Hand Washing Compliance
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Transcript of Hand Washing Compliance
EVIDENCE- BASED PRACTICE APPROACH
Hand Washing Compliance
WHAT DOES LITERATURE REVEAL REGARDING HANDWASHING
COMPLIANCE AMONG NURSES?
INTRODUCTION
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?
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?
EVIDENCE
Reviewing Evidence Based Research
from five separate articles on hand
washing compliance among nurses will guide us
in answering this question.
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 the 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 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)
Critical Analysis Of The Evidence
What are some of the reasons found that inhibit our compliance?
Most nurses know the importance of hand washing, yet the majority of nurses
do not perform this while giving direct patient care.
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)
Reason 7: Workers with poor attitudes were shown
to be less compliant.(Blot, Labeau, Maes, Vereecken, & Wandel, 2010)
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.
1. Fear for one’s own health and safety2. A desire to increase patient
satisfaction3. Observation by others
The following factors and values can influence whether or not to utilize this evidence:
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).
Recommendations:
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.
Summary
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.
What Does Literature Reveal?
Molly Bach-BullenHeidi ErtmanMelissa KurekShawna Nietz
Sarah Rousseau
PRESENTERS
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
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
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
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
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
Nieswiadomy, R.M. (2008). Foundations of nursing research (5th Ed.). Upper Saddle River, N J: Prentice Hall.
REFERENCES