Evaluating the Evidence: Handwashing in Improving Patient Safety and Preventing HAIs
Healthcare associated infections (HAIs), also known as nosocomial infections, are considered the most common and severe complications in the healthcare context. These are infections that occur in patients after 48 hours or more of admission to a healthcare facility, and were not present in the patient at the time of admission. These infections are usually acquired during the care process in hospitals or other healthcare facilities such as outpatient services, nursing home care, and primary care. HAIs mainly affect patients, with geriatric patients facing the greatest risk of infection. Other people at risk of infection include nurses, physicians, hospital staff, trainees, and students. According to the World Health Organization (WHO), there are various strategies for controlling, managing, and preventing HAIs some of which include implementing preventive measures such as appropriate hand hygiene practices. This narrative explores how handwashing with soap helps to improve patient safety and prevent HAIs particularly among geriatric patients.
According to Brosio et al. (2017), HAIs adversely impact delivery of care through the delay of the recovery of patients, lengthened hospitalization, as well as increased need of subsequent controls for outpatients. HAIs are also a financial burden when it comes to the use of healthcare service as well as human suffering for families, patients, and personnel (Brosio et al., 2017). These adverse impacts can be prevented through adoption of proper hand hygiene practices by everyone involved in the healthcare process. Proper hand hygiene such as handwashing with soap plays a key role in improving patient safety and preventing HAIs in various ways. The practice reduces and eliminates the spread of germs and infections from one person to another within the healthcare setting (Malliarou, 2017). For instance, handwashing prevents the spread of germs from the nurse to the patient. It also helps to prevent the spread of germs from patient to patient.
Patient safety within healthcare settings is improved through handwashing with soap given how the intervention helps to reduce the spread of infectious illnesses such as flu, colds, and upper respiratory illnesses. Other than handwashing with soap, the use of chlorhexidine gluconate (CHG) disinfectant is recommended. The use of CHG helps to prevent HAIs as it guarantees continuous microbial killing for up to six hours (Fox et al., 2015). CHG achieves this objective through the disruption of bacterial cells as well as resulting in cell death and cytoplasmic leak. Malliarou (2017) affirms that it is important for nursing and medical professionals to adopt hand washing practices and make them a priority. Frequent handwashing particularly using soap can save more lives as compared to a single medical intervention or vaccine. Handwashing has been proved to be effective and less expensive in the prevention of diseases such as pneumonia and diarrheal diseases that account for millions of deaths around the world (Malliarou, 2017). Even though a good number of people around the world use water to clean their hands, only a few use soaps for the same purpose and this should be a great concern.
Proper hand hygiene such as handwashing with soap is important in improving patient safety and preventing HAIs. Handwashing with soap reduces and eliminates the spread of germs and infections from one individual to another within the healthcare setting. Patient safety is further improved in that handwashing with soap reduces the spread of infectious diseases such as flu, colds, and upper respiratory diseases. It is important for today’s nursing and medical professionals to prioritize handwashing.
Brosio, F., Kuhdari, P., Stefanati, A., Sulcaj, N., Lupi, S., Guidi, E., Bergamini, G., & Gabutti, G. (2017). Knowledge and Behaviour Of Nursing Students on The Prevention of Healthcare Associated Infections. Journal of preventive medicine and hygiene, 58(2), E99. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584094/pdf/2421-4248-58-E99.pdf
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., Kirkwood, P., Jones, L., & Bader, M. K. (2015). Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses Hand Washing. American Journal of Critical Care, 24(3), 216–224. doi: 10.4037/ajcc2015898
Malliarou, M. (2017). Hand Hygiene of Nurses and Patient Safety. International Journal of Nursing & Clinical Practices, 4(1). doi: 10.15344/2394-4978/2017/217
|Study 1||Study 2|
|Citation: (i.e., author(s), date of publication, & title)
Level of Evidence
|Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C., Kirkwood, P., Jones, L., & Bader, M. K. (2015). Use of a Patient Hand Hygiene Protocol to Reduce Hospital-Acquired Infections and Improve Nurses Hand Washing. American Journal of Critical Care, 24(3), 216–224.
|Brosio, F., Kuhdari, P., Stefanati, A., Sulcaj, N., Lupi, S., Guidi, E., Bergamini, G., & Gabutti, G. (2017). Knowledge and Behaviour Of Nursing Students on The Prevention of Healthcare Associated Infections. Journal of preventive medicine and hygiene, 58(2), E99.
|Purpose of the Study||· To answer the question of whether patient hand hygiene protocol (PHHP) is associated with decreased central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) rates in the ICU.
· To answer the question of whether PHHP is associated with an increase in handwashing compliance among nurses in the ICU.
|· Assess knowledge about the risk and most effective measures of preventing HAI in students of an Italian university nursing school with specific attention to hand hygiene practices.
|Theory or Conceptual Framework||· Roughly 2.5 million hospital acquired infections (HAIs) occur every year in the U.S.
· HAIs are linked to 90,000 deaths deemed preventable.
· HAI-related deaths are attributed to poor hand hygiene by health care workers.
|· HAIs are common and severe complications in the healthcare sector hence adoption of safe care practices such as handwashing can help to reduce, control, or prevent infection transmission within hospitals and other healthcare settings.
|Design/ Method||· Pre-experimental study conducted.
|· An anonymous questionnaire administered to investigate knowledge about HAIs, standard precautions, and hand hygiene.
|Sample/ Setting||· Study conducted in a 27-bed adult cardiovascular medical intensive care unit (ICU) at Mission Hospital in Mission Viejo, California.
· Mean annual ICU daily census was 22.2 patients.
|· 339 1st, 2nd, and 3rd year nursing students of the same academic year attending the University of Ferrara, Italy, were enrolled to participate in the study.
|Major Variables Studied and
|· Central line-associated bloodstream infection: lab-confirmed infection of the bloodstream that is not related with infections at any other site. It usually develops with 48 hours after placement in a central line.
· Catheter-associated urinary tract infection: a urinary tract infection in which the positive culture was taken with indwelling urinary catheters predisposed to bacteriuria and UTIs.
· Nurses’ hand-washing compliance: nurses following handwashing practices or procedures within the healthcare setting.
|· Infections associated with healthcare practices (HAI): Infections patients get while getting treatment for various surgical or medical conditions, and most are preventable.
· Standard precautions (SP): infection control practices that enable prevention of transmission of diseases acquired through contact with body fluids, mucous membranes, and blood.
· Hand hygiene (HH): appropriate use of handwashing.
|Measurement of Major Variables||· CAUTIs measures and reported through the use of CDC’s definition of incidence per 1000 indwelling urine catheter days.
· CLABSIs measured and reported through the use of CDCs’ definition of incidence per 1000 central catheter days.
· Nurses’ handwashing compliance measured and compared between groups as well as time of hand washing.
|· HAI measured using the percentage of the correct answers to HAI section in the questionnaire.
· Measured using the response rates by participants/respondents.
· Measured using percentages of correct answers to the hand hygiene section in the questionnaire.
|· Data analysis conducted using SPSS version 21.
|· Collected data analyzed by Statview® 5.0.1 software (Abacus Concepts, Berkeley, CA, USA).
· ANOVA used to reveal the difference in average score for the 3 variables according to year of attendance.
|Study Findings||· Mean monthly CAUTI rate decreased from 9.1 to 5.6 per 1000 catheter days.
· Mean monthly CLABSI rate decreased from 1.1. to 0.50 per 1000 catheter days.
· During the implementation of protocol, handwashing compliance rate increased.
|· Age and invasive procedures are risk factors for onset of HAI.
· Adoption of standard precautions reduces the risk of contamination with biological fluids.
· Hand hygiene reduces the risk of HAIs.
|Strength of the Evidence (i.e., level of evidence + quality [study strengths and weaknesses||· Strengths:
o Answers the PICOT question that handwashing practices reduce or prevent HAIs.
o comparison of protocol results with preintervention results rather than a randomized control group.
o Answers the PICOT question stating that handwashing reduces or prevents HAIs.
o Results obtained are in line with those reported in other studies.
o Study carried out on learners attending the lessons of the degree course who were administered the questionnaire. Other students might have been left out.
Legend: Citation, level of evidence, purpose, theory or conceptual framework, study design, sample or setting, major variables, measurement of variables, data analysis, study findings, and strength of evidence for 2 strongest external studies supporting the intervention of the PICOT question formulated.