Research Paper on "Yes Scholarship"

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Epidemiological Study Proposal: Nursing Hand Hygiene and Noscomial Disease

Hand hygiene has increasingly been viewed as an important part of the hospital and nursing procedure based on the connection between nosocomial disease and habits of handwashing amongst healthcare workers. However, research has been inconclusive regarding the effects of hand-washing training as well as the cultural impacts on hand-washing habits. Therefore, the proposed research would measure these conditions as they relate to the epidemiology of nosocomial disease. It is expected that the findings will demonstrate a positive correlation between the cultural enforcement of proper hand-washing techniques through effective training methods and the reduction of nosocomial disease.

Introduction:

Most HCAIs are spread by direct contact, mainly via the hands of healthcare professionals when they touch vulnerable patients or objects and equipment in the near-patient environment (Pittet et a1 1999. Hand hygiene is widely regarded as the most effective way of preventing HCAI on the premise that cleansing hands breaks the chain of infection (Beggs et al. 2009). However, research studies and audits have demonstrated repeatedly that healthcare professionals perform hand hygiene too seldom and not always when hands are most likely to transfer pathogens, and that technique is often poor (Gould et al. 2008).

The extent to which good hand hygiene compliance contributes to the prevention of HCAI is hard to establish. Many authors have made encouraging claims for the success of campaigns intended to boost hand hygiene (Pittet et al. 2000, Harbarth et al. 2002, Lam et al. 2004), but equally there have been a number of initiatives in which attempts to increase hand hygiene compliance have not met with success (Gould and Chamberlain 1997, Marra et al. 2008, Rupp et a1 2008). Many factors contribute to the transmission of infection and the susceptibility of the individual patient. Some pathogens responsible for HCAI are transmitted more readily than others because they resist drying and survive for relatively long periods on the skin (Gontijo Filho et a1 1985). The severity of patients' underlying illness and the number of invasive procedures they have undergone, such as surgical operations, mechanical ventilation and urinary catheterisation, are also important factors contributing to susceptibility to infection.

The cleanliness of the clinical environment may also play a part in determining HCAI rates. Although there is a lack of evidence to demonstrate the effect of environmental cleanliness on HCAI rates (Rampling et a1 2001), it is logical to suppose that hands are likely to become re-contaminated easily after cleansing and that pathogens are transferred more readily in a non-clean environment. It is also worth considering what comprises 'good' hand hygiene. Most research studies and audits measuring hand hygiene compliance address the frequency with which hands are cleansed, and whether cleansing occurs before and after patient contacts and other 'clean' and 'dirty' activities, but few studies have assessed technique (Gould et al. 2007). Failure to assess technique is a drawback in light of evidence that training health workers to ensure hand surfaces receive contact with alcohol can reduce infection rates (Widmer et al. 2007).

Despite these criticisms, it is logical to suppose that hand hygiene plays an important role in the prevention and control of HCAI because, if performed correctly, it should interrupt the chain of infection (Beggs et al. 2009). Moreover, a recent trial indicates that ensuring hand contact with adequate amounts of antiseptic for long enough for the product to exert its antimicrobial effect is central to reducing the numbers of bacteria present and in turn reduces the risk of cross-infection (Widmer et al. 2007).

The following research proposal proceeds from the understanding that those individuals staying in hospitals or other populated medical facilities are vulnerable to the host of bacteria and infectious diseases contained within their walls. This vulnerability provoked coinage of the term 'nosocomial,' which is used to describe conditions or aliments secondary to the condition for which an individual was admitted to the hospital. The implication is that this condition was caused by something present within the hospital, and not initially within the patient. As the research conducted hereafter will indicate, this is most often caused by healthcare workers, presumably practicing poor sanitary practices. A discussion provided by the Centers for Disease Control (2007) offer the study the argument that the presence of nosocomial disease may often be attributed to poor hand hygiene compliance. To the point, the CDC indicates that "rates of central line-associated bloodstream infections were significantly lower in hospitals with higher rates of hand hygiene." (Larson et al., 666)

Confirming nosocomial infection as the proper focus for a dependent variable requires a surface understanding of the variable itself. Accordingly, a study by Beggs et al. (2006) denotes that "direct contact between health care staff and patients is generally considered to be the primary route by which most exogenously-acquired infections spread within and between wards." (Beggs et al., 621) as the research considers the best manner in which to direct focus between cause and effect (i.e. dependent and independent variable), it is useful to recognize that personnel within the hospital are largely to be seen as the primary carrier of nosocomial infection. Beggs et al. provide the research with a considerable degree of help in this area as well, indicating that "handwashing is therefore perceived to be the single most important infection control measure that can be adopted, with the continuing high infection rates generally attributed to poor hand hygiene compliance." (Beggs et al., 621) There is however a conflict between this declared perception and the finding produced by the study which contends that larger institutional problems such as staffing shortage and high worker turnover may actually contribute highly to the spread of infectious diseases. For Beggs et al., there was an incapacity to isolate and therefore fully endorse a correlation between hand hygiene patterns and the reduction of infectious disease. This denotes the research problem at the center of the proposed study.

Methods:

The proposed study design is a qualitative study and would be conducted across two years of observation as modeled in the article by Rosenthal et al. (2005). Here, a program of education, training and performance feedback would be implemented and the methodology would be centered on a survey of performance conducted every other week in correlation to the rate of nosocomial infection per 1000 patient days. (Rosenthal et al., 392) the sample would be the whole nursing staff for a selected hospital facility divided by different units. The intent would be to use the success of the study by Rosenthal et al. As model for the study here proposed. This study's findings would produce some compelling evidence of the positive association between hand-hygiene and the prevention of disease. Accordingly, the study would conclude that, in "4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P < .0001). During the same period, overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409)" (Rosenthal et al., 392) This is an outcome which substantially endorses the need for improved hand-hygiene practices in hospitals where compliance is low and for further study to validate the best ways to achieve this.

The research proposed here also is supported by the research design used by Roberts et al. (2009), which intended to address the perspective that some methods of hand-washing are superior to others with respect to the prevention of the spread of infection or disease. This is the case with the study conducted by Roberts et al. (2009), which would be taken up with the intention to examine the effectiveness of alcohol-based hand washing methods which have been so extensively proliferated in recent years within the medical field.

The study would employ an experimental design in multiple phases. The methodology promotes the intention to draw a comparison between the use of alcohol-based hand cleaners and the use of liquid soap and water, as well as to draw a comparison between the use of alcohol-based hand cleaners with training and without training. For our purposes, variables will center not on the difference between sanitation method bout on the training methods applied in different nursing units, the cultural outcomes produced and the health outcomes produced. Therefore, the method would divide selected nurses into two separate groups, which would begin the first phase of the study using both hand sanitizer and liquid soap and water. After a period of nine weeks, Groups a and B. would be differentiated for the second phase. Here, Group a would continue with the same hand-washing program while Group B. would be considered the intervention group. The intervention would, for Group B, engage the participants in regular training in hand hygiene with both hand sanitizer and soap and water. This phase would also last for a duration of nine weeks, with the intent to produce two separate measurements to follow each phase.

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