EVIDENCE BASED PRACTICE APPROACH WHAT DOES LITERATURE REVEAL

EVIDENCE- BASED PRACTICE APPROACH

WHAT DOES LITERATURE REVEAL REGARDING HANDWASHING COMPLIANCE AMONG NURSES?

As health care providers, hand washing is an important step in decreasing the spread of infection not only to each other but to our patients. As nurses, we need to be aware of evidence based research studies on hand washing and the results obtained. Having a better understanding of the effect of hand washing on our patients, will improve our compliance and the care we provide each day. The aim for this project is to analyze and interpret literature regarding hand washing compliance among nurses. The evidence gained from research allows the recognition of healthcare deficiencies, leading to implications for nursing practice changes.

“Each year, an estimated 2. 5 million patients in the United States develop health care-associated infections that result in 90, 000 deaths and cost the health care system an estimated 4. 5 to 5. 7 billion dollars” (Korniewicz & El-Masri, 2008, p. 86).

“ Studies have shown that contamination from the hands of health care professionals is the primary factor for the spread of hospital infections involving the urinary system, lower respiratory tract, and surgical site infections” (Celik and Kocash, 2008, p. 207).

Why, then, are so many health-care workers non-compliant to hand washing practices?

EVIDENCE Most nurses know the importance of hand washing yet, the majorities do not perform this while giving direct patient care. After reading and analyzing the literature it was found in every study that hand washing compliance is low among all healthcare workers. We have to ask the question why are we, as nurses, not doing what is acknowledged to be the correct course of action – washing our hands when entering and leaving patient’s rooms?

Reviewing Evidence Based Research from five separate articles on hand washing compliance among nurses will guide us in answering this question.

Critical Analysis Of The Evidence Article 1: Hygienic Hand Washing Among Nursing Students in Turkey: The results of this study should be used toward evidence based practice however; the study should not stand alone as evidence to support hand washing compliance and perceptions. Even the researchers of the study state that further research is needed to verify and clarify the results. This study has certainly proven that hand washing perceptions vary tremendously and the student nurses knowledge of hand washing is significantly higher than their compliance. Celik & Kocash, 2006

Critical Analysis Of The Evidence Article 2: Exploring the Factors Associated with Hand Hygiene Compliance of Nurses during Routine Clinical Practice: The first limitation was the observational nature of the study. When the nurses were being observed they may have been more compliant with their hand hygiene practices. Another limitation would be threat of the Hawthorne effect on the validity of the results. The Hawthorne effect occurs when the study participants respond in a certain way because they are being observed (Nieswiadomy, 2008). The researchers believe that “regardless of these limitations, our findings shed light on the issue of hand hygiene practices in acute health care settings and the factors impacting these practices” (El-Marsi & Korniewiz, 2008, p. 89).

Critical Analysis Of The Evidence Article 3: Nurses’ Motivation to Wash Their Hands: A Standardized Measurement Approach: The researchers for this study stated that additional research is needed to thoroughly examine the nurses thought process in answering the assessment with socially desirable answers versus what the nurse really feels. Also, a continuing study related to nurse’s frustrations with workloads on hand motivations were suggested. Detailed records were kept of the data collection, and informed consent and ethics approval was properly obtained. The researchers clearly described the criterion for the participants. Duckett, Henly, & O’Boyle , 2001

Critical Analysis Of The Evidence Article 4: Hand Hygiene Behavior in a Pediatric Emergency Department and a Pediatric Intensive Care Unit: Comparison of Use of 2 Dispenser Systems: The first limitation of this study is the placement of the dispensers. The touch-free dispensers were placed high on the walls next to the manual dispensers and this could have resulted in poor dispense of the sanitizer. The second limitation was the counting of the electronic devices. The researcher counted each hit towards an incident of hand hygiene. This could have resulted in higher hand hygiene rates due to the fact that a healthcare worker may have hit the dispenser a few times. The third limitation was the location of the experiment. This study was conducted in a pediatric emergency room and a pediatric intensive care unit and these locations due not make up a general hospital setting. Lastly the time frame for the research was fifteen weeks. In order to get a better estimate of hand hygiene behavior the researcher suggested extending the time frame for the experiment. The results of this study are beneficial in the education of nursing because it does examine factors that influence hand hygiene. Albrecht, Larson, & O’Keefe, 2005

Critical Analysis Of The Evidence Article 5: Behavioral Determinants of Hand Hygiene Compliance in Intensive Care Units: The results obtained illustrated that nurse’s knowledge of proper hand washing did not increase hand washing compliance and nurses with pessimistic attitudes and low self-efficacy were shown to be less compliant. This information is relevant to the nursing profession and could benefit all nurses, by educating them on the need for increasing their hand hygiene techniques. Blot, Labeau, Maes, Vereecken, & Wandel (2010)

What are some of the reasons found that inhibit our compliance?

Reason 1: Many health care workers have a misperception that their hands are not dirty. ( El-Marsi & Korniewicz, 2008)

Reason 2: Busy and hectic setting led to less compliance. (Duckett, Henly, & O’Boyle, 2001)

Reason 3: Workers not dealing with blood were less likely to comply. (El-Marsi & Korniewicz, 2008)

Reason 4: Lack of sink convenience (Celik & Kocash, 2006)

Reason 5: Forgetfulness (Duckett, Henly, & O’Boyle, 2001)

Reason 6: Perception that hands have been washed often enough to meet compliance (Celik & Kocash, 2006)

There are many varied reasons for non-compliance as previously shown. Studies indicate knowledge of proper hand washing did not increase compliance. Therefore, it is clear health care workers have the education and knowledge of its benefits. The interpretation of the evidence leads one to believe health care workers have not made this practice habitual or an automatic ritual.

The following factors and values can influence whether or not to utilize this evidence: Fear for one’s own health and safety 2. A desire to increase patient satisfaction 3. Observation by others 1.

Recommendations 1. Increase awareness of health care workers’ personal safety through: A. Infection control and blood borne pathogens safety training. B. Informing staff of patient response surveys. C. Conducting hand washing skills stations to provide visual aid and reminder to staff.

Recommendations: 2. Work with staff who have low self-efficacy to increase job satisfaction and patient care. A. Continuous and on-going feedback on job performance in order for compliance to increase. B. Reward and praise for effective compliance. C. Provide strategies and skills necessary to reach compliance.

Recommendations: 3. Increase vigilance for hand washing observation. A. Conduct unannounced observations to check for compliance. B. Make patients and family members aware of hand washing policies. Encourage them to report non-compliance. C. Remind workers they can be observed anytime by anybody for compliance (Hawthorne Effect).

Summary Hand hygiene is the easiest and best line of defense for disease and infection prevention. Unfortunately, the evidence reveals that a majority of health care workers lacked proper hand hygiene techniques even though awareness existed. In an attempt to better understand why health care workers did not follow hand washing guidelines, we have found knowledge of its benefits did little to increase its practice. Knowledge and awareness are not enough to change a culture of non-compliance. A direct and systematic approach is needed to address the lack of hygiene in the health care industry.

Overall, there is overwhelming evidence suggesting that nurses are aware of hand washing knowledge, but do not use this knowledge in their nursing practices. Each study supported the correlation between hand hygiene and lack of nurse’s compliance. All of the studies focused on the same issue and they all provided evidence that the majority of healthcare workers lacked in proper hand hygiene techniques. Group two believes this is an area of great importance and continued knowledge of the subject is needed. That is why each of the members of group two will share these findings with their unit of employment.

Molly Bach-Bullen Heidi Ertman Melissa Kurek Shawna Nietz Sarah Rousseau

REFERENCES v Albrecht, S. , Larson, E. L. , & O’Keefe, M. (2005). Hand hygiene behavior in a pediatric emergency department and a pediatric intensive care unit: Comparison of use of 2 dispenser systems. American Journal of Critical Care, 14(4), 304 -310. Retrieved from http: //aacnjournals. org v Blot, S. , Labeau, S. , Meas, L. , Vereecken, C. , & Wandel, D. D. (2010). Behavior determinants of hand hygiene compliance in intensive care units. American Journal of Critical Care, 19(3), 230 -239. Retrieved from http: //aacnjournals. org v Celik, S. , & Kocash. S. (2006). Hygienic hand washing among nursing students in turkey. Applied Nursing Research, 21(4), 207 -211. doi: 10. 1016/j. apnr. 2006. 12. 001 v Duckett, L. , Henly, S. J. , & O’Boyle, C. A. (2001). Nurses motivation to wash their hands: A standardized measurement approach. Applied Nursing Research, 14(3), 136 -145. doi: 10. 1053/apnr. 2001. 24412 v El-Masri, M. , & Korniewicz, D. , M. (2008). Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice. Applied Nursing Research, 23(2), 86 -90. doi: 10. 1016/j. apnr. 2008. 06. 002 v Nieswiadomy, R. M. (2008). Foundations of nursing research (5 th Ed. ). Upper Saddle River, N J: Prentice Hall.