Introduction
Hospital-acquired infections (HAIs) are a fundamental health problem that affects millions of patients, mainly in intensive care units. HAIs include central line blood infections, surgical site infections, and catheter urinary tract infections. Research statistics show that in the United States, approximately 1.7 million people are diagnosed with HAIs per year, and around 90,000 die annually from complications (Akanji et al., 2017). One of the most effective measures for the prevention of HAIs is hand hygiene. With the hospital environment full of disease-causing bacteria, both healthcare workers and patients can transfer diseases through hand contact. Hand sanitation is proved to be a critical measure in reducing the spread of disease-causing microorganisms and preventing infection in hospital settings. In order to develop successful HAIs prevention strategies for intensive care units, the effectiveness of healthcare workers’ and patients’ hand washing behavior needs to be analyzed with application to this type of setting.
PICOT Question
Does healthcare workers’ and patients’ handwashing behavior minimize hospital-acquired infections in an intensive care unit during hospitalization?
Research Critique
Quantitative Research
The quantitative research on the subject of hand hygiene in hospitals primarily focuses on quantitative analysis of patient and hospital workers’ hand washing habits and their impact on HAIs transmission. The article by Foà et al. (2017) studies the self-reported hand washing behavior of citizens in healthcare settings and various factors affecting it. The Theory of Planned Behavior is used to determine whether an individual’s hand washing habits are influenced by the intention, which, in turn, is shaped by attitudes, subjective norms, and the perception of control (Foà et al., 2017). Other analyzed factors include the threat of infective risk and socio-demographic variables.
The research method is a self-report anonymous questionnaire aimed to measure the variables related to health-related behaviors. The questionnaire was filled out by 195 volunteers, relatives, and caregivers who have access to healthcare settings in Emilia Romagna Region (Italy) (Foà et al., 2017). The results show that hand hygiene is influenced by socio-demographic and socio-cognitive variables (such as intention, attitude, subjective norms, and control beliefs) as well as the threat of infection (Foà et al., 2017). Citizens have a generally favorable attitude towards hand hygiene but tend to wash hands more frequently when they feel at risk (Foà et al., 2017). The study is useful for the development of the posed PICOT question because it provides an understanding of how hand hygiene is perceived in society and what factors influence patients’ hand washing habits.
A number of studies particularly address the efficacy of hand hygiene in reducing HAIs. The article by Haverstick et al. (2017) aims to determine if patients’ hand hygiene is improved and the transmission of HAIs is reduced due to an increased access to hand hygiene products and patient education. The study is based on a quasi-experiment conducted among the patients of a cardiothoracic postsurgical step-down unit, who were provided with hand sanitizer and hand hygiene education when admitted to the hospital (Haverstick et al., 2017). The results were analyzed based on the survey that the participants were asked to complete before and after the intervention, and hospital-acquired infection data tracked monthly by infection prevention staff (Haverstick et al., 2017). The results indicated that the intervention led to the decline in the rate of infections. The study can be used to support the hypothesis that patients’ hand hygiene compliance reduces HAIs.
Qualitative Research
The qualitative research on the subject analyzes the factors that affect the hand hygiene habits of health professionals with a particular emphasis on the availability of relevant training. The article by Ghaffari et al. (2020) aims to identify the factors that influence the hand hygiene habits of nurses in Shariati Hospital of Tehran, Iran. The study was performed using the content analysis approach on the basis of 16 interviews with the members of the nursing staff (Ghaffari et al., 2020). The results identified eleven main factors that influence nurses’ hand washing behavior. Three of them (attitude, subjective norms, and perceived behavioral control) lie within the framework of the Theory of Planned Behavior. Eight other factors include environment, perceptions, lifestyle, morality, education, organizational culture, salience, and personality (Ghaffari et al., 2020). The study is relevant to the posed PICOT question because it provides an understanding of factors that influence the hand washing habits of healthcare professionals.
Access to adequate training on hand hygiene is considered to be one of the most significant factors of influence. The study by Chatfield et al. (2017) provides “the report of integrated findings from qualitative research reports on hand hygiene compliance among healthcare workers” (p. 104). The GRADE-CERQual process is applied to describe the level of confidence for all findings (Chatfield et al., 2017). The analysis of 36 studies on the subject shows that “healthcare workers believe that they have access to adequate training, but the management and resource support is sometimes lacking” (Chatfield et al., 2017, p. 104). The study contributes to the posed PICOT question by providing a structured analysis of hand hygiene compliance worldwide with an emphasis on the necessity of adequate training.
Overall, both the qualitative and quantitative research on the subject proves that the hand washing behavior of both patients and health professionals needs to be thoroughly analyzed in order to suggest improvements. No specific studies were identified that address hand hygiene behavior in intensive care units. However, the research of hospital settings, in general, provides conclusions that can be applied to intensive care units as well. Hand washing is proved to reduce the transmission of HAIs, with a range of factors having various types of influence on the hand hygiene behavior of patients and health professionals.
Proposed Evidence-Based Change
Based on the analysis of research articles and the practice problem identified, the following practice changes can be suggested. The first is the introduction of adequate hand hygiene training to both patients admitted to hospitals and healthcare professionals in intensive care units. According to the study by Haverstick et al. (2017), the implementation of patient hand hygiene interventions, which include education and access to hand sanitizers, leads to the decline in the rate of infections. The research by Chatfield et al. (2017) reports the increased level of confidence in nurses regarding their access to adequate hand hygiene training. Increasing of HAIs awareness of all people within healthcare settings is believed to be the key to infection transmission reduction.
The second proposed change is the emphasis on the threat of infection in the prevention strategy development. According to the study by Foà et al. (2017), the threat of infection has a significant effect on people’s behavior, with most people washing their hands more often when they feel at risk. These findings suggest that an emphasis on the threat needs to be placed in health promotion campaigns to achieve behavior improvement.
The third proposed change addresses a range of factors that influence the hand washing behavior of patients and health professionals. The study by Foà et al. (2017) suggests that patients’ hand hygiene habits are shaped by their socio-demographic and socio-cognitive characteristics as well as the threat of infection. In the article by Ghaffari et al. (2020), the factors affecting health professionals are identified, which include attitudes, subjective norms, perceived behavioral control, environment, perceptions, lifestyle, morality, education, organizational culture, salience, and personality. All these factors need to be considered when creating and implementing HAIs prevention strategies for intensive care units.
Conclusion
Infection risk prevention is one of the main objectives of the healthcare system in general and intensive care units in particular. With the hospital setting being full of disease-causing bacteria and patients being particularly vulnerable to infection, comprehensive strategies need to be developed and constantly updated to prevent HAIs. As proved by the studies, hand hygiene is considered to be a critical measure for reducing infections. The anticipated outcome of the posed PICOT question is the improvement of hand washing behavior of both patients and health professionals in intensive care units and the minimization of HAIs. In order to develop an effective infection prevention strategy, a number of factors that influence patients’ and health workers’ hand washing habits need to be taken into consideration. The emphasis is suggested to be placed on education and training aimed to increase public awareness of the importance of hand sanitation for the prevention of HAIs.
References
Akanji, J., Walker, J., & Christian, R. (2017). Effectiveness of formal hand hygiene education and feedback on healthcare workers’ hand hygiene compliance and hospital-associated infections in adult intensive care units: A systematic review protocol. JBI Evidence Synthesis, 15(5), 1272-1279. Web.
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. Web.
Foà, C., Tura, G. A., Camelli, C., Silingardi, R., Malavolti, M., Kuenzer, E., Carraro, G., De Paolis, B., & Sarli, L. (2017). Hand hygiene in health care settings: The citizens’ point of view. Acta Bio-Medica: Atenei Parmensis, 88(1S), 40-53. Web.
Ghaffari, M., Rakhshanderou, S., Safari-Moradabadi, A., & Barkati, H. (2020). Exploring determinants of hand hygiene among hospital nurses: A qualitative study. BMC Nursing, 19(109), 1-9. Web.
Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’ handwashing and reducing hospital-acquired infection. Critical Care Nurse, 37(3), 1-8. Web.