Background of Study
Chatfield, DeBois, Nolan, Crawford, and Hallam (2017) discussed hand hygiene among health workers by providing a qualitative meta-summary that explored how it (hand hygiene) influences the quality of health care. It focused on infection control as a problem and hand hygiene as one of the most proposed approaches of addressing the challenge. The study focused on providing a first report of findings from qualitative research studies on hand hygiene compliance among healthcare workers across the world. It applied the GRADE-CERQual process of assessing quality. The authors outlined the importance of infection control in improving the quality, safety, and effectiveness of care in healthcare facilities. Its discussion of hand hygiene in the context of healthcare workers outlines its significance to nursing. It provides crucial information highlighting the necessity of hand hygiene training for health professionals, the need for management support such as provision of hygiene and human resources, risk assessment, ensuring compliance with hand hygiene policies, and surveillance among others (Chatfield et al., 2017).
Chavali, Menon, and Shukla (2014) discussed hand hygiene compliance among healthcare workers in a tertiary care hospital. The objective of the research was to apply the multimodal technique for the improvement of hand hygiene compliance among healthcare professionals. The researchers identified poor hand hygiene compliance as one of the issues affecting the implementation of hand hygiene and the prevention and control of infections in hospitals. The observational study assessed nurses and allied healthcare workers’ adherence to hand hygiene. The research offers important information for application in nursing practice. It found that nurses had an adherence rate of 63 percent while allied healthcare workers’ adherence was 86.5 percent. The results show the importance of supporting and promoting adherence. Importantly, the 63 percent adherence was before patient contact but improved to 93% after patient contact. The authors suggested the need for adopting interventions for hand hygiene compliance improvement such as the multimodal intervention approach.
How do these two articles support the nurse practice issue?
The research studies offer critical information applicable in answering the PICOT question. Chatfield, DeBois, Nolan, Crawford and Hallam (2017) offered a qualitative meta-summary of studies that discussed hand hygiene among healthcare workers. The study provided information on issues surrounding hygiene and, therefore, is applicable for discussing whether or not hand washing among healthcare workers reduces hospital acquired infections. The study explored numerous perspectives developed on different qualitative studies and argued that hand hygiene is essential for infection control. It identified other important issues such as surveillance and management support in ensuring the effective implementation of hand hygiene. The multi-perspective study will prove essential in discussing the role of hand washing among healthcare workers in the prevention and alleviation of HAIs. Similarly, Chavali, Menon, and Shukla (2014) provided essential information regarding hand hygiene adherence among healthcare workers. The study will provide critical insight in the discussion of the PICOT question. It draws the correlation between adherence and infections in hospitals, which will facilitate an in-depth discussion.
The interventions identified in Chatfield, DeBois, Nolan, Crawford and Hallam (2017) and Chavali, Menon, and Shukla (2014) compare to the ones identified in the PICOT question. Chatfield et al. (2017) identified training workers on hand hygiene, providing resources and general management support, assessment of risks, promotion of hand hygiene policies’ adherence, and improved surveillance as critical interventions. Chavali et al. (2014), on the other hand, suggested the implementation of a multimodal intervention for improving hand hygiene compliance. The interventions from the studies are more comprehensive and cover different aspects other that improvement of hand hygiene through training and provision of the necessary tools.
Method of Study
Chavali, Menon, and Shukla (2014) used a cross-sectional observational study that included the application of the direction observation technique while Chatfield, DeBois, Nolan, Crawford and Hallam (2017) applied a search strategy, identified 36 reports from different databases, and used the Dedoose software for analysis. The observational technique involved an observer who collected hand hygiene data while Chatfield et al. (2017) identified qualitative and mixed-method studies/reports that discussed hand hygiene compliance. The qualitative meta-summary used by Chatfield et al. (2017) involved extensive search for qualitative research on hand hygiene, which resulted in the inclusion of different studies and perspectives on hand washing and its contribution to infection control. A notable limitation is that the method can result in the omission of relevant studies/reports. Chavali et al.’s method allowed a first-hand observation, collection and analysis of data. Observation made it possible for researchers to understand the issue of hand hygiene compliance better. However, the method may compromise the credibility of the results especially if healthcare workers become aware of the on-going study. Observation is likely to influence the healthcare workers’ hand hygiene behavior.
Results of Study
The cross-sectional observational study conducted by Chavali et al. (2014) found that the overall hand hygiene in hospitals as per WHO Guidelines was 78 percent. Results from the observation indicated that nurses’ hand hygiene (HH) compliance was at 63% in the surgical ICU, which was the setting. Additionally, the research identified that compliance of allied healthcare professionals higher at approximately 86.5 percent. The authors noted that compliance is higher after patient contact at 93 percent as compared to before patient contact as 63 percent. Nurses recorded lowest HH compliance when surgical procedures were not aseptic at 39 percent. Healthcare workers indicated knowledge of the preventable diseases caused by non-compliance and understood the need for hand washing, ideal duration of hand hygiene, and its importance in reducing healthcare acquired/associated infections. The study has various implications in nursing. It offers key information for the enhancement of HH adherence, which is increasing becoming a central nursing and hospital intervention for preventing HAIs.
Chatfield et al. (2017) identified highest confidence findings such as the belief by healthcare workers that they have access to adequate hand hygiene training but sometimes management and resource support are missing. Additionally, the findings indicated that individual and subjective criteria influence hand hygiene. Intervention studies identified showed that training and education components are prioritized in most hospitals that implement hand hygiene programs. However, while managerial support is essential for effective implementation, most healthcare workers lack the support and the necessary resources. The authors outlined the need for healthcare management to facilitate the availability of enough staff and resources such as hand hygiene products among others. Moreover, the study found that risk assessment is an essential component of hand hygiene practice and argued for the necessity of hand hygiene policies. Further, the qualitative research identified surveillance and organizational and staff compliance with hand hygiene as fundamental for contributing to the infection control in hospitals. The findings serve as critical for application in nursing practice. Incorporating the study findings into healthcare facilities would inform better, effective and safer healthcare environment for nursing practice.
Ethical Considerations
Confidentiality and respect for intellectual property are two ethical considerations made in conducting research. Confidentiality involves respecting data/information provided in confidence by protecting the identity of the participants/respondents or information through elements such as anonymity. On the other hand, respect for intellectual property involves the avoidance of plagiarism, copying of other people’s work, or failing to acknowledge borrowed information.
The two studies applied the ethical considerations in conducting the research. Chatfield et al. (2017) shows respect for intellectual property by citing all the studies/reports used in the qualitative meta-summary. Similarly, Chavali et al. (2014) cited the studies utilized for secondary information and kept the identity of the healthcare workers observed in the course of performing the study anonymous.
References
Chatfield, S. L., DeBois, K., Nolan, R., Crawford, H., & Hallam, J. S. (2017). Hand hygiene among healthcare workers: A qualitative meta summary using the GRADE-CERQual process. Journal of infection prevention, 18(3), 104–120. doi: https://doi.org/10.1177/1757177416680443
Chavali, S., Menon, V., & Shukla, U. (2014). Hand hygiene compliance among healthcare workers in an accredited tertiary care hospital. Indian Journal of Critical Care Medicine, 18(10), 689–693. https://doi.org/10.4103/0972-5229.142179
