have participated in this study.

Gould et al (2017) aimed at evaluating the short- and long-term effectiveness of various intervention programs to improve hand hygiene compliance and its effect on patient care. Unlike the previously mentioned studies, this study was a literature review of quantitative interventional studies. The researchers selected 26 research articles, including 14 randomized controlled studies, 2 non-randomized trials, and 10 interrupted time-series analyses. The researchers came up with a finding that multi-modal interventions consisting of some of the guidelines provided by the World Health Organization contributed to the improvement of hand hygiene compliance and slight reduction of infection rates. This study filled in the gap of Phan et al’s (2020) study by providing evidence in support of the reduced infection rates due to hand hygiene compliance. The limitation of this study was that this study was also not free from biases which might have contributed to the outcome of this study.

Conclusion and Recommendations

As highlighted by Hammmerschimdt and Manser (2019) that hand hygiene compliance depends a lot on the role modeling behavior of nursing managers, it is important that some of the nursing managers who failed to perform responsibly as role models experience educational intervention.

NRS 493 EBP Project Discussion

Reference

Gordon, C. J. (2018, March 7). An educational intervention to improve hand hygiene compliance in Vietnam. BMC infectious diseases. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840927/.

Hammerschmidt, J., & Manser, T. (2019, August 5). Nurses’ knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Services Research. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-019-4347-z.

McDonald, M. V., Brickner, C., Russell, D., Dowding, D., Larson, E. L., Trifilio, M., Bick, I. Y., Sridharan, S., Song, J., Adams, V., Woo, K., & Shang, J. (2021, May). Observation of Hand Hygiene Practices in Home Health Care. Journal of the American Medical Directors Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490582/.

Phan, H. T., Tran, H. T. T., Tran, H. T. M., Dinh, A. P. P., Ngo, H. T., Theorell-Haglow, J., &

Thi Anh Thu L;Thi Hong Thoa V;Thi Van Trang D;Phuc Tien N;Thuy Van D;Thi Kim Anh L;Wertheim HF;Truong Son N; (2015). Cost-effectiveness of a hand hygiene program on health care-associated infections in intensive care patients at a tertiary care hospital in Vietnam. American journal of infection control. https://pubmed.ncbi.nlm.nih.gov/26432185/.

NRS 493 EBP Project Discussion