NRS 493 Handwashing to Prevent Infection

In their studies, Phan, et al., (2018) surmised hand hygiene was effective in decreasing the rate of infection transmission, with emphasis on the inclusion of hygiene educational programs for patients, as well as professionals. This was supported by Thoa, et al., (2018), who found these programs were not only educationally beneficial, but cost-effective in terms of fewer resources being used for avoidable infections and admissions to the hospital, as well as resources used within the home healthcare setting. They discovered, however, that adherence to hand hygiene was roughly 45.60%, suggesting perhaps personnel were not adhering to this hygiene, or were not teaching it appropriately to patients.

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Hammerschmidt and Manser (2019) found nursing leaders to have an adequate understanding of hand hygiene, though those working lower on the nursing hierarchy were never reprimanded for not following procedure. Rather this was an issue to be acknowledged and handled by nursing managers. More closely related to the purpose of the study, McDonald, et al., (2020) studied hand hygiene practices specifically within a home setting; over the course of 400 home-care setting visits it was eventually asserted hand hygiene practices were not near the standard necessary to achieve optimal reduction in avoidably transmitted infections.

With a plethora of research mounting regarding the importance of hand hygiene, the encompassing background of this issue turns in a question of why it was not handled sooner, and why it is still an issue particularly in home healthcare settings. Granted there are many elements of healthcare that go into a patient’s treatment and care in any setting, however hand hygiene is becoming more imperative to health, especially with the recent global pandemic.

Literature for the background and review was obtained electronically via online search engines, such as GoogleScholar and Ebscohost. A few keywords used to search for material included, hand hygiene, avoidable transmission, patient awareness, patient education, nursing, home healthcare and reduction, among others. The literature was then evaluated based on its relevance to the study. Certain criteria needed to be met, including studies conducted on hand hygiene, with emphasis of conduction within a home healthcare setting. Information included on current and newly implemented hand hygiene programs were also included, as were studies with any results better explaining the connection between hand hygiene, reduction in transmittable illnesses, and adherence rates for personnel, as well as patients.

Problem Statement

Hand hygiene and whether patients understand its potential to stop the transmission of infection is becoming an issue that is potentially leading to a plethora of avoidable health problems and even hospitalizations.

Purpose

The purpose of the study is to assert whether the implementation of new hand-washing techniques and schedules is effective against what is perceived to be avoidable infection transmission within the home healthcare setting. It seeks to provide results salient with the hypothesis, suggesting such an implementation will indeed experience an increase in health and a decrease in infection transmission within a 30-day period.

Picot Question

In home health care settings (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)?

Utilized Nursing Theory

The process utilized Dorothea Orem’s Theory of Self-Care wherein patients are provided the time, care, education, and tool necessary to become a greater part of their own care and treatment. As an evidence-based practice, it ensures a reduction in the number of avoidably transmittable diseases and infections exponentially and must be an action taken on by the patient at any point in time hand hygiene is found necessary. This evidence-based practice, according to Kramer (2020) is prime for integration into current care practices. Orem’s theory also allows for Damilare’s (2020) assertion that implementing an evidence-based practice can incorporate preferences from the patient, as well as evidence and clinical expertise to ensure optimum results.

Orem’s theory also addresses the relationship between the patient and the practitioner. It requires a level of trust and bonding that shows the patient they can rely on the professional, ensuring all manner of evidence-based practice taught to the patient be taken seriously and practiced regularly. Within the context of a patient-nurse relationship promoting any evidence-based practice, best results are also had when the nurse is able to relate certain tasks to the patient in a way that makes them easy to understand. For example, certain patients may not feel hand hygiene is a necessary part of their care and may not even believe it helps reduce avoidably transmitted illnesses and infections. They may not understand the seriousness of not allowing these infections to transmit. The nurse can use the context of this theory to build a relationship with the patient, asserting they will listen and abide by the procedure provided.

Implementation

Implementation of the proposal requests a certain educational program or form of guidance be supplied to patients in home healthcare settings regarding hand hygiene. Professionals should be aware of appropriate practices, and the steps should be made easily understandable for all patients. Breaking it down into steps allow for most patients to maintain the regimen, eventually remembering what it is on their own. Home healthcare settings can host a variety of illnesses and injuries, but it should be assumed the patient will need help remembering the process, meaning written literature should be provided, and possibly even displayed in the bathroom. Outcome measures regard the rate of avoidable infection transmission following a 30-day observation period.

Discussion

Evidence-based practice was the foundation for development of this implementation for a few reasons. To begin, it is proven hand hygiene decreases the transmission of infection. This has been observed in all medical settings, in home or on sight. Moreover, previous studies indicate in many instances patients are unaware of satisfactory hand hygiene protocol; even some professionals are unaware. Thus, evidence-based practice would suggest hand hygiene can reduce transmittable illnesses, and that more education is necessary to ensure this occurs.

Evaluation

The program will be evaluated based the presence of transmittable infections. If the rate of infection does not decrease, the study will be considered a failure. If it reduces noticeably, it may be considered a success. If there is marginal difference there may be more research to perform, and even further studies to fully address the issue.

Limitation

Limitations may include unwilling patients. They may not believe professionals or may be obstinate for other reasons. Patients will need to cooperate for the study to be successful. Education programs may not be suitable for every patient. There may need to be different educational approaches throughout future studies depending on patient responsiveness. Professionals may also not take education seriously, believing they are a professional and know what they are doing. As such, they will pass incorrect information to the patient, skewing the results of the study.

References

Damilare, O. K. (2020). Hand Washing: An Essential Infection Control Practice. International Journal of Caring Sciences, 13(1), 776-780. https://www.proquest.com/openview/78771fa7811ef4975f0201859f4110b3/1?pq-origsite=gscholar&cbl=1606338

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.

Kramer, A. (2020). Requirements for hygienically safe, environmentally friendly dispensers for hand disinfectants and hand washing preparations. GMS Hygiene and Infection Control, 15. https://dx.doi.org/10.3205%2Fdgkh000337

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 Handwashing to Prevent Infection