Hospital-Acquired infections can lead to a double burden on the health of the patients and health systems of a country. Unhygienic environments, lack of awareness, forgetfulness, and patient-healthcare staff ratio are the risk factors for these infections. There are several prevention strategies such as education, maintaining hygiene, and healthcare training. Hand hygiene is a cost-effective and efficient way to reduce cases of hospital-acquired infections.
The field of nursing has developed over the years, and researchers and medical specialists have found cures for many diseases. However, there are new concerns related to hospitals that are impacting the health of the patients and their family members as well as medical staff such as nosocomial infections. Nosocomial infections are also commonly known as Hospital-Acquired Infections (HAIs). Nosocomial infections or hospital-acquired infections are defined as:
“An infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurs in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge and also occupational infections among the staff of the facility” (Ducel, Fabry, & Nicolle, 2002).
While visiting the hospital, you might get a fever or flu because of the environment in the hospitals. But also when a patient is admitted with a chronic disease, they might also have infectious diseases such as flu, infection during surgery and other health issues and these are because of a virus which was acquired during the hospital stay. Hospital-acquired infections are one of the primary causes of morbidity and mortality in the United States. This kind of infection not only puts patients at risk because of their reduced immunity but also influence the health of visiting members of the family and medical staff. It is estimated that approximately 1.4 million people around the globe are affected by nosocomial infections (Ducel et al., 2002). Also, another comprehensive study reported that in the year 2002 there were 1.7 million cases of HAIs in hospitals of the United States (Klevens et al., 2007). According to 2014 estimated by CDC, about 722,000 HAIs cases were present in Acute care hospitals in the united states, and 75000 patients died during hospitalization (“HAI Data and Statistics,” 2018). The impact of these infections can lead to increased hospital stay duration, increased mortality rate, economic issues in the family, resistance to antimicrobial and other medications, and decreased immunity (Khan, Baig, & Mehboob, 2017). Nosocomial infection accounts for 7% in developed countries and 10% in developing nations. These types are surgical site infections, urinary infections, respiratory infections, vascular catheter infections, and Septicemia (Ducel et al., 2002). Surgical site infections are any cellulite or discharge which occurs after a month of operation or surgery, urinary infection is the positive urine culture, and respiratory infections refer to the initiation of coughing and purulent sputum during hospitalization (Ducel et al., 2002). Vascular catheter infection is put as inflammation and purulent discharge while inserting the catheter and septicemia identifies fever and one positive blood culture (Ducel et al., 2002).
Hospital-acquired infections (HAIs) are infections that impact the health of the patient to a greater extent because if the person acquires the infection during surgery or operations, then it will increase the pain and difficulty for the person. These infections increase the economic burden on the patient as well because of the extended length of the stay in the hospital and treatment cost (de Lissovoy et al., 2009). A study has concluded that because of hospital-acquired infections (HAIs), approximately 1 million additional days and 1.6 billion dollars were used to treat nosocomial infections (de Lissovoy et al., 2009). Also, hospital beds are occupied for the longest time and required more staff care to treat patients with HAIs. Therefore, the health system will have a burden of meeting the needs of all patients and also the quality of the care will be reduced. The treatment cost paid by the hospital can be used in another productive way if hospital-acquired infections are reduced and morbidity among patients is decreased.
There are several risk factors that are associated with HAIs such as poor hygiene, interaction with people especially with patients without washing hands, prolonged stay in the hospital wards, and lack of awareness regarding risk factors, prevention, and treatments (Khan et al., 2017; Naraya, 2014). The unhygienic environment is one of the primary causes of HAIs infection, and it is also the source of all the pathogens. For instance, via air, food, and water the pathogens can transfer to the patients and other people impacting their health negatively. Medical staff and hospital cleanliness also determine the frequency and prevalence of nosocomial in hospitals and other medical centers (Khan et al., 2017). Waste from the hospital can also be a reservoir for potential pathogens. Awareness among healthcare staff is also essential to prevent hospital-acquired infections. There are several types of nosocomial infections which are the result of lack of awareness, unhygienic environment, unhygienic conditions of the healthcare staff, waste mismanagement in the hospitals, and types of equipment used by the medical specialists. It is also essential to clean and sterilize the materials and other apparatus used in medical procedures for the safety of the patients because unsterilized equipment can be fatal during surgeries or other processes.
Hands are one of the most common modes of transmission of diseases from one person to another. The improvement in hand hygiene among all people whether at risk or not will decrease the number of cases of hospital-acquired infections. Hand hygiene is proven to be the most straightforward and efficient method to prevent infections in hospitals (Pittet, 2001). Hand hygiene is defined as “washing hands with soap and water, or disinfection using alcohol-based hand rub” (Erasmus et al., 2010). A systematic review of studies on compliance related to hand, hygiene concluded that there is an overall 40% compliance rate for hand hygiene (Erasmus et al., 2010). Also, the promotion of hand hygiene is considered as challenging because of its low compliance rate among general people and healthcare staff. World Health Organization (WHO) has increased the emphasis on patient safety and reduction in the cases of nosocomial infections. One of the most effective measures to reduce the instances of hospital-acquired infections is compliance with hand hygiene. The government and other agencies have been working towards the improvement in compliance among healthcare staff and general populations.
Lack of knowledge about the hand hygiene importance and the unavailability of hand hygiene products can be the reasons for low compliance rates. Also, people do not consider that hand hygiene can prevent them from several infections and keep them healthy. There are different techniques to maintain hand hygiene such as hand washing, hand sanitizers, and alcohol-based disinfectants. Evidence-based studies concluded that alcohol-based hand sanitizers are useful in the reduction of cases of hospital-acquired infections and also for infection control programs (Hilburn, Hammond, Fendler, & Groziak, 2003). Different promotional strategies have been used to prevent the frequency and prevalence of nosocomial infections such as educational awareness among healthcare staff and general people. Hand hygiene is most crucial among healthcare workers because it can be a mode of transmission of pathogens and other infections between patients to patients and in the healthcare settings.
The significance of the problem:
Hospital-acquired infections (HAIs) are leading preventable infections among patients. Hand hygiene is one of the methods to prevent the occurrences of hospital-acquired infections. Low compliance with hand hygiene is a universal issue, particularly among healthcare staff. The most cited reasons are high patient-healthcare staff ratio, patients needing to be considered as a priority, use of gloves, forgetting to use hand sanitizers, lack of knowledge about hand hygiene guidelines, and high workload (Pittet, 2001). With increased promotion and focus on patient safety and nosocomial infections, there is an improvement in the use of hand sanitizers. Hand washing might be the cheapest and easiest way to improve hand hygiene but asking a healthcare staff to leave the patient or visit the wash basin before attending to the patient would be time taking. Therefore, hand sanitizers are the best way to improve hand hygiene compliance among healthcare staff.
If compliance among nursing staff is increased using hand sanitizers, then it will decrease the transmission of infections. Increased cases of hospital-acquired infections (HAIs) would not only impact the patients regarding safety but will also pose a financial burden on the families and the healthcare system as well. For instance, if the stay of the patient is more extended than expected, then it will increase the healthcare cost, and requirement for healthcare attendants and thus influence the overall health system. Better compliance with hand hygiene using hand sanitizers would enhance the quality of care and safety of the patients.
Because of the importance of hand hygiene among nursing staff, it is essential to understand the knowledge and practices of nurses regarding the preventive methods for patient safety. Hand hygiene and knowledge about the guideline of proper protocol to maintain cleanliness is essential. Given the low compliance and behavioral issues related to hand hygiene, the promotion of the hand hygiene practice is a complex model in terms of effectiveness. The following five questions are the potential questions related to nosocomial infections and hand hygiene:
- What is the knowledge of nurses related to hand hygiene and nosocomial infections?
- What is the knowledge and practices of nurses regarding hand hygiene?
- Is the use of soap effective in preventing infections in the general population?
- Will hand washing among healthcare staff increase patient safety?
- Would the placement of hand sanitizer at the entrances of the hospitals increase hand hygiene compliance among healthcare workers?
Evidence-based practices (EBP) are essential in the field of nursing, and this process ensures the nurses that clinical interventions or the decision-making process are reliable and safe for the patients and healthcare providers. EBP helps the nurses to focus on real-world problems and concerns, and one of the primary challenges in EBP is developing a research question that is feasible to answer in the real world (Davies, 2011).
Preliminary PICO question:
PICOT question is a step-by-step process which is being used in the development of clinical research questions which help to find the best evidence in nursing research (Echevarria & Walker, 2014). PICO question has four main components where P refers to the population, and in nursing mainly patient population, I stand for intervention which will be carried out, C refers to the comparison group in the study and O is for the desired outcome from the evidence-based research (Davies, 2011). The PICO question which will be feasible for the evidence-based research will be:
Does the placement of hand sanitizer at the entrances of the hospitals would increase hand hygiene compliance among healthcare staff?
PICO variables in this selected question are:
P- Patients are dealt by healthcare staff
I- Placement of hand sanitizers at the entrances
C- Comparison to the other location for the placement of hand sanitizers
O- Increase in the compliance
In some variations, there is a T which refers to the time for the study is also added but for this research, time is not known.
The ten keywords which will be used for the literature search are:
- Hand washing
- Nosocomial infections
- Compliance with hand hygiene
- Hospital-acquired infections (HAIs)
- Hand Sanitizers in hospitals
- Hand washing and nurses
- Health care staff and hand hygiene
- Nursing staff and nosocomial infections
- Patient safety
- Hand disinfection
Davies, K. S. (2011). Formulating the evidence based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80.
de Lissovoy, G., Fraeman, K., Hutchins, V., Murphy, D., Song, D., & Vaughn, B. B. (2009). Surgical site infection: incidence and impact on hospital utilization and treatment costs. American Journal of Infection Control, 37(5), 387–397.
Ducel, G., Fabry, J., & Nicolle, L. (2002). Prevention of hospital acquired infections: a practical guide. Prevention of Hospital Acquired Infections: A Practical Guide., (Ed. 2).
Echevarria, I. M., & Walker, S. (2014). To make your case, start with a PICOT question. Nursing2018, 44(2), 18–19.
Erasmus, V., Daha, T. J., Brug, H., Richardus, J. H., Behrendt, M. D., Vos, M. C., & van Beeck, E. F. (2010). Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infection Control & Hospital Epidemiology, 31(3), 283–294.
Hilburn, J., Hammond, B. S., Fendler, E. J., & Groziak, P. A. (2003). Use of alcohol hand sanitizer as an infection control strategy in an acute care facility. American Journal of Infection Control, 31(2), 109–116.
Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478–482.
Klevens, R. M., Edwards, J. R., Richards Jr, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2007). Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Reports, 122(2), 160–166.
Naraya, K. (2014). Hospital infection prevention: Principles and practices. Indian Journal of Medical Microbiology, 32(3), 355.
Pittet, D. (2001). Compliance with hand disinfection and its impact on hospital-acquired infections. Journal of Hospital Infection, 48, S40–S46.