Nurse Hand Hygiene To Prevent Cross Infection In Nursing Health Care

Nurse Hand Hygiene To Prevent Cross Infection In Nursing Health Care

NURSE HAND HYGIENE AND CROSS INFECTION

TOC o “1-3” h z u HYPERLINK l “_Toc361610533” Introduction PAGEREF _Toc361610533 h 3

HYPERLINK l “_Toc361610534” Background & Justification ` PAGEREF _Toc361610534 h 4

HYPERLINK l “_Toc361610535” Aims, Objectives and Purpose PAGEREF _Toc361610535 h 6

HYPERLINK l “_Toc361610536” Methodology PAGEREF _Toc361610536 h 8

HYPERLINK l “_Toc361610537” Study Population PAGEREF _Toc361610537 h 8

HYPERLINK l “_Toc361610538” Sampling and the sample size PAGEREF _Toc361610538 h 8

HYPERLINK l “_Toc361610539” Sampling Method and Rationale PAGEREF _Toc361610539 h 9

HYPERLINK l “_Toc361610540” Data Collection PAGEREF _Toc361610540 h 10

HYPERLINK l “_Toc361610541” Philosophical Basis for Research Design PAGEREF _Toc361610541 h 10

HYPERLINK l “_Toc361610542” Discussion PAGEREF _Toc361610542 h 13

HYPERLINK l “_Toc361610543” Transmission of Infections from HCPs PAGEREF _Toc361610543 h 13

HYPERLINK l “_Toc361610544” Demographic Determinants of Nurse Hand Hygiene PAGEREF _Toc361610544 h 13

HYPERLINK l “_Toc361610545” Planned Behavior Theory PAGEREF _Toc361610545 h 14

HYPERLINK l “_Toc361610546” Conclusion PAGEREF _Toc361610546 h 16

HYPERLINK l “_Toc361610547” References PAGEREF _Toc361610547 h 17

IntroductionHand hygiene by health care workers and ancillary staff is the single most imperative measure in reducing the risk of cross-infection. This kind of infection can be from one patient to another, from patient to the health care worker or from one health care worker to another after becoming contaminated. Hand hygiene refers to the process of washing the hand or hand decontamination. Health care related infections are a significant concern for morbidity that results among patients in neonatal intensive care units. Health care service providers interact with patients in these service centers via hand interaction and therefore targeting hand hygiene becomes one of the most effective ways of ensuring that health care related infections are either controlled or mitigated.

The contaminated hands of health care service providers, more so nurses working in neonatal intensive care units, are some of the major ways through which potentially pathogenic organisms are transmitted to the infants in these units (Pessoa-Silva et al., 2004). In addition, infants are among a group that is highly vulnerable to the development of health care associated infections (Brady, 2005; Saiman, 2002). This truth that stares at every health care service provider makes the need for careful hand hygiene among health care service providers and nurses to be of utmost importance. Meanwhile, there are hand hygiene guidelines that every nurse is expected to adhere to and it would be of great importance to investigate why some nurses would find it difficult to follow these laid down guidelines. Therefore, when it comes to hand hygiene in extremely sensitive places such as the neonatal intensive care unit, consistency in hands hygiene practices is important in mitigating the health care associated infections among the newborns. Research studies carried out in the past have attempted to uncover the predictors that would make some nurses fail to consistently follow hand hygiene guidelines while others perform conscientious hand hygiene and the most investigated parameters include gender, cognitive attributes and individual behavior (Ajzen, 1985).

Background & Justification `Health care related infections can markedly increase mortality rates, length of stay in the in-patient care units, the general cost of health care services and even increase pain and suffering to more vulnerable patients such as newborns that are critically ill (Aziz et al 2005). Aziz et al (2005) further note that newborns who are critically ill can suffer various yet different forms of health care associated infections. This observation is also supported by the study done by Raskind et al (2007) who reiterate that besides increasing the length of stay in a health care system, health care associated infections can also endanger the life of critically ill newborns and mothers. These observations make prevention of health care associated infections an uppermost goal in controlling the risks and dangers and mitigate the mortality rates that accrue due to these infections.

In their 2005 study of health care associated infections among neonates and neonatal patients, Aziz et al (2005) found that 78.7% of newborns in the neonatal intensive care units developed at least one health care related infection. The same study found that at least 16% of these newborns developed two health care related infections. Those who developed more than two health care related infections stood at 5.1% of the newborns in the neonatal intensive care units. Yet, these figures only accounted for newborns with very low birth weight in the neonatal intensive care units. Even when the research investigated the subject with respect to newborns very high birth weight, it was established that about 88% of high birth weight in the neonatal intensive care units experienced at least one health care associated infection, about 9% developed two health care related infections and about 3% developed more than two health care related infections. It is logical to associate increase in morbidity to higher costs of management of heath care services, increased risks of mortality and increased financial strain in economic sense. Various studies have attempted to map and trace the factors that relate to health care associated infections and found that increasing the length of stay of the patients (especially neonatal newborns) drastically increases the occurrence of health care related infections (for instance, Sankara et al 2002; Sheng et al 2005). Besides these risks of more infections and economic costs associated with protracted stay in the health care facilities, the parents and relatives of the patients also undergo other psychological costs; some of which may not be easily quantified in monetary form (Jenner et al 2002). In the background of all this is hand hygiene, which can be applied to reduce further infection and protracted stay in the health care facilities.

The study to be conducted shall provide a need assessment of the people in Missouri as far as the determinants of hand hygiene of nurses in the state is concerned. Because this is a descriptive study, I plan to use the community-based participatory research approach (CBPR). The CPBR approach engages members of the group under study in all the phases of the research process with a shared goal of producing knowledge that will translate into action or positive changes for the community. This approach is not a specific method or research design. However, it is an approach to or a process in which the researcher uses different types of designs and methods. This is applicable to quantitative research methods. It is also more applicable and acceptable by minority communities.

There are four key types; descriptive research that attempts to identify or elucidate social determinants of health, research that attempts to understand or elucidate disparities in health status or health-related risk factors, research to identify or define needs and assets in specific communities, and efforts to design, implement and evaluate interventions and policies aimed at increasing nurse hand hygiene hence help in reducing negative impacts of poor nurse hand hygiene thereby squarely tackling the costs associated. (reference, date)

Aims, Objectives and Purpose The study intends to conduct a quantitative descriptive research on factors that determine nurse hand hygiene in prevention of cross-infection in health care service delivery in Missouri health care system. Here define with a ref, (date) whjat a quantitative descriptive … is .. e.g from Parahoo…This study aims to assess determinants of hand hygiene among practicing nurses in Missouri as well as in other American states with an objective of preventing cross infection that results from poor hand hygiene as one element of health care associated infection. The study will focus on nurses practicing in counties within Missouri and shall attempt to employ a sociological approach to come with ways to prevent cross infection resulting from hand hygiene. The objectives of the study will therefore include:

Identify and discuss factors that determine nurse hand hygiene

Identify barriers to proper nurse hand hygiene in and during health care service delivery

Increase an understanding of the importance of nurse hand hygiene in the health care delivery system

Define and describe current hand hygiene practices among nurses in Missouri

Improve public awareness and recommend interventions designed to decrease the occurrence of health care associated infections due to poor nurse hand hygiene

Complement existing bodies of research on improvement of health care service delivery through good nurse hand hygiene practices

MethodologyStudy PopulationGupta (2011) defines a study population as the entire set of individuals (human or non-human) from which a representative sample is drawn hence which forms the broad core of the study based on specifically defined characteristics such as age, geographical distribution or sex among other characteristics that must be well defined. The population for this study comprised of all health care service providers especially nurses in Missouri, United States. Through the principles of statistical inference (Baker & Kramer 2003), the results derived from the population to be studied can be generalized and extended to all other States and counties in the US.

Sampling and the sample sizeA sample size equivalent to about 5 or 10% of the population is to be used for the study. The rationale behind the sample of this size is provided by Levinson et al (2008) who argue that a good sample size should be 10% or more of the target population (also mentioned in Hinton 2004). Implications of a small sample size or reducing the estimated sample are manifold. First with respect to the standard error, a small sample size increases the possibility of a large standard error since the standard error is a function of the sample size. What this implies is that if a sample that is needed should give a proper representation of the target population, it should be as large as possible to represent the population with more precision. Hinton (2004) gives an important point to discourage small sample sizes, especially in non-experimental designs where the target population is large. Hinton (2004), describes that small samples should be avoided because in addition to increasing the standard error, they have an impact on how the results of the study can be generalized to other settings or time. Therefore, the targeted sample size is justified on the point of being large enough to represent the target population as much as possible.

Sampling Method and RationaleThe respondents shall be randomly sampled for the survey using a stratified random sampling technique. Sharma et al (2009) define stratified sampling as a form of random sampling where the population under study is classified into distinctive strata and then ransom samples drawn from the strata. To achieve this, some assumptions will have to be made about the sample. First, it will be assumed that the sample shall be a representation of the target population with Gaussian distribution characteristics. Secondly, it will be assumed that in carrying out random sampling, the sample selected will have a normal distribution. As noted by Creswell (2009) these assumptions are important for the study as they shall provide a philosophical rationale and basis for the sample to be related to the characteristics exhibited in the population attributes. Furthermore, Bryman and Bell (2007) note that having an assumption of normal distribution provides a rationale for use of random sampling procedure, which gives equal chances of selection for every target participant in the target population. Furthermore, random sampling is essential when a representative sample of the population is desired as it is desired in this current study yet the target population is characterized by different groups. For instance, in this study, there are students are the sophomore level, those at the fresher levels and those at the finalist level. Stratified random sampling is also the best for the study because it allows for the proper selection of a control sample to compare the results derived from the study sample. To ensure equal representation of all the groups, stratified random sampling is the technique most fit to be used. It provides best rationale that combines the effectiveness of random sampling in providing equal probability for selection and the importance of ensuring equal representation through stratification. These qualities combine to ensure representativeness of the sample size selected (Gupta 2011).

Data CollectionBetween 200 and 250 questionnaires will be distributed to nurses in health care facilities offering nursing services that include neonatal intensive care services for newborns. The study is intended to use a Likert scale to collect and assess data regarding various aspects of hand hygiene that shall be investigated, including predictors of hand hygiene among nurses and factors that hinder consistency in hand hygiene undertaking of this good practice. A Likert scale can be defined as a psychometric scale used in research where questionnaires are employed and responses ranked on a five-point, nine-point or seven-point scale bases (Bryman & Bell 2007). The data collected from the study was used to compare with the data obtained from other past studies to come up with an assessment of significant similarities and differences between the two sets of information.

Philosophical Basis for Research DesignThe rationale for choice of mixed method design as the best research design for the study was arrived at based on several aspects of the research study that call for a mixed methodology approach in order to be effective. Creswell (2009) notes that mixed method should be used firstly, when the study encompasses multilevel perspectives that are intended to solve research questions that require real-life contextual understandings. For this to be achieved effectively, Creswell (2003) suggests that a mixed method approach is essential to ensure that the advantages of employing multiple methods such as in-depth interviews and survey questionnaires are utilized and built upon. Creswell further points out that taking the mixed method approach enables the research study to draw from the strengths of each approach; that is, strengths of qualitative approach and quantitative approach as shown in the table below:

Quantitative Research Qualitative Research

Advantages Allow for a broader study and enhancing the generalization of the results

Allow for greater objectivity and accuracy of results.

Employs prescribed procedures

Personal bias can be avoided Provides depth and detail

Creates openness: encouraging people to expand on their responses can open up new topic areas not initially considered

Simulate people’s individual experiences

Attempts to avoid pre-judgments

Disadvantages

Gather a much narrower dataset

The context of the experiment is ignored

The results are limited

Should involves a large sample of the population, this can cost more.

The development of standard questions by researchers can lead to ‘structural’ bias and false representation More difficult to generalize

Difficult to make systematic comparisons

There may be more subjectivity concerned in analyzing data and the researcher may have more influence over the results.

Not easy to conclude the reliability and validity of data

Data overload may need a lot of time to analyze!

Recorded interviews would cost more time and money

Source: Adopted from http://www.learnhigher.ac.uk/analysethis/main/quantitative1.html

In addition to the philosophical bases provided above for choice of research design, there is yet another basis for the choice of mixed methodology approach as identified by Greene (2007). Greene points out that generally researchers and investigators collect diverse types of data and these can only be integrated through the use of mixed method where the strengths of different data types are brought together to form a coherent data output (Greene 2007).

DiscussionTransmission of Infections from HCPsPessoa-Silva et al, (2004) recommends that the nurse plays a major role in providing the requisite care to ensure optimal chances for survival of individual under care. When the issue turns to newborns that are in critical conditions the role of the nurse in providing this care not only becomes increasingly sensitive but also requires any possible mode of transmission to be mitigated as much as possible. In the neonatal intensive care units, the hands of the nurses can become loaded with potentially harmful microorganisms, which may easily pass to the newborns under care. These pathogens accumulate after initiation of care, during routine care and after contact with a newborn, diapers or secretions. Fingertips are a key center for accumulation of these pathogens (Pessoa-Silva et al 2004).

Demographic Determinants of Nurse Hand HygienePast research studies by Tai et al (2009) and Nobile et al (2002) have identified several demographic variables that can be used to predict hand hygiene practices among nurses. Most studies found that gender has some correlation to hand hygiene practices of nurses such that female nurses were found to have a higher likelihood of washing their hands more frequently after than male nurses (Nobile et al, 2002). Even studies that employed anonymous self-reported questionnaires found that male nurses tend to wash their hands less often as compared top their female counterparts (Sax et al, 2005).

Another demographic predictor that has been investigated is age, where the studies either used self-report method or observation. All the studies found no relationship between age and hand hygiene (e.g. Tai et al 2009; Snow et al 2006). Meanwhile, when the nurses were rated on the basis of their education and any prior experience in healthcare setting, it was found that health care practitioners with previous experience in health care setting tended to be more improved in terms of hand hygiene as compared to their counterparts without any prior experience in healthcare setting. On the other hand there hasn’t been any significant relationship between formal HH education (hand hygiene education) and hand hygiene behavior of nurses or health care service providers or practitioners.

Planned Behavior TheoryAccording to the theory of planned behavior an individual’s behavior is not at all times under one’s volitional control but intent to comply with a particular social pressure may be hindered by some external factor that may then hinder the individual from executing the behavior. Under this theory, there are various variables that may be taken as predictors of a nurse’s HH behavior. Among attributes highlighted under the theory of planned behavior include attitude, subjective norms, perceived behavioral controls and intentions. Positive attitude is reported to be correlated with implementation of hand hygiene guidelines among nurses. For this reason, it would be expected that a nurse with positive attitude has more likelihood of consistently observing HH behavior and implementing the HH guidelines as compared to the counterpart with negative attitude toward the hand hygiene practice.

Subjective norms comprise an individual’s perception of how other people socially exert pressure on the individual to perform a specific behavior. Most past studies that have included this variable in the study have found that adherence to hand hygiene and subjective norms have significant correlation such that nurses would show higher levels of adherence to HH guidelines or hand hygiene practice when they perceived that their seniors or colleagues held higher expectations for them in terms of adherence to the HH guidelines. When the individual’s perception relates to whether the requisite resources to perform are available to enable performance specific behavior then it is referred to as perceived behavioral control. A majority of past studies (e.g. Jenner et al 2002; Erasmus et al 2009) have found this to be one of the factors that also predict nurse hand hygiene even though others (e.g. Larson et al 2007) have found that this attribute does not influence hand hygiene behavior.

Lastly, still under theory of planned behavior, intentions act as determinant of hand hygiene of the nurse depending on whether the nurse intends to comply with the set hand hygiene guidelines or not. For this reason, it would be expected that a nurse that has intentions to observe hand hygiene guidelines is more likely to consistently perform hand hygiene practices than the counterpart who has no intentions of observing them.

ConclusionPreventing infections during provision of health care services is definitely one of the prominent ways to ensure efficiency and effectiveness in the management of health care service provision process. Hand hygiene by health care workers and ancillary staff is the single most imperative measure in reducing the risk of cross-infection. The nurse plays a major role in providing the essential care to ensure optimal chances for survival of individual under care especially newborns under the neonatal intensive care unit, who are in critical condition. In the neonatal intensive care units, the hands of the nurses can become loaded with potentially harmful microorganisms, which may easily pass to the newborns under care. These pathogens accumulate after initiation of care, during routine care and after contact with a newborn, diapers or secretions.

The study will offer a link between medical and general sociology. It will be fundamental in explaining the predictors of nurse hand hygiene and coming up with an explanation to the factors that hinder consistency in hand hygiene behavior among nurses, especially in the neonatal intensive care units. While the focus of the study is in Missouri, it will give a way forward on the best way that transmission of pathogens from health care service provider to the neonate can be mitigated.

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Appendix:

For example, Gupta notes that when a research study focuses on investigating accuracy or performance of computers of certain make such as Dell or Compaq in an office environment, then the elementary set of computers of that particular make become the study population. In addition, this elementary set can be of locusts in a particular area or lions in Sub-Sahara Africa (Gupta 2011).