An Explanatory Quantitative Methodology Utilizing A Multisite, Cluster Randomized Control Trial ( Rct )

This experiment illustrates the importance of handwashing and proves that hand washing is worth it. Since our hands are constantly coming into contact with ourselves and others, touching surfaces, grabbing objects, being sneezed into, etc., keeping our hands clean is one of the most effective, yet simple way we can take to avoid getting sick and spreading germs to others. Many diseases and conditions are spread by not washing hands with soap and clean, running warm water. “The human skin is a host to anywhere between 10,000-10,000,000 bacteria per square centimeter and since health care providers come into contact with pathogenic bacteria by being engaged in patient care, hand washing can reduce the risk of spreading diseases (page 3).” The objective of the experiment is to test the effectiveness of hand washing and demonstrate normal flora. This report presents the procedures and materials for the experiment, the experiment's results, and an analysis of those results.

Hospital acquired infections (HAIs) affect over 1.7 million patients each year, causing almost 100,000 deaths annually in the United States alone (Johnson, 2010). According to the World Health Organization, HAIs are the most frequent adverse event in the healthcare industry. Fortunately, most of these infections can be prevented with one single intervention, proper hand hygiene (“The Evidence,” n.d.). Four out of five pathogens that cause illness are spread by direct contact. Proper hand hygiene eliminates these pathogens and helps to prevent cross-contamination and HAIs (Linton, 2015; “Hand Hygiene,” n.d.). Reduction of cross-contamination and HAIs improves patient outcomes, increases employee wellness, and lowers health care costs. Adherence to proper hand hygiene is the single most important safety measure in the health care setting. However, for many years compliance to proper hand hygiene in the healthcare industry has been dismally low. New and inventive measures must be implemented to increase compliance to proper hand hygiene and lower the rate of hospital-acquired infections.

NRS-433V Week 5 - Evidence-Based Practice Presentation - Healthcare Associated Infections [12 Slides + Speaker Notes]

Keeping our hands clean is one of the most effcient and important steps we can do as humans to avoid getting sick or spreading germs to other people. Unwashed hands spread many diseases such as the flue, E. coli, and salmonella. Unfortunately, hand hygiene is still one of today’s most leading causes of infection in health care facilities. The risk of clinicians, patients, and visitors not complying with hand hygiene protocols creates a practice problem for nurses and their patient care. The cause of health care infections, also known as, health care-associated infections (HAIs) are increasing along with the rise of the inability to control or treat infections that are multi-drug resistant. Lack of proper hand hygiene is a major problem in clinical settings sourcing from critical care divisions where the most contaminations are prevalent. This paper will discuss how hand hygiene affects the nursing process and solutions of how to better prevent HAIs within the nursing scope of practice.

A two-year program called On the CUSP: Stop BSI was formulated in 2008 to prevent CLABSIs in hospitals nationwide and was organized as a state or region-level collaborative with centralized education, data collection, and program management functions (AHRQ, 2012). More than 1,000 hospitals and 1,800 hospital units, representing a total of 44 states, the District of Columbia, and Puerto Rico, participated in the program (AHRQ, 2012). The program structure included three main components: (1) a model to translate evidence into practice at the bedside to prevent CLABSIs; (2) the CUSP to improve the safety culture; and (3) a system to measure and report infection data (Sawyer et al., 2010). Results of the program revealed success in reducing CLABSIs nationwide by 41% from a baseline of 1.915 infections per 1,000 line days to a rate of 1.133 infections (AHRQ, 2012). With the nationwide success of the On the CUSP: Stop BSI program (AHRQ, 2012), the state of Hawaii embarked on their own study to determine if a national ICU collaborative to reduce CLABSIs would succeed in the state (Lin et al., 2012). The study, which began in January 2009 and ended in December 2010, included the CUSP, a multifaceted intervention approach to CLABSI prevention, and infection rate monitoring (Lin et al., 2012). Data was collected and reported from 20 ICUs representing 16 hospitals across the state (Lin et al., 2012). The results revealed the overall mean 9statewide CLABSI rates decreased 61% from 1.5 infections per 1,000 catheter days at baseline to 0.6 at 16 to 18 months post-implementation of the project, reinforcing the evidence that the On the CUSP: Stop BSI program can succeed in other states and substantially reduce CLABSI rates in hospitals (Lin et al., 2012). The success of the initial Hawaii study was the catalyst to conduct a second study in the state. This cohort study continued the national On the CUSP: Stop BSI program interventions, extended

This study was intended to prove that hand hygiene practiced according to the CDC guidelines will decrease the incidence of hospital acquired infections. This could not really be proved in this study since the hospitals were not able to maintain improvement in hand hygiene. Health care workers were familiar with guidelines but significant practice changes were not maintained. Some of the infection rates did improve during this time but the correlation with hand hygiene is not consistent. There were other practice changes occurring during this same time and those changes may be responsible for the decreased infection rates.

Contact precautions include: the patients being placed in private rooms, performing proper hand hygiene with antimicrobial soap and water, using friction for 15 seconds, and using gloves and gowns during patient care (Keske and Letizia 332). “One should also ensure adequate cleaning and disinfection of environmental surfaces and reusable devices. The uses of both buffered and buffered phosphate hypochlite solutions (bleach) have been shown to decrease the rate of C. difficile contamination and helps in reducing Clostridium Difficile associated disease (CDAD) rates” (Patel 104).

CDCs clean hands count campaign aim to improve healthcare provide adherence to hand hygiene recommendations, address, myths and misperceptions about hand hygiene and empower patients to play a role in their care by asking or reminding healthcare providers to clean their hands and the most germs that cause serious infections in healthcare are spread by people’s action, every patient is at risk of getting an infection while they are being treated for something else, hand hygiene is a great way to prevent infections and healthcare providers clean their hands less than half of the time they should, good hand washing is the first line of defense against the spread of many illness.

The hospital is compliant with infection control protocol according to the CDC standard guidelines. “Hand hygiene, contact precautions, as well as cleaning and disinfecting patient care equipment and the patient’s environment are essential strategies for preventing the spread of health care–associated infections. Hand hygiene is addressed in NPSG.07.01.01. Contact precautions for patients with

(McCaughey, 2016). The Center of Disease Control recommends hand washing with vigorous scrubbing for at least 15 seconds with soap and water. Using alcohol based gel hand sanitizer can be an appropriate alternative if soap and water is not readily available but does possess drawbacks including being ineffective against alcohol resistant bacteria. Programs for surveillance have also been implemented in hospitals with the intention of monitoring staff to ensure that policies are being followed to ensure the safety of the patients. Mandated reporting of hospital-specific rates and statistics for healthcare-associated infections has the potential to serve a purpose that could result in bringing down the instance for infection. Being forced to announce to the public infections rates versus other healthcare organizations has the potential for higher administration to implement better policies to assure their good standing in the eye of the

In an article entitled “Effect of single- versus double- gloving on virus transfer to health care workers’ skin and clothing during removal of personal protective equipment”, which was published in the American Journal of Infection Control in August, 2011, authors Lisa Casanova, William Rutala, David Weber, and Mark Sobsey performed a controlled study of 18 volunteer health care workers, tracking both their adherence to CDC guidelines for donning and doffing personal protective equipment (PPE), as well as the spread of bacterial contaminants the health care workers were exposed to while performing routine patient care. The purpose of this study was to identify whether airborne contaminants were transferred to heath care workers’ hands and uniforms less often with double-gloving than with single-gloving. Though this study was performed on a very small sample of health care workers at the University of North Carolina Chapel Hill, the results of the study showed that there was far less contamination of participants’ hands after utilizing double-gloving standards than with single-gloving.

After the program, there is an increase in level of knowledge (79% to 91% to correctly identify hand washing guideline) about the hand washing issue and an increase in compliance rate (51% to 83%). The participants in the study have positive attitudes towards hand washing, before and after the program, suggesting that it is fine for a patient to remind his or her doctors to wash their hands. This study suggests an immediate rearrangement of the alcohol hand rub at each patient’s bedside, and a ongoing issue regarding caregivers’ skin irritation that has to be addressed quickly. Overall, the research shows that increasing hand washing compliance rate is a multifaceted problems that have to be addressed in multiple ways, from the position of the alcohol hand rub to the hand rub that do not irritate the healthcare workers’

The background section reveals the purpose of the study was to conclude if the catheter was safe, effective in preventing bacteriuria and if future studies were warranted. The literature reviewed for this study included articles on the significance of the problem and articles specific to catheter materials used in manufacturing. This study also included literature about the use of silver as an antimicrobial agent. The methods section detailed the selection of the site, the population chosen for the randomized control trial and information on the catheter selection for the study. Also covered in the methods section was information on the procedures used to randomize the catheter selection and the assessment of participants. The results section of the study reveals the statistical data that lead the researchers to the final conclusions. The total number of participants that met the criteria to complete the study were divided into the test group or the control group. The results were then defined by the percentages that met certain assessment criteria or developed bacteriuria and the timeframe to bacteriuria. Each section with-in the article supports the final conclusion that the test catheter is safe, provides a decreased incidence of bacteriuria, decreased time to bacteriuria and therefor revealed a larger study of this catheter is warranted (Leuck et al., 2015).

Healthcare associated infections have an impact on patients - how? Can be prevented greatly with compliance to hand hygiene protocols (REF).

This assignment will encompass how the results of the personal hygiene and susceptibility microbiology experiments provide a framework for the basis of the NICE Clinical Guidance (CG139) on Infection and how crucial the reasons for the hand wash protocol and hygiene is in all healthcare settings.