“Hygiene is two third of health.”
“An evaluative study to
assess the knowledge and practice regarding hand hygiene among health care
personnel.
INTRODUCTION:
Lebanese
proverb on hygiene.
Hygiene
is the practice of keeping oneself and one’s surroundings clean, especially in
order to prevent illness or the spread of disease. Hand washing for hand
hygiene is the act of cleaning the hands with or without the use of water or
another liquid, or with the use of soap, for the purpose of removing soil,
dirt, and/or micro-organisms. Healthcare- associated infections are an
important cause of morbidity among hospitalized patients worldwide.
A prevalence survey conducted under the auspices of who in 55 hospitals of 14
countries representing four who regions
showed an average of 8.7% of hospital patients had hospital acquired
infections. At any time, over million people worldwide suffer from infectious
complications acquired in hospital2. Accordingly hand hygiene (i.e.,
hand washing with soap and water or use of a waterless, alcohol-based hand rub)
has long been considered one of the most important infection control measures
for preventing healthcare-associated infections3. Hand hygiene
compliance varied depending on five moments of with highest compliance after
body fluid exposure 65%, before patient contact 31%, after patient contact with
surrounding 24%.
The
Centre’s for Disease Control and Prevention (CDC) has stated, “it is
well-documented that one of the most important measures for preventing the
spread of pathogens is effective hand washing.” The main medical purpose of
washing hands is to cleanse the hands of pathogens and chemicals which can
cause personal harm or disease4. Hand washing by healthcare
professionals while caring for sick patients in surgical and critical care
units has been regarded as the single most important factor in preventing
hospital acquired infections (HAI) in patients throughout the world. Hand
washing is the most cost effective way to prevent infections in surgical and
critical care unit as well as other hospital units which is the practice of
choice for the best outcome.
It
is the most important action a health professional can take to prevent
infection among patients being admitted to the hospital. The most likely
outcome of the practice of not following a strict hand washing protocol is that
contribution of drug resistant infection (sepsis) in patients, which may
require the use of other resources. Many a studies conducted in India and
hospitals across the world has shown that hand washing is the single most
important factor that can prevent many diseases and infections that occur in
surgical and critical care units.
Nurses
constitute the largest percentage of health care workers. (HCW) and they are the “nucleus of the health care
system”. Because they spend more time with patients than any other HCWs, their
compliance with hand washing guidelines seems to be more vital in preventing
the disease transmission among patients5. Hand hygiene also is
critical in the prevention of hospital acquired infection, which contributes to
death for nearly 90,000 hospitals patients per year and $4.5 billion in medical
expenses6. The importance of hand hygiene was recognized as early as
1840s, by prevent childhood fever and in the late 1840s, by Dr. Ignaz Semmelwis
to reduce maternal mortality in a Vienna hospital, however, adherence still remains
low (40% or below) of the health care institutions7.
The World Health organization estimates that
10-30 per cent of all hospital admissions result in Healthcare acquired
infections. An estimated 1.4 million people suffer from Healthcare acquired infection
at any given time. The average rate of prevalence of Healthcare acquired
infection in Europe is 7.1 %, resulting in 16 million extra days of hospital
stay and this accounts for a loss of approximately 7 billion a year (excluding
indirect costs), states annual report on communicable diseases.8
NEED OF THE STUDY:
Hands
are also the most likely way in which infections or micro organisms might be
spread between patients, so simply washing hands is the most effective method
of preventing the transmission of infections. In the healthcare setting, hand
washing is often cited as the primary weapon in the infection control9.
It is known that organisms survive and multiply on human hands, creating the
opportunity to infect others or the host. Hand washing reduces the number of
transient organisms on the skin surface. Although hands cannot be sterilized,
most transient organisms can be removed by 30 seconds of proper scrubbing with
soap and water. Proper scrubbing would include vigorous motion with the hands
rubbing together and fingers working in between the finger web space and
inclusive of the dorsal and ventral surfaces of the hands.
The
need of hand hygiene indicating a link between hand hygiene and hospital
acquired infection and the effect of hand care practice on skin integrity
clinical practices changes recommended included the use of waterless alcohol
based product and moisturizers. Surveys have shown that one in five medical
professionals carries potentially antibiotic resistant pathogens on his or her
hands. Hand washing by medical professionals occurs at only 30% of the ideal
rate. Failure to wash one’s hands before and after each patient contact is
probably the most important contributor to the spread of infections4.
STATEMENT OF PROBLEM:
An evaluative study to assess the
knowledge and practice regarding hand hygiene among student nurses in selected
hospital, Dehradun, UK.
OBJECTIVES:
1. To assess the existing level of knowledge
of student nurses regarding hand hygiene.
2. To assess the level of practice of
student nurses regarding hand hygiene.
3. To find association between knowledge
and practice with their selected demographic variables.
ASSUMPTIONS:
·
Student
nurses may have basic knowledge regarding hand hygiene.
OPERATIONAL DEFINITIONS:
·
Knowledge: In this study, it refers to the scores obtained by
the Student nurses in response to structured knowledge questionnaire.
·
Practice: The customary, habitual, or expected procedure or
way of doing of something.
·
Hand hygiene: In this study, it refers to the act of
cleansing the hand with or without the use of water or another liquid or with
the use of soap before and after patient contact, use gloves in patients care
activities (administration of parental medications, wound dressings, insertion
of IV canulas and indwelling catheters) for the purpose of removing soil, and/
or microorganisms.
·
Student nurses: who are participating in this study and
doing practice and study for achieving a diploma or degree.
DELIMITATIONS:
The study is limited to:
·
Student
nurses who will be working in surgical and critical care units of selected
hospital.
·
Student
nurses who will be willing to participate in the study.
INCLUSIVE CRITERIA:
·
Student
nurses working in surgical and critical care units of selected hospitals.
·
Student
nurses care personnel who will be present at the time of data collection.
EXCLUSIVE CRITERIA:
Student nurses are working in other
areas exclude.
ETHICAL CONSIDERATION:
The main study will be conducted after
the approval of research committee permission will be obtained from the
concerned head of the hospitals. The purpose and after details of the study
will be explained to the study subjects and an informed consent will be given
to the study subject on the confidentiality of the data collected from them.
Information consent will be taken from the student nurses who are willing to
participate in this study.
EXPECTED OUTCOME:
·
To
enhance the practice of hand hygiene among Student nurses regularly.
·
To
promote hand hygiene culture inside hospital.
REVIEW OF LITERATURE:
A
comparative study was conducted to examine the hand hygiene knowledge, beliefs
and practices of Italian nursing and medical students. A questionnaire was
administered to a convenience sample of 117 nursing and 119 medical students in
a large university in Rome. Nursing students hand hygiene knowledge (F=9.03
(1,230); P=0.003), percentage compliance (Z=6.197; P<0.001) and
self-reported hand hygiene practiced (F=34.54(1,230); P<0.001) were
significantly higher than that of medical students. There are no statistically
significant differences between hand hygiene beliefs. Mean scores on the
knowledge questions were low for both groups. Statistically significant
disciplinary in hand hygiene knowledge and self-reported practice were apparent
undergraduate Italian health care student11.
A
cross-sectional study was conducted to assess compliance with hand hygiene
guidelines among nursing staff in secondary care hospitals in Kuwait. The study
was conducted through direct observation using the Lewisham observation tool
and self-administered questionnaire in six major public secondary care
hospitals in Kuwait. A self-administered questionnaire was prepared and
distributed to 454 nursing staff immediately after conducting the inspection. The overall compliance was 33.4%. Of
the 454 nursing staff who participated in self-reported compliance, 409 (90%)
indicated that they always washed their hands upon practicing patient care
activities. The study concluded that nurses consistently reported higher
compliance after conducting patient care activities rather than before. Observed hand hygiene compliance among
nursing staff in secondary care hospitals in Kuwait was poor.12
A
prospective study was conducted to investigate the health care workers’ had
hygiene compliance rates and the efficacy of a multimodal intervention strategy
improving compliance in a tertiary level intensive care unit at Ludhiana. A
self reported questionnaire was also circulated to assess perceptions regarding
compliance. The study results showed that the hand hygiene compliance among
medical personnel working in the ICU was 26% and the most common reason cited
for non-compliance was lack of time (37%). The overall compliance improved
significantly following the intervention to 57.36% (P<0.000). The study concluded that hand hygiene
compliance among health care workers in the ICU is poor; however, intervention
strategies, such as the one used, can be useful in improving the compliance
rates significantly13.
Sharek PJ e. tal., (March 2002) has conducted
study to determine the effect of implementing an evidence-based hand
washing policy on between-patient hand washing compliance and on blood and
cerebrospinal fluid (CSF) culture rates in a level III neonatal intensive care
unit (NICU). The study showed that compliance with appropriate between-patient
hand washing improved (from 47.4% to 85.4%, p=0.001) after the hand washing policy was introduced14.
METHODOLOGY:
RESEARCH APPROACH: Quantitative
RESEARCH DESIGN: Modified Time series design
POPULATION: The
population of present study comprises of Student nurses of selected units of
selected hospital, Dehradun, UK.
SAMPLE:
Student nurses.
SAMPLE SIZE: 46
SAMPLING PROCEDURE: The data will be collected with the
prescribe time period that is two week in the surgical and critical care units.
SETTINGS:
The study will
be conducted in the selected area in Himalayan Institute Hospital Trust (HIHT)
Jollygrant, Dehradun, UK.
INSTRUMENT/TOOL:
·
Structured knowledge Questionnaire
·
Practice checklist
1. Pretest
and teaching on first day.
2. Post
test after seven days of teaching.
DATA ANALYSIS:
Data
analysis will be done by descriptive and inferential statistics.
BUDGET PLANNING:
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Stationary
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1500/-
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Printing
|
2000/-
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Binding
|
2000/-
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Internet
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1500/-
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Total
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7000/-
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REFERENCES:
2. World
Health Organization. Prevention of hospital-acquired infections, a practical
guide. 2nd ed. Malta: Department of Communicable Disease; 2002.
3. Infection
control guidelines for the prevention of transmission of infectious diseases in
the healthcare setting. Endorsed 2002 by the Communicable Diseases Network of
Australia. Draft 2002, Version 3.
4. Reybrouck
G. The role of hands in the spread of nosocomial infection. Journal of Hospital Infection 1983;
90:30, 63-4.
5. McKane
L, Kandel J. Microbiology essentials
and application. 2nd ed. Philadelphia: McGraw-Hill; 1996.
7. KatzJD.
Hand washing and hand disinfection: more than your mother taught you.
Anaesthesiol Clin North America. 2004; 22:457-471.
8. Trampuz
A, widmer A.F. Hand hygiene: a frequently missed life saving opportunity during
patient care. Maya Clin Proc. 2004; 79:109-116.
9. Van DE, Mortel TF, Kermode S, Proganto T, Sansoni J.
A comparison of the hand hygiene
knowledge, beliefs and practices of Italian nursing and medical students.
Journal of Advanced Nursing. 2011 Jul 3.
10. Beulah Devadason, Senior Research Analyst,
Healthcare, EIA, 19 Sep 2011- Hand Hygiene Compliance Solutions - What
Manufacturers Need to Know, available in
www.frost.com › Home › Our Services › Research.
11. Van
DE, Mortel TF, Kermode S, Proganto T, Sansoni J. A comparison of the hand hygiene knowledge, beliefs and practices of
Italian nursing and medical students. Journal of Advanced Nursing. 2011
Jul 3.
12. Al-Wazzan B, Salmeen Y, Al-Amiri E, Abul A, Bouhaimed M, Al-Taiar A. Hand hygiene
practices among nursing staff in public secondary care hospitals in Kuwait:
self-report and direct observation. Med Princ Pract 2011;
20(4):326-31.
13. Mathai
AS, George SE, Abraham J. Efficacy of a multimodal intervention strategy in
improving hand hygiene compliance in tertiary level intensive care unit. Indian
Journal of Critical Care Medicine 2011 jan- march; 15 (1):6-15.
14. Arson,
Elaine L. RN, PhD, FAAN, CIC; APIC Guideline for Hand washing and Hand
Antisepsis in Health Care Settings, August 1995, P. 251-261.
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